How to train the scapular muscles for Thoracic Outlet Syndrome (TOS)
Many patients with TOS will present with altered positioning of their scapula. Most commonly the scapula is drooped (depressed, downwardly rotated and at times anteriorly tilted).
The premise of scapular retraining is that upward rotation will raise the clavicle, decompressing the neural structures within the thoracic outlet and reducing tension/compression of neurovascular structures and muscles originating from the cervical spine (Watson, et al., 2010).
STEP 1: ASSESSMENT
First scapula position and movement needs to be assessed. Every patient is different. The final step of assessment is scapula correction. “Correction manoeuvers can be applied to any assessment position, including loaded tests such as glenohumeral external rotation. If correction of the scapula improves symptoms (pain, weakness, distal symptoms, range of motion) due to better biomechanical performance of the shoulder girdle then logically correction of the scapula position should be addressed in the patient’s rehabilitation” (Watson, Pizzari, et Balster, 2010, p. 307).
STEP 2: TREATMENT
A good way to look at patients with TOS is to treat their pain before function. This is to say a patient whose symptoms are acute and severe (and potentially irritable) may not respond well to scapular retraining until their pain levels are better managed.