Targeted exercises for the thoracic outlet area — stretching, posture, and strengthening. Do together, daily.
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Release & Open
Scalene & pec minor stretches — relieve compression
Lateral Neck Flexion
Ear toward opposite shoulder. Gentle hand pressure on top of head. Hold 30 seconds each side.
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Tip: Keep the opposite shoulder down — don't let it hike up. Should feel like a gentle pull along the side of the neck, never sharp.
Scalene-Specific Stretch
Rotate head 45° away from affected side, then side-bend. Targets anterior/middle scalenes depending on rotation angle. Hold 30s each side.
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Tip: More rotation = anterior scalene. Less rotation = middle scalene. Experiment to find the deepest stretch.
Mobility
Dynamic shoulder work — warm and loosen the joint
W-Extensions
Stand tall. Reach both arms straight overhead, palms forward. Pull elbows down and back into a “W” (elbows at shoulder height, forearms vertical, palms still forward), squeezing the shoulder blades. Press back up. 10 reps.
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Tip: Focus on pulling with the back, not the arms. Keep ribs down — don't let the low back arch as the arms go overhead.
Elbow Clicks
Stand tall. Bring arms into a goal-post position: elbows at shoulder height, forearms vertical, fists up. Bring the elbows together in front of your face until they touch (“click”), then open wide. 10 reps.
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Tip: Keep the forearms vertical the whole time — only the elbows travel. The opening half is just as important as the closing half.
Elbows-Together Rotations
Press your forearms and elbows together in front of your face, palms facing you, fists near forehead. Keeping elbows joined, draw big circles with the “locked” arms — up, around, and down. 5 each direction.
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Tip: The harder you press the elbows together, the more the work moves into the upper back and rear shoulder. Go slow — quality circles, not speed.
Posture Reset
Chin tucks & wall angels — reverse forward head posture
Chin Tucks
Draw head straight back — "double chin" motion. Hold 5–10 seconds each rep. Repeat 10 times. Do frequently throughout the day.
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Tip: Think "slide head backward on a shelf" — don't tilt up or down. You should feel a gentle stretch at the base of the skull.
Wall Angels
Back flat against wall. Arms in "field goal" (W) position, slowly slide up and down keeping elbows and wrists touching the wall. 8–12 slow reps.
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Tip: Go slowly — 3–4 seconds up, 3–4 seconds down. If wrists can't stay on the wall, that's normal. Work toward it over weeks.
Strengthen
Middle/lower traps — pull the shoulder blades back and down
Band Pull-Aparts — Two Angles
Standing tall, hold a light resistance band with arms extended. Part 1 (Horizontal): band at chest height, pull apart to the sides — hits middle traps. Part 2 (Diagonal): one hand high, one low; pull apart on the diagonal — hits lower traps. Switch which hand is high halfway through. 8 reps each angle.
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Tip: Lead with the shoulder blades, not the hands. The diagonal version is the key piece for lower-trap activation — pause briefly at end range and feel the blade pull down and back.
Rows with Scapular Squeeze
Band or light dumbbell rows. Pull elbows back, squeeze shoulder blades together at end range and hold 2 seconds. 10–12 reps.
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Tip: Use a very light band or 2–3 lb weight. The squeeze at the end is the important part — hold it, don't rush.
Stabilize
Serratus anterior — shoulder blade control
Wall Push-Up Plus
Push-up against a wall. When your arms are fully straight, keep pressing — round your upper back slightly so the shoulder blades wrap forward around your ribs (this moves your body a tiny bit further from the wall). That extra reach at the top is the “plus.” 10 reps.
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Standing Serratus Punch
Stand tall. Hold a light weight (1–3 lb or a water bottle) at shoulder height with elbow bent. Punch straight forward, reaching as far as possible by protracting the shoulder blade. 10 reps each side.
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Tip: The reach matters more than the weight. At full extension, push the fist a little further — that extra inch is where the serratus anterior fires.
Remember
Several short sessions daily beats one long session for postural retraining
Avoid overhead exercises that reproduce symptoms, especially early on
Progress gradually — frequency over intensity
Stop any exercise that causes increased tingling, numbness, or sharp pain
Chin tucks can be done throughout the day — at your desk, in the car, anytime
If the Roos test reproduces symptoms (arms up in "surrender", open/close fists for 3 min), mention this to a doctor or PT — it’s a strong clinical signal