I had a PT session two days ago and when the PT began to gently rub on the scalenes on the TOS side I thought I would jump off the table. She took it easy but every time she tried to gently work on a trigger point, I thought I was going to faint. I even broke out in a sweat.

So my question is this, should I be trying to stretch that side, even though it seems to trigger a flare? My PT does not know and said if it hurts, do not do it. I also have head forward posture and I am so tired of trying to correct it. I keep trying to gently pull my head back, but then when I catch myself in a mirror, I am always back to head forward.

Does anyone have a recommendation as to how the calmed the scalenes and also how to deal with this head forward problem? I can calm it by laying on my back in a corpse position, but I can't live my life like this and I think my neck muscles are getting weaker. Any suggestions are so appreciated.

[QUOTE=ElyseHart;885355]I had a PT session two days ago and when the PT began to gently rub on the scalenes on the TOS side I thought I would jump off the table. She took it easy but every time she tried to gently work on a trigger point, I thought I was going to faint. I even broke out in a sweat.

So my question is this, should I be trying to stretch that side, even though it seems to trigger a flare? My PT does not know and said if it hurts, do not do it. I also have head forward posture and I am so tired of trying to correct it. I keep trying to gently pull my head back, but then when I catch myself in a mirror, I am always back to head forward.

Does anyone have a recommendation as to how the calmed the scalenes and also how to deal with this head forward problem? I can calm it by laying on my back in a corpse position, but I can't live my life like this and I think my neck muscles are getting weaker. Any suggestions are so appreciated.[/QUOTE


Hello, I have been in physio and massage therapy since 2006(had a 3 level ACDF and have bi-lateral TOS) and have many trigger points in my neck, scalenes, and thur shoulder blades and both arms, and many times laid there with tears and those sweats, but even tho it hurt I endured the massages and PT and the exercises because I felt if I don't then all my muscles will just sieze up I won't be able to move my neck properly at all. I do turn my head left, right, up, down and lift my shoulders up and down several times to help with the scalenes and I do my exercises 3 x's daily along with heat and ice packs which help the swelling of your muscles also a warm bath with epsom salts is very soothing. I also have the poked-nosed forward head posture(what my vascular surgeon cald it) lol my hubby is always saying put your head up and stand tall dear, blah blah blah lol, I know its difficult but I really try to keep my posture straight and my head held high, I'm afraid of getting a hump in my neck from being slumped all the time.
Good luck and take care,
Bunz

I say NO firmly. I found that stretching and strengthening the neck was triggering flares. Stretching the scalenes often has the effect of pulling up on the 1st rib, making matters worse. If you feel you must stretch, some form of rib mobilization must be used (karate belt, towel, etc). Even using rib mobilization during stretching caused me problems. Now that both of my ribs have been removed, I have been able to do the stretches and exercises without ill effects. My neck muscles are weak but strengthening now. I was not getting any benefit to the exercises previously.

I do believe therapeutic massage of these muscles can be helpful (even though it may be painful initially when you are flared). It was definitely helpful to me. Keep trigger points at bay by any means necessary.

Thread: How I got my trigger points under control

Generally if you have trigger points , stretching isn't going to do you any good until those TrPs get resolved.
That's something Sharon Butler doesn't cover, trigger points.
..they are real and they happen!

Was the PT just rubbing on those muscles or actually doing manual TrP release?
*a specific pressure on 1 TrP at a time until it fades away.*
TrP sticky thread-
http://neurotalk.psychcentral.com/thread125577.html

If your muscles are in spasms also then that needs to be addressed -
I had best luck with my chiro doing the ultrasound, low level laser, IF stim (low setting only - like a soft massaging - nothing that tightens the muscles)
but mine were not as hyper sensitive as yours sound like..

I saw a website that tells about a way to work trigger points w/ ultrasound I'll see if I can locate that.
LLLT (low level laser therapy) may work in the same way without having actual pressure of touching..


Found it- explore the whole site and the practitioner topics , maybe share it w/ PT person to see what they think about it.
you could also have a co condition of fibromyalgia... others have developed it along w/ TOS.
http://www.drlowe.com/myofascial/pra...ltrasound1.htm

Thank you for all the advice and support. I have an appointment with my vascular surgeon on Monday. I need to go back over these posts and write out my questions to ask him. At the top of my list is this statement from Marc, "I hope everyone can learn from my experience and find someone who can truly evaluate the source of their TOS and design a proper plan for therapy so we aren't all stuck trying to run through a brick wall with fruitless stretches and exercises." I don't know what the source of my TOS really is other than it was caused by an auto accident where I had side whiplash so badly I was knocked unconscious.

