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Activities of Daily Living That Increase the Risk, Cause, or Perpetuate Thoracic Outlet Syndrome

In this article, you will learn new ways of thinking about what lifestyle choices to make to be sure you don’t cause additional compression of your human spring and your thoracic outlet.

You should find this all makes sense, because it follows the basic principles of the laws of physics, the laws of nature, and engineering that are easy for anyone who is a logical thinker to grasp.

In this chapter, I will point out the most common activities of daily life that put your spring in a position to trigger the strain receptors that will create the reflex from the brain that will cause muscle spasms to further compress your neck, shoulder, upper back, and thoracic outlet.

I am going to teach you what to do and what not to do.

The human body is an object that exists on the planet Earth. Therefore, it is subjected to the same laws as any other objects. Breaking these laws, you’ll not live in peace and harmony, rather you will become incarcerated in a jail cell of chronic pain and suffering.

The successful therapies I have described are not the result of some “medical miracle.”

They came about because of an understanding that your body is a mechanical lever series and an integrated spring. The tension is moderated or controlled by the brain (laws of nature). We can see how the laws of physics and nature apply to the human body.

Because you are a spring, you must learn to read your “owner’s manual” to fully understand how it works, the important functions it serves, how it breaks down and locks, and how it affects so many aspects of your health. How it is engineered and how the nervous system reacts to changes in positions relative to the pull of gravity is an extremely important component of the owner’s manual.

I tell my patients all the time, “If you do not learn how the human spring works and how positions and movements during everyday activities, such as sleeping, sitting, standing, and walking affects its function, it is impossible for a doctor of any kind to help you.”

Not even my approach stands a chance. In fact, when a patient’s posture is off perpendicular I correct it. I don’t want to be blamed for why the treatment did not correct the TOS. That is how important this is.

Once you learn how to work with these reflexes, you will finally be able to live a more stress-free and strain-free life, and your TOS will finally go away.

Activities of Daily Life That Cause Compression of Your Spring

In Chapter 5, you learned that the cause of the compression of your magnificent human spring was muscle super contractions. These muscle spasms have been created and programmed into your body as a result of the activities of your daily life.

  1. Sustained contraction of muscles
  2. Unhealthy number of muscle contractions without adequate rest between
  3. Repetitive strained motions on muscles, tendons, ligaments, and bone
  4. Single overloading strain on muscles, tendons, ligaments, and bone

Sustained, Constant Contraction of Muscles

Sports science has come to the conclusion that it’s best to exercise with 3–4 sets of exercises, with at least 90 seconds of rest between. That is so the blood can flow back into the muscle to deliver oxygen to the muscles that were depleted of oxygen.

If the activity involving the healthy alternating phases of contraction and relaxation, as in the case with most repetitive resistance training, then blood flow will proceed during the relaxation phases and decrease the likelihood of fatigue being produced by a lack of oxygen in the muscle, leading to trigger points and eventual super contractions.

However, if the exercise involves sustained (isometric) contractions, lasting more than about six seconds, this circulatory cause of fatigue will be significant. This explains why activities involving sustained contractions result in more rapid and more depleting fatigue than dynamic activity. The lack of healthy blood flow back into the muscle will deplete muscles of oxygen and increase the level of lactic acid in the region.

The best example of a sustained, tonic, or isometric muscle contraction is when the muscle contracts to one length and stays that length so your bones don’t move, like holding your cell phone up to your ear or your eyes. A tonic contraction is defined as the sustained contraction of a muscle, as is necessary for maintaining posture.

These tonic, sustained, muscle contractions can lead to the formation of trigger points, which can lead to the super contractions mentioned in the last chapter.

  1. Examples of tonic, sustained contractions in daily life are when you are holding some object for a long time.
  2. Another example would be when muscles contract to hold a posture for a long time

Neck and Upper Extremity Problems—Workplace Stressors—Work Style

  1. Muscle activity might be affected indirectly through a changed work style due to these stressors (increased work pace, high forces on the keyboard and mouse, and more awkward and sustained postures), which can lead to fatigue and thus eventually cause musculoskeletal complaints (18–19).
  2. Doctors think that continuously increased muscular activity can lead to fatigue and thus eventually cause musculoskeletal complaints. Mental stress combined with too much activity of the muscles of the hands, wrist, shoulders, and neck can lead to a higher risk for musculoskeletal complaints (20).

The Keyboard and the Mouse

When you leave your arms resting at an angled position on a desk for long periods, fairly soon you start to feel a burning pain and tension in your shoulders. We all have experienced this when we work with our keyboards, handheld devices, or mouse.

Repetition Strain Injury—Keyboards

Work-related upper extremity disorders that result from keyboarding tasks are common (20). There are many ways your human spring mechanism can be locked up during simple typing at the computer.

  1. You have to hold the arm in a certain position to get your fingers on the keyboard, which strains your pectoralis minor muscle, the coracobrachialis muscle, and the long and short head of the bicep muscle.
  2. You have the activity of the fingers when you type, putting stress on the muscles involved, which are located in the forearm.
  3. You have the stress of holding your head in one position, which creates torsion strains as you try to hold your shoulders, arms, and hands to work the keyboard at the same time.
  4. You have the constant mental stress that affects your shoulders, abdominal muscles, and neck muscles—which is where a lot of us store our mental stress. The result can be a complete lockdown of the entire upper half of your body.

