TOS, thoracic outlet syndrome


(pic from the web, I have no rights on this image)

TOS, aka thoracic outlet syndrome, is a very interesting theme. Being a syndrome it is not based on a disease per se but on a bunch of symptoms that are somehow connected each other.


We have actually three thoracic outlets. The most known is the one between the anterior and middle scalene muscles (on the side of the neck). There is also one between the clavicle (collarbone) and the first rib and another one between the coracoid process and the small pectoral muscle (beneath the collarbone).


The syndrome starts when for any given reason the physical space of the outlet becomes so restricted that it presses on nerves and blood vessels. Symptoms vary depending on which structure is pressed. Pressed nerves can cause paraesthesia, abnormal sensations like tingling, prickling numbness; while it is more likely that pressed blood vessels cause discomfort like when our blood pressure is measured with the cuff. In both cases we have pain as well as symptom. Pressure has usually a mechanical source and there are specific movements provoking symptoms, like carrying heavy objects or raising arms over the head.


And if you have paid close attention you have surely linked over-head activities with climbing. Yes, it is indeed something that can affect climbers.


To sum up: we need a reduced outlet space to cause TOS. There are several investigated reasons that may lead to a TOS. Some of them, like an accident, an extra rib or a tumor sitting in the area, are not really interesting for us. However, one of the causes could be an increased muscle size. As you have maybe noticed, muscles or muscles and bones define all three outlets. Our muscles increase when we train them in a way that stimulates their growth, like when hardly climbing. And it is OK. Issues normally come where we put on already weak structures an extra load. Thoracic outlets unfortunately are weak structures so they are the perfect victims for a syndrome. It may be genetic – some of us have smaller outlets – but also very well foreseeable. I am an advocate of an harmonic growth of total body musculature because syndromes like TOS can very well be caused by unbalanced musculature. You have surely noticed the typical climbing/bouldering hunchback of some professional climbers so you know what I am talking about. Cause of such hunchback is that single muscles or muscle groups have become very big and strong without being counterbalanced on the other side by enough opposing muscles.


There is another topic related to TOS that I find very fascinating from a scientific point of view. Another cause of TOS is a poor posture of the shoulder blade and of the thoracic spine. Sitting jobs with rounded shoulders and head in protraction. Does it sound familiar? Generally speaking, poor posture causes rigidity of specific muscular groups. This can as well affect the thoracic outlets.

(pic from the web, I have no rights on this image)

Speaking of body posture in general there are also very strong hypothesis that it affects the whole body well-being: first of all because a bad posture affects our breathing; we breathe poorly and superficially and this has an impact on our body regulation. But also because thoracic spine and shoulder blade are located very near to sympathetic trunk and their misbalance has influence on the vegetative system and the hypothalamus. How? In several ways like muscle rigidity (again), paraesthesia (again), restricted blood flow in the arms until headache and sleep issues.


Restricted blood flow in the arms. Yes, the same arms we use for overhead movements and for climbing. There may be a connection? Maybe with the very common tennis elbow or carpal tunnel? There are many suggestions and correlations but it is very difficult to find a scientific link. However, I believe yes. I believe that everything is connected in our body and that any sort of issue has effects all over the body.


The message to take home today is to have a holistic approach to our body and activities. Climbing is not a separate entity in our life. Everything affects everything. Probably the way you are sitting at the computer affects the way you train or the way you breath affects your recovery. Or the way you are reading this post will affect how you will look at things from now on. Who knows…






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