Like many of you, I didn’t know I had thoracic outlet syndrome (TOS). I did not know what the thoracic outlet syndrome symptoms were. All I knew was that I had chronic neck pain, shoulder pain, upper back pain, tingling hands, and arm numbness caused by thoracic outlet syndrome.
Unfortunately, I was misdiagnosed and mistreated for seven painful years with thoracic outlet syndrome.
This book is written to ensure you don’t end up suffering as I did from thoracic outlet syndrome or live with untreated thoracic outlet syndrome symptoms.
The thoracic outlet (inlet or compartment) is a tunnel under the shoulder and over the rib cage that allows the safe passage of the subclavian artery, subclavian vein, and nerves (brachial plexus) that pass from the chest and neck area into the arm and hand. Understanding the thoracic outlet anatomy is essential for understanding thoracic outlet syndrome (1).
The thoracic outlet anatomy and how the subclavian artery, subclavian vein, neurovascular bundle, including the brachial plexus, pass through the passageway require an even more complex understanding of how the body moves— biomechanics. Subsequently, there is inadequate professional understanding about the thoracic outlet, thoracic outlet syndrome, thoracic outlet syndrome symptoms, and what causes thoracic outlet syndrome.
If you believe you are getting nowhere being treated for thoracic outlet syndrome, I know how you feel. I suffered from chronic neck pain, chronic upper back pain, constant shoulder pain, arm numbness, tingling arms, and tingling hands, which were misdiagnosed for seven years. What I was suffering from was bilateral thoracic outlet syndrome, a severe form of thoracic outlet syndrome.
Here is the really pathetic part of the story.
During that seven-year period, I was a chiropractic student in a top chiropractic college surrounded by teachers who were doctors of chiropractic and experts in chiropractic medicine. I asked for help from everyone, yet I graduated in chronic pain caused by undiagnosed thoracic outlet syndrome.
As a licensed chiropractor, I went to every back pain center to consult with physical therapists, sports doctors, orthopedic surgeons, neurologists, family practitioners, neurosurgeons, many massage therapists, and acupuncturists. Then I went to all the sub-specialty medical specialists, such as the back specialist, the sports chiropractor, a neck pain specialist, a shoulder doctor, a spine doctor, a carpal tunnel doctor, pain physicians, and even a specialist called an upper cervical chiropractic physician. I didn’t go to a thoracic outlet syndrome specialist, and I wasn’t the biomechanics expert back then because there weren’t any back then.
I got opinions from all these doctors, but not one of them could properly diagnose or explain this chronic pain syndrome, which I eventually came to know was thoracic outlet syndrome (TOS).
Why can't anyone diagnose my pain?
Traditional orthopedic examinations, neurological tests, X-rays, MRI scans, CT scans, and nerve conduction studies are designed to identify structural abnormalities such as fractures, disc herniations, arthritis, tumors, or permanent nerve damage. However, according to the Human Spring Theory, thoracic outlet syndrome is often not a disease of damaged tissues but a failure of the thoracic outlet spring suspension system. The thoracic outlet is designed to expand, recoil, and continuously maintain a protective space around the brachial plexus, arteries, and veins during movement. When the thoracic outlet spring suspension system loses its elasticity and becomes stiff or compressed, the available space narrows dynamically, creating thoracic outlet compression that places abnormal mechanical stress on the nerves and blood vessels—even though the anatomy may appear normal on an MRI scan or other static imaging.
This is why so many patients with thoracic outlet syndrome are told that their MRI scan, neurological tests, and orthopedic examinations are "normal" despite experiencing significant pain, numbness, tingling, weakness, or arm fatigue. These diagnostic tests are performed while the body is at rest and cannot determine whether the thoracic outlet spring suspension system is functioning normally during movement. The Human Spring Approach identifies the loss of spring function that produces dynamic thoracic outlet compression, rather than searching only for permanent structural damage. By restoring the elasticity and biomechanics of the thoracic outlet spring suspension system, the underlying mechanical cause of thoracic outlet syndrome can be identified and corrected instead of merely treating its symptoms.
For every expert I saw, I got a different differential diagnosis—from a herniated cervical disc, rotator cuff syndrome, pinched nerve in the neck, nerve compression between the thoracic ribs (called intercostal neuritis), and herniated discs in my neck instead of the correct diagnosis of thoracic outlet syndrome.
Why do doctors disagree about my diagnosis?
