Introduction

Are you sick of the pain?

Do you have chronic neck pain, chronic shoulder pain, upper back pain, arm numbness, tingling hands, hand weakness, or the symptoms of thoracic outlet syndrome like me?

Still wondering why the pain won’t go away?

Throughout this book, I will show you how to recognize the signs of thoracic outlet syndrome, understand why it is so commonly missed, and learn a logical approach for determining whether compression of the thoracic outlet may be the true cause of your pain and disability.

Tired of doctors’ promises ending in failure?

You aren’t alone. “The standard-of-care thoracic outlet syndrome treatments used by my doctors didn’t work for me.”

I know the thoracic outlet syndrome examination methods, diagnostic approaches, and treatment approaches used by your doctors aren’t working for you, because they’re not working for anyone!

Not only that, but these same examination methods, diagnostic tests, and treatment approaches used for headaches, herniated discs, cervical radiculopathy, chronic neck pain, chronic pain, chronic fatigue syndrome, fibromyalgia, carpal tunnel syndrome, and thoracic outlet syndrome don’t work for these conditions either.

It is because they are all based on a flawed model of human biomechanics that doesn’t even abide by the laws of physics and nature. This means they’ll never work, no matter how many thoracic outlet syndrome treatments, physical therapy sessions, chiropractic treatments, massage therapy treatments, injections, medications, or surgeries you get. Period.

I know, that’s some pretty strong language... but after you read this book, you will know I’m right and know why I’m right.

I had an epiphany after my arduous struggle that led to this revelation...

If you ask the thousands of doctors around the world who’ve evaluated my Human Spring Approach and Integrated Spring-Mass Model of Biomechanics, they will agree it is the only approach that makes sense.

This book offers an ultimate thoracic outlet syndrome examination, thoracic outlet syndrome diagnosis, thoracic outlet syndrome treatment, non-surgical thoracic outlet syndrome treatment, thoracic outlet syndrome recovery, and thoracic outlet syndrome rehabilitation approach to reversing thoracic outlet syndrome.

In this book, you will learn my new way to study, examine, diagnose, treat, rehabilitate, and prevent thoracic outlet syndrome and other compression syndromes, which is an advancement that I predict will forever change the way medicine is practiced. It will reshape your fitness, posture, movement, exercise, and lifestyle choices.

It can help bring relief to the millions around the world who suffer from thoracic outlet syndrome, chronic neck pain, chronic shoulder pain, chronic upper back pain, chronic pain, nerve compression, brachial plexus compression, chronic fatigue, and other compression-related disorders. It will improve your personal performance in sports and leisure activities, reduce your risk of injury, enhance recovery, and help prevent accelerated aging.

How Did It Get Discovered?

When I was injured, numerous doctors examined me using standard-of-care protocols for patients with chronic neck pain, upper back pain, shoulder pain, arm numbness, and hand tingling. Why did all their examination methods fail to arrive at the correct thoracic outlet syndrome diagnosis? Different doctors told me I had cervical radiculopathy, carpal tunnel syndrome, a herniated cervical disc, myofascial pain syndrome, or another chronic pain condition included in the differential diagnosis of thoracic outlet syndrome.

Despite receiving multiple diagnoses, not one doctor using these standard examination protocols could explain the true cause of my pain. They treated me with traditional approaches for neck pain, back pain, and shoulder pain, but I received no lasting relief because the underlying thoracic outlet compression was never identified.

By 27 years of age, I was suffering from chronic thoracic outlet syndrome with symptoms consistent with neurogenic thoracic outlet syndrome and possible vascular thoracic outlet syndrome. My symptoms included chronic neck pain, chronic shoulder pain, upper back pain, arm numbness, hand tingling, nerve compression, and signs of brachial plexus compression. I also experienced chronic fatigue syndrome symptoms, widespread pain that resembled fibromyalgia, chronic inflammation, and depression caused by living with constant pain. After years of failed thoracic outlet syndrome treatment, I felt hopeless because my condition remained misdiagnosed and untreated at its source.

Why do so many standard medical examinations result in a missed or misdiagnosed thoracic outlet syndrome? Why are compression disorders, such as thoracic outlet syndrome and forearm compartment syndrome, so difficult for doctors to recognize?

Why do so many thoracic outlet syndrome treatments fail?

My mother always said that when something does not make sense, you should keep asking questions until you find the answers. I knew that something important was missing from the conventional understanding of thoracic outlet syndrome, chronic pain, and human movement.

I believed in my body’s natural healing abilities, but something was interfering with that restorative process. I needed to identify what was preventing my body from healing and why the thoracic outlet compression continued.

So, I reconsidered human engineering from an entirely different and more logical point of view. I took off my white coat and studied the human body through the combined perspectives of biomechanics, human movement science, functional anatomy, mechanical engineering, anatomy, and physics. I then combined this new perspective with years of experience interviewing leading sports scientists and coaches, as well as consulting, examining, treating, and training hundreds of elite athletes from many sports around the world.

So much is misunderstood about how the human body truly works, especially how it moves, absorbs impact, recycles energy, preserves joint spaces, and protects the nerves and blood vessels passing through anatomical tunnels such as the thoracic outlet. The conventional way patients are examined and treated is based largely on a 340-year-old lever model of biomechanics that describes the body as a series of rigid levers moved by muscles.

The human body does perform some movements through lever mechanics.

However, there are four essential functions that the traditional lever-series model cannot adequately explain. These unanswered questions have become mysteries that doctors, therapists, and scientists often have difficulty understanding.

Mystery 1—How does the body absorbs impacts?

Currently doctors and scientists think it is impossible for a body designed as a lever to absorb the impacts of walking and running without injury. That is why they recommend cushioned running shoes.

How do they explain millions of people around the world running barefoot and actually having less arthritis and aging than those who wear shoes? I became a barefoot runner after making this discovery.

Mystery 2—How does the body recycle energy to prevent early and chronic fatigue?

Doctors know lever mechanisms push with muscles, which burn a lot of energy. With this current method of thinking, it’s impossible for people to run a marathon without running out of energy. How do they do it then?

This is the science which studies energy conservation, elastic energy storage, movement efficiency, walking and running efficiency.

Mystery 3—How does the body maintain the healthy spaces for joints?

Levers cannot be engineered to open joint spaces. How does the body maintain these joint spaces? Why do doctors recommend joint decompression for joint space preservation?

Mystery 4—How does the body provide spaces for the safe passage of blood vessels and nerves? (For example, carpal tunnel syndrome, herniated discs, thoracic outlet syndrome, and many other conditions caused by compression.)

It’s impossible to open spaces for nerves and blood vessels with lever engineering. What is the engineering of the thoracic outlet and tunnel to protect the brachial plexus, subclavian artery, subclavian vein, peripheral nerves, and blood vessels from nerve compression, vascular compression, thoracic outlet syndrome (TOS), neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, and arterial thoracic outlet syndrome?

The body does accomplish certain tasks with levers, but the above four functions cannot be explained with levers. So why do doctors examine us by checking our lever movements when evaluating thoracic outlet syndrome, chronic neck pain, shoulder pain, upper back pain, arm numbness, hand tingling, nerve compression syndromes, and musculoskeletal disorders?

The reason why you have been misdiagnosed and mistreated is because they are examining and treating you as a lever mechanism when your body is really designed as a spring. This flawed model contributes to the misdiagnosis of thoracic outlet syndrome, chronic pain, herniated discs, carpal tunnel syndrome, cervical radiculopathy, and other compression syndromes.

Makes sense, doesn’t it?

How could so many doctors miss this new model of biomechanics and human movement?

