We casually refer to a minor annoyance in life as a “pain in the neck,” but as anyone with neck pain will tell you, it’s far from minor and much more painful and debilitating than an annoyance. If you’ve got it, you want neck pain relief now and I’m going to show you how to get it. I was forced to become an expert in chronic muscle and tendon pain to cope with muscle tightness and tendonitis from Lyme disease. For years, I would pull a muscle about every other month which sometimes left me in bed for three days at a time (often from neck pain). Once, I pulled a muscle after sneezing! Finally though, I’ve got it licked and I want to share with you what I learned.

Currently, one third of us suffer from chronic neck or shoulder pain, and this figure is predicted to increase as computer work, cell phones, and the myriad of other gadgets we now use force us to crane our necks forward for much more of each day than ever before.  We will literally be in a world of hurt.

Historically, neck and shoulder pain have been an older person’s complaint, but clinics are experiencing a rise in younger patients with neck and shoulder complaints.  According to Elite Myotherapy, “The impact that poor posture during tablet computers and smart phone use are having on small children and teenagers is an increasing health problem and one that more parents need to be aware of and manage.”

Because many cases of neck pain are related to posture, it can be difficult to distinguish which is which. Shoulder specialist, Eric Ricchetti, MD, of Cleveland Clinic’s Department of Orthapedaedic Surgery, states that, “People may come in with shoulder pain when they really have a neck problem.”  The reporting system of the body (and patients) can be unreliable so neck and shoulder pain commonly overlap. We can add in neck pain’s connection with headaches, too, to the mix of suffering that’s hard to tease apart.

Anatomy of the neck and shoulders

Understanding some of the basics of the body helps us manage our conditions and treatments more effectively.

By a beautiful design in nature that allows us to turn our head and see in all directions, our neck is engineered to be a bit unstable. Perhaps to balance this, the muscles in the neck are some of the fastest, most forceful muscles in the body, and have some of the greatest endurance of any muscles. The muscles of the head and neck control important, everyday tasks such as facial expressions, talking, chewing and swallowing and even the movement of the eyes.

The neck and shoulders are structured in such a way that they are entirely dependent on alignment and balance between the muscles and fascia that bind them together while allowing for movement.

All this depends on proper posture. But these days, who’s got proper posture? Maybe someone living in the jungle who doesn’t have a cell phone and laptop. Below, I’m going to show you how you can begin to correct your posture.

First, let’s look at the tough and resilient design around your neck.  The bones of the chest and upper back work together to form a strong, protective cage around the vital thoracic organs such as the heart and lungs.  This durable cage is the anchor of our neck, shoulders and head and is composed of powerful muscles designed to protect those vital organs and vulnerable systems in our bodies.

The cervical spine, collarbone (clavicle), and shoulder blade (scapula, or scap) form the skeletal infrastructure of the neck and shoulders. The neck is formed by seven bones stacked one on top of the other.

The trapezius (traps), levator scapulae, scalene and the sternocleidomastoid (SCM) muscles form the muscular structure of the neck and shoulders.  These upper back, shoulder and neck muscles travel in all directions which allows for greater range of motion and movement in the neck and shoulders.  When poor posture, injury, or trauma disrupt the balance between muscles and fascia, bones are forced out of position, causing muscles to spasm, range of motion to be limited and pain to develop as cervical and other nerves are affected.

Causes of neck pain

With so many of us gazing into computers or staring down at our smart phones most of the day, it’s no wonder data from the Centers for Disease Control and Prevention reports that nearly 20 percent of us have experienced neck pain within the past three months.

Poor posture:  Today, poor posture is often called nerd or text neck because so many of us spend hours looking down at our devices now. One recent study showed that 79% of those between the age of 18 and 44 have their cell phone on them almost constantly with only two hours of the waking day spent without the cell phone. Looking down at your phone or tablet has unavoidable consequences. In order to protect themselves from the constant strain of poor posture, muscles harden into tough bands, causing fatigue, spasms and hot, chronic pain along the ridge of the shoulder blades and neck.

The tendency toward poor posture in the upper back from slumping and rounding the shoulders is easy enough and important enough to correct.  When we slouch our shoulder blades slide away from the spine and overstretch and weaken muscles, particularly the pectoralis muscles.

