November 2025
Shaun Rodgers, Physiotherapist
Effective Treatment and Physiotherapy for Thoracic Outlet Syndrome
What is Thoracic Outlet Syndrome?
Thoracic Outlet Syndrome (TOS) can feel like a puzzle with missing pieces.
You might experience tingling down your arm, weakness in your grip, or a heavy, aching shoulder.
For many in Melbourne, especially those who sit at desks for long hours or perform repetitive overhead work, the frustration of misdiagnosis or lingering discomfort is all too familiar.
If you've been searching for answers and have come across the term Thoracic Outlet Syndrome, you're not alone.
Despite being underdiagnosed, TOS is a very real, very treatable condition.
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Effective Treatment for Thoracic Outlet Syndrome
Let’s start with the basics. Thoracic Outlet Syndrome refers to a group of disorders that occur when nerves or blood vessels are compressed between your collarbone and first rib — a narrow space known as the thoracic outlet.
There are three main types:
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Neurogenic TOS (most common): Compression of the brachial plexus (nerve bundle)
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Venous TOS: Compression of the subclavian vein
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Arterial TOS: Compression of the subclavian artery (least common but most serious)
So what’s the most effective treatment?
At Melbourne Sports Physio, the frontline treatment is conservative management for neurogenic TOS through physiotherapy — which includes movement re-training, manual therapy, nerve gliding exercises, and strengthening of specific muscle groups around the shoulder complex. There is no one size fits all approach and each plan is tailored to the individual and their symptoms.
A large percentage of people with TOS respond well to these non-surgical interventions. According to a 2020 review published in The Journal of Orthopaedic & Sports Physical Therapy, up to 90% of neurogenic TOS cases improve with targeted physiotherapy alone.
Imaging can be helpful to identify anatomical variants like a cervical rib which can lead to decreased thoracic outlet space. Your physio can help guide you on whether this is necessary. Your physio can also assess whether you present with more venous/arterial thoracic outlet presentation and refer you to the appropriate health care professional.
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Physiotherapy for Thoracic Outlet Syndrome
Physiotherapy isn’t just about exercise — it’s about optimising movement. In Melbourne, where many residents spend hours behind computer screens or in traffic, prolonged static positions can contribute to the development of TOS.
A skilled physiotherapist will typically focus on:
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Postural variations (reducing time spent in rounded shoulders and forward head posture)
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Neurodynamic mobilisation (nerve gliding techniques for the brachial plexus)
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Thoracic and cervical spine mobility
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First rib mobilisation
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Scapular/shoulder strength exercises
You might be surprised to hear that your diaphragmatic breathing patterns are also assessed. Shallow chest breathing can lead to elevated shoulders and muscle overuse — contributing to TOS symptoms.
Did you know? A local study from Victoria University found that desk workers in Melbourne had a 2.5x higher risk of developing posture-related neural compression syndromes like TOS due to prolonged static sitting and poor ergonomic setups.
TOS Treatment Options
Treatment options for TOS in Melbourne generally follow a step-wise approach:
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Initial Assessment
This includes ruling out cervical spine involvement, shoulder joint/rotator cuff injury, and peripheral nerve entrapments. Through the initial assessment your physio can help you identify whether you are suffering from TOS, or if it is something else. From there, you can get clarity and a roadmap for how to get back on track.
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Conservative Treatment (First-line)
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Physiotherapy involving strength work
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Movement re-training
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Activity modification
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Ergonomic corrections
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Pain relief modalities (manual therapy/exercise)
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Diagnostic Testing
In some cases, further testing (e.g. Doppler ultrasound, nerve conduction studies) may be needed to confirm vascular involvement.
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Injections
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Botulinum toxin injections into the scalene or pectoralis minor may be considered for stubborn cases
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Surgical Consultation
Reserved for patients who don’t improve after 3–6 months of structured physiotherapy and conservative care. Those with venous/arterial TOS will be co-managed with a doctor and may require more prompt referral.
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TOS Treatment Plan
Here’s what a typical TOS recovery plan might look like over a 12-week period in a Melbourne Sports Physiotherapy:
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Phase |
Focus |
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Acute (0–2 weeks) |
Pain relief, posture education, gentle mobility work |
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Subacute (2–6 weeks) |
Nerve gliding, shoulder strengthening, thoracic mobility |
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Reconditioning (6–12 weeks) |
Progressive strengthening, movement retraining, activity resumption |
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Maintenance (12+ weeks) |
Self-management, mitigation planning, return to full activity |
Most patients start seeing improvements by week 3–4, with full resolution often within 8–12 weeks for neurogenic TOS.
The key is consistency and individualisation — there’s no one-size-fits-all plan.
Non-Surgical Treatment for Thoracic Outlet Syndrome
One of the biggest misconceptions about TOS is that surgery is the only answer. In reality, non-surgical treatment is highly effective — especially when started early.
Our physiotherapists commonly use:
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Manual therapy: Soft tissue release of the scalene muscles and pec minor
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First rib mobilisation: Gentle techniques to reduce elevation or stiffness of the rib
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Neural mobilisation: Especially for the ulnar and median nerves
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Strengthening: Focusing on lower trapezius, serratus anterior, and deep neck flexors
Additionally, ergonomic changes at home or work — including desk height, screen placement, and chair support can be very helpful.
Physiotherapy Management of Thoracic Outlet Syndrome - What does long term success look like?
Long-term, it’s about building resilience in the shoulder and neck complex, not just treating pain. Once your over the painful period, our physios can use VALD dynamometry testing to identify any underlying weakness/strength asymmetry and help build you a robust mitigation plan to help keep you strong going forward.
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Final Thoughts: Don’t Ignore the Signs
If you're dealing with unexplained shoulder pain, tingling down the arm, or neck tension that won’t go away, TOS could be the missing link.
Early physiotherapy intervention has shown to be one of the most effective non-surgical treatments for thoracic outlet syndrome. Whether you’re an office worker, a tradie, an athlete, or a new mum — the right physiotherapy plan can change your quality of life.
What Should You Do Next?
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Book an assessment with one of our Physiotherapists
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Check your workstation or get an ergonomic review
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Start gentle stretches under guidance — don’t DIY your rehab
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Ask your physio about neural gliding and posture strategies
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Stay consistent — recovery is a process, not an event
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Over to You
Have you experienced symptoms of TOS?
Are you unsure if your shoulder or arm pain is posture-related?
Let us know and reach out to a Melbourne Sports Physiotherapy clinic for a personalised treatment plan.
Always consult a physiotherapist or healthcare provider before starting any treatment for TOS. Early diagnosis and guided intervention can significantly reduce the risk of long-term complications.
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Learn how our Melbourne Sports Physio Team can help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!
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