Stress vs. Strengthening and TOS Pain
 

I've been managing my symptoms quite well ever since being diagnosed with TOS a few months ago. A scalene stretching routine has kept my pain level below a 1.5 on a scale of 1 to 10 consistently with days at a time seeing 0 pain.

That said, I've noticed something strange and what would seem as counterintuitive.

On days where my stress level is high due to work related issues or travel for work, my irritation seems to increase. For example, this week I was presented with a new job opportunity that has me concerned about my future, family, etc. I've definitely been "agitated" and I can feel more irritation on my right scapula and elbow area. It's not tremendous pain, maybe as high as a 2. Still, it's irritating.

On the flip side, I often find that when my irritation increases, my gym activity actually makes me feel a lot better. This is counterintuitive to me considering what everyone says about strengthening exercises. And my gym activity is not your typical go through the motions type stuff. It's pretty hardcore and involves working both anterior and posterior muscles.

So in short, I don't get it.

How can emotional stress cause more issues than physically stressing my body?

What is it that I'm aggravating with emotional stress vs. physical stress?

It boggles my mind.

Hoping somebody can help me break this down. How is my body moving during each of these stress periods and why irritation?

And I'd be curious if anyone else runs into this.

Thanks.

KY

stress makes you unconsciously hold much more muscle tension, and there is a tendency to breathe more shallowly- thus much less oxygen in and the toxins don't get flushed out of the cells as well.

So my inability to relax basically is the culprit?

If that's the case, my muscles must hold tons of tension under stress.

And I wonder if it's any coincidence that I feel much more relaxed after I go to the gym.

Is diaphramic breathing the trick? Any others?

I have to get this under control because my work life is getting increasingly more stressful as I take on more responsibility. I'm fearful of moving up the ladder because it may do me in.

KY

I don't know what kind of workouts you do, but have you ever tried using Indian clubs, clubbells, or kettlebells?

I haven't used the latter two, but I've been having really good luck using Indian clubs to loosen up my shoulders, elbows and wrists. Swinging a club or weight helps to stretch everything out. Maybe it would help get rid of tension in your muscles?

I need something fitness wise for the upcoming winter months, so I decided to go with a mini trampoline -
Walmart has the Gold's Gym Circuit Trainer 36" Mini Trampoline w/resist bands. on sale for 34.77.

[Gold's Gym Circuit Trainer Mini Trampoline also includes:
2 resistance cords for upper body workout
Electronic monitor that measures time, calories, and number of jumps
Mini-trampoline stands on 6-legs.
Gold's Gym circuit trainer workout DVD ]

Easy to move indoors or outside, no motor/or belt like a treadmill, I had one years ago.

I read that trampolines are very good for lymph flow, bone strength & overall conditioning. Just a very mild bounce movement stimulates the lymph system, you don't even have to get airborne.

The store near me didn't have it on the shelf so not sure when it will arrive in the store for pick up.

The thing is, tension at the gym isn't the problem. When I'm there and afterward I feel great. The movements must loosen everything up.

It's when I'm in the office or doing work at home.

Maybe I need to do this "swinging" in my office?

I need to do something.

I'm really wound tight due to something that's come up at work. I wonder if a trip to the accupunturist wouldn't be a bad idea. I usually walk out of there loose as a goose. Feel like I need to "break the cycle of tension" or something.

KY

I have just finished 3 sessions of trigger point therapy massages, and no word of lie on the 3rd session 95% of my pain has dissapeared. 0 finger pains 0 arm and 0 SHOULDER pains.. there are days when i get no pains at all. I thought it was impossible to get rid of all these pains but turns out i had a bunch of active trigger points in my scalenes and back. I dont wanna get ahead of my self.. But i feel Cured.

I ahve been back to the gym this week and last and i msut agree, gym work and strengething makes me feel much much better. When all the muscles are strong they feel 100 times better. Im the same as you , posterior work , anterior work, core , legs everything. I havent felt this good all year.

The only pain i have left is a periodic throb slash raw burning pain that is restricted to the left collarbone/first rid area sometimes radiating down into the pec minor area/ anterior delt. very wierd pain , it only comes on wehn i chnge positions from laying down to standing up or when sitting at computer to long to standing up.

Any idea wats this could be.. Im still trying to dertimine weather its a soft tissue problem or a bone alligmnet problem?

