TOS *and* keeping fit
 

I first wrote the title as TOS vs keeping fit, but plumped for a more positive tone :)

The first purpose of this thread is to ask for any experiences and opinions regarding exercise whilst suffering from TOS. I don't mean exercise specifically to treat the TOS such as nerve glides and stretches, but any general exercise like cardio, resistance work or yoga.

What have you tried?
What can you do?
What do you avoid?

The second purpose is for me to share my experience, in case it might be of help to any others. I'll start that off in the second post. I intend to share some images, so will need to increase my post count ** first. For some background, I'll also link to my introduction post in the introduction thread as soon as I can do that.

My symptoms are fairly mild now and I never had symptoms severe enough to require rx'd meds, except for a few nights during the worst time.
I did eat way too much Advil/Motrin when trying to continue at work.. :(

I've used treadmill, elliptical, exercise bike with no problems, I don't hold on to the support bars continuously, but the elliptical does have the arm movement support/handles- it is a smooth movement and it works out OK for me, more so than static hold positions.

I tried Curves a few times but having to change to the next machine so quickly was a pain as well as the equipment could be padded better and smoother operating.
I wouldn't recommend it as most is resistance or magnet driven, and the one size fits all approach.

I can do most any normal activity, but I do avoid having my arms up overhead & a lot of looking up (some c spine bone spurs)
I also avoid hand writing LOL the fine finger coordination is shot..

I just got some yoga DVDs from the library so I plan to see if there are any that work for me.

Cycling

Prior to receiving a diagnosis of vascular and neurogenic TOS, but for a couple of months after experiencing the first symptoms (unknown at the time) I was spending 60 minutes a day cycling on a hardtail (no suspension) hybrid (part road bike, part mountain bike) bike.

I've had a few tentative trial sessions back on the bike since my dx, but do develop pain symptoms during. It is difficult to know whether these are due to TOS or are just normal pain following a long period of inactivity.

I am seriously considering whether acquiring a recumbent bike will be not only a short-term solution, but also be better for the long-term avoidance of issues which can be provoked by riding on upright bikes (low back, upper back, elbows, wrists, neck)

Treadmill, Cross-Trainer, Stepper
Any position where my head and neck are unsupported for periods of 45m+ currently provokes pain in the neck/shoulder region, so extended periods on almost any type of cardio equipment (treadmill, x-trainer, stepper) are not practical.

Before I became aware of the unsupported head and neck trigger, I did spend quite a lot of time on a treadmill. Sometimes whilst running, I would notice numbness developing in the 4th and 5th digits of both hands (ulnar nerve symptoms)

I've also spent time on a x-trainer, but this requires considerable shoulder movement in addition to flexion at the elbow, which provokes both neck/shoulder and ulnar nerve symptoms.

Currently offering hope are recumbent stationary bikes. I've been able to spend up to 60 minutes on one of these, with the help of a dedicated head and neck support to supplement the backrest of the bike itself. This is one of the things that I wish to share a picture of, and will soon.

Versa-Climber
This is another thing I was using almost every day, for about 20-30 minutes a day prior to stopping as a preventative measure against aggravating TOS. Exercising on a Versa Climber involves repetitive overhead movements. I'm concerned that my increased use might have contributed to development of TOS, but my phyiso is skeptical about this possibility.

I walk or ride a stationary bike when I'm feeling up to it. Even on a good day, walking more than 40 minutes can cause very severe problems, including migraine. So I do exercise in small chunks. There are many days when I'm not up to anything so I don't push it.

I tried yoga in the very beginning of TOS. I liked it but there was too much arm forward activity that caused flares. I did some resistance band work in PT after surgery -- a very bad idea I learned only afterward. Cardio is hard because there is too much neck and shoulder movement.

I think the TOX maxim holds true -- if it hurts or causes increased pain later, don't do it.

yoga
 

swimminng and yoga are good. be sure to modify them. there are always good modifications the instructor can suggest. i also park far away and use stairs a lot. shopping in a big box saves $ and gives exercise too. when standing in line do tree balance. balance is important in healing. i am very stiff so stretching is essential.

Weight-lifting
This seems an obvious one to avoid, but . . . .