I do know I have arterial compression on the right side which was confirmed with two separate doppler studies. An EMG showed no compressed nerves. I don't understand this. If I don't have a detectable neuroma, why do I have pain? Can a compressed artery (only in arm elevated positions) cause so much pain?

My vascular surgeon said all PT would be a waste of time and said only two exercises have been shown to help - shoulder shruggs and push-ups. However, a top notch hand surgeon and a second vascular surgeon said that PT is a must to keep things moving and and to strengthen the muscles around the scalenes so they are not doing all of the work.

I wish I knew the root of the problem. I see others don't always know at first either.

Elyse, so much depends on the pt and if they know anything about TOS. I have tried 4 and 2 chiros. To be fair,2 were treating my disc problem before I was diagnosed with TOS.After TOS diagnosis I was seeing Joyce Wilkinson who was highly recommended on this site, but it wasnt helping. One is a nationally recognized Chiro. ALL of them and the exercises made me feel worse. Recently I started going to marcs doc 50 miles away and so far it has been worth it. They do rib mobilization and soft tissue work.I may be able to avoid surgery. I do not have arterial symptoms though.

Good Luck! Did you ever see Dr. Atasoy in Louisville? He seems to be a good Diagnostician.I posted a link tovhis article for someone,I dont remember if it was you.

EMG if I recall correctly , only tests the major nerves and not the smaller sensory nerves.
It is more of a "ruling out" tool for any other causes like c spine or cubital tunnel or carpal tunnel etc. I've read that if they test the C8 area and it is slow then that can point a bit more to TOS. That might only happen for a few and not all cases. But maybe not all test that area, I don't know if the guy i went to did or not..


Sharon Butler, some PTs & bodyworker types mention sticky fascia /tissues that can cause many sx - plus the muscles spasming & clamping down on nerves and blood flow...
I think that was causing a lot of my problems, so it was more easily reduced to mild/ chronic after 2.5 yrs of tx & self tx , and of course removal of the reasons why I got TOS in the first place - my job- w/repetitive work & quotas.

[My vascular surgeon said all PT would be a waste of time and said only two exercises have been shown to help - shoulder shruggs and push-ups.]
I totally disagree with this statement.
I don't really agree w/ anyone (surgeon or otherwise) that says "only" certain things may help. Just not that cut and dried.
We are all a different and something may help one of us but not another.

[However, a top notch hand surgeon and a second vascular surgeon said that PT is a must to keep things moving ]
I do agree with this statement more - but it has to be with a very good and expert PT. (but some may be too set in "their plan") they have to constantly communicate w/ you as to how you are doing and if any sx increases, modify the tx..

Julia, I have not tried Dr. Atasoy in Louisville but I will look him up for sure. As for the EMG, I was certain I had carpal tunnel in the right wrist, but the test showed I absolutely do not. So it was very beneficial in eliminating carpal tunnel and cubital tunnel. The doctor did note some slowing somewhere along the line, it may have been higher up; I will have to check. I held up for as long as I could, but I could not tolerate the last couple of points he wanted to test because my pain level was through the roof. My hand was soaking wet with sweat from the electrical shocks. Funny thing though, as soon as I left the office, the pain began to subside quickly from the test. But not so from a physical therapy appointment.

If I was in a flare up and having neck spasm---- then no pt, chiro, stretching, exercising could help me. Had to get the flare ups/spasms under control first. I believe in cardiovascular exersize more than lifting weights. Cardio exercise reduces peripheral vascular resistance, improves blood flow, is aerobic, and causes a temporary decrease in inflammatory cytokines and other things that contribute to your neuropathic pain. After much trial and error (and pain) i have found that there are only a few resistance exercises that I can do. Everything else eventually causes major flare ups.

I'll share a story about muscle spasms and valium. I was talking to an older guy who used to dislocate his shoulder often. One time, too much time went by after the shoulder dislocated before it was put back into socket. The Dr. told him that his shoulder muscles spasmed and when that happens, he is not able to put the shoulder back in. The Dr. explained that he must take care of the muscle spasms first, then he will be able to manipulate the joint. The Dr. injected valium into the shoulder area to relax the muscles and then he was able to put the shoulder back in.

My feelings about TOS surgery and diagnostics: Diagnostics are hit and miss and there aren't any that consistently and reliably confirm TOS. I think the best are the MRA, MRI neurography (the one done in pasadena), and the physical exam done in the Dr's office (by a skilled TOS Dr.).
TOS surgery is also hit and miss and mostly is an exploratory surgery. The Dr. might know that you have TOS, but he won't know exactly where it is and what is going on inside until he opens you up (thus the exploratory nature of TOS surgery).