[smaug]

I'm very happy to report considerable success recently since suffering TOS-like symptoms following a ski injury (fractured neck) in 2010.

Following surgery in June this year (insertion of a prosthetic cervical disc), while the cervical nerve-related symptoms improved, general upper back, shoulder and well-being did not improve and even deteriorated. Still it's hard to say definitively what recent improvements have come from surgery and what has come from physio.

Over the past 4 years, I have seen over 12 PTs, all of them with very different approaches. Some brought more success than others, with the most success coming from those focusing on shoulder stability and mechanics. However, even with these improvements, symptoms in the shoulders, upper back and arms was still not satisfactory.

This all changed two months ago when I was referred to a doctor who calls himself a "movement specialist" (Dr Larsen at Spiraldynamik in Zurich, Switzerland). He did a thorough diagnosis of back mobility using a variety of handheld devices and concluded that the thoracic spine had too much curvature (kyphosis; 45 degrees compared with a healthy 30 degrees) and very limited mobility. He has a specific programme addressing this to restore healthy movement, which has resulted in an enormous improvement in two months (now at 38 degrees - half way there!) and much less pain.

The most important things I have learnt:

• Never give up looking for a solution. I didn't always have this pain so something in my body has changed mechanically, which I can fix.
• Most PTs still struggle to diagnose movement disorders, especially of the trunk.
• The underlying problem is generally incorrect recruitment of the deep stabilising (parasympathetic) muscles, which forces the less efficient superficial (sympathetic) muscles to take on this role, leading to trigger points, compression, inefficient stabilisation and restricted mobility.
• Trigger point therapy and stretching can greatly relieve symptoms, but it is temporary and does not help with the cause.
• I was very sceptical at first of Edgelow's TOS programme focusing on breathing, but this turns out to be a large part of restoring thoracic mobility, although it is only part of it.
• Efficient movement is everything. At every opportunity I now try and move, whether it's at my desk or at home.

The best English book I have read on the topic is:
Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction by Evan Osar. He has a very similar philosophy on movement disorders. His website (Fitness Education Seminars) also has excellent videos on thoracic mobility. I was very dissappointed with the Illig et al. TOS book (which I own) as the conservative treatment chapters number less than 5% of the pages.

I would highly recommend that people investigate whether such a disorder could explain their case.

[Akash]

Smaug, amazing. My symptoms are similar to yours (I think) and triggered by an accident (motorbike) as well, with a disc bulge at C6-C7. I have been reading your posts with great interest. I too have kyphosis and lordosis - and I think this has played a significant role in my issues. Is it possible to pick up the exercises from Dr Osars book and is it amenable to the relatively lay reader?

[Jomar]

There are free videos on the website mentioned..

here is the link to the videos..
http://www.fitnesseducationseminars.com/free-videos/

[smaug]

Originally Posted by Akash

Is it possible to pick up the exercises from Dr Osars book and is it amenable to the relatively lay reader?

Osar's book is aimed at the therapist, but I found after living with this condition for 4 years I knew enough about the muscles and how to describe shoulder and hip motion to understand it. The videos are much easier to follow.

The one important thing I felt missing from the book and videos, which I have learnt through my PT in Switzerland, is how to recruit the deep thoracic muscles, which has been the main driver in straightening the thorax. I have found Osar's exercises good for increasing and maintaining motion, but missed the crucial starting point. Maybe some of his videos on breathing address this better (I have only viewed the thoracic mobility videos).

The thoracic activation is a very subtle movement which, once re-learnt, makes me wonder how I could ever have forgotten something so fundamental to movement and breathing.

The big change came when, after a couple of weeks of starting the programme, I realised my scalene muscles were feeling so relaxed - what a feeling! And I had done nothing (stretching nor exercises) aimed at the scalenes.

[Hiker]

Very impressive smaug!
So what were the starting exercises which worked for you?
Were they similar to Edgelow's breathing exercises? Or was there something else?
You wrote a few months ago about serratus anterior strengthening. Was it helpful in your recovery or was it a dead end?

I think kyphosis and scapular instability are a part of my problem, but don't know what to do about it. Standard strengthening exercises only make thing worse for me.
I started doing Edgelow breathing, but can't tell if it is working yet.

[smaug]

Originally Posted by Hiker

Very impressive smaug!
So what were the starting exercises which worked for you?
Were they similar to Edgelow's breathing exercises? Or was there something else?
You wrote a few months ago about serratus anterior strengthening. Was it helpful in your recovery or was it a dead end?

Yesterday I reread Edgelow's chapter in Illig et al. It makes much more sense than when I first read it a year ago. He discusses much of what I summarised in my first post, especially the fact that the problems arise from hypomobility (reduced) stabilising muscles - especially serratus and lower trapezius, and hypermobility (increased) scalene, upper trapzius, rhomboid and levatator.

His programme uses breathing to activate the thorax, but there is a significant difference to what I was taught. With Edgelow's technique, when you lie on your back and breath in, you arch your back to raise the ribs. I was taught that this is wrong as it promotes mobility only in the lumbar spine and the thorax-lumbar junction. The exercises I use feel significantly different.

As a start:

• Lie on your back with legs bent (90 deg at knees) and lower back flat on the floor (lightly activated abs and core).
• Place hands on lower rib cage
• Practise breathing with the abdomen only. Feel it push against your hands and back.
• Now the crucial step: while keeping the core activated and the lower back in contact with the floor, breath in and gently raise the thorax. Your lower back should feel completely stationary and all movement should be in the thorax. Think always of a long spine and use gentle movements at first (10-20% muscle strength). It should feel like the movement is being controlled from deep within your trunk.

After learning this lying down you can progress to sitting and then sitting while rotating.

The other main mobilisation I do is with a foam roller - but always with the core activated to promote movement in the thorax.

[smaug]

Evan Osar has recently released two short videos on neck pain. The first shows the thoracic breathing I have mentioned and the second on correcting forward head position (while keeping scalene relaxed):

Part 1:
http://www.fitnesseducationseminars....eck-tightness/

Part 2:
http://www.fitnesseducationseminars....eck-tightness/

[Tengen]

Just wanted to say thanks. Will definitely check out this material later today.

[Akash]

Hi Smaug, can you please mention some of the other exercises you do to reverse Kyphosis & also recruit the deep stabilizing muscles? I tried Evan Osars videos & book- its a bit too subtle or technical at this point. However, your written descriptions seem straightforward & I intend to give them a serious effort.

Thanks

[smaug]

Originally Posted by Akash

Hi Smaug, can you please mention some of the other exercises you do to reverse Kyphosis & also recruit the deep stabilizing muscles?

The main one is the same as the breathing exercise but sitting:
* Sit on a firm chair with feet flat on the floor and knees at 90 deg.
* Roll the hips backwards (Tight abs) and forwards (arched back) to warm things up.
* Engage the abs to flatten the lower back and bring the hips backwards.
* While keeping the lower back flat and absolutely stable (work the abs), raise the thorax. If this is too difficult, go back to lying down version (previous post).
* After mastering this, try adding gentle rotation.
* Always think looooong spine and neck and stable core.