A Dr. Stoxen from the Chicago area gave a presentation on TOS in 2004, which I found interesting. *edit* if you search Google you will find it with these search terms:

vimeo stoxen thoracic outlet syndrome

I found these things especially interesting:

-- His comments on posture were spot on for me.

-- He points out that the first rib has no muscles that can pull it down, so it needs to be adjusted manually/externally.

-- He advises against certain neck stretches due to their pulling on the first rib. Interestingly, my chiro in Los Angeles warned me against the same thing.

-- He claims a high success rate with non-surgical treatment.

In addition to sharing this with you, I'm interested to know what your thoughts are on the contents of the presentation?

This is my first post btw. I've had mild TOS symptoms for years--without knowing what TOS was or what was going on--and then it "blew up" in early July. I've just started chiro and Egoscue exercises, and plan to add trigger point self therapy soon.

I also found this presentation very interesting and revealing. I am convinced that in many, many cases the TOS has its origin in a bad posture, forward head and shoulders (like in my case ) Also the facts stated in the presentation challenge many physical treatments I have undergone. The most bewildering statement is that you should do no stretching of the neck, something which is done by almost every physiotherapist (at least here in Germany ).

Yesterday I started the Sharon-Butler-selfcare program and I have to admit that I am totally confused now. Will this program help me or will it totally ruin my neck and cause more pain?

The physio says that my first rib is fine, can I trust her?

What do you think?

KR
Monica

I think we need to define stretching..

There is the often/usual PT way of push thru it no matter how you feel after...

and the gentle stretching mentioned by Sharon Butler.
"just a tiny hint of a sensation"

It is the smallest of a stretch sensation, and if that is too much after- or a day later - then you do even less of it when the discomfort is gone.

You want to aim for no added discomfort from her program, and then move forward slowly & gently to the next step.

I had to read her program quite a few times for it all to sink in about the fascia and how it reacts & is involved. And I have forgotten much but a few parts of it are stuck in my head.

Regarding the Butler stretches, I would like to hear if people have used them to resolve their TOS or at least get a significant reduction in symptoms (> 50%?). Maybe I should ask that in a separate thread.

The Pete Egoscue material is well reviewed at Amazon, which gave me the confidence to try it. I'm only a week in, but have already seen improvement. These *do* involve stretches, but not the side neck stretches that the two chiros (Stoxen and my local) advise against.

Also, I've been reading "The Trigger Point Therapy Workbook: Second Edition" which doesn't advise against stretching so much as it advises against stretching before releasing trigger points. I'm paraphrasing here, but the concern seemed to be that muscles that were chronically tight due to trigger points would not benefit (much) from normal stretching. I can't comment on the results, because I haven't started yet.

And of course we're all a bit different so what works for one might not work for others. All we can do is share, experiment and seek out a solution.

hey can you please tell me which neck streches the chiro advised against?

If I recall correctly, it was any stretch of the scalene muscles because they are attached to the first rib. The concern is that the first rib will be pulled further higher and reduce the space between the collar bone and the rib.

If you do a Google image search on "scalene" you will see which muscles these are and what they attach to. You can also watch the video. Also there is a text transcript below the video. It includes this:

(He also emphasizes that the patient must correct all postural problems that are involved or they will not get better permanently.)

On the other hand, the physical therapy (PT) people seem to recommend stretching those muscles in order to loosen them.

I am neither a chiro nor a PT and am only sharing what I've been hearing. Since I'm trying a chiro and he stated that side neck stretches were off limits, I'm following that course of advice.

Best regards.

Well i can see what they mean , but this has just left me very confused as my PT recommends that streching the scalene muscle will help the situation.

When i strech the scalene i Put my thumb on the first rib and press down on it and look the other way, i can actually feel the first rib and its not moving. Also if i press down hard enough on my first rib i can feel it lower very slighty, after all my PT sessions he has done a good job loosening up the first rib thats why this all possible.

So im wondering now, do i continue with the scalene streches or not?

Well I find the details of your stretching very interesting. You are holding the rib in place to avoid the problem the chiros are concerned about and you can feel it lower slightly. What's not to like? I would continue.

Can you produce a pic of the stretch with the thumb placement and everything? Either your own or one you find on the web on that matches? I would love to have one.

Ill have to take a pic, But pretty much what i do is exactly this

1.Put one hand behind my back as you would in a normal scalene strech
2. With the opposite hand i use the thumb and feel around until i can feel the first rib, it right under the upper traps just have to push down a bit.
3. Then i put pressure on the first rib with my thumb and turn my head away so it streches.

I can easily feel the first rib and when i push down on it hard it can feel it lower very slighty. I dont do it to often though cause it hurts a bit and can cause inflamation if i do it to often.

Im going to a chiro this week so ill check and see if there is anything wrong with what im doing.

Top Rib mob or stabilization for stretching -
see the bottom picture on this page-
http://www.nismat.org/ptcor/thoracic_outlet


"advises against stretching before releasing trigger points"
I've read this a few places also.