In the past 15 years, I have been invited to present this new model of human engineering, biomechanics, and the Human Spring Approach at more than 75 medical conferences attended by medical physicians and scientists from more than 60 nations. At 10 of these conferences, I was the keynote speaker lecturing on The Human Spring Approach to Thoracic Outlet Syndrome, thoracic outlet syndrome diagnosis, non-surgical thoracic outlet syndrome treatment, and biomechanics.

In 2014, I was invited to speak at the World Congress in Sports and Exercise Medicine in Kuala Lumpur, Malaysia. There were nearly 100 international and local leaders selected as speakers for the congress, representing the fields of sports medicine, physical medicine, rehabilitation, biomechanics, and exercise science.

You might be shocked that medical physicians would invite a chiropractor to address elite medical physicians from more than 35 nations on the subjects of thoracic outlet syndrome, biomechanics, human movement, sports medicine, and conservative treatment.

This was a unique opportunity for the global sports medicine, sports science, rehabilitation, physical therapy, chiropractic, and exercise medicine community to learn this new model and approach that I developed.

In this lecture, I presented strong scientific proof that the current model that explains how the body moves, and the standard-of-care examination, diagnosis, and treatment approaches currently used for thoracic outlet syndrome, chronic pain, herniated discs, headaches, and compression syndromes, do not abide by the laws of physics and nature.

In a sense, I presented proof that by using the current standard-of-care biomechanical model and treatment approach, it was impossible to achieve complete restoration of the human body because the diagnoses, biomechanics, and treatment protocols were based on flawed models of human movement.

Can you guess how these physicians responded to this chiropractor?

The accreditation committee recommended I receive the conferment of honorary fellowship for my distinguished research and contributions to the advancement of sports and exercise medicine on an international level.

by a member of the royal family, the Sultan of Pahang (left).

On November 5, 2015, I was honored with an Honorary Fellowship by a member of the royal family, the Sultan of Pahang, at the opening ceremonies of the World Congress in Sports and Exercise Medicine for my contributions to sports medicine, biomechanics, human movement science, thoracic outlet syndrome research, and the Human Spring Approach.

How did a chiropractor become recognized by a multinational committee of medical doctors (MDs), sports medicine physicians, orthopedic specialists, neurologists, rehabilitation experts, and researchers who are themselves leaders in their respective fields of sports medicine, biomechanics, orthopedic medicine, physical medicine, and rehabilitation?

Unfortunately, the majority of the world still doesn’t regard the body as a living spring. Consequently, people are missing out on understanding the most important aspects of human biomechanics, movement science, shock absorption, energy recycling, joint preservation, nerve decompression, blood vessel protection, thoracic outlet syndrome, chronic pain, injury prevention, athletic performance, and healthy aging, all of which function according to the laws of nature, the laws of physics, and common sense.

I have presented every aspect of this new Human Spring Approach, Integrated Spring-Mass Model, biomechanics model, thoracic outlet syndrome treatment approach, non-surgical treatment philosophy, and sports medicine approach at more than 50 medical conferences organized principally by medical doctors in China, Japan, the United Kingdom, Germany, Monaco, Malaysia, Indonesia, Russia, Australia, Brazil, Spain, Thailand, Mexico, Colombia, South Africa, the Philippines, and throughout the United States.

It is estimated that more than 50,000 doctors, surgeons, chiropractors, physical therapists, sports medicine physicians, rehabilitation specialists, and healthcare professionals have attended my lectures, and none have refuted the science behind the Human Spring Approach, Integrated Spring-Mass Model, thoracic outlet syndrome biomechanics, and non-surgical treatment principles. The global medical community continues to recognize and praise this discovery.

In 2018, after this book achieved #1 International Bestseller status, I was invited to teach my non-surgical Human Spring Approach to Thoracic Outlet Syndrome, Integrated Spring-Mass Model of Biomechanics, thoracic outlet syndrome diagnosis, thoracic outlet syndrome treatment, thoracic outlet syndrome rehabilitation, and compression syndrome management at eight international medical conferences organized by medical doctors in Amsterdam, Netherlands; Singapore City, Singapore; Dubai, UAE; Tokyo, Japan; Edinburgh, Scotland; Istanbul, Turkey; Kuala Lumpur, Malaysia; and Bangkok, Thailand.

Dr. James Stoxen Keynote Presentations

• 2019 – Keynote Presentation: The Integrated Spring-Mass Approach to Thoracic Outlet Syndrome, 5th Euro Global Physiotherapy, Physical Rehabilitation & Sports Medicine, Location: Amsterdam, Netherlands 2019 – Keynote Presentation: The Integrated Spring-Mass Approach to Thoracic Outlet Syndrome, 2nd International Conference on Orthopedics & Advanced Care, Location: Singapore
• 2018 – Keynote Presentation: Case Report: A Patient with Thoracic Outlet Syndrome Who Was Misdiagnosed and Mismanaged, 2nd Global Congress on Medical & Clinical Case Reports, Location: Dubai, UAE 2018 – Keynote Presentation: Conservative Care Options for Patients With a Failed Thoracic Outlet Syndrome Surgery, 2nd International Conference on Surgery and Medicine, Location: Dubai, UAE
• 2018 – Keynote Presentation: The Integrated Spring-Mass Model Approach to Treating Thoracic Outlet Syndrome, 18th Global Neuroscience Conference, Location: Tokyo, Japan 2018 – Keynote Presentation: The Integrated Spring-Mass Model Approach to Treating Thoracic Outlet Syndrome, 4th International Conference on Sports Medicine, Location: Edinburgh, Scotland
• 2018 – Keynote Presentation: The Integrated Spring-Mass Model Approach to Treating Thoracic Outlet Syndrome, World Physical Medicine & Rehabilitation Conference, Location: Istanbul, Turkey 2017 – Keynote Presentation: The Earliest Detection, Intervention and Prevention of Thoracic Outlet Syndrome, 10th Annual Meeting of Orthopedicians, Location: Kuala Lumpur, Malaysia
• 2015 – Keynote Presentation: The Sports Medicine Approach to Anti-Aging Medicine, 7th Annual Thailand Anti-Aging & Aesthetic Medicine Congress, Location: Bangkok, Thailand Editors from over 30 peer-reviewed medical journals have asked me to publish my research on The Human Spring Approach to Thoracic Outlet Syndrome, specifically its application to thoracic outlet syndrome diagnosis, thoracic outlet syndrome treatment, biomechanics, human movement, and non-surgical thoracic outlet syndrome recovery. I was also invited to submit my research on the Human Spring Approach to the examination, treatment, rehabilitation, training, injury prevention, sports medicine, chronic pain, musculoskeletal disorders, and compression syndromes to more than 250 peer-reviewed medical journals.

I was appointed Editor-in-Chief of the Journal of Orthopedic Science and Research and to the editorial boards of more than 50 peer-reviewed medical journals focused on orthopedics, sports medicine, biomechanics, rehabilitation, musculoskeletal medicine, pain management, and clinical research.

The fact that I am a chiropractor addressing the world’s medical elite at major teaching institutions, hospitals, universities, medical associations, and international sports medicine conferences is something I’m extremely proud of. I cannot tell you how many times I have stepped off the stage and heard someone ask, “How can I find out more about this new model and approach to thoracic outlet syndrome, biomechanics, chronic pain, and human movement? Do you have a book I can read?”

Well, here is the first book.

What you are about to learn is that you are suffering needlessly, and it’s all because you follow the advice of professionals who embrace an approach to medicine that is outdated and illogical. Because of this, it is impossible for many doctors to accurately determine and treat the root cause of chronic neck pain, shoulder pain, upper back pain, thoracic outlet syndrome, nerve compression, blood vessel compression, and other compression syndromes. In fact, despite their best intentions, the treatments they recommend may actually allow your condition to worsen.