Doctors often disagree about a diagnosis because each specialty is trained to recognize problems within its own area of expertise. An orthopedic surgeon may focus on bones and joints, a neurologist on nerve function, a physical therapist on movement, and a vascular specialist on blood vessels. Each may identify findings that fit their specialty, yet none of these evaluations may determine whether the thoracic outlet spring suspension system is functioning normally. As a result, patients with thoracic outlet syndrome are often given multiple diagnoses that describe the symptoms rather than identify the underlying mechanical cause.
According to the Human Spring Theory, the thoracic outlet is a dynamic spring suspension system designed to maintain a protective space around the brachial plexus, arteries, and veins during movement. When this spring system loses its elasticity, the resulting dynamic thoracic outlet compression may not be visible on an MRI scan, X-ray, or routine neurological examination. Because each specialist evaluates only one part of the problem, they may disagree on the diagnosis, while the true mechanical failure of the thoracic outlet spring suspension system remains undetected. The Human Spring Approach unifies these seemingly different diagnoses by identifying the biomechanical dysfunction responsible for the patient's symptoms.
I tried almost all the chiropractic techniques taught in chiropractic medicine, involving every way to adjust the spine. The only non-surgical treatment that helped me was my father’s adjustments for an elevated first rib, a condition commonly associated with thoracic outlet syndrome.
I did a lot of work with massage therapists trying different styles of bodywork, such as manual therapy, neck stretching, nerve gliding, which did nothing for my chronic nerve compression, deep tissue therapy, and Swedish massage. None of these treatments addressed the underlying thoracic outlet syndrome.
When those didn’t provide lasting relief, I tried more drastic measures, such as muscle injections for pain, injections for back pain, and trigger point injections. How long do trigger point injections last?
Most lasted a few days and gave a little relief or no change. How much do trigger point injections cost? Too much!
I eventually started losing my faith in the alternative care approach and started to consult with medical physicians. I was offered just about every approach to treatment, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants for back pain, analgesic drug therapy, and even painkillers for symptom reduction. I did not take the medications for my thoracic outlet syndrome, neck pain, shoulder pain, or upper back pain.
Some people think of chiropractors as doctors practicing holistic medicine, alternative medicine, or complementary medicine. My father and I practiced together for the first 12 years I was in practice. He was a naturopathic doctor and a good chiropractor. As a naturopathic physician, he offered natural healing with holistic therapy, so I guess you would consider our center an alternative health center specializing in chronic pain, neck pain, and thoracic outlet syndrome.
Toward the end, I was referred to spine doctors. These three orthopedic surgeons and neurosurgeons said, “Well, you tried everything already, so why don’t you try neck surgery or cervical disc surgery?” One doctor examined me for three minutes, did not order magnetic resonance imaging (MRI), and then recommended rotator cuff tear surgery for my shoulder pain.
I tried many different approaches, which the practitioners all assured me would work. I got no better and, in fact, got progressively worse. My thoracic outlet syndrome, neck pain, shoulder pain, upper back pain, and chronic pain continued to worsen despite treatment.
Why doesn't treatment work?
Many thoracic outlet syndrome treatments fail because they are designed to reduce symptoms rather than restore the function of the thoracic outlet spring suspension system. Medications may reduce pain, injections may temporarily decrease inflammation, and manual therapies may loosen tight muscles, but if the thoracic outlet cannot once again expand, recoil, and maintain the protective space around the brachial plexus, arteries, and veins, the abnormal mechanical compression simply returns. As a result, the symptoms improve for a short time but often come back because the underlying cause has not been corrected.
According to the Human Spring Theory, successful thoracic outlet syndrome treatment requires restoring the elasticity, mobility, and biomechanics of the thoracic outlet spring suspension system. When the spring system regains its ability to absorb forces and maintain adequate space during movement, compression of the nerves and blood vessels is reduced naturally. Instead of repeatedly treating the symptoms of thoracic outlet syndrome, the Human Spring Approach focuses on correcting the mechanical dysfunction that caused the compression in the first place, creating the opportunity for lasting recovery.
So, if this chiropractic doctor can’t find the right treatment and lifestyle approach to reverse thoracic outlet syndrome after seven years, you shouldn’t feel bad that you haven’t found the solution to your chronic thoracic outlet syndrome, thoracic outlet syndrome symptoms, neck pain, shoulder pain, and chronic pain.
In fact, thoracic outlet syndrome is one of the most commonly misdiagnosed, mistreated conditions in medicine. This confusion about thoracic outlet syndrome is why many of you are not finding relief from the chronic pain, neck pain, shoulder pain, upper back pain, and thoracic outlet syndrome symptoms.