Good posture requires conscious correction for only a short time and once the brilliance of adaption has occurred, a good habit is formed and it’s one more area of wellness that we’ve mastered and one less reason for pain.

If you want professional help with this, consider seeing an osteopath, rolfer, chiropracter or other bodyworker. I’ve seen quite a few myself and if you’ve got the money, it’s a great advantage. Here’s what you can do on your own to prevent and treat text neck:

• Make sure your work environment allows you to look forward at any screens you use, not down. I use a standing desk for that and it works well.
• Hold your phone up in front of your face whenever you can to avoid looking down at it.
• Take frequent breaks from your devices and walk around every 20 minutes, at least.

Soft tissue injury/Trauma: Muscles, tendons and ligaments in the neck and shoulder area are prone to injury from whiplash and other impact injuries.  These conditions can range in severity and be acute or become chronic.

Degenerative diseases/arthritis/degenerative disc disease: Inflammation in joints is painful and restricts movement and mobility, however, it’s important to employ exercise as medicine with arthritis, and degenerative disc conditions, research says.  Joints need the flexion caused by proper exercise to remain healthy, but improper movement is painful, so arthritis sufferers tend to err on the wrong side and reduce movement by too much and the stiffness worsens.

A great example of exercise as medicine for arthritis sufferers is Eddie, the otter at the Oregon Zoo.  Eddie was diagnosed with arthritis in his elbows and shoots hoops to treat the condition.  Game time is not part of a show, it’s Eddie’s behind-the-scenes therapy.

Pinched Nerves / Radiculopathy / Thoracic Outlet Syndrome: The pain, numbness and tingling from a nerve being compressed and irritated can be caused by physical overexertion or one of several medical conditions, so establishing cause by a doctor may be helpful. This condition responds well to physical therapy and exercise – see our post on thoracic outlet syndrome.

Fractures: Also called a broken neck, this occurs when one of the seven cervical vertebrae are fractured usually the result of a high-energy trauma such as car accident or a fall.  These accidents can have serious consequences because the nerves running through the neck can be impacted or damaged. The first thing to do if you suspect a fracture is to immobilize the neck until x-rays can be reviewed by a physician. Treatment can range from wearing a cervical brace for 60 weeks to spending three months in a rigid cast or some combination of those options. Afterwards, physical therapy and bodywork will aid a full recovery.

Medical conditions: It’s rare, but possible for a medical condition to refer pain up into the neck and shoulder area.  Talk to your doctor if no other cause of neck and shoulder pain is identified.

Treatments for neck pain

Relieving pain, stiffness and tension in the neck can range from simple, short-term treatments, such as RICE, or over-the-counter pain remedies, to long-term, continuous therapies, such as myofascial release, or regular exercises to keep the neck structure flexible.  We all know the ever increasing risks of medicine so we are better off with other treatments.

RICE is almost always a front-line treatment for soft tissue injury.  Rest, ice, compression and elevation continue to be therapeutic throughout most healing processes.

Myofascial release: Massaging the neck regularly goes a long way in reducing pain, stiffness and limited mobility. It’s difficult to do on your own and that’s why I invented the Neck-Track. Now I get neck pain relief at home, any time and no longer have any fear about muscle pulls. They just don’t happen when you treat your neck pain as soon as you notice it coming on…

Cervical traction: This is neck stretch often performed by osteopaths and other bodyworkers that I’ve always found very pleasant. You can do it at home on your own too as demonstrated in the video below. You’ll find lots of gadgets for sale of varying complexity to help you do the same thing. The goal of neck traction whether done with a therapists hands, a towel or a special device is decompression of the vertebrae.

Light Therapy: Photo-biostimulation is a non-invasive therapy using light or near infrared light energy that causes tissues in the body to exhibit specific complex biochemical responses, essentially healing the injured tissues.

The technology is being used in the form of lasers and LEDs by physiotherapists, physical therapists and sports medicine specialists to treat a wide variety of acute and chronic musculoskeletal injuries and pain.

Neck Pain Exercises: Exercise is medicine.  More and more we are seeing doctors refer neck pain sufferers to physical therapists, personal trainers and fitness specialists for treatment in alleviating symptoms.  The reason is because it works – the body is designed for motion! But guess what? You can learn your neck pain excercises right here:

Grounding: There is nothing new about the benefits of connecting with the earth, except that now we have scientific proof of its merits. We all need to ‘get back to nature’ to improve our overall well-being, as well as treat pain.

