T Nation

Help With Thoracic Outlet Syndrome

My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?

[quote]RugbyStrong wrote:
My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?
[/quote]

Start with stretching. Look up techniques online that stretch the chest muscles- both pec major and minor (corner stretch works well, changing arm height), the scalenes in the neck- especially anterior scalene, and the lats (prayer stretch with arms on gym ball, palms up and elbows in, then angling left then right tends to work well). Find a stretching intensity that allows a hold of 30 seconds but doesn’t provoke TOS symptoms.

Look up the best way to strengthen the deep cervical flexors (similar to “crunches”) along with exercises for scapular retractors and depressors (mid and lower trapezii)- “chest tall, shoulder blades down and back”. Practice diaphragmatic breathing exercises (rather than promoting “upper chest”/scalene breathing). There’s plenty more at greater depth but hope this helps get things started in the right direction…

(I’m a PT, OCS, CSCS)

Also: Chest stretch and thoracic mobilization on foam roll… Lay down face up with foam roll behind along length of spine (it should be long enough to support the back of the head all the way to the sacrum) and knees bent, feet flat on the floor. Using a broomstick or dowel in both hands, lift chest (arch mid back) toward ceiling and raise arms overhead while keeping shoulder blades down and back. Allow gravity to do the work- meaning relax, exhale fully and hold the stretch for 30-60 seconds, attempting to make as much contact as possible between forearms and ground surface. (This means the elbows will need to be slightly bent and the chest arched up high). Do not hold through pain or TOS symptom provocation.

@frmerritt Thank you very much for the info! I’ll definitely pass it along. What type of lifts would you recommend to strengthen the cervical flexors and scapular retractors and depressors? Shrug variations, etc?

No- definitely not shrugs. Cervical flexors: Think of your neck like your low back. Lie down in supine and “crunch” by lifting your head a short distance while tucking your chin down to your throat. Imagine the deep neck muscles contracting similarly as your abdominals do. Do not bring your head and neck through a full ROM toward your sternum (like a sit-up). Scapular retractors: Rows (double or single) with emphasis on keeping your chest tall and squeezing your shoulder blades down and back during each rep. Scapular depression emphasizing mid and lower trap recruitment takes a little more talent and focus on technique but if you’re already in the single row position- get in the power position of chest forward, shoulder blade down and back and hold a light dumbbell (most start at 1-2# and progress up to maybe a max of 10# if you’re female). Raise the dumbbell forward and at a slight diagonal with an outstretched arm and a very slight bend in the elbow In line with lower trap fiber direction). Pause at the top end range of motion and emphasize keeping the shoulder blade DOWN and back the entire time. Do not let your thoracic relax into flexion… make sense??

Quadruped “Bird Dog”- on all fours, opposite arm and leg, is a very similar spinoscapular stabilization exercise. All of these techniques can be easily found and demonstrated online- google or youtube.

Thank you!

[quote]RugbyStrong wrote:
My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?

[/quote]

frmerrit covered some good ground here, so I won’t rehash what he suggested.

One thing did stand out as I read your post. Why on earth is a college-level strength and conditioning coach having a swimmer/water polo player perform over head presses? There are exceptions to every rule, of course. However, the athletic population your gf belongs to (as well as pitchers) really need to question a program in which OHP are included. And let’s not forget that proper t-spine mobility/stability is critical in this movement (which is already compromised in your gf).

[quote]56x11 wrote:

[quote]RugbyStrong wrote:
My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?

[/quote]

frmerrit covered some good ground here, so I won’t rehash what he suggested.

One thing did stand out as I read your post. Why on earth is a college-level strength and conditioning coach having a swimmer/water polo player perform over head presses? There are exceptions to every rule, of course. However, the athletic population your gf belongs to (as well as pitchers) really need to question a program in which OHP are included. And let’s not forget that proper t-spine mobility/stability is critical in this movement (which is already compromised in your gf).
[/quote]

Some of the things that I see the strength coach have our athletes do just make me shake my head. No rhyme or reason to his programs. All the same no matter what the sport is. And the athletic trainer keeps giving orders for her to avoid those type of movements but her water polo/swimming coaches force her to do them anyway. Doctors notes and all.

