The most important corrective for TOS & chronic neck- and shoulder pain | CCS decompression
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- Опубліковано 15 жов 2022
- Costoclavicular compression is a wildly common cause of chronic chest, arm, neck and upper back pain, but is not well known. It is also the most important corrective in neurogenic thoracic outlet syndrome. Moreover, sadly, it is monstruously mistreated with cues such as "lower your shoulders", or worse, "pull your shoulders back and down". This worsens costoclavicular impingement and inevitably worsens the patient. Further, healthy patients may quickly get injured from these cues, and can drift on for years until they are cued to stop doing it.
The trapezius is an important stabilizer of the neck and shoulder complex, and two main roles it has is to decompress the costoclavicular passages' neurovascular bundle (brachial plexus and subclavian vasculature), as well as appropriate instigation of upwards scapular rotation. This is crucial for good neck and shoulder health.
Either way, even patients who are indeed aware of the benefits of keeping their shoulders up are often doing it wrong. This video will sirve as a "howto", and will also teach you what common pitfalls to avoid. Keeping your shoulders up, contrary to popular but deceptive beliefs, is one of the most helpful things you can do for your long- and short-term neck and shoulder health.
I want to add a couple if things that I forgot to mention. 1., the "de-numbing" period when getting the shoulders up, although usually only affecting as mall proportion of patients with TOS, will generally last anywhere between a few days to a few weeks. Hang in there. 2., if patients develop symptoms of VASCULAR TOS, eg., venous congestion when raising their shoulders, this suggests severe pec minor dysfunction. It will help to bring the scapulae up and forward a litte bit, along with stretching of the pectoralis minor a few times weekly. See my pec minor stretch video, as there are pitfalls there as well.
When your career is helping people get better on their own, over time it is essential that you learn to communicate ideas most effectively. These videos lately have been exceptional, especially with your inclusion of addressing specific nuances that certain patients have trouble with (“feeling” versus “seeing” the margin of error in the drop test, trainsient numbness, headaches after proper upper trap usage etc.) Keep up the good work.
Well said!
Great video thank you so much, I hope you keep releasing these!
Thank you very much for this! Game-changer!
All those juiceheads are still destroying people's body by saying to depress scapula and pinch your shoulder blades, i never felt comfortable doing that. Thanks for providing knowledge you have it has helped me a lot otherwise i felt drowsy throughout the day.
it's not just juiceheads, it's *everyone* including the medical community. This information is very different for me.
Appreciate what you do, and the new audio is tremendous
Simple, practical, makes sense! Thank you for the clear explanation.
i can't express how thankful i am for this information. you saved me man.
You might have just solved an issue I've been having with cycling, big thanks!
You are brilliant.
hey mate. i just wanted to say i really appricate your videos. i found your channel a week ago and i cannot begin to stress how helpful they have been to me. i have been in horrible chronic pain all over my body for 8 years. most likely a result from my severe tourretyes syndrome in the past( it is mild now) i hope i can learn more from u soon. espescially the ql muscle and serratus posterior inferior areas for bad pain and compression and also diaphram and core issues(i cant hold my core in at all)
Dude... I think you've just solved a lifelong problem I've had.
So much love
Feel like this video is going to change my life, so thank you and Merry Christmas good sir
your videos taught me more than uni has ever done
Brilliant. I'll try it.
Fantastic. Wish American physical therapist and doctors were this knowledgeable.
Much gratitude 🎉🎉🎉🎉
No, joke. Life changing lesson! I thought that relaxing my arms and shoulders I'd make the pain better:-) I've been trying every day and learning to be aware. Thank you so much.
Wow very informative, gotta work on this. I remember a couple of years back a lady told me to keep my shoulders up because it looks better and not lazy as she coined it. And ever since I have corrected myself when I look in the mirror.
I have also noticed that I definitely feel this exact thing whenever I do something like romanian deaflift. These are must watch videos for anyone, not just lifters.
Ive spent years getting told by Drs there is nothing that could be done. Your channel gives me hope!
It's crazy for the last few years I've been all back and down that all I ever saw all over you tube Facebook ect it's cray how they say to keep your scap locked down like that's literally killing your body's natural movement which I never thought but years of that really jacked up my scapular mechanics and now I'm dealing with so many issue but just this alone has helped much more
lifesaver! Takk!!