Microcurrent: electromedical devices are an effective, non-invasive pain therapy that can be used as often as needed and provide considerable relief. Using electrical stimulation to treat pain dates back to Ancient Rome, when they would stand on electrical fish at the seashore; thankfully, the method has greatly improved, but even Benjamin Franklin endorsed the use of electrical stimulation to treat pain. It’s the future of medicine (and yes I use it too). Watch Benedick Howard getting neck pain relief with his Denas PCM-6 SCENAR device in the video below:

Watsu: This aquatic therapy is a relatively new treatment performed by a certified practitioner who cradles the body as it is moved and stretched through the water.  If you are fortunate enough to have a Watsu practitioner in your area, check it out. If not, just floating in a pool of water or even your bathtub can provide relief.

Attitude: Last, but far from least and as effective as any other treatment for pain, is our attitude.  Positive thinking is not a platitude or for the cheerful dispositions, science tells us.  Recent studies indicate that the ability to use thoughts to regulate perceptions of pain employs a different pathway in the brain than the route used to send pain signals to the brain.  This explains how we can keep going at times, despite physical pain.  Scientists call it cognitive self-regulation; chronic pain sufferers call it nothing short of a miracle.

Neck Pain Relief or Prevention?

What’s even better than neck pain relief? Not having pain in the first place! Exercise Sports Science of Australia (ESSA) states that we shouldn’t be sedentary for more than half an hour at a time. Positioning yourself in a certain way for an extended period increases pressure on your spine and decreases mobility. If you require the use of technology all day, take “micro breaks” every 15-20 minutes. Lift your head up and stretch, in order to get your neck and shoulders moving.

Studies have shown that people who take these micro breaks are 21% less likely to suffer from neck and shoulder pain. Help yourself to maintain the health and well-being of your spine and help prevent further postural issues arising. Address any ergonomic issues whether at work with your desk, at home, or in your study.

The body is designed for motion, much like a car.  When we leave our car idle in the garage for several days, what happens?  The battery needs to be charged.  So it is with the body, and zones in the body that are often idle for hours at end, such as the neck and shoulders. So, in the immortal words of health guru Jack LaLanne, “Get up and move!”

Finally, if your shoulders and back are tight, you’ll have a hard time eliminating neck pain because your back muscles will be pulling on your neck. The body is an integrated system and we need to treat the whole body when we run into trouble. Here’s how I relieve tension in my back and shoulders:

Tell us about your pain in the neck!

Please share your story in the comments — what got you into trouble and what tools / techniques you’ve tried…

For most of us, massage is the ultimate therapeutic treat that we indulge in once a month or so; to a professional athlete, massage therapy is an everyday and on-the-field essential.

Sports massage is a valuable component in most collegiate, professional, and Olympic training programs across the world. Athletes, trainers and doctors recognize its value in the training room, and out on the field, for conditioning, recovery and competitiveness.

Go behind the scenes – and oftentimes, right on the sideline – at any international sporting event and you’ll find massage therapists either working for an individual athlete, a team, or an organization. And, most sports medicine teams include massage therapists in their ranks.

Research conducted by scientists at McMaster University in Ontario, shows that massage reduces inflammation and promotes the growth of new mitochondria, meaning that sports massage reduces pain, and builds and repairs muscles.

According to AMTA, research shows that massage benefits for pro athletes (or you) include:

• Reduce muscle tension
• Help athletes monitor muscle tone
• Promote relaxation
• Increase range of motion
• Decrease muscle stiffness and soreness after exercise
• Enhance athletic performance
• Help prevent injuries when massage is received regularly

Every day is game day

“Pro athletes spend the majority of the day getting themselves in tiptop shape,” says Kala Flagg, a physical therapist and certified athletic trainer who has worked with NFL players and other elite athletes. An injured pro may go to physical therapy as much as three times a day, according to Flagg. “These athletes also may have a setup at home with hot tubs and cold tubs and icing machines. They have massage therapists and one-on-one yoga instructors. Their bodies are important. They aren’t afraid to invest in them,” she said. Some teams even fine players if they miss a treatment session, she said.