Funnily enough, strengthenong makes me feel really good, computer work makes me feel not so good.

Triggery point therapy worked for me, maybe give it a shot?

Some thoughts:

Re: mental/emotional stress, yes it can cause tension in the muscles. It can also cause upper chest breathing which can narrow the space between the collar bone and first rib. Make sure you are belly breathing even when stressed. Furthermore, I notice that for myself and others close to me, stress generally aggravates just about any health problem.

Also, you might consider attacking the problem of stress itself more directly. An Amazon search for "stress" returns some well rated books whose explanations and exercises have helped people.

Re: exercise, there are studies that show that exercise can reduce pain. Here is one regarding yoga:

http://www.sciencedaily.com/releases...0727131421.htm

But I don't think boosting cortisol is exclusive to yoga. And there are other boosts too like human growth hormone.

For me, exercise makes me feel worse, but I have circulation issues in the neck area (which are gradually improving).

Re: computer work, if it is making you feel bad, make extra sure that you have *excellent* posture with no "forward head", "forward shoulders", "trap tension", etc. Just "sitting up" doesn't do it. I had to really study material on posture and study myself, and not compromise my posture at all.

But I still slump into bad posture when I get really engrossed in a project and, sure enough, start feeling bad again. Then I get up, stretch, straighten, do Brugger relief pose, relax and sit back down in good posture.

HTH

Can you tell us your exact scalene stretching routine?

Since about April, I started doing both an anterior and middle scalene stretching. Very rigorous and systematic.

Basically, every hour I would stretch each for 30-60 seconds. I noticed that this started relieving my elbow pain and burning scapular pain immediately. I also integrated boytos lying on the foam roller while doing chin tucks for 3 minutes plus. Also, pec minor stretching 3-4 times per day.

This has all worked great, but I've noticed that regardless of this, I get mini flare ups when I'm STRESSED OUT!

I think the deep breathing techniques are key. I didn't realize that shallow chest breathing can narrow the space. I've really slacked off on this.

I hate to ask this, but what over the counter (or under) pharm aides that could help here?


KY

Thanks for the details. Btw when I stretch my neck, I always follow up with a first rib adjustment out of paranoia of raising that rib, since the scalenes are attached to it. I use the method with the sheet/towel/strap looped over it which you can find in these forums or searching the web.

I really like your idea of regular stretch intervals spread throughout the day. I'm going to incorporate that. I've been doing most of my work in one session per day.

So when you lay on the foam roller, does it run vertical with your spine, or horizontal across some part of your back? youtube vid?

Are your pec minor stretches done when you're on the foam roller, or are you doing the "doorway pec stretch"? (or something else?)

Re: pills, I've recently been using "Now Foods True Calm Amino Relaxer". You can read reviews on Amazon. I get a stronger effect than some of the reviewers have mentioned, so I only use it before I go to bed. It really does make me calm. Many of the reviewers mention using it during the day.

Magnesium is also associated with numerous benefits and there are claims that most people don't get enough. I read "The Magnesium Miracle" and started supplementing. Like most supplements, the effects are subtle, so I base my decision on the purported benefits of the studies.

If you're feeling physical tightness in your muscles, I still get tremendous benefits from "muscle relaxation meditation":
-- on inhalation note the place of tension (scm, scalene, shoulder, general neck, etc.)
-- on exhalation, release that tension
-- control the duration of the exhale to match the inhale
-- belly breath
-- don't bother to breathe so deeply that you have to lift your rib cage, clavicle, etc. that's not necessary
-- but if you need a couple of giant breaths at the beginning or the end that expand everything, feel free
-- repeat for several minutes which will give you dozens of repetitions of "inhale and note" then "exhale and release"
-- lately I've been experimenting with saying mentally "soft neck" or "soft eyes" etc. as part of the exhalation, with good results

Stress includes how you think, react and feel though. I really think you should look into something like "The Relaxation and Stress Reduction Workbook" or any other well reviewed book. I had to years ago when I had problems with stress. It's worthwhile to pursue an increase in your understanding and skill re: stress.

There are also guided stress relief audios that I have found helpful. That's where I got the muscle relaxation meditation from.

HTH

Let me know about my questions above.