Mouse Use Duration

Studies have indicated that it is the amount of time that you hold the mouse in one position that is most strongly associated with the incidence of hand/arm symptoms rather than the amount of time you are using a computer keyboard (21).

Another factor is the mental strain of manipulating the mouse in the exact position required, combined with the constant concentration on what you are doing on the screen. You are straining the scalenes of the neck and straining the six muscles, which drag the shoulder into the outlet at the same time. What could be worse?

But if “too long” is a problem, exactly how long is too long?

One research study found an association between use of a mouse device for more than 20 hours per week and risk of possible carpal tunnel syndrome, rather than actual duration of keyboard use (22). I’m not recommending that you should work 20 hours or less a week and then go home. I’m just informing you of what the study reveals.

Companies that require workers to do more than 20 hours a week of the same repetitive work would probably find they could increase productivity and decrease health problems by introducing more variety in their workers’ schedules.

Computer Use Duration

Another study showed an increased risk for developing severe hand–wrist pain in the highest exposure category, which was greater than 30 hours per week of the same repetitive activity (23). One particular study revealed that time spent working with the mouse and the keyboard was an excellent predictor of elbow and wrist/hand pain (23).

So, you are more at risk for arm and hand conditions than for neck and shoulder conditions when you work long hours (22) (23) (24).

Tips to Less Stressful Desk/Computer Work

  1. Don’t use a laptop.
  2. If you have to use a laptop, plug the laptop into a full-size monitor that allows you to view the screen at eye level.
  3. When you are done with the mouse and keyboard, take your hands off and rest your arms and hands on the armrest of the chair.
  4. Get up periodically and shake your body out.
  5. Never stretch your neck from side to side. This will cause the scalenes to lift the ribs up even higher.

The United States Department of Labor Occupational Safety and Health Administration (OSHA) Good Working Positions (40)

  1. Hands, wrists, and forearms are straight, in-line and roughly parallel to the floor.
  2. Head is level, or bent slightly forward, forward facing, and balanced. Generally, it is in-line with the torso.
  3. Shoulders are relaxed and upper arms hang normally at the side of the body.
  4. Elbows stay in close to the body and are bent between 90 and 120 degrees.
  5. Feet are fully supported by the floor or a footrest may be used if the desk height is not adjustable.
  6. Back is fully supported with appropriate lumbar support when sitting vertical or leaning back slightly.
  7. Thighs and hips are supported by a well-padded seat and generally parallel to the floor. Knees are about the same height as the hips with the feet slightly forward.”

The OSHA Positions were determined by people and people make mistakes. Here is where I agree with OSHA and where I do not and why.

  1. Hands, wrists, and forearms — I agree.
  2. Head and torso— I disagree – If your head and upper body is bent slightly forward the muscles of the upper back and neck will be in a constant contraction attempting to maintain your head from falling forward. You should just stack your head directly you’re your neck and relax. Remember “Stack and Relax”.
  3. Shoulders and upper arms— I disagree – Your arms should not hang, as this causes fatigue in your trapezius and levator scapula muscles. Rest your arms on the arm rests.
  4. Elbows — I disagree – The elbows should be exactly at 90 degrees slightly above the desktop.
  5. Feet — I agree.
  6. Back — I disagree – Your back should never be supported. Your abdominal muscles support your back.
  7. Thighs and hips — I agree.
  8. Knees and feet — I disagree – All your body parts should be either horizontal or perpendicular and never on angles for an extended period of time.

If OSHA wants to challenge me on my opinions, I can prove with surface EMG testing their sitting recommendations will lead to sustained contractions of muscles therefor sustained strain on the muscles, ligaments, tendons and bones. Id love to do a study with them to prove it.

If you go to the OSHA web site listed below and look at the Computer Stations eTool you will see 4 examples of body posture changes that all provide neutral positioning for the body.

    1. Upright Sitting – In this photo they say its ok to lean back on the back rest. This causes the body to lean back out of the perpendicular position. In this position the 9-12 pound head is held in a sustained angled position forcing the anterior cervical, anterior and middle scalene muscles to remain in a sustained contraction. Never sit this way. Sitting in this position could cause and will exacerbate a thoracic outlet syndrome.
    2. Standing – Standing for a sustained period of time will strain the tibialis posterior, tibialis anterior, peroneus longus, peroneus brevis muscles or what I call the arch spring suspension muscles. This constant strain on the arch of the foot can also stretch and strain the ligaments of the foot and lead to a drop and lock of the joints of the arch causing abnormal motion during walking. Conditions caused by sustained standing include plantar fasciitis, ankle pain, knee pain, chondromalacia patella, illiotibial band syndrome, hip and lower back pain, varicose veins and more.
    3. Declined Sitting – In this position the legs are not horizontal and perpendicular. If the body senses you could slide forward the gluteal muscles will contract constantly to prevent this. Sitting for long periods of time in this position can cause lower back and hip pain.
    4. Reclined Sitting – This position is the absolute worse position to sit in if you would like to prevent neck strain, neck pain, scalene spasms leading to a possible thoracic outlet syndrome or exacerbation of thoracic outlet syndrome. Again, in this position the 9-12 pound head is held in a sustained angled position forcing the anterior cervical, anterior and middle scalene muscles to remain in a sustained contraction. Never sit this way at work, home or anywhere. If you do you will never reverse a TOS no matter how many treatments you get.

OSHA should delete this article and apologize for misguiding the public on “good working positions”

If you are the safety director for a company and would like me to do a fun and informative workshop for your workers on how to avoid workplace injuries, please contact us at

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