Prior to TOS, I performed 3 full body weights sessions per week, using the Hypertrophy Specific Training (HST) method and free-weights (bench, squat, deadlift etc). When I began to cease activities as a precautionary measure against worsening symptoms but prior to diagnosis, weight lifting was the last thing I stopped. This was partly because it is the thing I wanted to keep the most, but mostly because with one outlying exception, this never appeared to have any impact on my symptoms.

Advice against resistance exercise for TOS-sufferers seems to be consistent. However, after a 2 month break I have started resistance exercise again, but limit this to my lower body and core region. I do wall squats, leg extensions, leg curls, seated calf raises, back extensions and bicycle crunches. I can detect no negative outcomes during or after such sessions.

Yoga
I'm happy to see a few others already mention yoga. I'm currently practicing yoga each day now. It has somewhat filled the gap created by the cessation of cardio and weight-lifting. As a complete beginner, I do have to be selective about which poses I perform and which I avoid. For example, eagle pose, which involves interweaving your arms and bending elbows, is out because it does irritate my ulnar nerve related complaints.
Of course, corpse pose is always very welcome :)

Jo, if you are interested I can recommend some Yoga DVD’s. I recently began yoga practice as a complete beginner, and have done so based on instructional DVD’s rather than taking a class. I’ve found some extremely useful, and others less so. If you are a complete beginner like me, the ones I like may suit you too.

Regarding use of an elliptical, I want to ask – are you free of double-crush symptoms affecting for example the ulnar nerve?

Kelly, your problem with walking may be similar to mine. My symptoms onset somewhere between 40-90 minutes of walking, and begin with a crawling sensation in the posterior cervical region that acts like an early warning system for the pain that follows if I don’t lie down or rest my upper back/neck/head against something.

I am interested in the small chunks of exercise approach. I have considered this. I am concerned that although I wouldn’t experience pain during that short period, I may nevertheless be aggravating the underlying condition. May I ask for your take on this?

My GP (who I think would not object if I said possesses a poorer understanding of TOS than I do) has suggested swimming. What about the overhead shoulder movements involved though? Do you use some strokes and not others?

Yoga’s Tree pose is something that I found hilarious at first because I was akin to a spinning top, constantly either twisting or falling over. I enjoy it now, and even try doing it with my eyes closed.

Yes, post the ones you like, it's hard to find good one sometimes.

I had ulnar problems for about 2 months , it didn't appear until about the 10 month mark of my RSI/TOS/?? injury.
I was having PT at the time so they gave me the ulnar compression wrap w/little air pillows. Plus addressed those sx with therapies too.
Luckily it faded away, but the elbow sensitivity/soreness really messed up my sleep for awhile.

BKRich,

I often have a delayed pain response to physical exercise. This happened to me repeatedly during PT. It would aggravate my pain a few hours later. I found this is actually quite common. It makes it very difficult to identify which activity aggravates ones pain, though.

I walk my dog quite often. I do a loop that takes 35-40 minutes. This seems to be my tolerance limit. I went on a trip last summer where the primary activity was walking and site seeing. Within one day I had horrible pain and migraine. This lasted on and off (mostly on) for 3 weeks. It was the worst 3 week period in my life. The only thing I did that could have spiked my pain was walking; I wasn't using the computer, driving, cooking, etc.

It's definitely a trial and error system to figure out what you can tolerate. I don't really think in terms of exercise anymore. I just try to keep moving.

Good luck,
Kelly

I have been a fitness instructor for approximately 20 years. Yoga instructor for 6 and TOS sufferer for 25 years. However, I suppose I am a bit different in that I have a large cervical rib, my tos has developed over time, but without yoga, I can't imagine where I would be right now, probably chopped-up before necessary.

I would recommend yoga to everyone; however, very few yoga instructors understand TOS let alone know what it is. I happen to have a degree in kinesiology, and with my symptoms, really know how and what is right. For example, in Eagle, you would want to crisscross your forearms in an x across your chest and place your palms on opposite shoulders. But, there are very few poses that area unavailable, in fact, with the right modifications, I can't think of any pose that is unavailable.

For everyday fitness, I practice power yoga, a little less intense would be a vinyasa style. For flare-ups, I will do bikram, aka hot yoga. Specifically, I love the Bikram shalambasana or locust pose. I do it a bit differently, at the point when they call to lift both legs, I left my legs and my chest (by millimeters) this is an awesome nerve glide when your body is at it's most flexible!