I take credit for the mic upgrade ;) Joking, great content that I can't find anywhere else
Thank you. Benching and all chest movements have been making my arms feel weak and now I can see the problem with shoulders back and down
For sure.
It’s been a week of maintaining good posture and my symptoms have got better guys ! I actually stumbled upon on the “drop test” on my own since I wanted a way to know if I was actually keeping my shoulders up.
The article on his website was honestly life changing for me !
Glad you are doing good keep it Up! I agree also on life changing.
Me too! The TOS article is gold
How are you going now? Any updates?
Thanks for your videos, crystal clear and very helpful, they make the most "sense" compared to many other posture correction videos I have seen.
Have you had any experience with treating postural induced gastrointestinal symptoms? I suffer from ibs/trapped gas/splenic flexure syndrome, and I was wondering if it could be caused by poor posture (i have been searching for the cause of my problems for 2+ years without much success...).
Thanks a lot!
Yep. Got rid of shoulder impingment around the front of the shoulder then noticed i got another type more in the rear and its for sure because of this
Hello Kjetil, I have two questions:
1. How can one differentiate from myogenic symptoms from re-engaging weak traps, versus venous congestion symptoms from a potentially overly tight pec minor? (Since they can both cause headaches in the back of the head?)
2. To compensate for a tight pec minor, should one protract their scapula, or anteriorly tilt the scapula when raising their shoulders?
Is there any typical link with TOS to a long term shoulder separation?
I think I've had symptoms of both over many years, although I only learned about shoulder separation recently (after seeing an explanation of the protruding collarbone). I think the lack of a stable join in the bones had made it additionally tricky to raise the collarbone without the two bones of the ac joint jamming. They became a lot more stable since I became aware of the issue, and concentrated more on getting the acromion up and back (rather than lead with the collarbone).
could the angle of your clavicle be used to determine whether your shoulder is raised sufficiently or not? also would flaring your lats or lat spreading be a good cue to raise the shoulder girdle? or is that irrelevant to this
Hi Kjetil, first of all thanks a lot for your videos, they help a lot.
Question: Do you think letting the shoulders drop/pulling back/TOS may induce atrophy in the (upper) chest region along with your described numbness etc.?
Cheers!
Hi, what do you think about exercise called "vaksh vikasak dand". The shoulders are internally rotated but people perform this exercise without impinging their shoulders. How can that sort of pushup form be safe to perform? I know that we can "widen the scapula" and therefore be able to safely do wide pushups with more chest activation. But in this kind of pushup (vaksh vikasak dand), aren't the shoulders very unstable and rotator cuff compromised?
Thanks so much for the video! All these issues seemed to have happened at once. My issue is - tight traps is what caused the issue. So will holding the shoulders up not make this issue worse? and will holding up make the scapula stay in place? My scapula feels so out of control and hard to control and move. Thanks again for the content and reasoning behind all of the pain!
Hello Kjetil, I’ve been reading your articles and watching your videos and I’m truly amazed by your deep insight and understanding of the human body. I just have one question. At 5:40, isn’t it the other way around (i.e. even if you induce correct scapular position on a patient, they will still be in depression)? I was just curious, since I think that applies to myself as well and have had difficulty finding the correct scapular resting position.
What could cause a better contraction in one trap over the other when raising the shoulders? I notice that one side often rises 'smoothly' compared to the other. Is there any way to ensure both traps engage equally.
your recommendation to raise the shoulders makes a lot of sense. going to try and support my elbows while i'm sitting so they're raised. i've had numbness in 4th and 5th fingers and weakness in the thumb for over a year. i had surgery to fuse 3 vertebrae and to remove bone spurs in June, but 7 months later no improvement. I've figured out it's actually TOS from every description i've heard. I'm back to weightlifting now. would working the traps more in the gym help too? dumbbell shrugs or something like that? this all started from a fall i had from a ladder. broke my fall with my left arm and a week later this started, so i'm guessing that precipitated it.