Mark Allen, six-time winner of the Hawaiian Ironman Triathlon, believes that massage was an indispensible part of his training: just as athletes need hard work to excel, they also need massage to quicken recovery between workouts, prevent injuries and reduce stress.

Ancient medicine that’s still working today

Sports massage isn’t new. In fact, the National Center for Biotechnology Information (NCBI) states that Chinese writings dating back thousands of years describe the use of massage therapy to treat injuries and prepare for sporting events.

Records indicate its methods date back to 2700, B.C., when ancient Greek Olympians were massaged with oils, herbs, and dirt with the goal of creating a better athlete, a better competitor, a better champion. Truth is, it remains a pretty accurate view of what sports massage can do to this day, and elite athletes recognize this fact.

The elite advantage

“While professional athletes are in terrific shape, which helps when they get injured, they also have advantages rarely available to the weekend warrior: an instant medical response and a physical therapy regimen that kicks in quickly, that operates practically around the clock and that continues even after the athlete is back in the game,” said Benjamin Shaffer, an orthopedic surgeon in Bethesda who is head team physician for the Washington Capitals and assistant team physician for the Washington Wizards.

The advantage starts as soon as a player goes down. Trainers and physicians rush in with immediate care and decide whether to bring the staff massage therapist into the locker room.

Time is of the essence when treating an injury, doctors and trainers say. In contrast to the pros’ quick-response teams, most of us are stuck scrounging for an appointment with an orthopedist or waiting to schedule an MRI after an athletic injury.

“Amateur athletes go home, wrap some ice on the injury, elevate, take some pain medicine, and call the doctor in a few days if things haven’t improved,” said Jason Craig, an associate professor of physical therapy at Marymount University in Arlington, who has worked with Irish Olympic athletes.  By the time an armchair athlete sees a doctor, not only may an ankle sprain still be very painful, but the delay — and what people do during that time — may also have made the injury worse.

“When our guys hurt themselves, moments after, we are treating them,” said Greg Smith, the head trainer for the Capitals.

“A cadre of professionals using electric stimulation, compression sleeves, anti-gravity treadmills and individually tailored exercises to speed the repair of the body. These techniques and devices can mean the difference between an early return or weeks on the bench,” Shaffer said.

Elite triathlete Marco Coelho agrees: “Massage helps me avoid injury. It reduces my muscle tension and stress.  Bodywork, especially massage, should be part of every athlete’s training.”

The go-to treatment of the elite

Coach, speaker and nationally ranked athlete, Brad Walker, says, “Massage is one of my all-time favorite injury rehabilitation techniques. I’d even go as far as saying; it’s the most effective form of injury rehabilitation therapy for speeding up the healing process and preventing re-injury. Without it, the injured athlete rarely recovers fully.”

According to the American College of Sports Medicine, delayed soreness can begin 12-24 hours after the muscle trauma happens and massage therapy can prevent or relieve this soreness.

NBA stars and legends such as Grant Hill, Steve Nash, and Kobe Bryant, have all used sports massage as a means to stay healthy on and off the court. World Series champs, the 2005 Chicago White Sox, relied heavily on the team’s massage therapist to experience peak performance. Most NFL teams also have a massage therapist on staff. And according to Forbes, James Harrison, the famed Pittsburgh Steelers linebacker, spends around half a million dollars per year on bodywork, which includes massage therapy.

Double-duty treatment

An athlete’s state of mind is almost as important as the state of their body.  Sports massage can also reduce stress and anxiety, which according to the Journal of Sports Medicine and Physical Fitness, can heavily impact performance. The psychological effect provided to an athlete by an experience such as massage may be of importance in a non-physiological manner.

The endorphins released during massage help to decrease anxiety, provide pain relief, improve mood and enhance the athlete’s sense of well-being.

Sports such as cycling, gymnastics or golf, which require maneuvering and focusing, can be affected by experiencing a sports massage prior to the event. The relaxed, lowered-tension states promote focus and agility – qualities of the elite athlete.

Our mission here at Deep Recovery, is to bring you the advantages enjoyed by elite athletes so you can relax, recover and avoid injury like a pro!

Thoracic Outlet Syndrome (TOS) is a complex and controversial condition in which the nerves and/or blood vessels in the thoracic outlet are compressed.  The thoracic outlet is the area between the base of the neck and the armpit, including the front of the shoulders and chest.