The most important thing to remember is you do not have to do exactly what the instructor tells you to do. Modifications and props are an integral part of yoga. There are not rules (although bikram can feel that way and you must have a strong constitution to ignore them a bit). You do not have to extend arms and twist arms or straighten your arms, its all optional. Bringing your hands together at heart level is very meditative and an honorable position. It's also important to keep space through the collarbone by rolling your shoulders down and away. But bend your elbows whenever you want/need. Tell the instructor beforehand, that there are arm positions which may not be available to you. Any instructor worth taking a class from, should have no problem with that, and should then offer alternative options during class. Also, holding your head in any sort of craned-neck position is not necessary. Soften your neck whenever necessary. In fact Forrest yoga bases a lot of her stuff on total neck release.

Hope that gives you some food for thought. **Contact via PM or email ** if you have more questions as I am not on this forum very often.

Recumbent Stationary Cycle

This appears to be a very good option. By very good I mean that:

1. I experience no flare in symptoms during or after
2. I can exercise for extended periods of time
3. I can watch TV, listen to music or even read whilst exercising
4. The riding position on a recumbent is (arguably) superior to that on an upright even disregarding my specific TOS-driven needs

Downsides are:

1. I don't own such a bike currently, so permanent and convenient access will require expenditure
2. The maximum intensity (heart rate) is significantly lower than alternatives such as running or climbing

The problem I had to solve was that most recumbent stationary bikes have a back rest that does not extend up past the thoracic spine, whereas I need support up to the cervical spine or a headrest. The solution I found was the addition of a tall back support intended for use in a car seat. You can see this illustrated in the pictures below. I won't mention the supplier of the support in this post as I don't wish to appear to be marketing, but if anyone wants to know, please ask.

As an aside, I wear home-made elbow splints every night. I constructed them from a fleece blanket and duct tape and they limit elbow flexion without preventing me from using my arms if I must. Since using them, I no longer wake during the night due to 4th and 5th digit numbness, which was previously occurring up to 6 times per night.

Okay for the Yoga, here is the list I've tried. The ones I have found most useful and would recommend to another beginner are emboldened in green text. I'm not saying the others are bad, but they have been of less use to me.

Basic Yoga Workout for Dummies = simple asanas that are very well explained and demonstrateed
Beyond Basic Yoga for Dummies = good next step after the above, presents a sun-salutation sequence
Yoga for a Healthy Neck = equally well presented as the above and focused on neck. Also contains some general healthy neck tips e.g. for seating
Yoga for Inflexible People = not a sequence, but a library of short videos for a range of about 50 asanas. Good once you have an idea what you want to do but need to brush up on how

Kundalini AM PM Yoga
Power Yoga Total Body
Yoga Earth Water Fire

Concoulor, thanks for posting. :)

I shall follow up via PM or email. I would value your advice regarding yoga practice to the extent you are willing and have time to share it.

Oh yes...I forgot that I made elbow pads with kitchen towels at first...held it on with big diaper sized pins & some left over elastic bandage wrap from my previous minor knee surgery. Quite a sight, for awhile.

recumbent bike. Hot tub range of motion when someone will maintain and clean it for me. A little pricey to heat but the best medicine for me.

When I can afford the gas I go to local rehab that has heated pool. $25 a months to use the facility. The 99* water is great. Just hanging on noodles loosens things up, but I need to do range of motions and any bike first because too tired from the heat. Great when I top it off with a deep massage.

Just wish I had $$ to keep up with it. my lumbar is shot now,

What make/model recumbent do you use DiMarie?

I am considering acquiring a recumbent, but there are just two I've identified that *might* have a sufficient backrest, by which I mean their backrests extend up to the neck or head.

Both are high-end commercial machines rather than home machines, so discouragingly pricey.

