Thoracic outlet syndrome--a myofascial variant: Part 2. Treatment.

Thoracic outlet syndrome (TOS) may be treated successfully with a powerful form of myofascial release manipulation and stretching. Self-stretching exercises complement all other treatment modalities for TOS. Maximal effect is achieved with high-frequency, progressive stretching, tapered rapidly to a maintenance level as symptoms diminish. Stretching must be demonstrated "hands on" with the patient and reviewed and modified regularly. The techniques are similar to those of Travell and Simons, with modifications. The pain of TOS is intimately connected with short, contracted muscles that develop trigger points. An engram for the shortened muscles develops centrally. The myofascial release technique involves local release of myofascial structures, re-energizing of the tissues, and reprogramming of the central engram for the particular muscle length.