The term ‘thoracic outlet syndrome’ was originally coined in 1956, to indicate compression of the neurovascular structures in the interscalene triangle. Since then, the condition has emerged as one of the most controversial topics in musculoskeletal medicine and rehabilitation. This controversy extends to almost every aspect of the condition, including the definition, the incidence, the pathoanatomical contributions, diagnosis and treatment.

TOS affects mainly the upper limbs, with signs and symptoms manifesting in the shoulders, neck, arms, hands and sometimes fingers. In rare cases, the condition can lead to eye and vision problems.

Symptoms of TOS

Due to the many variations in cause and symptoms, TOS is a clinical controversy.

The National Center for Biotechnology Information reports that TOS is a frequently overlooked peripheral nerve compression that creates difficulties for the clinician regarding diagnosis and management.

The symptoms of TOS range from an aching pain in the neck, shoulder, arm, or hand, as well as pain, numbness, or tingling in the forearm and the fourth and fifth fingers of the hand. The pressure can limit blood flow to and from the arm, causing swelling, redness, and fatigue. Many sufferers of thoracic outlet syndrome have trouble performing overhead activities. Some experience swelling or discoloration of the arm as well as a depression in the shoulder.

Pain can be present on an intermittent or permanent basis. It can be sharp/stabbing, burning, or aching. Pain can also be in the side of the neck, the pectoral area below the clavicle, the armpit/axillary area, and the upper back (i.e., the trapezius and rhomboid area). Discoloration of the hands, one hand colder than the other hand, weakness of the hand and arm muscles, and tingling are commonly present.

Types of TOS

Currently, TOS is classified into three main categories, named according to the cause of the symptoms; however, these classifications are part of the condition’s controversial status because TOS can involve all three types of compression to various degrees.

The compression can occur in three anatomical structures: arteries, veins and nerves; it can be isolated, or, more commonly, two or three of the structures are compressed to greater or lesser degrees. In addition, the compressive forces can be of different magnitude in each affected structure. Therefore, symptoms can be variable.

• Neurogenic thoracic outlet syndrome: This condition is related to abnormalities of bony and soft tissue in the lower neck region (which may include the cervical rib area) that compress and irritate the nerves of the brachial plexus, the complex of nerves that supply motor (movement) and sensory (feeling) function to the arm and hand. Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms.
• Venous thoracic outlet syndrome: This condition is caused by damage to the major veins in the lower neck and upper chest. The condition develops suddenly, often after unusual and tiring exercise of the arms. Symptoms include swelling of the hands, fingers and arms, as well as heaviness and weakness of the neck and arms. The veins in the anterior (front) chest wall veins also may appear dilated (swollen).
• Arterial Thoracic Outlet Syndrome: The least common, but most serious, type of TOS is caused by congenital (present at birth) bony abnormalities in the lower neck and upper chest. Symptoms include cold sensitivity in the hands and fingers; numbness, pain or sores of the fingers; and poor blood circulation to the arms, hands and fingers.

Causes of TOS

According to clinical evidence, the disorders caused by TOS are not well understood. When the shoulder muscles are too weak to properly stabilize the collarbone, the bone can slip down and forward into the thoracic outlet. The bone puts pressure on the nerves and blood vessels in this small passageway, creating the various symptoms.  Poor posture rapidly aggravates TOS.

The following may increase the risk of developing thoracic outlet syndrome:

• Participating in sports that involve repetitive arm or shoulder movement, such as baseball, swimming, golfing, volleyball and others
• Repetitive motion injuries from carrying heavy shoulder loads
• Trauma to the neck or back (whiplash injury)
• Poor posture
• Weightlifting
• Pregnancy
• Anatomical abnormality causing an extra first rib
• Tumors or large lymph nodes in the upper chest or underarm area
• Stress or depression
• Sleep disorders

Often, there is no direct cause found in patients suffering from TOS, which leads to one of the controversial points on the condition.

Chicken or egg?

Since TOS is often the underlying cause of conditions such as frozen shoulder, carpal tunnel syndrome or forward head posture, it is difficult to pinpoint true cause or to determine which came first, TOS or a related condition.

Another clinical puzzle is that the symptoms of TOS mimick other conditions that can produce similar symptoms, such as rotator cuff tear, cervical disc disorders, fibromyalgia, multiple sclerosis and complex regional pain syndrome.

