My nTOS Recovery: What Finally Helped Me
Hey everyone,
I wanted to share my experience recovering from neurogenic thoracic outlet syndrome (nTOS) because there is so much conflicting information about it, and finding doctors and PTs who genuinely understand how to treat it can be extremely difficult.
This is my personal experience, but I spent years trying different approaches before finally finding a PT who completely changed how I understood my problem. Hopefully this helps someone else who is going through something similar.
BACKGROUND
I was 27 when my symptoms first started. I've always been extremely active despite several injuries and surgeries.
That suddenly changed after backpacking in Yosemite. I noticed some tightness in my trap, and the next morning I stretched my arms out and felt like I pulled a nerve.
From that point forward, I couldn't really do anything with my right arm.
I spent thousands of dollars on PT appointments, doctors, imaging, and different treatments without getting anywhere. About a year after the initial onset, a doctor hit a nerve during an injection, and that's when everything started to flare significantly.
Soon after, I became convinced that I had TOS.
Several doctors told me I didn't have it, including three well-known TOS doctors in the United States. One doctor and one PT thought it was plausible but couldn't say for certain.
At that point, I knew there had to be an answer somewhere. I eventually decided to travel to Boston to see a PT who specializes heavily in nTOS.
SYMPTOMS
· I couldn't load my right arm with anything heavier than a pencil.
· Severe neck tightness that could become extremely painful and was exacerbated by weight, poor sleep, stress, and the depression caused by my nTOS.
· Pain where my chest attaches to my shoulder.
· Nerve pain throughout the inside of my arm, forearm, neck, and wrist. I initially thought I had carpal tunnel.
· I couldn't reach my right arm out without feeling like I was going to tear or stretch a nerve.
· I couldn't listen to music or be around vibrations without my neck/ear tightening significantly and exacerbating my symptoms.
· Back pain.
· Groin, hip, and knee pain.
· An extremely heightened sensitivity to pain everywhere.
· Extremely poor balance and thoracic mobility.
· Typical TOS rehab often made my symptoms exponentially worse. For example, dry needling my scalenes would cause them to tighten even more.
Looking back, I believe a lot of what I experienced was my nervous system becoming extremely reactive and protective due to the TOS and how indirectly it forces your nervous system “on”.
I could do something as simple as washing dishes and suddenly have an elbow flare. At the time, I thought I had developed golfer's elbow or some other injury. In reality, it felt like my body had become extremely good at producing pain whenever I loaded certain areas.
Thankfully, I never had significant muscle weakness.
I actually found one back exercise that I could tolerate extremely well. I would have two kettlebells on the ground, push down through the kettlebell on my left side, and row with my right arm.
For whatever reason, I could do this without reproducing my normal right-arm pain.
I gradually loaded this movement and eventually got to the point where I could row 60 lbs in one arm. I did this for over a year and stopped increasing the weight once I got here. I'm also on TRT, which I believe helped me preserve a lot of muscle during this period. Without it, I think I would have lost considerably more muscle mass.
GETTING EVALUATED FOR TOS
Eventually, I saw a Johns Hopkins doctor who ruled out the other forms of TOS (vTOS and aTOS), but he couldn't definitively confirm or rule out nTOS. I remember asking him what the treatment for nTOS actually was.
He gave me a list of basic posture and breathing exercises. Unfortunately, these didn't help me and often made me worse.
I also remember him saying that many nTOS cases are “subjective” and that some people eventually give up trying to treat it or rely on things like repeated Botox injections to manage their pain. I had a hard time believing that this was simply something I had to deal with forever. Given I never trusted our medical system and believe many doctors are incompetent, I knew there was an answer somewhere. I eventually decided to move to Boston to see a PT who specializes heavily in nTOS.
DIAGNOSIS AND TREATMENT
In December 2025, I had my first appointment with my new PT, who I still see today.
After a very thorough examination, he determined that I definitely had nTOS. More importantly, he identified what he believed was the primary driver of my problem: ribcage dysfunction and altered ribcage mechanics.
This wasn't just something he had seen in me. He told me that ribcage dysfunction is one of the main things he sees in his nTOS patients, and that a very large percentage of the nTOS patients he treats have a high degree of altered ribcage mobility.
His hypothesis for my particular case was essentially:
Ribcage dysfunction → altered breathing mechanics → excessive scalene/neck involvement → brachial plexus irritation → improper back/shoulder mechanics → median and ulnar nerve symptoms throughout the arm, elbow, forearm, and wrist
There was also another downstream pathway:
Ribcage dysfunction → back mechanics → hip/pelvic dysfunction → lack of glute firing and excess hamstring use → groin, hip, and knee pain
The idea was that when the ribcage isn't moving and engaging properly, the body starts compensating elsewhere.
In my case, I was relying heavily on my neck muscles to breathe and stabilize myself. That created a domino effect where my neck, shoulders, back, pelvis, hips, etc. were all compensating for the underlying problem. My PT specifically emphasized that he sees this pattern beyond frequently in his nTOS patients.
THE TREATMENT
The treatment was surprisingly difficult. The goal wasn't simply to stretch my neck or strengthen my shoulders. Instead, we worked extensively on breathing, ribcage mobility, positioning, and retraining how my entire body moved together.
I did a lot of very weird-looking breathing and posture exercises and some one-off work in my pec, shoulder, lat, and armpit.
I remember after my first appointment already noticing some improvement.
One of the main things we were trying to accomplish on my first appointment was getting my ribcage to actually move and engage properly when I breathed. He also worked on my neck to some extent, but he didn't want to focus heavily on it because I'd already spent years trying to treat my neck without success. His reasoning was that the neck tightness appeared to be downstream from the ribcage problem.