How do you deal with the medical associations and accreditation people when they teach the items you are correcting? I have been to many many PTs that say pull back and down. If you question them you get a "what do you know" response. Your videos have helped more than most of my PTs in the USA
kjetil is so much more advanced than a PT. they’re seriously so unhelpful and couldn’t figure out my TOS symptoms. i even had an orthopedist tell me my symptoms are because i needed a stronger back…i was deadlifting 450 pounds at the time lol.
kjetil is truly the best. he’s really changed my life for the better.
Can wearing a posture brace help with retraining muscles to stay in correct position?
I had some issues a couple of years ago, I was practicing doing ju jitsu type rolls (breakfall) , and all the parkour videos etc don't mention the need of mechanically protecting these nerves , but it's also clear that uncontrolled falling can be very bad in advanced age, to the hands etc , without a well rehearsed fall reflex in place...
Explain more with hands.....
Would you recommend withholding from any compound pushing movements? After incorporating pushups again (past week with shoulders elevated), I got a lot of pain and stiffness in the front of my shoulder and pec and I had to stop.
Hey Buddie,
this is my result of an nerve sonographie. What do you think i should do exactly? I am scared of a surgery. Is there a conservative way for me?
Nerve ultrasonography: Supraclavicular cervical roots C5-C8 were unremarkable. Hypertrophy of the scalenus anterior muscle on the left side was suspected. As an anatomical variant, the roots C5 and C6 on the left side do not run in the hiatus gap but in the scalenus anterior muscle. Infraclavicularly, a prestenotic signal with decrease of flow below 100 cm/s can be detected intermittently on the left side at 90° abduction, in addition pectoral stenosis with Vmax around 200 cm/s. On the right side, stenosis in the subclavian artery with Vmax above 200 cm/s can be detected only during the special maneuver described by the patient with retraction of the scapulae and lowering of the clavicle. Venous stasis cannot be detected on both sides.
Thanks in advance.
Re the worsening of nerve pain where would this usually be? In the arms/hands?
Thank you!
When traps are overworked after holding shoulders up/ doing shrugs; how long is it necessary to pause before continuing the excercises? In my case stiff neck with some headaches. Referring to 15:45 in the video.
Best regards
Until symptoms cease
Excellent explanation! Would training heavy weight trapezius strengthening (or longer times 'holds' or 'carries' with dumbells) lead to less fatique when trying to hold the shoulders up?
Usually makes it harder. There are caveats, and they are individual so I am not going to get into it. Doesn't matter so much.
Hey Ketil! Thank you for the video. Can I ask please. When we do exercises like barbell curls or deadlifts, do we need to lift our shoulders and pay attention to the height of our shoulder blades?
Following
Im lifting up my shoulders but i am in more pain then before. How long does it need to get better?
So, are you saying that you are constantly holding your shoulders up? Or if you build up the traps correctly they will be holding the shoulders up naturally?
you needd constantly hold shoulders up, habits not exercises fix posture! exercising traps can speed up process
but what if you have scar tissue? although i dont know if i have that yet
when we hold the shoulders in a normal position, should the upper trapezius be tense?
A little but not like you are holding the world on your shoulders
Thanks for videos. I'm going to work on this. Was wondering if the way we breath is aggravating the condition? I had a chiropractor tell me that I'm breathing stressfully which could aggravating the condition. For instance breathing up into the chest too much? if scapular is weak or dysfunctional could it have to do with weak core on the same side generally ?
See the video I posted a few days ago
I am a carpenter so constantly moving and lifting so easy to get into bad posture. Any advice? Thank you for the great videos.
See my video on upwards scapular rotation
the only thing I'm struggling with this is it seems like if I consciously shrug my shoulders/elevate my scapula as shown here, it can hamper my ability to fully utilize my diaphragm when I take deep breaths. It seems like the neck/accessory breathing muscles are more likely to kick in. Any advice regarding this?
Any tips on keeping shoulders raised while sleeping? Sometimes I wake up with numbness in my arms
Did you find a solution for this? I have been putting pillows under each arm and a blanket under the elbows. It elevates the shoulder blades when I'm lying there awake but by the time I wake up, the pillows have been pushed out of that position, so I don't think it's really working.
My left side is my problem side neck/shoulder amongst other things.