Chroma,

I've never really done the first rib adjustment. I need to incorporate this. I've read about the towel approach and I've thought of seeking out manual therapy, but have done neither. I think somebody also posted on the board a method where you take a deep breathe, put the hand on the effective side on your head, and then try and turn your head towards the effective head while applying force. Don't really get it.

Foam roller is right along the spine. I've actually done it three times today and feel better. It seems to incorporate many things: Diaphramic breathing, posterior neck muscle strengthening if you do chin tucks, and then scalene inhibition. What I do is 60 seconds of deep breathing, then I do 8 chin tucks, then repeat twice more.

Unfortunately, I've been blowing all the above off for the last month and I think it caught up to me.

Pec minor is a doorway stretch.

KY

I posted on that rib adjustment asking if anyone had used it. I didn't get it either.

Thanks for the details. I found a pic here:

http://activereliefla.com/d-i-y-acti...ul-stretching/

Yup. That's the one.

The one thing I haven't done is try and manually adjust my first rib. I've done all this scalene stretching and it hasn't dawned on me that...duh...the scalenes are attached to the first rib. It would make sense that you have to keep that rib down to really make the most of the scalene stretch.

I tried the towel wrap thing where you pull down on the opposite side...I get nothing from that. Tried something last night...I may be on to something:

* Grabbed a whiffle ball bat and stuck a tennis ball on top of it. I then wedged the bat into the wall and then wedged the other end of the bat with the ball on the end into my first rib while lying down. I then tried moving my arm up and down and then also attempted to stretch my scalenes while on the floor.

Wow. Big time feeling of stretch there with the rib pinned. This may be a keeper.

I also did my normal scalene stretches, but I made a concerted effort to not only put my right arm behind my back, but also grab on the corner of a table while pulling down to keep that first rib down. Definitely feel the scalene stretch more.

I'd be very interested in what others are doing with the first rib.

KY

This is similar to Edgelow's "Ball on a Stick" method of first rib adjustment. I use a Pinky Ball which you can buy at most toy stores, drill a hole in it and stick it on the end of a wooden dowel.

I use a 6" foam roller for pec stretching and rolling side by side with it placed vertically along my spine. I also use a 3" foam roller under my hips for stretching side to side by bending my knees. I then take the 3" horizontally, starting near the lower diaphragm and moving up towards my neck. I relax on it in the various positions. This was to much for me at first and I would flare. My PT had me start with a rolled up towel which was effective and easier to do. I still use a towel if I travel for tools on the road.

its hormones, especially cortisol i believe

my blood sugar is on the fritz right now (i am a twig) and i blame tos pain keeping me tense/mag deficiency

The stress response is designed to prepare you to face danger, either imaginary or real (the body cannot always tell the difference).

I don't think stretching is necessarily the cure-all for tight muscles in the neck (either posterior or lateral neck). Restricting your breathing, IMO, is a bad idea. But doing more diaphragm, abdominal breathing is a very good idea.

BTW, pec minor is NOT a doorway stretch. Pec major attaches to ribs, to the clavicle and to the humerus-- it can bring the arm forward as in a bench press or across the body as in a fly movement or doorway stretch. Pec minor is beneath the pec major; its primary purpose is to depress the arm & shoulder, as in performing a dip with cross-over cables or a dip between two chairs (with the considerable help of triceps brachii. It arises from lower ribs and attaches on the coracoid process of the scapula, so it works to depress the shoulder.

A search for "pec minor stretch" yields lots of hits for the doorway stretch:

http://www.mikereinold.com/2010/02/p...r-stretch.html

http://www.google.com/search?q=pec+m...bm=isch&tab=wi

Especially with the arm in the door raised up, which is one of the positions I've seen, I can see how the pec minors would get a stretch.

Regarding the pec minor "arises from lower ribs"... it arises from the middle ribs, specifically 3 through 5, not the lower.[1][2]

[1] http://en.wikipedia.org/wiki/Pectoralis_minor_muscle

[2] http://en.wikipedia.org/wiki/Human_rib_cage

The doorway stretches never worked very well for me - the arms up ones anyway... stops my blood flow to my arms while they are up like that....

But the ones using gravity or foam roll, inflatable ball, rolled towel work nicely for me.

Yeah I'm also more comfortable laying down with the arms hanging back. It's another one of those nice "exercises" where gravity does the work. :)

Stretching ideas........ thanks!
 