I was once confused myself, but I discovered why so many doctors have such a difficult time with thoracic outlet syndrome. I have been free from chronic neck pain, upper back pain, shoulder pain, and thoracic outlet syndrome for the past 25 years.
What I found was a huge misunderstanding of human engineering. The secrets behind thoracic outlet syndrome, neck pain, shoulder pain, upper back pain, and lasting recovery are revealed in great detail in this book.
Why am I getting worse?
According to the Human Spring Theory, you continue to get worse because the thoracic outlet spring suspension system is no longer absorbing and distributing mechanical forces the way it was designed. Every time you lift your arm, work at a computer, sleep, exercise, or simply go through your daily activities, the weakened spring suspension system places repeated stress on the brachial plexus, arteries, veins, muscles, and connective tissues. Instead of recovering between activities, the tissues become increasingly overloaded, causing the compression, inflammation, and symptoms of thoracic outlet syndrome to gradually worsen.
As the thoracic outlet spring suspension system continues to lose its elasticity, the protective space surrounding the nerves and blood vessels becomes progressively smaller. This creates increasing dynamic thoracic outlet compression, allowing less room for normal movement while producing more irritation with every repetition. According to the Human Spring Approach, recovery cannot occur until the spring suspension system is restored. Otherwise, each day adds another cycle of mechanical overload, causing symptoms to slowly progress instead of heal.
Here Is My Painful Story
While in college, I played rugby for the Las Vegas Rugby Club. The two-hour practices of running and agility drills motivated me, as I knew they were making me run faster and I was at less risk for injury.
This is really important, as I was 140 pounds, playing full-on tackle without pads or a helmet against former, top-university, football players weighing 200–260 pounds.
At 20, I felt I was indestructible. It seemed like it would all last a lifetime until one day in a tournament in Santa Barbara, California, I sustained a whiplash spinal injury that left me with constant neck pain, shoulder pain, extreme upper back pain, severe pain in the shoulder, and back rib pain from first rib dysfunction. I had symptoms of thoracic outlet syndrome but did not know it until seven years later. My thoracic outlet syndrome, neck pain, shoulder pain, and upper back pain became constant companions.
It happened in a scrum, a potentially dangerous pushing-and-shoving competition between 16 players that is an integral part of the game. A scrum is a play that restarts play after a minor violation or penalty. It involves up to eight players from each team jamming, then interlocking, their necks and shoulders, creating tremendous stress on the cervical spine, first rib, neck muscles, shoulders, and the structures that can later contribute to thoracic outlet syndrome.
The scrum is one of the most dangerous plays in rugby, since a collapse can lead to the most dangerous sports injury, where a player can get a serious neck injury, including a broken neck. A rugby scrum collapse is a devastating sports injury mechanism that can result in severe neck injury, spinal trauma, and long-term disability.
I was playing hooker, a position in the middle of the rugby scrum. Imagine me, at 140 pounds, being lifted by my shorts off the ground by two, 260-pound, former college linebackers. Then they slammed me into the opposing player’s head, neck, and shoulders like a battering ram and we all interlocked to form the scrum. This also formed a tunnel between both teams during one of rugby's highest-risk situations for neck injury and catastrophic sports injury.
Scrums are one of the most dangerous plays in rugby, because a collapse can lead to a serious traumatic head injury or spinal trauma, such as an acute spinal cord injury, leading to spinal paralysis or a concussion. You have probably heard the media talking about the dangers of post-concussion syndrome, leaving the athlete with signs of brain damage. In fact, a top surgeon in the United Kingdom has called for the ban of scrums, asserting they are too dangerous (1) (2). Every collapsed rugby scrum increases the risk of neck injury, traumatic brain injury, spinal cord injury, and catastrophic sports injury.
As the props (the rugby forwards) jammed my neck and shoulders into the opposing team’s props and hooker, both teams started to push. Just as the ball was thrown into the tunnel, I felt the prop next to me slip in the mud. He fell, thrusting me headfirst into the puddle of mud, until my head struck the hard, clay bottom. In an instant, a routine rugby play became a catastrophic sports injury with the potential for permanent neck injury.
As my forehead hit the hard clay, I felt my neck snap like a twig. I felt a tingling pain shoot through my entire body, and then I had numb arms and legs, as if I had spinal paralysis. Then the weight of our entire team of 2,000 pounds of players piled on my rib cage and back, causing severe, sharp, stabbing rib, chest, and back pain. This neck injury created immediate neurological symptoms consistent with a severe cervical sports injury.