The key discovery I made is that these four functions can only be performed if you understand the body as a miraculous spring mechanism, rather than simply a system of levers. This new understanding forms the foundation of the Integrated Spring-Mass Model, the Human Spring Approach, and a new way of understanding human biomechanics, movement, injury, recovery, and performance.

Once you learn how this spring mechanism works, the important functions it serves, how it breaks down and locks, and how it affects so many aspects of your health, you will understand why so many individuals suffer from thoracic outlet syndrome, herniated discs, chronic pain, headaches, nerve compression, joint compression, repetitive strain injuries, and musculoskeletal disorders, and why they are so often misdiagnosed and mistreated.

Then, when I teach you my new approach to releasing the compression on your thoracic outlet, restoring healthy biomechanics, and strengthening your body's natural spring mechanism, you will understand why my patients recover from thoracic outlet syndrome, achieve maximum medical improvement, reduce chronic neck pain, shoulder pain, arm numbness, tingling hands, upper back pain, and nerve compression, while many conventional treatment approaches have failed.

In this book, I will teach you the Integrated Spring-Mass Model, the Human Spring Approach, and apply these principles to the examination, diagnosis, treatment, rehabilitation, prevention, and long-term recovery of thoracic outlet syndrome using a logical model based on the laws of physics, biomechanics, and nature.

Ready for the “aha” moment?

What Is Thoracic Outlet Syndrome?

What is thoracic outlet syndrome? What is the thoracic outlet anatomy? What causes thoracic outlet compression? What are the symptoms of thoracic outlet syndrome? How is thoracic outlet syndrome diagnosed? What is the best thoracic outlet syndrome treatment?

If you don't know what thoracic outlet syndrome (TOS) is, you are not alone.

In 2017, more than 74,000 people each month were searching on Google for answers about thoracic outlet syndrome, thoracic outlet syndrome symptoms, thoracic outlet syndrome diagnosis, thoracic outlet syndrome treatment, thoracic outlet syndrome causes, thoracic outlet anatomy, neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, thoracic outlet syndrome specialist, thoracic outlet syndrome surgery, and non-surgical thoracic outlet syndrome treatment. If you combine all the search engines, more than 1,000,000 people per year are searching for answers to thoracic outlet syndrome, chronic neck pain, shoulder pain, arm numbness, hand tingling, brachial plexus compression, nerve compression, vascular compression, and thoracic outlet compression. One reason why so many people are searching for information about thoracic outlet syndrome is because it remains one of the most controversial, misunderstood, underdiagnosed, misdiagnosed, and difficult-to-treat compression disorders in medicine.

In fact, one author described thoracic outlet compression syndrome (TOCS), also known as thoracic outlet syndrome (TOS), as one of the most controversial subjects in medicine. It may also be one of the most underrated, overlooked, underdiagnosed, misdiagnosed, and difficult-to-manage peripheral nerve compression syndromes affecting the brachial plexus, subclavian artery, and subclavian vein as they pass through the thoracic outlet anatomy into the upper extremity.

It may be the most underrated, overlooked, misdiagnosed, and probably the most important and difficult to manage peripheral nerve compression in the upper extremity. (1) In fact when I published this book I became public enemy number one of the hospitals that make millions from thoracic outlet syndrome surgeries. Im one of the only doctors fighting to educate you to keep you from having thoracic outlet syndrome surgery.

Besides misdiagnosed, some think that it is underdiagnosed (2). Some doctors say it’s over diagnosed (3) (4). In my opinion, most doctors just can’t diagnose it.

So many people suffer in pain for weeks, months, and even years, and then someone finally asks, “Could it be thoracic outlet syndrome?”

Why do so many patients with thoracic outlet syndrome get misdiagnosed?

When it comes to the thoracic outlet syndrome diagnosis, the exact criteria about how to diagnose it are not well defined, even by experts. Putting it bluntly, the majority of doctors are really confused about thoracic outlet syndrome! What is scary is that they don’t really know the cause of thoracic outlet syndrome!

In order to do a quality examination that leads to the correct diagnosis, your doctor must know the thoracic outlet anatomy, the brachial plexus anatomy, the subclavian vessels and the signs and symptoms of compression of the thoracic outlet.

Here’s the problem! For nearly 30 years, there has been discussion of the decline in undergraduate knowledge of anatomy among the surgical community (5) (6) (7) (8) (9). In the studies that have been conducted, they suggest that the knowledge of the qualifying doctor is now below an acceptable level (10) (11) (12).

If the cause of TOS is compression of the outlet and tunnel, it’s absolutely necessary for doctors to understand that the outlet is engineered to perform these four amazing functions. This is called biomechanics.

Here is an example of how the medical profession doesn’t really understand the engineering of the thoracic outlet area.

The shoulder is the roof of the thoracic outlet, costoclavicular space, thoracic outlet and thoracic outlet inlet. If it drops down into the tunnel, it can compress the blood vessels and nerves.

I have done extensive online searches; searched the massive National Institutes of Health (NIH), PubMed, and other medical research databases; and read thousands of books, magazine articles, peer-reviewed journal articles, and scientific research studies to find an explanation for how the shoulder is suspended over the thoracic outlet and thoracic tunnel. This is extremely important to understand when diagnosing and treating patients with thoracic outlet syndrome, neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, and other compression syndromes.

I found nothing! Go ahead and do an NIH, PubMed, Google Scholar, or online search.

It is impossible to explain how the shoulder suspends itself over the thoracic outlet and thoracic tunnel if you understand the body only as a series of levers. That is why there is no accepted explanation for how the shoulder is suspended over the thoracic outlet, how the thoracic outlet remains open, or how the body protects the safe passage of the brachial plexus, subclavian artery, and subclavian vein.

If there is no information available for doctors, surgeons, anatomists, biomechanists, engineers, and scientists to understand how the roof of the thoracic outlet and thoracic tunnel is engineered, then how can they re-engineer it to open and reduce the nerve compression and blood vessel compression that causes thoracic outlet syndrome?

This is why I had to determine the correct engineering of the human body, human movement, and thoracic outlet biomechanics, because this explanation was simply not available anywhere in medicine, biomechanics, anatomy, engineering, or sports medicine.

I dare you to ask the top 10 engineers and physicists in the world this question.

"Could you please tell us how the human body is engineered with a spring suspension mechanism, Human Spring Engineering, or the Integrated Spring-Mass Model to allow the safe passage of blood vessels and nerves through the thoracic outlet and thoracic tunnel using only lever engineering?"

Doctors and scientists cannot explain the design or engineering of the thoracic outlet, thoracic tunnel, or the safe passage of the brachial plexus, subclavian artery, and subclavian vein with traditional lever engineering. That is because the thoracic outlet is engineered as a spring suspension mechanism rather than a simple lever mechanism.

I dare you to ask the top 10 engineers and physicists in the world this question.

"Could you please tell us how the human body is engineered to withstand approximately 270,000,000 collisions with the Earth during a lifetime of walking and running without causing progressive joint degeneration, cartilage damage, arthritis, or chronic musculoskeletal pain using only lever engineering?"

This cannot be explained by traditional biomechanical knowledge because the human body is not designed solely as a series of levers. It is engineered as a spring mechanism, spring suspension mechanism, or Human Spring System that absorbs impacts, recycles energy, maintains healthy joint spaces, and preserves the safe passage of nerves and blood vessels throughout the body.