1. The Star Track 8730

http://img3.prosperent.com/images/25..._8730_hero.jpg

2. Technogym Excite 700

http://s7v1.scene7.com/is/image/Harr...tail_main_new$

Since my experiment with adding a tall back support to a machine which didn't already have it, I may be able to widen the search of course. Still, I'd like to hear about your experience, and perhaps you do not have the same specific issue to overcome (within 60 minutes of having my neck/head unsupported, pain commences and builds)

I've got it! I should make a video: Yoga for TOS... Anyone a movie producer out there? Want to fund production costs? :wink::p:wink:

Perhaps I can vimoe something. I really like Hot aka Bikram Yoga for TOS, but this is guided and you have to find a "nice" (read not strict instructor). But, quality is very important.

Another way to help reduce numbness/tingling is gently wrap a rubberband around the knuckles of the hand, including the thumb (so fingersprints are touching each other, like holding a golfball in the palm of hand) . If it's not too tight you can sleep this way. it opens up the tunnels, allowing room of the nerves to "cool-down". But during the day, do this and then try to open and close the fingers - which strenghtens the muscles.

I have a fairly large c7-rib, but I don't seem to suffer as bad as it sounds many others seem to... I have had my TOS symptoms since college, when rowing really exasperated the issue. I was finally diagonosed many years later, but concurrently started with yoga (on my own accord) - so I have no idea if my conditions just has never progressed to any degree naturally or if the yoga has prevented progress. But, I do know I am a full 1/2" taller NOW (at age 40) then I was then. Can't help but think that having a longer spine is helping the issue.

Monday I go in for a consult with TOS specialist (5 years after consulting with a chop-doc) - should be interesting...

Exercise bike and TOS
 

Just thought i'd revive this thread in case it helps anyone searching for exercising and TOS.

I have functional TOS (rounded,internally rotated shoulders,muscle imbalances) so don't know how good this would be for those with anatomical anomalies.

I have an upright bike at home but was worried about the continuous leaning forwards and also possible irritation of my ulnar nerve on the handle bars.I therefore take an EZ curl bar(available for a few dollars)like this one http://1.bp.blogspot.com/_Q2E5yITblz...Z+Curl+Bar.bmpand place it on the seat behind my bum.I then grab the diagonal part of the bar so the arms are externally rotated.This puts the shoulders back,opens the TO and also gives a stretch on the pec muscles. Works for me

Another thing that really helps me is using special anti-vibration gloves when in the gym. They are sold for cyclists and have loads of special gel padding - for me, I go for the ones that protect the ulnar nerve more and not too expensive.

I use them on cross trainer and when cycling, both in gym and outside. Make a huge difference for me so might be worth a try. I used to love swimming but my physio reckons that one of things that flares my symptoms so I need to just do a small amount now and change the way I do front crawl.

Hope this helps - really interesting to share others experiences as we try to stay as fit as we can despite all our TOS symptoms

I've an EZ Curl bar in my home gym, which I've not gotten much use out of since I began suffering from TOS. I would never have thought of using it this way, but I plan to try this myself now. My condition appears to be improving but bending and then placing load on my arms with elbows bent remains something to avoid.

Both physio's I've had have encouraged me to swim, which I've found odd. I have experimented however, and found that I can perform breast stroke and . . . . I can also lie on my back and do what I can only describe as breast stroke whilst lying on my back, with my arms performing the stroke action beginning with arms at 90 degrees to the body and ending against the obliques. Crawl and Backstroke are out, Freestyle I'm incapable of anyway :)

pilates and walking
 

i've just done a couple of pilates classes. it's in the day so there are plenty of us with physical limitations and it's not competitive. the teacher is lovely and shows me adaptations. if i think they won't work for me i do it the way i don't think will aggravate things too much. just good to get the core strength up a bit. otherwise, walking the dogs is brilliant and aerobic. support arms in coat pockets as and when and i can do a bit of trigger point massage at the same time. and the lovely landscape takes my mind off the pain a little. :) i did try a spin class and it was ace, but i had a big flare the next day in the upper back and shoulders. like one of the other posters i often only get a reaction many hours after the activity, so can't tell at the time.

I was prompted to return by the thread resurrection.

I am thankfully about 85% recovered from the worst of my TOS symptoms and over the past 18 months have gradually restarted most exercise activities I previously engaged in. Results are somewhat surprising, and as follows. I share in case my discoveries can be of use to anyone else seeking to engage in exercise.