Hello Jo*mar
I'm loving this forum!!!!! Thanks to all of you out there, I'm picking up some fantastic tips/techniques.
I experience the same as you regarding arms up ( blood flow issues ) so will work on the ones lying down.
From SD38:)

muscle relaxation meditation......YES!!!!!!!
 

Hi Chroma,
I really like the sound of the muscle relaxation meditation!!!!!!
Over the years trying to cope with my symptoms I have found that I am more and more turning to the Buddhist way of life, and looking into how I can self-help and MEDITATION is high up there on my list of priorities. I'm no expert, I'm still relatively new to it even after a few years, however I find it extremely comforting and it helps me to refocus and find inner strength.
I love your ideas here...... Many thanks and best wishes with pain management!
From SD38:hug::circlelove::I-Agree:

You're welcome! Glad I could help.

So I just got back from a business trip last Friday. Extremely stressful. I had to travel across a couple time zones and manage some organizational change at my company. There's been a lot building in terms of stress up to this point...lot on my mind as I work through taking on more responsibility in my brain, etc.

It's just now, almost a week later, that my body seems to be recovering from stress induced TOS symptoms.

I tell ya, this is becoming a problem.

I'm not a good traveller as it is. I'm a creature of habit and at night I just don't have an "off" button. I find it hard to relax and as a result, don't sleep well if at all. Compound this with work stress and I'm a bundle of nerves while I'm away. While on a trip, my stress just seems to escalate and my TOS symptoms flare up. I have to resort to ambien to force my brain to shut down and get some sleep. When I get home I feel like I need to check myself in a hospital for 48 hours.

Having a difficult time trying to meditate or anything while I'm away. When on business trips there's no slack -- early meetings, nonstop all day, then go right out for dinner, etc. I don't get home basically until it's time for bed and even then, I have little things to mop up and do like iron clothes for the next day, etc.

I'm at my wits end with this problem...and I have trips to Phoenix, Atlanta, and London scheduled for January.

Ugh.

I keep thinking that xanax could be an option. Seems to calm me down and position me for relaxation. Of course, nobody wants to prescribe me this.

Anyways, would be interested how folks deal with this while travelling with a packed schedule.

Thanks.

KY

KY: Keeping stress and anxiety on the back burner is a constant chore for me. I do find taking time for yourself, self-care, is the most important piece of the puzzle.

Since you don't have much "down time", I'd get meditation audios, mindful based stress types of things or even relaxing music and use the airplane as an opportunity to decompress. Even if you take 20 min before you got to bed to calm your adrenals down, it may take the edge off and allow you to relax and sleep better.

I also resort to Ambien a few times every couple of months when I start spinning out of control. It seems to reset my sleep pattern and head me in the right direction.

Non-pharmaceutical things which have helped me the most are self-care, taking a Mindful Based Stress Reduction Class and meditating, Melatonin, Valerian Root and some Chinese Herbs seem to be helping a bit. Some people swear by a product called "Rescue Remedy" to keep the adrenals from overacting. Personally, I can't give it a thumbs up yet.

After a recent traumatic event, which was not only an emergency situation but required me to physically exert myself, my acupuncturist performed a needling which felt like I had popped 10mg of Valium. It took me from extreme "fight or flight" to a drooling idiot.

There are a lot of different things out there, including pharmas, but making time to take care of yourself is first and foremost.

Some thoughts:

-- When I'm too stressed to meditate on my own and bring myself down, I use a guided relaxation audio which helps grab my attention. This could be on an mp3-player/phone for example. Lately, I've been using apps though because they have options like setting the duration or changing the volume level of the music relative to the voice. The two on the iPhone that I like are:

* Infinite Relaxation

* Deep Relaxation with Andrew Johnson

-- Sometimes on business trips I just can't stand to do the dinner thing. I just spent 8 hours with these people and now I'm going to spend 3 more? Ug. So sometimes I explain that I'm not feeling well and I skip the dinner. :cool:

-- This is a longer term thing, but practicing relaxation techniques when you're not stressed is important. Anything you practice, you become better at. With regards to relaxation, getting better means that you reach a deeper level of relaxation and in less time. Once you find yourself in a stressful situation, you can't suddenly practice and get there. In fact, practice is harder at that time. So you have to find the discipline to practice during the good times. It does pay off.

