Rupert Hambly

Neck | Rupert Hambly Health and Performance

Tight Neck, shoulder & back? You must read this!

Thoracic outlet syndrome (TOS) is a very real problem in the 21st century.

It is often a symptom of chronic exposure to long periods of sitting, laptop use and texting.

What is thoracic outlet syndrome?

The thoracic outlet is the space between your collarbone (clavicle) and your first rib. This narrow passageway is crowded with blood vessels, muscles, and nerves. If the postural muscles surrounding the area are imbalanced and not strong enough to hold the collarbone and glenohumeral joint in place, it can slip down and forward, putting pressure on the nerves and blood vessels that lie under it. This causes a variety of symptoms which together are known as thoracic outlet syndrome.

It is a common symptom of chronic bad postural alignment and it’s becoming more common every year!


So what’s the big deal?

Symptoms may vary, depending on which nerves or blood vessels are compressed. Symptoms from nerve compression are much more common than symptoms from blood vessel compression.

Pressure on the nerves (brachial plexus) may cause a vague, aching pain in the neck, shoulder, arm, or hand. It may also cause pain, numbness, or tingling on the inside of the forearm and the fourth and fifth fingers of the hand. Weakness may make your hand clumsy, to the degree that items you hold can fly out of your hand! I’ve seen this several times with clients.

In more severe cases pressure on the blood vessels can reduce the flow of blood out of your arm, resulting in swelling and redness of your arm. Less commonly, pressure can reduce the blood flow into your arm and hand, making them feel cool and easily fatigued.

Overhead activities are particularly difficult because they worsen both types of compression. There may be a depression in your shoulder, or swelling or discoloration in your arm and your range of motion (ROM) may be limited.

Although ‘bad posture’ may increase the risk of TOS, the following may also increase the risk:


  • Sleep disorders
  • Tumors or large lymph nodes in the upper chest or underarm area
  • Stress or depression
  • Participating in sports that involve repetitive arm or shoulder movement, such as baseball, swimming, golfing, volleyball and others
  • Repetitive injuries from carrying heavy shoulder loads
  • Injury to the neck or back (whiplash injury)
  • Weightlifting with poor program structure and form
  • Obesity (tends to carry the rib cage angle forward)

How to avoid and fix the problem:

  • Specific exercise program design for the individual.

The coach will need to take all your activities into consideration and perform clinical postural measurements to then ensure progress is made. The right exercises  can help strengthen the muscles surrounding the shoulder so that they are able to support the collarbone, shoulder girdle and thoracic spine. Postural exercises can help you stand and sit straighter, which lessens the pressure on the nerves and blood vessels.

  • Weight loss.

Being overweight can cause length tension relationships in the body to break down and so reducing over all fat loss can help this enormously.

  • Lifestyle changes and ergonomics.

You may need to change your workstation layout to enhance posture, avoid repetitive strenuous activities that exasperate the problem and modify everyday activities that aggravate your symptoms.

The main point I’d like you to focus on is prevention more than anything else and by being aware of how this condition is caused, avoiding it is easier!

Here’s to a joint pain free life.

Rupert Hambly


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