My upper trap /levator scap are constantly contracted causing torguing/pulling downward.
When I did your exercise, I could feel it in my brachial plexus on the left side. Also the top left shoulder closest to the neck, it traveled up my neck laterally and and also to my occipital region on the left side, also my eye.
I took a break as you suggested & eventually everything started feeling better.
When I did your exercise on my lower, right shoulder everything feels fine.
I have several questions but will keep it to one because I don’t expect you to answer all of them but hopefully you can at least answer this one. It would be much appreciated..
Should I do this only on my right side because it is the lower shoulder or should I still continue to do it on both sides b/c maybe my left side is the weaker /dormant side ?
I’m sure both sides are probably weak, but I think the right side is more dominant (taking over for my weakening left side) b/c of me being right handed AND you have the larger right diaphragm and your liver so even if your left handed, in reality you’re right side dominant according to Postural Restoration .
Thank you if you respond.
I've had the same issues I think as you exception the right side. Have you improved more? I've been down the postural restoration road too but it hasn't helped me so far
@@kristiniandolo3809 no, not much has helped. My problem is that I’m soo imbalanced from top to bottom. I still believe in postural restoration but don’t like some of their positions. Some are contorted and anger by neck. Have you listened to Neal Hallihan? He’s really good. I still keep trying both Postural Restoration and regular stuff. All this dysfunction is ruining my body. If you ever find anything that works, plz let me know. Brst wishes.
Any recommendations on a specific work chair that has high arm leans?
Specific, no. High arm-leans, yes.
I went down several years forcing my shoulders down after going down the rabbit hole of UA-cam videos preaching that this was “proper” posture.
Since doing that to myself, my life has changed so negatively. My neck and face are always red, cognitive decline, brain fog, unbelievable tension in the upper body.
I would bench press and lift very hard with the shoulders forced down and scapula frozen anteriorly and not moving naturally. I’ve spent thousands on chiropractors and massage therapy and to no avail, I haven’t improved much until I realized holding the shoulders up was what I needed to reverse this.
Recently I had an ultrasound and they found poor blood flow in one of my carotid arteries and not from plaque, literally from forcing my shoulders down I def inflicted this on myself.
Do you think I could have done irreversible damage from lack of blood flow and nerve damage? I’m starting to feel better now but I imagine I have a long road ahead.
Thanks if you read through this, this specific issue really resonated so deeply with me. It’s made my life hell since I watched those UA-cam videos preaching that shoulders back and down, I took it very literally and did it for a very long time.
Cheers.
schedule an appointment with him it’s very affordable.
Did you jhave a blog on correcting Long thoracic nerve injury/ scapula winging with shrugging / upper trap ? To this day I find many shoulder issues can be alleviated by using more upper trap when raising the arm, most people say the opposite.
Long blog post on scapular dyskinesis on my website. Almost none of these cases are caused by long thoracic nerve injury. Only select cases, usually post trauma, MS or similar
@@MSKNeurology It was post trauma (FOOSH). Very likely LTN injury. Complete wasting of serratus anterior and winging of scapula same side.
I'm curious how shoulder elevation would work in the context of rock climbing? More specifically in regards to overhead pulling movements. Especially in bouldering, a lot of powerful movements require the shoulders to be pulled back atleast.
Crucial of course
I have treated LOTS of climbers with TOS
is it okay to work out when having this problem with my right shoulder? I can clearly see some upper trap wasting on my right side…
IF you're able to hold your shoulders up.
After having surgery due to venous TOS will this still be important to keep scapula up?
Even more important. If your rib got removed there is more room for compression against the 2nd i think. Anyways shoulders up is a must
Are you saying we should go through life constantly thinking about our shoulders Kjetil?
Over time it will feel normal. Build the muscle memory and eventually you won't have to think about it
Can dead hang be beneficial for TOS, or at least not make it worse?
Irrelevant
Is this good for jugular vein compression? I have cci and Ed’s but The past week if I don’t stay in this position I feel my heart starting to get pressure and my head starts to feel funny like I need to lay down like blood isn’t getting to heart.