-- This thought is a little more vague, but I've reduced my stress at work before by going "zen" on it: more observation, less concern over control. I do the things I can and should do for my projects, and then I accept that the rest is out of my hands. It's a mindset. Cultivating it is valuable. I wish I had more tips for doing so, but it was like I made the decision to reframe how I was reacting to things.

-- Okay this one is funny, but you mentioned not having time to destress during the trips. Mini-meditations can be useful, but where/how do you do them on a trip? In the bathroom while you're wizzing.

-- I did in fact find the NOW Foods True Calm product to be relaxing. Since you can't get xanax, try that or other related products.

I hope that helps.

Ambien has the opposite effect on me. While it does give me enough sleep to function, it doesn't give me enough. I'm usually up after 4 hours and that's it. Worse, I have this "hangover" type feeling all day and I'm still tired. And this tends to increase anxiety about not relaxing and sleeping the next night! I really want to get off this.

Agree on accupuncture. I wish I could take mine on my trips. After walking out of their office I feel like I just walked out of a bar after 12 beers.

Come to think of it...a session before and after trips may be a good idea.

KY

Yeah, I always say I'm going to do this but never do. And corporate social functions are probably more stressful than the actual work. What I normally try to do is "put in the time" early in a trip and then later just say "I'm cooked" so I can at least get one night to start decompressing, but usually, I'm too far gone at that point.

It's funny. I think the most relaxing sound sometimes is...silence! My wife is always wondering why I don't like to listen to music in the car. But then again, thinking critically about this, I like listening to the sounds of nature -- wind, ocean, etc. So maybe this is an avenue I can pursue.

KY

Woops. That last one should be:

* Deep Sleep with Andrew Johnson

Best iPhone app for that which I know of is Naturespace. The reviews were so good, I wondered what the big deal was. And it is this: In addition to being really high quality, the sounds are done in a stereo/3D-ish kind of way that make it feel like you're in the natural setting rather than listening to a flat recording. Comes through when using headphones.

Chroma,

Thanks for the recommendations.

I don't have an Iphone...have a blackberry bold with limited app availability due to corporate restrictions.

Are these available for downloads on Itunes?

KY

There is an album called NatureSpace on iTunes, but when I sampled the tracks it appears to be a coincidence in the naming.

Also, for ambient music (no lyrics, no strong melodies), I really like Brian Eno's "Music for Airports".

Here's what makes zero sense to me. When I'm stressed, I must be breathing in a shallow manner, raising the rib cage, and also tensing my upper musculature.

Ok fine.

Then tell me why when I'm working out at the gym...vigorously...and I'm huffing and puffing, tensing my muscles, I don't have the same reaction post workout?

Don't get it.

Post workout, am I relaxed? Is it due to endorphin release?

There's some kind of brain to muscle connection thing here that's important. Something very positive is going on in my head during and after workouts, while something very negative is going on while emotionally stressed. And my body reacts accordingly.

KY

I would guess that after you workout, your muscle tone goes way down. Also, your circulation improves. Both good things.

Stress increases muscle tone.

There is more on this in "Somatics" by Hanna and "Muscular Retraining" by Williamson, although I can't say the Williamson exercises cured by chronic neck tension. I haven't tried the Somatics yet, but found the material about tension interesting.

I've also read other books and articles where authors lament that people have a flight-or-fight response to stressful situations that are not physical (such as office work and relationships) and because they are not physical, they are left in an unhealthy stew of adrenaline and muscle tension that they can't immediately work off. I agree that this is a problem in modern life.

I agree with you that "There's some kind of brain to muscle connection thing here that's important."

So true.

One of the primary benefits of going to the gym for me is that it's my own personal decompression chamber. I vent out everything there. If I head into a session stressed, my focus on executing movements and exertion just forces it all out of me.

I need the "non-gym" equivilent!

KY

I don't think that there is a non-gym equivalent based on "pushing through" or "being forceful". There is, however, a different approach which is mindfulness and avoiding the stress in the first place. In other words, getting through your day with fewer stress responses so that you don't become compressed in the first place.

With some practice, a mindful person can choose their response rather than simply reacting and therefore being at the whim of their environment.

This approach works, but it takes time and effort to master. I think it's worth it.