Thoracic Outlet Syndrome (TOS) is a condition Pilates teachers should be aware of, as clients may present with related symptoms or be referred to Pilates for management.
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome is a group of disorders that occur when nerves, arteries, or veins in the space between the collarbone (clavicle) and the first rib (the thoracic outlet) become compressed or irritated. This can cause pain, numbness, tingling, and weakness in the shoulders, neck, arms, and hands.
There are three main types:
Neurogenic TOS: Most common, involving nerve compression (usually the brachial plexus nerves).
Vascular TOS: Less common, involving compression of blood vessels (arteries or veins).
Non-specific TOS: Symptoms are present, but no clear cause or diagnosis is found.
Common Symptoms Pilates Teachers May Notice:
Numbness or tingling in the arms, hands, or fingers, especially when the arms are elevated or overhead.
Pain in the neck, shoulders, or arms, often radiating into the hand.
Weak grip or difficulty performing exercises requiring sustained arm positions.
Swelling or discolouration in the arms or hands (more common in vascular types).
Relevance to Pilates:
In Pilates, movements that repeatedly or prolongedly position the arms overhead, or involve strong shoulder depression or retraction, might exacerbate symptoms in clients with TOS. Awareness of neutral shoulder alignment, correct positioning of the shoulder girdle, and controlled scapular movement is essential.
Pilates Considerations and Modifications:
Focus on Posture: Emphasise exercises that promote neutral spine alignment and open chest posture to reduce compression at the thoracic outlet.
Avoid Excessive Arm Elevation: Limit or modify movements that keep arms elevated overhead for extended periods, such as prolonged hanging from a Cadillac or long holds with arms raised.
Strengthening and Mobilising the Shoulder Girdle: Exercises that gently strengthen shoulder stabilisers, mid-back muscles, and encourage correct scapular movement patterns (e.g., scapular isolations and stabilisation exercises) are helpful.
Breathing and Relaxation: Teach diaphragmatic breathing to reduce tension in the neck and upper chest muscles.
Mindfulness of Muscle Balance: Balance exercises that strengthen the posterior chain (rhomboids, mid and lower trapezius) while gently stretching tight anterior muscles (pectorals, anterior deltoids).
Sample Pilates Exercises Helpful for TOS:
Gentle spine and shoulder mobilisation (Spine Stretch, Cat/Cow)
Chest-opening exercises (Book Openings, Arm Openings)
Mid-back strengthening (Dart, Swan preparation)
Shoulder blade awareness (Scapular isolations on all fours or standing)
Exercises to Modify or Avoid:
Long duration of arms overhead or weight-bearing exercises that overly depress the shoulder girdle (e.g., prolonged hanging, aggressive overhead reaches).
Heavy arm pulling or pushing without proper shoulder stabilisation (e.g., loaded arm springs without sufficient control).
Key Points for Pilates Teachers:
Always communicate clearly with the client about their symptoms.
If symptoms worsen, adjust or cease the exercise immediately.
Collaborate closely with a physiotherapist or clinician if your client is under medical supervision for TOS.
Pilates can play an effective role in managing TOS symptoms by emphasising correct alignment, posture awareness, gentle strengthening, and mobilising exercises, enhancing the client’s overall comfort and functional ability.
Comments