Case Study: Thoracic Outlet Syndrome – Don’t Be Bound by Your Diagnosis.

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Picture courtesy of Mayo Clinic

Thoracic outlet syndrome (TOS) is a blanket term used to describe compression of the first rib and collarbone, resulting in nerve pain, discomfort, numbness in the arm or extremities, etc. The cause of TOS is unclear, but genetics play a role, as can traumas or lifestyle-related activities.

Anyone with TOS will tell you that it’s an unpleasant, life-altering syndrome that often is debilitating and painful and a general deterrent from activities that require you to use your arm (aka, most things).

Prognoses for TOS are often gloomy, resulting in people feeling like they have to live with the outcome of their condition with little to effective treatment aside from surgery. It’s a sad but false reality perpetuated by people not in a position to be helpful, which is a whole different problem for another article.

Meet Kira, a hard-working mother of one who was long ago diagnosed with TOS on her right side. As a result of her condition, she experienced pain and discomfort in her neck and shoulder, which progressed down to the elbow. So, in essence, Kira’s right arm wasn’t working very well. 

As We Always Say: Assess, Don’t Guess.

Kira stepped foot into Motive Training and the first thing we did was take baseline videos of her doing shoulder CARs (click here to learn what CARs are) using the Functional Range Assessment (FRA). We use the FRA to examine how joints move independently, which you can learn more about here

We noticed that her shoulder flexion was significantly inhibited, as was internal rotation. You can see from the picture that Kira’s active shoulder flexion is limited; there is a slight degree of bend in the elbow that is somewhat normal given her condition, but this is where her shoulder flexion capped out.

What you can’t see is that Kira also compensated a lot through her neck and lumbar spine to attempt to get more out of her shoulder, which is a pretty common compensation for someone who is lacking overhead shoulder mobility.

So, not only was Kira not able to use her shoulder, but she was also more likely to use her back, neck, or elbow every time she went to use her shoulder.

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You’re Not Stuck, But You Have Been Led To Believe That.

Most people in Kira’s shoes feel like there is nothing they can do to improve their situation, and their doctors give some pretty substandard advice in these situations. 

“Make sure to stretch.” 

Yeah, okay. How long? How often? What are you supposed to stretch? What’s the best way to do so? What are you trying to feel? 

“Move your body, but cautiously.” 

So, do things that don’t hurt but avoid things that might hurt, which could include anything and everything. Great.

Or better yet, “Rest.”

Continue not moving so the thing that hurts when you move it hurts when you go to move it. Got it.

The truth is, most movement conditions can be helped (not fixed) when you direct effort in the right places, at the correct times, and for long periods. And this is precisely what we do in the gym.

Functional Range Conditioning (FRC) Can Change Your Life.

We used principles from Functional Range Conditioning (FRC) and more directly attacked Kira’s shoulder internal rotation and flexion, doing PAILs/RAILs (as seen below), passive range holds, lift offs, etc. 

Simply put, we showed her what her shoulder was missing in terms of movement. Then, we taught her how to engage stretches, hold positions correctly to get better outcomes, and expressed the importance of doing all of this on an ongoing basis (the more inputs, the better!)

What you see in this new picture (5 months later) is a drastic difference in Kira’s ability to move her shoulder. 

Not only is this an incredible jump in range of motion, but her pain went down, her neck stiffness decreased, and she doesn’t ever mention her elbow pain.

This is why we do what we do!

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As Dr. Spina from FRC says, if you try to do shoulder stuff with a shoulder that doesn’t work, you’re probably not doing shoulder stuff but shoulder compensation stuff. Our goal is to show you how to actually move your body in a way that leads to real, sustainable change. 

If you’re stuck like Kira was, reach out and we’ll show you a better way. You don’t have to be beholden to a prognosis that your doctor gave you.

Brian Murray, FRCms, FRA
Founder of Motive Training


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