The Integrated Spring-Mass Model, also known as the Human Spring Model, is an advanced biomechanics model of human movement that proposes the body is designed as an integrated spring mechanism, rather than solely as a system of levers. This model explains how the body uses spring biomechanics, elastic energy storage, and energy recycling to slow the aging process, improve movement efficiency, absorb impacts, preserve joint spaces, and maintain open tunnels and passageways for the safe passage of blood vessels and nerves, including the brachial plexus, subclavian artery, and subclavian vein through the thoracic outlet.

The concept that is most misunderstood is that the human body is not only a system of levers but also an integrated spring, or Human Spring, that functions according to the laws of physics, laws of nature, and the principles of human biomechanics and spring engineering.

It is a new biomechanical model, movement model, and Human Spring Approach that will help you finally understand the mysteries of why the body breaks down, fails to heal, develops chronic pain, compression syndromes, joint degeneration, movement dysfunction, and chronic musculoskeletal disorders, while providing a logical explanation for recovery, performance, injury prevention, and long-term human health.

Chapter 1, “What Is Thoracic Outlet Syndrome?”

reveals that thoracic outlet syndrome (TOS) is caused by compression of the thoracic outlet or thoracic tunnel where the subclavian artery, subclavian vein, brachial plexus nerves, blood vessels, and nerves pass from the neck and thorax into the arm and hand. What is causing the thoracic outlet compression?

If you and your doctor know the cause of the compression and know how to reverse it, you can end your suffering. Understanding this concept prevents surgery in just about every patient with venous thoracic outlet syndrome (VTOS), arterial thoracic outlet syndrome (ATOS), and neurogenic thoracic outlet syndrome (NTOS) while promoting non-surgical thoracic outlet syndrome treatment and long-term recovery.

To understand this, you need to have extensive knowledge of three things:

1. Thoracic outlet anatomy, brachial plexus anatomy, and neurovascular anatomy
2. Which muscles keep the thoracic outlet and thoracic tunnel open and which muscles close or compress them
3. How muscle tension is controlled and how abnormal muscle tension contributes to thoracic outlet compression In this chapter, I discuss exactly what thoracic outlet syndrome is and provide an extensive review of the thoracic outlet anatomy, including the brachial plexus, subclavian artery, subclavian vein, first rib, clavicle, scalene muscles, pectoralis minor muscle, and surrounding neurovascular structures.

Included in this chapter are custom illustrations of a normal thoracic outlet anatomy and an abnormally compressed thoracic outlet anatomy. After studying these illustrations, I guarantee you will better understand thoracic outlet syndrome, thoracic outlet compression, brachial plexus compression, vascular compression, neurovascular compression, and other conditions associated with this region of the body, including costoclavicular syndrome, interscalene triangle compression, pectoralis minor syndrome (PMS), cervical rib syndrome, double crush syndrome, and compression neuropathies.

Chapter 2, “A Painful Misunderstanding of Human Engineering,”

In Chapter 2, “A Painful Misunderstanding of Human Engineering,” I present the 340-year-old model of human engineering that doctors and other healthcare professionals base their approach to examining, diagnosing, and treating thoracic outlet syndrome, chronic pain, neck pain, shoulder pain, back pain, herniated discs, and other musculoskeletal disorders. Then I present a model of human movement and biomechanics proposed by Harvard University scientists that better explains how the body absorbs impacts, recycles energy, and preserves healthy joint function. Then I present an advancement of the model proposed by Harvard University scientists that I nicknamed the Human Spring Model.

The Human Spring Model not only explains how the body absorbs impacts, recycles energy, and opens spaces for joints, it also eloquently explains how human spring engineering provides a safe passage for blood vessels, nerves, the brachial plexus, the subclavian artery, and the subclavian vein through the thoracic outlet, thoracic inlet, and thoracic tunnel, helping explain the true biomechanics and underlying cause of thoracic outlet syndrome (TOS) and other compression syndromes.

I present logical, easy-to-understand arguments explaining why my Integrated Spring-Mass Model of Biomechanics is the only model that fully explains how the human body performs these important biomechanical functions according to the laws of physics, engineering, and nature.

1. How does the body absorb collisions with Earth during walking and running? A spring off the ground better protects the joints from impact forces, repetitive stress, degenerative joint disease, arthritis, and chronic musculoskeletal injuries than a bang and a twist with a rigid lever.
2. How does the body recycle energy to prevent chronic fatigue? A spring off the ground with elastic tissues and energy-storing elements can recycle more energy than a bang and a twist with a rigid lever, improving movement efficiency, athletic performance, endurance, and resistance to chronic fatigue.
3. How does the body open spaces for joints, such as the ankles, the knees, and the hips? A spring can maintain and open healthy joint spaces in the ankles, knees, hips, spine, and other joints, whereas the body cannot maintain these spaces with a rigid lever mechanism alone.
4. How does the body open spaces and tunnels for the safe passage of blood vessels and nerves? Springs and spring-suspension engineering can suspend the shoulder over the thoracic inlet, thoracic outlet, and thoracic tunnel, maintaining healthy spaces for the brachial plexus, subclavian artery, and subclavian vein. It is impossible to maintain or open a tunnel between the shoulder and the chest to allow the safe passage of blood vessels and nerves into the arm using lever biomechanics alone.

You will learn that this lever-series model of biomechanics cannot explain these important functions the body must perform and, in fact, it does not even abide by the laws of physics, engineering, and nature. I will present scientific evidence demonstrating that the human body uses spring engineering, elastic energy storage, and spring-mass biomechanics to accomplish these four essential functions.

When I’m done, you will agree that my Human Spring Model, or Integrated Spring-Mass Model of Biomechanics, is more logical and must replace the old, outdated, and incorrect lever-series model of human movement. Don’t worry—medical physicians, sports medicine specialists, rehabilitation professionals, and doctors around the world have evaluated this model, so there should not be any arguments about its scientific foundation.

Chapter 3, “Human Spring Engineering,”

explains thoroughly, in simple terms, how looking at the human body as a spring is a more comprehensive and logical biomechanical model for understanding human movement, human biomechanics, thoracic outlet biomechanics, musculoskeletal biomechanics, and how the body works according to the laws of physics and nature.

Looking at the human body modeled as a spring allows you to fill the gap in what is misunderstood about human biomechanics, movement mechanics, musculoskeletal function, thoracic outlet syndrome, chronic pain, compression disorders, joint mechanics, and the human body. It gives you an approach that is well-researched, sound in principle, and, best of all, delivers optimum results for understanding thoracic outlet syndrome diagnosis, non-surgical thoracic outlet syndrome treatment, movement dysfunction, injury prevention, rehabilitation, chronic pain recovery, and human performance.

Chapter 4, “The Control of Tension on Your Human Spring,”

I discuss how we can make changes in the tension of our body’s spring as a part of everyday life. When you step off a curb, you know exactly the amount of muscle tension and spring tension needed to have a safe landing. Gymnasts know exactly how much tension to have throughout their body's spring mechanism for a safe landing. Jogging is different from sprinting, only by the level of tension in the lower body spring, which affects biomechanics, movement efficiency, shock absorption, energy recycling, joint protection, and athletic performance.

This change in tension is considered normal and essential to live in harmony with Earth’s gravity, maintain healthy biomechanics, preserve joint spaces, and optimize the body's natural spring mechanism for movement, injury prevention, and recovery.

How does this apply to your thoracic outlet syndrome, thoracic outlet compression, chronic neck pain, shoulder pain, nerve compression, and recovery from thoracic outlet syndrome?

Chapter 5, “The Cause of Compression!”

discusses the difficulties that doctors have in diagnosing the cause of thoracic outlet syndrome (TOS), thoracic outlet compression, brachial plexus compression, and neurovascular compression.

