Was recently diagnosed with TOS and a subclavian artery compression. I've read on the boards here that many PTs have recommended that those of us with this condition avoid being in a hands and knees position and especially the pushup position.

Question: Why?

Why does this movement cause such a problem? What is moving causing even more compression / tightness?

I know that when I do pushups I get radiating pain down my scap. I just don't get why this causes such an issue vs. other movements.

Thanks.

KY

I think a lot of it for many of us is the extra weight when your arms have to hold up the whole upper body. Cause much more strain on our already blood flow or nerve affected muscles.

Even with just the head tilted forward of the body the weight on the upper back & neck muscles is compounded.
head weight is 8 -14 pound approx - forward or when on all fours it is many times more than that due to gravity and the fact that the head is not sitting lined vertically up with the spinal column to help hold the weight.

example-
Like when you hold a gallon of milk close to your body vs holding it out at arms length or even 5" away from the body. It is a lot harder & more tiring to hold it away from the center mass of the body.


here's a site I found with more details -
[The average head weighs about 10 pounds. If the head sits in proper alignment the load of its weight on the neck bones and discs and muscles is exactly 10 pounds. If the head is translated forward, that load increases by 10 pounds for every inch. Imagine a 30 pound bowling ball on top of a flexible stick! It is no wonder so many people present with stiff necks, headaches, shoulder, arm and wrist (carpal tunnel) problems. With this abnormal posture the neck and shoulders must` carry excess weight all day and the spinal tissues deform. The normal curve in the neck flattens, the discs get compressed and arthritis develops as the joints degenerate.
FHP can be improved through chiropractic correction of spinal misalignments and the following exercises and postural corrections:]
http://www.alicebehrchiropractic.com/words_from_dr.htm

Right, but when you're doing a pushup, your head is looking up. So I'd think you'd be working the posterior neck muscles...which should be good? Also, a pushup works the back muscles as well and is universally known as a great exercise for shoulders.

I don't understand how those anterior neck muscles are strained.

What's interesting to me is if I do a dumbell press it feels better...as if the movement of bringing my arm down with the dumbell stretches my chest and neck out.

I know that resistance training is frowned upon with TOS, but I'm getting mixed messages in my reading on the subject. Some say stay away from everything (especially say a pushup) while others say strengthen your mid-back and external rotation...which improves posture and helps to keep those shoulders back and down.

KY

Perhaps if your nerves are already in a state of irritation (ie. In adverse neural tension)beneath the scalenes then having significant enough pec minor muscle activation can also bring on symptoms

My last post seems to not have appeared so here it is again

1.Perhaps if your nerves are already under adverse neural tension from the scalenes then pec minor activation is also able to irritate them further enough to cause symptoms (presuming you have some degree of neurogenic as well as vascular TOS) I know that if it was the case you would expect it to occur with dumbells but perhaps the slightly different arm position prevents the nerves being compressed as much.Also are your dumbells heavier or lighter in comparison to the pressups ? Does it still occur if you widen your hands doing press ups ? (not that Im suggesting you should do them though ! As you mentioned you should be working out your external rotators)

2.Perhaps your head is moving forward inadvertently as suggested above , together with the natural tendency to strain the neck muscles when working out.

It's possible that the pec minor activation causes the irritation. That said, my pec minor is as loose as can be at this point. More likely, I'd think that I'm straining my neck while working out.

In general, I think I have a lot more tension in my neck and shoulders than I ever thought. I've found that when I'm at work in the office, I "feel it" a lot more...and I'm sure it's due to postural stress. Meanwhile, when I'm in my home office (and don't have all kinds of uncontrollable stress walking in my office) I feel it far less.

I really need to work on the above. Many times I feel worse after a day at the office than I do after an hour at the gym.

KY

All of us need a scanner and a thermography, and then inject some real product in these bastards muscles

It would certainly be nice to know exactly where the compression is coming from.I think mines from my pec minor.

KY- if you work out a lot have you assessed yourself/or a physio assessed you to make sure you don't have upper crossed syndrome? Id make sure before contiuning to work out those internal rotators.Biggest mistake I made was to continue doing my normal work out

Plexus,

Great insight.

I've done a lot of research on upper crossed syndrome and I believe this to be a contributing factor. Couple reasons:

* I of course focused way too much on those "showey" muscles. Chest mostly. There is no doubt my pec minor was insanely tight.
* When this madness all started 18 months ago, it started first with a posterior mid - back / right shoulder injury. I think a weakening or loosening of my back muscles may have contributed to the overtightening of my chest muscles.
* During this time period, I had ZERO tissue work done to loosen me up and I hardly stretched.

Since January, I've had a manual orthopedic therapist stretch me out all over. He noted tightness in my pec minor and scalenes and worked them out to some degree. I saw some relief, but didn't see SIGNIFICANT relief until I REALLY started stretching both my scalenes and pec minor MORE FREQUENTLY on my own. Since this time, I've found the symptoms diminish AND I've found it easier to do pushing exercices. There's no doubt I was overly rotated internally to the point where when I did those exercises with a band, it hurt.

I really think my cause of TOS is more of just tightness gone absolutely haywire and me being my worst enemy. I'm going to be really surprised if on June 1 when I visit the doc he tells me I've got some genetic issue with my first rib.

KY

Thats interesting.Im just at the beginning of trying to resolve this imbalance.Did you manage to correct it with exercises? Is your shoulder posture imbalance improved or do you still have to think about it to maintain good posture? At the moment if I don't concentrate I fall back to my old ways.

Lastly did you find having UCS hampered your chest/bench gains because i reached a plateau on chest exercises just before all this TOS stuff started and wondered if shoulder muscle imbalance was the cause