Who is affected by TOS?

Thoracic outlet syndrome can occur in people of all ages and gender, though recent studies have shown that TOS is more common in women, particularly middle-aged women, and those with poor muscular development, poor posture, or both.  Clinical evidence suggests that TOS affects less than 2% of the population.

The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball (especially pitchers), swimming, volleyball, and weightlifting. It’s not uncommon to see musicians and electricians with TOS, as they work long hours with their hands above their heads.

Several major league baseball players have been diagnosed with TOS.  In July this year, Mets starting pitcher Matt Harvey, announced that he is opting to have surgery for TOS after saying “his shoulder was dead, his arm was dead, that there was no energy there and that he couldn’t feel the ball” after his last start.

Musician Isaac Hanson suffered a potentially life-threatening pulmonary embolism as a consequence of thoracic outlet syndrome.

UFC fighter Matt Serra had a rib removed to alleviate TOS, as did singer Tamar Braxton.

Diagnosing TOS

NCBI reports that the disagreement regarding the definition of TOS makes the overall incidence of the condition difficult to track. Complicating matters, the recognized prevalence of the diagnosis varies between disciplines. For example, it is estimated that surgeons diagnose TOS 100 times more frequently than neurologists.

In some cases, a thorough evaluation by a neurologist may be recommended to rule out cervical spine disease or other neurological conditions that may be mimicking or causing TOS symptoms.

Additional tests performed to diagnose thoracic outlet syndrome include:

• Nerve conduction studies (to evaluate the function of the motor and sensory nerves)
• Vascular studies (of the arteries or veins)
• Chest X-ray, to rule out cervical rib abnormalities
• Cervical spine X-rays to rule out a cervical rib (extra rib) or cervical (neck) spine abnormalities
• CT scan and (MRI) of the chest
• CT scan or MRI of the spine to rule out cervical spine impingement (pressure), which can mimic neurogenic thoracic outlet syndrome
• Magnetic resonance imaging with angiography (MRA) to view blood vessels
• Arteriogram/venogram (X-ray that uses dye to look at blood flow)
• Blood tests

How to treat TOS

Early identification of TOS can help improve the success of treatment. Thoracic outlet syndrome treatments vary, depending on the type of TOS and symptoms. The goals of treatment are to reduce symptoms and pain.

Start with simple therapy like the doorway stretch:

Treatment of neurogenic thoracic outlet syndrome include:

• • Physical therapy / bodywork: The most common initial treatment for neurogenic thoracic outlet syndrome is physical therapy. Physical therapy increases the range of motion of the neck and shoulders, strengthens muscles and promotes better posture. Most patients experience an improvement in symptoms after undergoing physical therapy including deep tissue massage, myofascial release and other bodywork. Of course it makes sense that restoring the posture, flexibility and good biomechanics we’re born with, might be helpful! Watch our how to videos for upper / lower back and chest / shoulders.
  • Microcurrent: electromedical devices are an effective, non-invasive pain therapy that can be used as often as needed and provide considerable relief. Using electrical stimulation to treat pain dates back to Ancient Rome, when they would stand on electrical fish at the seashore; thankfully, the method has greatly improved, but even Benjamin Franklin endorsed the use of electrical stimulation to treat pain. It’s the future of medicine (and yes I use it too). Watch Benedick Howard getting neck pain relief with his Denas PCM-6 SCENAR device in the video below:
    
  • Medications: For pain relief, over-the-counter pain medications, such as aspirin, acetaminophen, or ibuprofen may be recommended. A muscle relaxant or cortisone may be recommended for additional pain relief. Just remember that pharmaceuticals are processed by your liver and may cause unforeseen complications. Please try yoga, physical therapy and bodywork first!
  • Surgery: In some cases, surgery may be considered if the symptoms continue after all other efforts fail.

Additionally, stretching, acupuncture, breathing exercises, ergonomic desk set-up, motion and posture practices and chiropractic or osteopathic adjustments, are common non-invasive approaches used in the treatment of TOS.

Ice can be used to decrease inflammation of sore or injured muscles. Heat can also aid in relieving sore muscles by improving blood circulation to them. While the whole arm generally feels painful in TOS, some relief can be seen when ice or heat is intermittently applied to the thoracic region (collar bone, armpit, or shoulder blades).

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