The Mayo Clinic, the Cleveland Clinic, and the National Institute of Neurological Disorders and Stroke, plus top-10 ranked hospitals for neurology and neurosurgery, tell us that compression of the thoracic outlet, brachial plexus, and surrounding blood vessels and nerves is what leads to thoracic outlet syndrome (TOS).

However, this spring tension, muscle tension, and abnormal muscle tightness can get out of your control. This happens when reflexes in the brain take over and dominate the tension, putting you in an abnormally compressed state of chronic pain, nerve compression, reduced circulation, and long-term suffering.

Therefore, how this tension is controlled by reflexes is extremely important for understanding the cause of thoracic outlet syndrome, neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, herniated discs, headaches, chronic neck pain, shoulder pain, upper back pain, and many other painful compression syndromes.

This was the “aha” moment that determined what was getting in the way of the healing process and why conventional treatments often fail to permanently relieve thoracic outlet syndrome.

Understanding that tension creates drag on the energy-saving spring system is what explains the cause of chronic fatigue syndrome, movement inefficiency, muscle fatigue, and impaired healing.

So, if doctors and other healers don’t know how these important parts of the body are engineered and how the tension is controlled that causes thoracic outlet compression, brachial plexus compression, vascular compression, and narrowing of the thoracic outlet tunnel, then how could they possibly reduce the thoracic outlet compression, restore the thoracic outlet tunnel back to normal, decompress the nerves and blood vessels, and achieve long-term, non-surgical recovery from thoracic outlet syndrome?

Chapter 6, “Break These Laws... Get Sentenced to a Lifetime of Suffering”

lists the most common activities of daily living, poor posture habits, repetitive movements, and lifestyle factors that violate the laws of physics and nature, placing your body in disharmony with Earth's gravity and leading to thoracic outlet compression, nerve compression, blood vessel compression, chronic neck pain, shoulder pain, upper back pain, and other compression syndromes.

When your posture, movement patterns, body mechanics, and muscle tension are not in harmony with gravity, your nervous system reacts by increasing protective muscle tension, twisting your Human Spring, and placing you into a chronic state of compression, inflammation, chronic pain, stiffness, fatigue, and physical dysfunction that can last a lifetime.

In this chapter, I present simple posture correction strategies, ergonomic principles, movement guidelines, and lifestyle modifications that you must follow in your everyday life to abide by the laws of nature and physics so your nervous system can remain in harmony with Earth's gravity, reducing abnormal muscle tension, nerve compression, and thoracic outlet syndrome symptoms while allowing your body's natural healing mechanisms to function properly.

Here I educate you on the best sleeping posture for thoracic outlet syndrome, best sleeping position for neck pain, proper sitting posture, standing posture, multitasking, and computer ergonomics, including proper use of the computer mouse, keyboard, monitor height, workstation setup, desk ergonomics, laptop ergonomics, and visual stress reduction. I also review the dangers of excessive use of your mobile phone, smartphone, tablet, remote controls, gaming devices, and other handheld electronics, as well as the effects of occupational injuries, repetitive strain injuries, poor workplace ergonomics, whiplash injuries, auto accidents, sports injuries, and personal injuries that can overload your Human Spring and contribute to thoracic outlet syndrome, herniated discs, headaches, and chronic musculoskeletal pain.

If you follow these principles and eliminate the daily activities that trigger your nervous system to increase muscle tension and compress your Human Spring, you can reduce thoracic outlet compression, chronic pain, neck pain, shoulder pain, upper back pain, muscle spasms, nerve irritation, inflammation, and movement dysfunction, allowing your body to recover more naturally—even without treatment.

Chapter 7, “How Do They Diagnose It?”

discusses why so many conservative, nonsurgical thoracic outlet syndrome treatments, physical therapy treatments, and other approaches fail thoracic outlet syndrome (TOS) sufferers, as well as patients with other compression syndromes, peripheral nerve compression disorders, and conditions caused by nerve compression, blood vessel compression, or musculoskeletal compression throughout the body.

Most important, your road to recovery starts with a thorough thoracic outlet syndrome examination and the doctor’s physical examination.

Your doctor illogically uses standard orthopedic examinations, lever-based movement examinations, and traditional musculoskeletal examination techniques to determine why your body’s spring system is compressed. It’s illogical!

In this chapter, I review the only way to determine if your thoracic outlet, thoracic outlet tunnel, or neurovascular bundle is compressed and exactly what structure is causing the compression. This requires doctors to perform a comprehensive hands-on physical examination, palpation examination, and thoracic outlet syndrome evaluation. Most don’t even touch you where it hurts!

Don’t you hate that? When they don’t touch you where it hurts, you begin to become skeptical of their medical opinions, don’t you? I did! Maybe that is why you need to read this book.

I will teach you how you should be examined to determine whether you have a pinched nerve, thoracic outlet syndrome, neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, compartment syndrome of the forearm, cubital tunnel syndrome, carpal tunnel syndrome, double crush syndrome, or all of the above. I will review the key thoracic outlet syndrome orthopedic tests, thoracic outlet syndrome physical examination tests, provocative tests, and diagnostic examination procedures that will uncover the true cause of your thoracic outlet compression, brachial plexus compression, subclavian artery compression, subclavian vein compression, and your other pain and suffering.

Most important, I will teach you how to perform a self-examination for thoracic outlet syndrome so you can better understand your condition and identify the cause of your symptoms. Then you can take an active role in your recovery by using the self-treatment techniques, thoracic outlet syndrome exercises, and non-surgical treatment methods I provide in Chapter 13, “What Works and Why.”

Chapter 8, “More Tests?”

reviews why most patients think that thoracic outlet syndrome diagnostic tests might be able to spot thoracic outlet syndrome or a herniated disc of the neck.

You’ll understand after reading this book that if doctors tell you they can diagnose thoracic outlet syndrome (TOS) or most musculoskeletal conditions, compression syndromes, or peripheral nerve compression disorders with a single diagnostic test, such as an MRI scan, they are not being truthful.

In fact, the findings on your MRI scan of the neck (cervical spine MRI) that you eagerly await oftentimes lead your doctor to a misdiagnosis or incorrect diagnosis. This can delay your thoracic outlet syndrome recovery and appropriate treatment. What is worse is that it could lead you into unnecessary thoracic outlet syndrome surgery, cervical spine surgery, or herniated disc surgery. Getting cut open to have metal plates screwed into your neck, when you never needed the operation, may leave you with chronic neck pain, persistent postoperative pain, and you may still have the same thoracic outlet syndrome symptoms, including arm numbness, hand tingling, and shoulder pain because the true cause of your symptoms was never addressed.

In 2016, I gave a presentation titled "The Earliest Detection, Intervention and Prevention of Compression Syndromes, Thoracic Outlet Syndrome (TOS), Herniated Discs and Degenerative Joint Disease" at the World Congress of Anti-Aging and Longevity in Mexico City, Mexico.

Did I talk about the latest diagnostic imaging tests, including the MRI scan for herniated discs, MRI of the cervical spine, or diagnostic tests for thoracic outlet syndrome? Yes. Here is the scientific study that confused many of the doctors in the audience.

I presented three individual studies conducted by Japanese researchers who performed MRI scans of the cervical spine (neck) on volunteers who were completely pain free. These healthy volunteers had never experienced neck pain, back pain, or symptoms of a herniated cervical disc during their lives.

The researchers found that more than 30 percent of these volunteers had cervical herniated discs, disc bulges, or other degenerative changes in the neck that they never knew they had.

