Canadian RMT Spring 2018 Canadian RMT Spring 2018 | Page 15

Image 2
Image 1
Image 4
Image 3
Image 5
been my experience that many DCS clients respond well to mas-
sage, movement, and any type of cognitive training that lowers
the brain’s threat level during movement. In Image 3, I demon-
strate my favorite anterior and middle scalene stretch to create
space at the interscalene triangle.
Subclavius and the Costoclavicular Canal
In clients with a drooping clavicle, the underlying subclavius
muscle can reduce the costoclavicular canal size and compress
the brachial plexus against the first rib. Upper chest breath-
ing can exacerbate the problem, as the first rib elevates during
inhalation and can get stuck there. A 2015 study published in
BMC Research Notes also noted brachial compression from the
subclavius posticus muscle, which ties the first rib to the superior
3
border of the scapula. Rather than dig in to the sensitive tissues
under the clavicle, I always begin with the subclavius stretch
demonstrated in Image 4. This slow, gentle, graded exposure
stretch is designed to reassure the brain that it’s now safe to move
in previously painful positions.
Retropectoralis Muscle Impingement
Repetitive movements of the arms above the head, common
among tennis enthusiasts, may cause friction and overstretch
the nerve plexus under the pectoralis minor at the coracoid. The
least irritating way I’ve found to create space here is by stretch-
ing the distal fibers that attach to ribs 3, 4, and 5. Notice in
Image 5 that the stretch is directed at a 135-degree angle, which
is the approximate pectoralis muscle fiber angle from coracoid
to the rib insertions.
Many NTOS studies recommend postural correction, includ-
ing muscle strengthening and lengthening for double crush
complaints. However, there is no consensus in the literature as
to exactly which muscles should be targeted. Posture is dynamic
and the best results are gained through whole-body strength-
ening and balancing programs such as swimming, yoga, and
martial arts. The bodywork goal is to bring mental awareness
to areas of restriction and to teach the client it is safe to move
through those previously painful barriers.
References:
1. A. R. Upton and A. J. McComas, “The Double Crush in Nerve Entrapment Syndromes,” Lancet 2, no. 7825 (August 1973): 359–62. 2. D. B. Roos, “The Thoracic Outlet Syn-
drome is Underrated,” Archives of Neurology 47, no. 3 (1990): 327–28. 3. J. Muellner et al., “Neurogenic Thoracic Outlet Syndrome Due to Subclavius Posticus Muscle with
Dynamic Brachial Plexus Compression: A Case Report,” BMC Research Notes 8, no. 351 (August 2015). doi:10.1186/s13104-015-1317-3.

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