Tips for Treating Clients with Thoracic Outlet Syndrome - a MT lifting up a client's arm

Tips for Treating Clients with Thoracic Outlet Syndrome

Amelia Wilcox
February 5, 2018
October 18, 2022

Because of a similar pain pattern, thoracic outlet syndrome is sometimes mistaken for carpal tunnel syndrome.

But thoracic outlet syndrome is unique in that it usually can be distinguished by a pain that originates in the shoulder and extends all the way down the arm. This uncomfortable feeling is sometimes due to an impingement of the brachial nerve.    

In this training video, see how you can identify and treat thoracic outlet syndrome during a chair massage session.      

Chair Massage Techniques for Treating Thoracic Outlet Syndrome  


1. Identify Your Focus Area

Begin by placing your hands or forearms on either side of your clients’ spine, observing their breath.

If their breathing is not immediately obvious, you can always ask them to take a nice, deep breath.

Doing this will allow you to get a feel for which side of their body is holding most of the tension.

Whichever side of their body moves less, is the side that we recommend you try first. This may be true even if your client says that their other side actually hurts more.

Try working this side by applying petrissage, light compressions, and some gentle jostling of the shoulder and arm. Begin with no more than a medium level of pressure.

Then work the opposite side applying the same opening techniques.   

2. Locate Brachial Plexus and Trapezius

After that warm-up, locate the brachial plexus. It will be located close to the back of the neck and will attach just by the collar bone and near the scalene.

With supportive thumbs, pick up the trapezius muscle, while placing your fingers on the area near the client's collar bone.

With an added swaying motion from side to side, you will be able to apply a pressure that feels deeper for the client without using the strength of your forearms alone.     

3. Remember Your Body Mechanics

Next, apply pressure by leaning into the top of their traps with an elbow or forearm, but make sure you are in a comfortable stance where you can begin to lean in and relax.

It is important to remember that if you are feeling uncomfortable at any point, then your client is likely picking up on it and feeling uncomfortable too.   

4. Apply Traction to the Shoulder Joint

Bring their arm out and apply a traction to the shoulder joint, by pinning near the bottom of the scapula, and cupping the deltoid from the front.

It should almost look like you are cradling their arm. Be very mindful of your own body mechanics during this technique to ensure respectful boundaries between you and your client.   

5. Work the Forearm

Massage the client's forearm muscles and hands with your forearm, but make sure that your back is straight in this posture. See the video above for detailed instruction on doing forearm work in this way.   

6. Finish with SCM Work

End with some massage on their neck. If performing a chair massage on your client, ask them to bring their head out of the face rest so you can massage their SCM muscles with your fingertips.

Pinning techniques are particular effective here too! Ask them to make a fist with their hand while squeezing their inner bicep towards their pec. Then pin the top of their trap muscle with your forearm, and ask them to lean their ear towards their opposite shoulder. Your client can even move their neck around in gentle circles here if they would like.   

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Amelia Wilcox
Amelia Wilcox
Amelia Wilcox is the Founder and CEO of Nivati, a leader in corporate massage and employee mental health support since 2010. Her high-growth B2B company provides employee stress management tools that arm businesses with actionable data and positive employee experiences to improve wellbeing, boost morale, and increase engagement. Amelia has exponentially grown her company from a solo living-room service business to an international technology brand.