Doctors know that with an MRI scan of the neck, they have more than a 30 percent chance of finding a herniated cervical disc. If that disc herniation existed before the onset of your thoracic outlet syndrome, pinched nerve symptoms, arm pain, hand numbness, or chronic neck pain, then that herniated disc is not necessarily the cause of your symptoms.

But many doctors will probably tell you it is. Are they intentionally misleading you, or do they simply not understand the limitations of MRI findings and the importance of correlating diagnostic imaging with a thorough physical examination and your actual symptoms?

For more than 30 percent of you, the MRI scan will reveal a herniated cervical disc that existed long before the onset of your pain.

That finding alone can confuse even a well-meaning doctor. The difference is that now you are sitting face to face with a neurosurgeon or orthopedic spine surgeon, discussing neck surgery, cervical fusion, or herniated disc surgery for a condition that may never have been the true cause of your suffering.

Again, this misunderstanding of MRI scan results, cervical spine imaging, and other diagnostic tests can lead to a misdiagnosis, mistreatment, unnecessary surgery, and ultimately a lifetime of unnecessary pain and suffering. Because most patients do not fully understand the strengths and limitations of these diagnostic tests, it is easy to accept an incorrect explanation for the cause of your symptoms.

That ends right here and right now.

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Chapter 9, “Is It Thoracic Outlet Syndrome (TOS), This, That, or All of the Above?”

teaches you that patients with thoracic outlet syndrome are among the most misdiagnosed, mismanaged, misinformed, and mistreated patients today. The overlapping thoracic outlet syndrome symptoms, complex anatomy, and wide range of conditions that mimic TOS make an accurate thoracic outlet syndrome diagnosis extremely challenging.

Treatments fail when treatment is applied to the wrong diagnosis. Failed attempts at conservative thoracic outlet syndrome treatment, physical therapy, chiropractic care, massage therapy, medications, injections, and rehabilitation exercises may be related to an incorrect diagnosis or an incomplete diagnosis. Keeping it simple, the patient may be misdiagnosed, underdiagnosed, or treated for only one part of a complex nerve compression or vascular compression disorder.

What is even more challenging is that many physicians who get the thoracic outlet syndrome diagnosis right still get the underlying cause wrong. Because they do not identify and treat the cause of the thoracic outlet compression, even the correct diagnosis can lead to a treatment approach that is destined to fail.

After consulting with hundreds of patients with neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, chronic neck pain, shoulder pain, arm numbness, hand tingling, arm weakness, and swollen hands, it has been my experience that not one of the doctors they previously consulted told them that continuing their current posture habits, movement patterns, and daily activities could prevent meaningful relief and eventually lead them to consider thoracic outlet syndrome surgery. Why would they? TOS surgery is how they make a living.

Many time-strapped doctors in every branch of medicine typically spend only 10 to 15 minutes with each patient—not necessarily because they do not care, but because there are simply not enough hours in the day to meet the demands of a comprehensive thoracic outlet syndrome examination, detailed medical history, neurological examination, vascular examination, orthopedic testing, posture evaluation, and biomechanical assessment.

Before I accept a patient, the patient must complete a comprehensive online application that requires a detailed description of how the condition progressed from being pain-free to developing chronic thoracic outlet syndrome symptoms. Patients grade every symptom, including neck pain, shoulder pain, upper back pain, chest pain, arm pain, arm numbness, hand tingling, weakness, swelling, and circulation changes. They also provide their medical records, diagnostic imaging, MRI reports, nerve conduction studies, vascular tests, previous diagnoses, and treatment history.

I then spend approximately five hours reviewing the submitted information and preparing a detailed preconsultation report covering the patient’s complete medical history. Depending on the complexity of the case, this thoracic outlet syndrome case review may be between 25 and 150 pages long.

I email the preconsultation report to the patient so the patient can confirm that the information is complete and accurate. Once the report has been verified, we schedule a three-hour consultation and review the report page by page and word for word. During this thoracic outlet syndrome consultation, I gather additional information about the symptoms, injuries, posture habits, occupational demands, sports activities, previous treatments, and possible causes of the nerve and blood vessel compression.

After examining the case in this level of depth, I believe I can provide the patient with a more accurate explanation of what is wrong, how the condition developed, what is causing the thoracic outlet compression, how it should be approached, how it should be treated and managed, and how long the recovery process may take.

Yes, I said how long it may take to reverse the condition, because I believe the mechanical and functional causes of many thoracic outlet syndromes can be reversed. The body has the ability to heal when the factors interfering with the healing process—such as chronic muscle tension, poor posture, abnormal biomechanics, repetitive strain, nerve compression, vascular compression, and inflammation—are identified and properly addressed.

How are doctors supposed to differentiate between thoracic outlet syndrome and the 30 or more conditions that can mimic thoracic outlet syndrome? These differential diagnoses may include cervical radiculopathy, cervical disc herniation, brachial plexus injury, carpal tunnel syndrome, cubital tunnel syndrome, pectoralis minor syndrome, rotator cuff disorders, shoulder impingement, myofascial pain syndrome, multiple sclerosis, syringomyelia, vascular disease, and double crush syndrome.

Even when thoracic outlet syndrome is a doctor’s area of expertise, a thorough thoracic outlet syndrome differential diagnosis may require an hour or more of detailed history-taking, physical examination, neurological testing, vascular testing, orthopedic testing, palpation, posture analysis, and biomechanical evaluation.

Patients will tell you that it takes me approximately two to three hours to properly examine a patient with thoracic outlet syndrome. This is why we perform the complete thoracic outlet syndrome examination on Sunday afternoon, the day before the first treatment begins on Monday.

This is why it is so important to take your time with the examination. A rushed examination may miss the true cause of the symptoms, while a comprehensive examination can help identify whether the patient has neurogenic thoracic outlet syndrome, vascular thoracic outlet syndrome, another condition that mimics TOS, or several compression disorders occurring at the same time.

Here are the 30 conditions that mimic thoracic outlet syndrome.

1. Herniated disc, bulged disc, or slipped disc pinching the C6 nerve root (cervical disc herniation)
2. Herniated disc, bulged disc, or slipped disc pinching the C7 nerve root (cervical disc herniation)
3. Herniated disc, bulged disc, or slipped disc pinching the T1 nerve root (thoracic outlet syndrome mimic)
4. Cervical radiculopathy, brachial plexus injury, or brachial neuritis (brachial plexopathy)

5. Cervical spondylosis (neck arthritis, cervical osteoarthritis, degenerative disc disease)

6. Neck trauma, whiplash injury, sports injury, or cervical spine injury

7. Thoracic disc injury, thoracic disc herniation, or thoracic radiculopathy

8. Clavicle injuries, acromioclavicular (AC) joint injury, or shoulder separation

9. Clavicle fracture malunion (broken collarbone), clavicle deformity, or healed clavicle fracture

10. Inflammatory shoulder conditions including shoulder tendonitis, shoulder arthritis, bursitis, or adhesive capsulitis (frozen shoulder)