THE CUES
PT was hard.
I remember having a surprisingly difficult time simply breathing in through my nose and out through my mouth while following all of the positioning cues.
Some of the major cues I used included:
· Breathing in through my nose and out through my mouth while trying to engage my ribs and obliques rather than excessively using my abdomen.
· Trying to push air through my back and feel the air move all the way down my back. This also helps loosen your back out.
· Tucking my tailbone/hips/pelvis.
· Getting my arms fully extended while retracting my shoulder blades.
· As I progressed, moving my hips in specific directions depending on the exercise. This is important so I might add a comment later, but for reference, doing this cue with the two below is what causes the hamstrings to fire less and the glutes to fire more.
· Pushing my back in the opposite direction of my arms. When doing an exercise where I had to lie on the ground, I needed to make sure my back was flat on the ground. When I moved my arms out while tucking my pelvis, my back would want to lift up from the ground, so in the beginning my PT just had me focus on getting the upper and lower part of my back to be flat at bare minimum.
· Keeping my chest up during certain exercises to help engage the pec minor and improve the mechanics around the shoulder.
· Keeping my neck straight.
· Keeping my ribs down.
There were many other cues depending on the exercise, but those were the main ones.
When I started, I could only focus on the major cues. It was too damn hard doing everything at once. Over time, I added more as the exercises got more complicated.
THE FIRST FEW MONTHS
I flared a lot during and after PT. My body was so accustomed to moving incorrectly that when I tried to change those patterns, it would immediately overuse certain muscles and fail to engage the ones that were supposed to be doing the work. Despite that, things were improving.
A couple of months in, I hit a major brick wall.
I don't remember what cue it was specifically I had a hard time doing, but at one point I ended up spending 8+ hours on a Saturday day trying to teach my brain and body how to move in ways that weren't natural to me to get that cue down. I wouldn’t say everyone is going to be in my boat though. My PT described my case as being around an "8/10" in complexity because of how hard it was for me to do basic movements and cues.
It was exhausting, but eventually, I got the cue down, and things started moving forward again. This time, it was much faster though. It was as if my body learned to move how it was supposed to.
RETURNING TO THE GYM
In February 2026, I started lifting again.
I incorporated the movement and breathing cues into basically every exercise. At first, I had to think about the cues constantly. A couple of months later, I did get tired of doing the cues on some major lifts like Bench. It did flare up my median nerve in my arm and tighten up my neck and collarbone a lot, but honestly, I just wanted my bench back up, so I didn't really care too much. Things settled by the time it was my next bench day anyway for the most part. Around this point in time, I had pain, but my sensitivity to flare decreased significantly. Personally, I was very happy living with pain knowing that I could live my life normally and do certain things at the gym without making things worse. That sounds like a sad reality, but much better than rotting in bed all day.
JULY 2026
By around July, most of my symptoms had settled significantly. I could watch movies and listen to music without immediately causing my back and neck to tighten up. Life started becoming normal again. I eventually moved back to my old town.
I still had some limitations. For example, sitting on the couch for too long could easily flare my back, and increasing weight too quickly at the gym could cause symptoms. But compared with where I started, the difference was enormous.
OCTOBER 2026 — WHERE I'M AT NOW
I'm writing this in October 2026. The back issue that used to dominate my life seems to have largely gone away. I can still flare myself at the gym if I’m not careful, but I'm otherwise able to live a normal life.
My PT currently estimates that my ribcage issues are around 65% resolved. I don't need to be 100% perfect if I can live my life though I am still working on improving hard.
One thing I've come to appreciate is that I'm much more aware of how my body moves now. I can feel certain parts of my body moving that I never noticed before. It's almost mentally engaging making sure my posture and positioning are correct. Most of it happens naturally now, though. I don't have to consciously think about every single cue anymore.
The frustrating part is that my body can still be somewhat unforgiving. If I'm stressed, don't sleep well, or push myself too hard in the gym, I can feel my body start tightening up in the same TOS-related areas and sometimes flare. I think this is due to my nervous system activating because I want to breathe with my neck more like I used to.
When that happens, I go back to the basics:
· Sleep.
· Hydration.
· Breathing work.
· My PT exercises.
· Getting my movement patterns back in order.
· Not aggressively loading things when I'm already irritated.
This is the nature of how chronic pain begins to resolve according to my PT though, so at least that's encouraging.
WHAT I WOULD TELL SOMEONE WITH nTOS
If you're currently struggling with nTOS, the biggest thing I would say is:
Don't automatically assume that the area that hurts is the root cause of the problem.
For years, I focused on my neck, scalenes, shoulder, nerves, etc. because that's where I felt the symptoms.
But in my case, the problem appeared to be much more global.
My PT's experience is that ribcage dysfunction and altered breathing mechanics are extremely common among the nTOS patients he treats, and in my particular case he believed they were a major driver of the entire chain of problems.
Changing my ribcage mechanics and breathing completely changed how my neck, shoulders, back, hips, and nerves behaved.
That doesn't mean everyone with nTOS has the exact same problem. But if you've tried conventional TOS rehab repeatedly and keep getting worse, it may be worth finding a clinician who looks at your entire movement system rather than just the spot where you feel the pain. I spent years being told that my symptoms were either not TOS or that there wasn't much that could be done about them.
Today, I'm living a mostly normal life.
I'm still not 100%.
But considering where I was a few years ago, I’ll take it.
EDIT 1: It looks like I had a different account signed in on my computer, which I used to post this thread from, so I am going to respond to the comments in order from my normal Reddit account (No_Presentation1212) using my phone shortly.