The weight of the players piled on me collapsed my rib cage, as the air was forced out of my lungs. I had the wind knocked out of me and I was underwater. I gasped for air—only to inhale mostly muddy water in my nose and mouth. I was drowning. The combination of crushing force, drowning, and neck injury made this one of the most terrifying sports injury experiences of my life.
Finally, the huge hand of my teammate, Dave Handwerker, latched on to me, and I was lifted out of the water. All I remember as they carried me off the field was this excruciating pain under my right rib cage. Even then, I knew this sports injury involved much more than broken ribs and that my neck injury was severe.
My fourth, fifth, and sixth ribs had broken like toothpicks. When I took a breath in, I could feel a sharp lower neck pain and a sharp shoulder pain between the shoulder blades. I remember telling the team sports chiropractor that my arm felt numb, my hands felt tingly, and I felt my fingers going numb. Those classic symptoms of neck injury, cervical nerve involvement, and serious sports injury would ultimately change the course of my life.
The Neck and Upper Back Pain I Got from Learning How to Treat Neck Pain
A year later, I was at National College of Chiropractic, now called National University of Health Sciences in the western suburbs of Chicago, Illinois, studying my passion in the fast track, taking between 18 and 27 credits, three semesters a year, and between 24 and 27 credits in the summer.
The problem was that sitting with my head down, studying 12 hours a day, aggravated my chronic neck pain, neck pain, chronic upper back pain, and shoulder pain. It was called “student syndrome” back then. It would be called “office syndrome” or “computer syndrome” now. You know, the muscle spasms in the neck, neck stiffness and pain, chronic upper back pain, sore neck, neck pain, shoulder pain, lower back pain, while sitting for hours or working for a long time at the computer. The long hours of studying also made my neck pain and upper back pain progressively worse.
Next Injury? Car Accident... Rear-Ended... Whiplash Injury!
Then to make matters worse, I got rear-ended by a drunk driver going 70 mph, which caused a whiplash injury to my upper spine! I remember on impact that I had sudden upper back pain and sharp middle back pain. I suffered from the typical whiplash injury symptoms, the cervical sprain symptoms of extreme neck pain, constant upper back pain, severe middle back pain, shoulder muscle pain, and shoulder pain at night when I turned over in bed. The whiplash injury dramatically increased my neck pain and upper back pain.
I suffered a head trauma from hitting my head on the steering wheel, which caused a head contusion. I was diagnosed with a mild concussion, but the doctor in the emergency room said I had no signs of brain damage.
I remember that my ribs hurt! When I breathed, I could feel rib cage pain from the separation of the broken ribs. It was such intense rib pain that it took my breath away.
I started to wake up with swollen hands in the morning. I started to suspect carpal tunnel syndrome. In my work as a chiropractor, I’d do 10 to 12 hours of trigger point therapy per day. I thought the swelling was coming from too many myofascial trigger points or pain points. Then I switched the trigger point therapy techniques to take the pressure off my hands, but the swollen hands did not go away. Even when I did not do hands-on treatment, I had swollen hands. Now I realize these were all thoracic outlet syndrome symptoms.
I recognized later that the swollen hands were not a sign of carpal tunnel syndrome. I did not have the wrist pain. Also, when I took a photo of both arms and hands side by side, I noticed my forearm on the right was thicker, more swollen than the left. The signs of carpal tunnel syndrome swelling are only from the wrist down and not in the forearm, arm, or shoulder. What was causing my swollen hands and fingers?
I did not know that the swelling in my arms was a sign I had vascular thoracic outlet syndrome. No one told me that if the muscle spasms in my neck and shoulder got bad enough, I could get costoclavicular syndrome or compression of my collarbone to my rib cage. This form of thoracic outlet syndrome is worse than neurogenic thoracic outlet syndrome because, if the compression of the vein gets bad enough, a blood clot can form. This is what we call vascular thoracic outlet syndrome.
This is why it is vital you determine if you have a thoracic outlet syndrome diagnosis.
If the clot, or thrombus, breaks off, it becomes a pulmonary embolism. A clot would have traveled to my lungs, causing a lung infarction, which is the death of lung tissue due to inadequate blood supply to the cells. I could have died.
You are probably thinking what I was thinking. That won’t happen to me. That is what the other 600,000 people in the United States probably thought before they had a pulmonary embolism. What did the 60,000 who died from it think? They didn’t have much time to think because most of those who die do so within 30 to 60 minutes after symptoms start.