11. Shoulder impingement syndrome (subacromial impingement)

12. Rotator cuff inflammation, rotator cuff tendonitis, rotator cuff tendinopathy, or rotator cuff tear

13. Intercostal neuritis (pinched nerve between the ribs), intercostal neuralgia, or rib nerve pain

14. Cubital tunnel syndrome, cubital tunnel compression, or pinched ulnar nerve at the elbow ("funny bone")

15. Carpal tunnel syndrome (CTS), median nerve compression, or wrist nerve entrapment

16. Compression of Guyon's canal (ulnar tunnel syndrome, ulnar nerve compression at the wrist)

17. Median nerve entrapment, pronator syndrome, or forearm compartment syndrome

18. Double crush syndrome (two nerve compression sites or two nerve choke points)

19. Triple crush syndrome (three nerve compression sites or three nerve choke points)

20. Quadruple crush syndrome (four nerve compression sites or four nerve choke points)

21. Vascular disease, atherosclerosis, peripheral artery disease (PAD), or arterial insufficiency

22. Paget-Schroetter syndrome, effort thrombosis, upper extremity deep vein thrombosis (DVT), or blood clot

23. Pancoast tumor (superior sulcus lung cancer or lung apex tumor)

24. Spinal cord tumor, spinal neoplasm, benign spinal tumor, or malignant spinal tumor

25. Complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD), or chronic regional pain syndrome

26. Degenerative spinal cord disease, Multiple Sclerosis (MS), demyelinating disease, or autoimmune neurological disease

27. Degenerative spinal cord disease, syringomyelia, spinal cord syrinx, or Chiari malformation–associated syringomyelia

28. Raynaud's phenomenon (Raynaud disease, Raynaud syndrome, or cold-induced vasospasm)

29. Cervical ribs, fibrous bands, congenital cervical rib syndrome, or congenital thoracic outlet anomaly

30. Myofascial pain syndrome, myofascial trigger points, chronic muscle pain, or trigger point syndrome This version broadens search coverage while preserving the meaning of each diagnosis and is much more likely to capture the ways both patients and clinicians search for these conditions.

All these conditions mimic the symptoms of thoracic outlet syndrome. So, if you only got that 10–15-minute patient history and the brief examination, and then the doctor made a diagnosis, or if the treatment approach the doctor is using isn’t getting you the results you expected, you might be misdiagnosed.

Also, what really confuses doctors and patients is that you could be underdiagnosed. What that means is that you were diagnosed with carpal tunnel syndrome, but in reality you have carpal tunnel syndrome, median nerve entrapment, rotator cuff tear, and a thoracic outlet syndrome at the same time.

If it’s not the doctors’ area of expertise, and they don’t know what goes into a thorough exam, you’ll probably get 10 minutes of chitchat. If they don’t know some basic anatomy (for example, how the thoracic outlet is engineered, how you should be examined), then a doctor could simply skim over the exam, never touching the area that hurts, and instead order an MRI scan of the neck and a referral to a neurosurgeon.

Do you wish there was a way to fact check your doctor’s thoracic outlet syndrome diagnosis?

Well, in this chapter, we will review each of the 30 different medical diagnoses that could be considered with your array of thoracic outlet syndrome like symptoms and give you tips on how you can differentiate between each of them and thoracic outlet syndrome.

Chapter 10, “What Treatment Doesn’t Work and Why?”

reviews my exhaustive research of more than 2,500 studies in the U.S. National Library of Medicine, part of the National Institutes of Health database. This is the complete list of treatment procedures and approaches studied for the treatment of thoracic outlet syndrome. I can almost guarantee the treatment approach used by your doctor is on this list.

1. Medication therapy for thoracic outlet syndrome: analgesic drug therapy, antidepressants, anticonvulsants, and other prescription medications.
2. Scalene muscle injection (bupivacaine) for thoracic outlet syndrome.
3. Nonsteroidal anti-inflammatory drugs (NSAIDs) for thoracic outlet syndrome pain relief.
4. Painkillers and pain medication for thoracic outlet syndrome symptom relief.

5. Botox (botulinum toxin) scalene muscle injection for thoracic outlet syndrome.

6. Scalene muscle stretching and pectoralis minor stretching exercises for thoracic outlet syndrome.

7. Cervical traction and spinal traction therapy for thoracic outlet syndrome.

8. Nerve gliding (nerve flossing) exercises for thoracic outlet syndrome.

9. Therapeutic ultrasound and electrical muscle stimulation (EMS/NMES) for thoracic outlet syndrome.

10. Supportive bras and bra modifications for breast hypertrophy–related thoracic outlet syndrome.

11. Breast reduction surgery (reduction mammoplasty) for breast hypertrophy–related thoracic outlet syndrome.

12. Ergonomic corrections and posture correction for thoracic outlet syndrome.

13. Workstation ergonomic assessment and computer workstation modifications for thoracic outlet syndrome.

14. First rib adjustment, first rib mobilization, and first rib manipulation for thoracic outlet syndrome.

15. Massage therapy, deep tissue massage, and myofascial massage for thoracic outlet syndrome.

16. Strengthening exercises, rehabilitation exercises, and physical therapy exercises for thoracic outlet syndrome.

Which one do you think, by itself, removes the compression causing thoracic outlet syndrome and restores the normal opening of the thoracic outlet and thoracic tunnel?

None of them!

Now do you wonder why you’re not getting better from your thoracic outlet syndrome symptoms, chronic neck pain, shoulder pain, arm numbness, and hand tingling?

I will provide simple and logical explanations of why these 16 thoracic outlet syndrome treatment approaches, when used individually, cannot reverse the underlying cause of thoracic outlet syndrome, eliminate brachial plexus compression, or permanently relieve the compression of the nerves and blood vessels that produce your symptoms.

If thoracic outlet syndrome treatment, rehabilitation, and training approaches are not compatible with the true engineering of the human body and are contrary to the laws of physics and nature, they are destined to fail. And you know what? Time and time again, they do fail.

Much of today's standard-of-care treatment for thoracic outlet syndrome, including chiropractic adjustments, joint mobilization, stretching exercises, physical therapy, rehabilitation exercises, nerve gliding, trigger point injections, medications, and thoracic outlet syndrome surgery, is destined to fail to achieve true maximum medical improvement, because these approaches do not remove the abnormal tension on your Human Spring or correct the underlying compression of the thoracic outlet.

The vertebral discs, thoracic outlet, and thoracic tunnel are engineered with spring mechanics, not simply lever mechanics. Doctors cannot permanently reverse thoracic outlet compression, brachial plexus compression, or the compression of the subclavian artery and subclavian vein using treatment approaches that are effective only for lever-based biomechanics rather than the body's true Integrated Spring-Mass Model.

What is logical about a doctor not knowing the engineering of a machine he is paid to fix?

Chapter 11, “When in Doubt, Cut It Out?”

provides additional information about why doctors recommend thoracic outlet syndrome surgery for relief of thoracic outlet syndrome (TOS). After repeated attempts with conservative treatment, physical therapy, massage therapy, stretching, medications, and other treatments designed to address the body as a lever mechanism fail to decompress your human spring mechanism, many patients elect to undergo thoracic outlet decompression surgery, first rib resection, or scalenectomy. You tried everything, so when in doubt, cut it all out, right?

Don’t forget, doctors are not magicians. Surgery cannot simply cut the pain out of your body if the underlying cause of nerve compression, blood vessel compression, and abnormal biomechanics has not been corrected. You can’t think this way!

Because doctors could not find a logical, conservative treatment to relax chronically tight scalene muscles, they remove them with a scalenectomy. Because tight scalenes can elevate the first rib, compressing the brachial plexus, subclavian artery, and subclavian vein between the first rib and clavicle, surgeons may perform a first rib resection to enlarge the thoracic outlet.

So, do you really still think doctors perform thoracic outlet syndrome surgery because they have exhausted every logical, evidence-based, conservative treatment option?

You would think there is a more logical way to reduce muscle spasms, decrease thoracic outlet compression, restore normal thoracic outlet biomechanics, and reposition the first rib to reopen the outlet and tunnel rather than permanently removing muscles and bone, right?

Should thoracic outlet syndrome surgery be a last resort? After reading this book, you will understand why surgery for compression syndromes, including thoracic outlet syndrome, neurogenic thoracic outlet syndrome, and herniated discs, is often the result of a painful misunderstanding of human biomechanics, human engineering, and the body's natural spring mechanism, rather than the only remaining treatment option.