A somewhat related question I have: Whenever I try to elevate my shoulders and try to think about posterior tilting/upward rotation of my scapula, I feel a popping sensation (mostly painless) in my rib/serratus area as I come out of my slouched position. It feels almost as though the inferior part of my scapula is colliding with my ribs; it's not a smooth transition. Is this just a weak serratus anterior?
Weak and thin subscapular (ie. muscles below scap, such as subscap, serratus) muscles
@@MSKNeurology Thanks so much, I'll focus on training those a bit more
After doing CCS decompression for TOS, what is the longest time it would take to see nerves recover? 6-12 months? Longer?
Depends what you mean by "recover". Regain normal strength, usually in less than 6 months. But regarding pain you must remember that there are more potential compression sites, such as peripheral areas or the interscalene triangle.
The improved audio is just ... 🤌
Hi Kjetl, what is your opinion on the right amount of protein intake for muscle building? Your material is incredibly valuable. Thank you much.
Actually, is there a resource you recommend for diet as a whole? Also, in a previous video you responded to a question of mine and said that my neck-tongue syndrome was probably a result of jugular outlet syndrome. I did the recommended corrective in this video and it relieves my symptoms. You are a Godsend sir. Please never stop sharing your gifts with the world.
2.6 grams of protein per kg bodyweight is the max your body will process naturally if you are not on steroids so i consider it the optimum
i would say at least 2 gramms per kg bodyweight is still ok to build up strength and for muscle grow
natural competitive bodybuilder here
Is it common to only get TOS on one side?
Think so. Started right for me and then spread to left 2 years later. Right shoulder Always was more depressed for me so in hindsight makes sense
Should I raise my shoulders up significantly or just a little bit? That’s where I’m unclear I have been also doing shrugs pausing at the top of the movement
Watch the video
Do you have opinions on foot and hip posture, proper gait mechanics ect?
Rabit hole
@@MSKNeurology yea agreed
How long should we expect the nerve pain to last (I get pain under the inner corner of the clavicle immediately when lifting my shoulders)? 11:58
It's gone within two weeks in almost all circumstances. I have seen less than 10 cases that have lasted longer. Remember that when you put your shoulders back down, the problem doesn't actually go away, you're just numbing it down again.
Почему нет русского перевода?
I am afraid if I engage raised shoulders, I will stress the already tight trap muscles with knots even more.. please correct me if my concern is incorrect
Tight = weak. Yes, it will hurt the first 3 months or so.
Would you recommend doing shrugs in order to assist traps with keeping the shoulders elevated? Frankly I am not sure the etiology but I have had pain behind my shoulder blade on the left side for a year. Neck X rays are ok, its been pretty confusing for me. I have been trying shoulder and neck CARs and face pulls to try to remedy with no effect really. Also did 6 weeks of PT with no discernable benefit. PT felt that I had levator dysfunction of some kind but wasnt sure. I'm kind of at my wits end
X ray is not useful. MRI should exclude C5 or C6 root impingement first. If none, then consider dorsal scapular neuralgia secondary to costoclavicular impingement.
@@MSKNeurology yeah I have had troubles getting a MRI order cause my docs servers have been down. Hopefully soon
What are your thoughts on the subclavius muscle and TOS?
Nonsense
@@MSKNeurology Thanks! What about the pectoralis minor? Is it important to focus some strengthening of it?
@@fredrikhaugerud587 See my recent pec minor video
Tried these tips on myself for people wondering if this works.
Was taught back and down by a chiropractor. Did it for 2 years, developed problems with numb, white hands and increase of my eczema on arms due to circulation loss. It also increased migraine frequency from once a month, to 2 days a week.
I have tried this as well as scalene and neck strengthening with a rubber band for 3 months now.
1. week, mild pain, nothing too bad.
2. week severe migraine, and a fever. Lasted 5 days in bed.
3. week headache but able to move and trying to think about lifting arms.
4-8 week mild headaches and still struggle doing my job as a builder. Core muscles feels sore, like after a hard workout.
8-12 week headaches at start of work day, but they seem to disappear if i keep going. Sleep seems to be improved as well.
Im 25 years old and from pictures, my scapula have always been down and i have been doing craniocervical tucking since 7 years old.
Have you been able to keep shoulders up the whole time successfully?