One of the worst complications of my chronic thoracic outlet syndrome and undiagnosed thoracic outlet syndrome was the effect on my social life. I couldn’t find a good chiropractor near me, so I started cracking my neck. This neck cracking started once every few days. Then the neck popping happened every day. Then my neck started cracking when I wasn’t trying to crack it, like when I was close to my date in a romantic moment.
I called my father and asked him, “Is it bad to crack your neck?”
“Are you cracking your neck? Stop doing that or you will get a pinched nerve!” he admonished me. I should have listened to him, but I didn’t.
I got to the point where I developed motor tics in my neck that were noticeable. These are nervous tics that feel like muscles jumping in the neck. I had excessive muscle twitching that would show up as shoulder twitching, neck twitching, and muscle twitching. It felt like an involuntary twitching of muscles, because I didn’t know I was doing it.
It was really bad when I went on a date with this beautiful girl I really liked. She asked me, “What are these muscle twitches you do constantly? Your neck keeps twitching.” She noticed my arm twitching and shoulder twitching too. “You have these twitching movements all the time! Are you nervous, or is there something wrong with you?”
I told her the truth, looking for sympathy. “I know I have twitching muscles. My muscles twitch, because I have over-reactive nerves, muscle spasms, and muscle twitching all over my neck and shoulders. These chronic muscle spasms lead to muscular twitching, neck twitching, and shoulder twitching.”
The next question was, “What do you do for a living?”
I told her, “I’m studying to be a chiropractor.”
“Oh, I see,” she commented, combined with a shake of her head movement.
Then I’ll never forget what she asked me next, “Why don’t you go to the doctor for some thoracic outlet syndrome treatment?” I guess I looked fairly pathetic to her, unable to solve my own problem. What she didn’t realize was that none of the doctors I’d seen could solve my problem! I knew this thoracic outlet syndrome, neck twitching, muscle twitching, and spasmodic twitching would not only affect my love life but also my professional reputation. Who would go to a chiropractor who has a twitching neck from thoracic outlet syndrome?
I desperately needed help.
My father was a chiropractor. His first rib adjustments helped me a lot. Unfortunately, I would have to drive one hour to his office and then another hour back to school. By the time I got back to school, my pain had returned. I couldn’t spend 2.5 hours of treatment and travel, just to feel the same. After many months, I asked my father, “How long does whiplash last?”
He said that sometimes people have whiplash syndrome pain that lasts for the rest of their life. The chronic rib pain caused by the inflammation of the rib cage from the twisted and broken ribs was becoming daily upper middle back pain. One chiropractor had a referred pain chart and told me I had fibromyalgia pressure points or fibromyalgia trigger points. To some doctors, if patients have chronic pain syndrome, muscle pain, or body pain, and they can’t get rid of it, it must be fibromyalgia.
No one seems to know how to clearly define fibromyalgia, how to diagnose fibromyalgia, how to cure fibromyalgia, or even the best treatment for fibromyalgia, but there is a medication for fibromyalgia. Numbing the brain with drugs for a few hours wasn’t an option, as I was committed to finding the cause and a permanent, drug-free solution for this chronic pain, fibromyalgia symptoms, and thoracic outlet syndrome!
Patients often feel there is no cure for fibromyalgia, so they think they have to just go on living with fibromyalgia. This is why you see many patients with fibromyalgia and depression in fibromyalgia support groups. No one is talking about the difference between fibromyalgia vs thoracic outlet syndrome, thoracic outlet syndrome symptoms, and fibromyalgia symptoms either.
Natural healing was failing me. I almost quit my healthcare profession and considered going on disability.
· Why weren’t the adjustments working?
· Why wasn’t exercise working?
· Why wasn’t anything working?
· Doesn’t natural healing work?
When do you lose hope, give up, and just live with the pain?
When do you get so frustrated that you beg the doctor to cut the pain out of your body? Yes, I contemplated neck surgery. Thank God, I still remained a rational thinker. Can neck surgery cut out the pain? NO!
When do you turn to painkillers? When do you stop taking painkillers?
When do you give up? Giving up means a lifetime of chronic pain. That is what I was contemplating. Is that what you are contemplating?
Please don’t!
I know how you feel right now.
I felt that same way.
I found my way out of pain, and I can help you like I’ve helped thousands of others with thoracic outlet syndrome, chronic pain, muscle pain, neck pain, and fibromyalgia.
Please read on, be optimistic, and prepare for the aha moments!