[quote]RugbyStrong wrote:

[quote]56x11 wrote:

[quote]RugbyStrong wrote:
My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?

[/quote]

frmerrit covered some good ground here, so I won’t rehash what he suggested.

One thing did stand out as I read your post. Why on earth is a college-level strength and conditioning coach having a swimmer/water polo player perform over head presses? There are exceptions to every rule, of course. However, the athletic population your gf belongs to (as well as pitchers) really need to question a program in which OHP are included. And let’s not forget that proper t-spine mobility/stability is critical in this movement (which is already compromised in your gf).
[/quote]

Some of the things that I see the strength coach have our athletes do just make me shake my head. No rhyme or reason to his programs. All the same no matter what the sport is. And the athletic trainer keeps giving orders for her to avoid those type of movements but her water polo/swimming coaches force her to do them anyway. Doctors notes and all.
[/quote]

This is one of those never-ending battles. I know it all too well.

I don’t know all the relevant details; however, I am concerned they are telling her to OHP. Furthermore, the movement becomes more dangerous for people like her if she uses a barbell.

If she performs movements that are contraindicated for her - no matter what her coach, some writer on this or other website, or anyone else says - she will eventually pay the price. By then these coaches and writers will have a whole new batch of impressionable people they can ruin.

How you and your gf address this conflict is up to you. Obviously, a great deal of tact is critical because she doesn’t want to jeopardize her standing on the swim and water polo teams.

[quote]56x11 wrote:

[quote]RugbyStrong wrote:

[quote]56x11 wrote:

[quote]RugbyStrong wrote:
My girlfriend is a two sport college athlete (swimming and water polo) and has thoracic outlet syndrome. Both sports aggravate her condition, causing her severe pain in her shoulders and neck. Since giving up the sports isn’t an option, I thought that a strategically designed weight lifting program would help strengthen her muscles and alleviate the pain. The current routines that the trainers at our school have her doing are causing her more pain (primarily from push ups, overhead press, etc.), so I was wondering what advice you guys might offer to help her out?

[/quote]

frmerrit covered some good ground here, so I won’t rehash what he suggested.

One thing did stand out as I read your post. Why on earth is a college-level strength and conditioning coach having a swimmer/water polo player perform over head presses? There are exceptions to every rule, of course. However, the athletic population your gf belongs to (as well as pitchers) really need to question a program in which OHP are included. And let’s not forget that proper t-spine mobility/stability is critical in this movement (which is already compromised in your gf).
[/quote]

Some of the things that I see the strength coach have our athletes do just make me shake my head. No rhyme or reason to his programs. All the same no matter what the sport is. And the athletic trainer keeps giving orders for her to avoid those type of movements but her water polo/swimming coaches force her to do them anyway. Doctors notes and all.
[/quote]

This is one of those never-ending battles. I know it all too well.

I don’t know all the relevant details; however, I am concerned they are telling her to OHP. Furthermore, the movement becomes more dangerous for people like her if she uses a barbell.

If she performs movements that are contraindicated for her - no matter what her coach, some writer on this or other website, or anyone else says - she will eventually pay the price. By then these coaches and writers will have a whole new batch of impressionable people they can ruin.

How you and your gf address this conflict is up to you. Obviously, a great deal of tact is critical because she doesn’t want to jeopardize her standing on the swim and water polo teams. [/quote]

Definitely a tough situation. That’s why I just want to help her take preventative measure since the source of the issues is going to be a constant. Although there is a chance that she will be able to stop swimming and get water polo to match both scholarships, so that would at least be one stressor rather than two. As of right now she is just trying to avoid all such movements until called out for it and forced to do them.