There's more going on here than just this. I am glad you're better but this won't fix all your issues.
@@TS-lm5po As i continue my path to get better i realise i have general dysfunction of my body.
I have been sitting most my childhood.
So the answer is no, i haven't been able to keep the shoulder up all the time because i haven't in 20 years.
But i am now stronger in my traps and shoulders and it have helped greatly in arm strength, and less migraines.
Did someone heal tos using these methods?
This helps but helping my posture with exercises and stretches helped alot more, i still have pretty bad tos but not as bad as it was
Would a band around the back of the neck and looped underneath the front of the foot force someone to strengthen their natural resting posture. I tried this out with a client who had a terrible neck hump as well as posteriorly tilted pelvis and it dramatically if not fixed the problem and made her have a regular resting spinal curvature. I do not know as much as yourself so any feedback would be lovely for this movement. Of course keeping the shoulders slightly up is included
Don't be lazy
@@MSKNeurology they are still holding the cues you use such as, butt behind shoulders, shoulders slightly up, neck elongated, I also think that knees should be slightly bent and have been using this enforces the anterior tilt. Would this not give a slight stimulus for those who use standing desks?
I said no
@@MSKNeurology I appreciate it 🔥
Could a cat cow holding good spinal positioning with good shoulder positioning be a good corrective in a differert plane of gravital resistance?
Will you do a video on the diaphragm?
Probably not
hi my left shoulder is causing me issues. It's been stuck in depression ever since it got dislocated years ago. What muscles are weak? its lower than my right shoulder which is the healthy one
Doesn't work like that
@@MSKNeurology all the physios are telling me that it isn't depressed both are level, so idk whats going on
@@coachingconfidant2785 couldn't care less what they say or claim
@@MSKNeurology any help? what should i do? my left shoulder is unstable or somethings not right with it
@@coachingconfidant2785 Other than all the free videos on my channel and tons of free reading material on my website? Book a session
ok i get this that i need to keep by shoulder blades elevated to heal my TOS. But i do have tight scalene muscles and it's probably elevating my 1st rib, so should i also incorporate some neck strengthening exercises ?
Sure. Read my TOS article
Does doing the back and down cue in a wide grip,supinated bench press worsen this. Or it doesn't make a difference.
Always makes it worse of course.
Any people in the comments which had issues with their vision and saw improvements after implementing this solution?
Does it work for arterial TOS?
Yes, but there are caveats.
@@MSKNeurology for example?😄
WTH, ain’t nobody got time for that!!
You made a few perfect form videos on some exercises, can you make more? Clearly youre a unit so pass on your secrets lol
For example
After doing some of your exercise my neck muscles feel weak as fuck and all the area from mid back to neck doesn't feel jammed anymore, left side of my head felt numb and now i feel like there is increased blood flow or something. Thanks for help🙏.
Which video?
@@ll-wd7mv proper suboccipital strengthning, you should watch all his videos it will help more.
I have no neck or shoulder pain yet my shoulders don't drop?
Age
Activity level
Which activities done
Posture in general
Presence of scapular dyskinesia
Co-presence of anxiety or similar predisposing factors
ETC
It is not that simple. Good for you, though.
@@MSKNeurologyI have been following you for a long time... would you recommend I should strive for this elevated position in general? I am 25 and have been doing contact sports 3-4 times a week plus strength training aprox 3-4 times a week for several years and have never had any issues except subacromial impingement (both from bracing bad falls one handed in wrestling)..
@@Drikkerbadevand I recommend this to everyone yes, but to be motivated to do this --> most people need to have some sort of symptom. I have kept my shoulders up for 10 years, and I am NEVER injured in the shoulders or neck.
@@MSKNeurologyI am glad. I've been doing judo and wrestling and have seen countless people dumped on their neck and shoulder with full force +another persons weight on top.. at that point an injury is often inevitable but I always had the mindset a strong rotator cuff and scapular support could mean the difference from completely tearing something and 'only' partially doing so.
Hi. What is your opinion on a good pullover machine and also your opinion on medx machines for the neck (4-way and cervical rotation one)? Much love from Greece.
Can TOS cause Tinnitus ?
yes as it raises cranial arterial pressure on the same side