Chapter 12, “Paget-Schroetter Syndrome?”

asks, “Is thoracic outlet syndrome dangerous?”

If you make mistakes in your game plan to reverse thoracic outlet syndrome (TOS) or wait too long to treat this compression disorder, you could be putting yourself at risk for serious and potentially life-threatening complications.

A blood clot (deep vein thrombosis or DVT) can form in the compressed subclavian vein or axillary vein as a result of venous thoracic outlet syndrome (VTOS). If this clot dislodges, it can travel through the bloodstream into your lungs, causing a pulmonary embolism (PE), lung tissue death (pulmonary infarction), severe difficulty breathing (shortness of breath), chest pain, or even sudden death. This condition is known as Paget-Schroetter syndrome, also called effort thrombosis or primary upper-extremity deep vein thrombosis (UEDVT).

In this chapter, I review Paget-Schroetter syndrome, venous thoracic outlet syndrome, subclavian vein compression, blood clot formation, deep vein thrombosis, pulmonary embolism, and the warning signs that every patient with thoracic outlet syndrome should recognize. I also commissioned a detailed medical illustration that explains Paget-Schroetter syndrome, venous thoracic outlet syndrome, and how a blood clot develops from compression of the subclavian vein, so you can clearly understand this serious complication and truly "get it."

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Chapter 13, “What Works and Why?”

reveals the ONLY two forms of treatment that can effectively reduce the compression that causes thoracic outlet syndrome, including neurogenic thoracic outlet syndrome and vascular thoracic outlet syndrome, without surgery.

Here I outline the most effective non-surgical treatment for thoracic outlet syndrome by reducing the compression on the brachial plexus, subclavian artery, and subclavian vein that pass through the thoracic outlet. I had a photographer take pictures of a model demonstrating these self-massage techniques, thoracic outlet syndrome stretching exercises, and therapeutic stretches that will begin to reduce compression, ease your symptoms, improve mobility, and get you on the road to recovery.

I also reveal the most powerful drug-free therapy that doctors should be using to quickly reduce inflammation, pain, muscle tension, and the muscle spasms that compress the thoracic outlet, restrict normal biomechanics, and twist your frame into a chronic state of pain and suffering.

The reason most doctors are not using this conservative treatment for thoracic outlet syndrome is because they cannot receive insurance reimbursement for the therapy. Unfortunately, many healthcare providers are limited by what insurance companies will pay for rather than what may be most effective for reducing compression and restoring function.

What is great is that you do not need to be a doctor to use this therapy. You can purchase the recovery tool, perform these self-treatment techniques at home, and begin improving your thoracic outlet syndrome symptoms, reducing compression, and accelerating your recovery without depending entirely on repeated visits to a healthcare provider.

Chapter 14, “Spring Training!”

tells you my personal story. Several years ago, my friend and I were in a really bad motor vehicle accident (car accident). The 70-mile-per-hour collision into a concrete median totaled her car and caused significant injuries. The accident caused my friend spinal trauma, whiplash, an upper back injury, a cervical disc bulge (herniated disc), thoracic outlet syndrome (TOS), and the symptoms of a mild concussion (traumatic brain injury).

After the accident, I had no pain whatsoever. What?

I had been doing the spring strengthening exercises, thoracic outlet syndrome exercises, posture strengthening exercises, and barefoot running training listed in Chapter 14.

So, the reason I did not get hurt was because my Human Spring "Spring Training" approach to strengthening the human spring to resist these incredible impact forces and collision forces. This approach not only rehabilitates injuries and restores normal biomechanics, but it also protects the body from injury, improves shock absorption, enhances athletic performance, and helps prevent neck injuries, back injuries, sports injuries, and overuse injuries.

I hired one of the top photographers from Muscle & Fitness and Shape magazines, Bill Dobbins, to shoot color photos of top fitness models Rachel Moore and Sherry Goggin demonstrating these thoracic outlet syndrome exercises, rehabilitation exercises, strengthening exercises, mobility exercises, stretching exercises, and injury prevention exercises.

I also hired Chicago photographer Stan Magoni to photograph model Gabija Guzauskaite performing the 10 recommended thoracic outlet syndrome stretches and the exercises we use to open, stabilize, strengthen, and decompress the thoracic outlet in our thoracic outlet syndrome (TOS) patients. These photos were taken at River North CrossFit and at Team Doctors® Rehabilitation and Training Center in Chicago.

There are 30 thoracic outlet syndrome stretches and exercises specifically designed to widen, open, strengthen, stabilize, and decompress the muscles surrounding the thoracic outlet. These thoracic outlet syndrome rehabilitation exercises will also help you prevent neck injuries, whiplash injuries, sports injuries, repetitive strain injuries, workplace injuries, and car accident injuries while improving posture, shoulder stability, and upper body biomechanics.

The increased blood flow, circulation, mobility, flexibility, and strengthening of the muscles of the back, chest, neck, and shoulders greatly improve your posture, spinal alignment, shoulder mechanics, and help you fight the fatigue, muscle tension, and neck pain associated with sitting for long sessions at the computer or performing repetitive work.

Also, I will teach you which thoracic outlet syndrome stretches, neck stretches, shoulder stretches, and rehabilitation exercises can actually make thoracic outlet syndrome symptoms worse and which exercises are most effective for safe recovery and long-term prevention.

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Chapter 15, “Conclusion,”

explains why the odds are often against recovering from thoracic outlet syndrome (TOS) when patients follow conventional treatment alone. However, by applying what you learn in this book about thoracic outlet syndrome treatment, biomechanics, the Human Spring Model, and my proven approach, you can overcome chronic pain and begin your journey toward long-term recovery.

This book is about the earliest detection, accurate diagnosis, early intervention, prevention, and non-surgical treatment of thoracic outlet syndrome to help you avoid years of unnecessary pain and suffering.

However, it is about much more than just thoracic outlet syndrome. In this book, you will learn an entirely new model of human biomechanics and a revolutionary approach that helps explain why the body breaks down, why chronic pain develops, why healing sometimes fails, and why so many people degenerate into a chronic state of pain, compression, inflammation, and suffering.

It also reveals practical strategies for restoring human performance, movement efficiency, healthy biomechanics, and long-term musculoskeletal health. You will discover new ways of thinking about lifestyle choices, posture, exercise, injury prevention, recovery, and how healthcare professionals examine, diagnose, and treat thoracic outlet syndrome, chronic neck pain, shoulder pain, upper back pain, and other compression disorders. Most importantly, everything you learn follows the fundamental laws of physics, biomechanics, and nature in a way that is logical and easy to understand.

I strongly believe the current standard of care for thoracic outlet syndrome and other musculoskeletal disorders must eventually be replaced with examination, treatment, rehabilitation, and prevention protocols based on the true engineering of the human body. After reading this book, you will understand why the Human Spring Model and the Integrated Spring-Mass Model of Biomechanics provide the only comprehensive explanation of human movement that fully respects the laws of nature and physics.

I am confident you will agree that evaluating and treating the body as a human spring, rather than only as a system of levers, offers a more logical approach to achieving predictable improvements in thoracic outlet syndrome recovery, chronic pain relief, injury prevention, sports performance, and long-term musculoskeletal health. These are the same principles and treatment strategies we use every day to help patients recover. I believe that after reading this book, you will never again allow your doctor to examine and treat your body the same way without first considering the role of biomechanics, compression, posture, movement, and the Human Spring Approach.

Read on to discover more "aha" moments as you learn the science behind thoracic outlet syndrome, human biomechanics, and the Human Spring Approach to lasting recovery.