Resistance Exercise (weight-lifting):
# I can do almost anything without provoking any symptoms
# Overhead presses for reps remain problematic because I lack blood flow to my peripheries (arms) whilst they are abducted beyond 90 degrees
# Even exercises which involve holding on to a heavy load, like shrugs and deadlifts, I can perform without issue

Swimming
# Any significant period of swimming has led to significant stiffness bordering on pain in the muscles surrounding and to the side of the cervical spine area. The pain is entirely different to the muscular pain I am very familiar with from regular exercise over the last 20 years in that it doesn't feel muscular in origin.

Cycling
# I've found that the more upright my riding position, the better, to avoid placing my upper body load upon my arms and shoulders
# I've experienced flare-up of symptoms following a period of cycling each day for 4 weeks. Specifically, I began to awake during the night with part of my arm (all of it, or some of it, or just some fingers) numb. The numbness is caused by nerve impingement, not by cut off of blood flow

Other Cardio
# Running, skipping, Eliptical training, Stepping, all okay. Rowing a definite no no, that leads directly to symptoms within hours, I believe due to the tension in the upper back.

This gives me hope becasue it is too hot to run in Cuba and since there is plenty of water I would love to take advantage of the year round swimming - without causing a lot of pain and discomfort of course. I went kyaking the other day without any problems but then maybe the botox is working.

Hi BK . Did you have surgery? How did you get 85% recovered? Thanks JKL

Recovered is not quite the right word. I no longer suffer symptoms very frequently, and those I do are mild.

I was diagnosed with the neurogenic & arterial types of TOS following EMG, MRI, X-Ray, CT scan, Ultrasound and of course physical examination. I have no cervical rib or structural abnormality other than a depressed right clavicle. There was no obvious reason for the onset of symptoms and absolutely no direct help available from physicians other than physios.

However, even at the worst of my symptoms, I was no candidate for surgery. I did get 2 consults, but the shared conclusion was there was no reason to expect improvement from surgery and I wasn't badly enough off to justify the risk.

What I did and do:

1. Stopped all forms of physical activity for a 6 month period (because I could not know which if any were contributing to TOS)

2. Lost approximately 10kg as result of 1 (mainly lean mass I'm afraid)

3. Engaged in a program of 3 x daily stretches and nerve glides, developed with 2 physios with specific knowledge & positive experience of treating TOS

4. Sleep with elbows encased in a wrap which limits the angle of contraction at the elbow joint, thus allowing the nerves running down the arm to relax overnight

5. Gradually re-introduced physical activity, spaced 3 months apart so that if an activity re-introduced symptoms, I'd have a chance at isolating the cause

6. Converted my home and office environments into ergonomic paradises. Specifically, I have only chairs that ensure proper alignment of the whole spine and provide support for the cervical spine, and never have my elbows or wrists in contact with a hard surface)

I do still have arterial TOS, it just doesn't affect me very much in daily life. If I would walk with a heavy backpack, or just spend a day with my head and neck unsupported I'd develop pain symptoms in the cervical region. There are some things I just can't do - like cycling.

thanks for all this info. Can you describe the wrap? I'm not familiar with it. type of wrap and brand name?

Oh dear, here I expose my DIY.

I did indeed visit a custom-maker of splints for various nerve & bone injuries, but didn't get them to make me anything.

Here is what I actually do, and it is gosh-darn effective:

1. I take a fleece like this one: http://www.amazon.co.uk/gp/product/B...ls_o05_s00_i01
2. I cut it into 2-3 strips, then fold it until one strip is no more than about 30 cm long
3. I wrap the strip around a juice bottle
4. I duct-tape the strip so that it stays together

Bingo, I have a wrap. It restricts movement without preventing it. Wearing this, I never experience numbness during sleep. Without them, I'd be waking up 5-6 times per night. Want me to post some pictures to help bring this to life?

that's amazing!!

i do wonder how my sleep position is aggravating my tos

what kind of nerve glides did you do? were they just median/ulnar or specific to the brachial plexus?

very encouraging, ty

@BKRich, can you share which stretches you do?

A Yoga for TOS video would be awesome!
 

Do it!! I would LOVE to have this. Seriously, if you ever do...even if you could uploa a few youtube videos to help TOS people and you may gain exposure for your yoga classes that way? I have wanted to see TOS specific yoga for a while now...I hope you will seriously consider doing it!