Hi Everyone!

Just when I thought I had a handle on what was happening (TOS) and why (posture, shortened muscles, trigger points etc), a new PT has turned it on its head!
For the past 4 months I've been focusing on stretching (scalenes, pecs, scm, upper traps) and releasing (soft tissue work). In my mind, my rounded shoulders and forward-head posture had created chronically shortened scaleni, which then irritating the plexus, elevated the 1st rib, and caused further spasm due to neural inflammation, round and round. I've had dry needling, myofascial release and mobilisation, and I've been self-massaging and stretching as much as poss.

Things haven't really been improving so I sought out a new PT, basically wanting more of the above (thinking what I was having/doing wasn't enough). Anyway, I saw him today (after getting his assurance he was experienced in treating TOS), and HE TURNED IT ALL UPSIDE DOWN.

He thinks my traps are OVER-stretched and weak (scalenes same). Basically what he described was 'droopy shoulder syndrome', which is a sub-set of TOS, caused by TRACTION of the brachial plexus, rather than strict compression. Of course, this also causes the 1st rib to rise, so also causing compression. When I elevate my shoulders the awful tight pulling pain down my arms immediately stops, and though it feels unnatural to me, I look a lot more 'normal'. He pointed out I'm also hypermobile (which I knew), and therefore although I'm addicted to stretching, I MUST NOT STRETCH, I must strenthen my upper traps (I thought I had to switch them off) and correct posture.

As you can image this all feels very wrong. Can I accept this PT's view that my scalenes are not the problem, and that I should not stretch, only strengthen? I've read so much on this forum about the dangers of PT regimes that get you building strength straight away, but I wonder if the difference with me is this peculiar 'droopy shoulder' diagnosis, and therefore if the usual rules don't apply?

I've just spent $99 on Sharon Butler's protocol - which is all about stretching and sticky fascia - so am now totally confused. Stretch or strengthen??

All opinions greatly received! Thanks x

I don't know anything about droopy shoulder syndrome. I do know first hand that certain strengthening and stretching can be counter productive when there are other underlying disfunctions.

Once I started seeing the therapists at http://www.andoaston.com/staff they really opened my eyes. They showed me that nerves can shorten/tighten and be perceived as muscle tightness (which lead to overstretching of muscles in my case).

It sounds like your new therapist may be on to something with you. I hope he is educated on nerve mobilization and gliding. Also, evaluation and treatment of rib subluxation is also important (all ribs, not just the 1st).

Here is Dr. Ando's 5-Step Functional Approach:

To date, none of the following have had any significant, lasting effect on my TOS: stretching/strengthening, trigger point therapy, ART, massage therapy, nerve glides, FSM (frequency specific microcurrent), chiro, etc. In fact, stretching/strengthening, and some trigger point therapy have put me into some serious flare ups that took 6-8 months to resolve.

I've bought Sharon Butler's book, many books about trigger points and looked at Simons and Travell, "it's not carpal tunnel syndrome", and countless other books ---- nothing gave me my life back or allowed me to continue doing the job I loved.

Be caferul with PT as it can reeeeaaaallllly f you up.

However, it's possible that these things may help you get your life back and be very effective for you. Just sharing my experiences. I wish you the best.

Sometimes we just have to try things and take it day by day to see if you feel better or worse.

But if you feel uncomfortable with what the PT is wanting you to do, or if you are getting worse, say no and hopefully they will listen.. and make adjustments to the PT plan. If not walk out.

Stretching + hyper mobility is a fine line, you don't want to over extend yourself.
And some muscle tone does help to balance & protect the lax joints.

Does that PT place have expert /advanced team?
Maybe they could each evaluate you and compare notes??

I'm assuming you had x rays / MRI to rule out any obvious things.

Do you know how you acquired TOS?
Repetitive work or some other injury - sports , car accident etc?

if you are truly hypermobile (can u touch your thumb to your wrist?)

then you must strengthen but i wouldnt strengthen your upper traps wtf. do your lower traps..rotator cuff muscles. DO NOT stretch or you will end up like me!! i used to have droopy shoulders now my shoulders are hiked up to my ears from overstretching as a defense mechanism. theres no middle ground. and your neck will hate you for it.

what works for me is strengthening without weights just holding up your body weight, dont let them talk you into resistance bands, you will get worse! trust me then you combine that with the barest MINIMUM of stretching...one stretch i do is just lying down on my back and putting my arm over my head to stretch my armpit. THATS IT and if i ihave any slight tingling or nervy sensations i dont even do that. people who are hypermobile don't know how to stretch properly. they overstretch. nerves go into protection mode. repeat ad nauseum.

Here is one website that shows how you can test/score for hyper-mobility -
http://hypermobility.org/beighton.php

Thanks so much for this message, it makes so much sense.This is exactly my problem, I am hypermobile too. I think this is worth posting as a new thread for all members on the forum as it is very valuable advice.

Klm207, I am so glad you started this thread because it sounds like we are going through a very similar exerpience right now. I just saw a new PT and she is prescribing very similar exercises for me to work on. She stopped all of my stretches, which is what I was doing all day long, which really seemed wrong to me. She now has me doing 12 shoulder shruggs six times per day along with wall pushups. I like how the wall pushups feel because it puts compression in my right arm which has been so, so painful, but the shruggs really irritate my nerves.

TOS is hard. The pain and lack of sleep are wearing me down. I have been doing the shoulder shrugg routine for only three days so it is far too early to tell if it will help or hurt. Right now I feel a bit more tingly in my left and right hand after I do the shruggs and my trapezius muscles scream at me. I also have to work very hard to keep my head from going forward. It has become a habit since an auto accident I had because that posture helped me keep my balance for months. However, as the balance issues calmed, the TOS surfaced.

I sure hope this new routine helps us both out. I have been so unsure about the whole thing as I have read here how improper or aggressive PT can make things worse.

Klm207, one more thought, have you had your thyroid level checked?

I like Brugger Relief Pose for correcting forward head posture. Basically, you pull your head back at the beginning before you do the arm rotation.

I can't do wall pushups without creating a flare up down the line. They create extra tension and muscle mass in my upper chest which is where the subclavian vessels run.