The Clinical Coach: Bilateral Thoracic Syndrome w/ Hypermobile EDS

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When this patient was referred to me by her husband, all he said was “she’s got some shoulder and back pain, but she just had our baby.”

Ok, cool. No problem. I figured.

I’ve dealt with these two situation before, and I’ve worked with women at all stages of their pregnancy before.

I figured, it would be a simple rehab case.

Far from it.

As I was reading Sara’s paperwork [not her real name]. It came clear to me, that this was not going to be a simple case.

Her complaints read:

• Bilateral Thoracic Outlet Syndrome

• Hypermobility Syndrome (possible EDS)

• Sacroiliac Joint pain

• Chronic low back pain

• Headaches

• Neck pain

• Bilateral hand numbness and tingling

• General Joint pain

I mean, there was a lot she wrote in her new patient paperwork.

When she arrived at the office, she was hesitant of what we’d be able to accomplish together. After all, she’d been through various DPT’s, MD’s, and DC’s with the same results — not great ones.

She began by telling me her story. Which was fascinating.

Had been diagnosed with EDS almost 10 years ago. Years later, they told her it was cured. A few years later another physician diagnosed her with hypermobility EDS.

This is how doctors where able to explain all of her aches and pains she was currently having.

Six years ago, she was diagnosed with Bilateral TOS simply because both of her hands would go numb when she was driving. (not a good thing)

A few years ago, she came across a chiropractor who knew what he was talking about and promised her she would be 80-90% better after completion of their treatment plan. Six months later, $6500 out of pocket and 52 visits later — her symptoms had just worsened.

She had been told to avoid heavy lifting, avoid running and avoid cycling. All activities which she participated in weekly. She ended up gaining over 20lbs in those six months.

As she continued to tell me the horror stories she was put through as a patient. I just couldn’t believe there were actually doctors out there that were so incompetent. Don’t ever become one of them.

Once I gathered more information about what she’d like to accomplish with a healthcare provider, it was clear she wanted to be able to carry her son without issues, participate in outdoor activities with her husband again, and be able to go on adventures with their son.

They are both highly adventurous people.

With all the information I needed, I went ahead and began my evaluation, which consisted of:

• Blood Pressure, and pulse bilaterally

• Active, Passive and Resisted ROM of the c/s, t/s, l/s, shoulders and hips

• Orthopedic examination to assess for TOS (roos was positive BL in less than 20s)

• Orthopedic examination to assess physical strength, mobility and control

• Orthopedic examinations to rule out red flags in the cervical spine

• Outcome Assessment Tools for neck pain and back pain.

• and some additional questions regarding the headaches.

By the end of the evaluation it was clear the patient presented with:

• Bilateral thoracic outlet syndrome aggravated by shoulder flexion past 90 degrees, abduction and ext. rotation.

• Cervicogenic headaches associated with muscle hypertonicity of the c/s aggravated by prolonged desk job.

• Low back pain associated with poor intra-abdominal pressure, aggravated by prolonged sitting.

• Joint Hypermobility - we were able to exclude EDS hypermobility by following this criteria

We sat down and discussed the findings, and the recommended treatment plan.

At first she was hesitant of adding any sort of resistance training. Thinking it would make things worse. She however agreed to manual therapy, dry needling, manipulation and stretching.

So we started there.

Within three weeks, she started to notice quite the improvement.

• Her arms where not falling asleep at the wheel.

• Her headaches were less persistent and much less frequent.

• Her back pain was starting to ameliorate.

During her follow up at the fourth week, we sat down and discussed her improvements.

At this time, I once again brought up the topic of resistance training. To my surprise she was less hesitant of it. She decided she’d give it a go. After all, she had seen improvements with the work we were already doing.

We started as light as possible and focused mostly on machine work. The first couple of weeks her RPE was a 3-4/10. And was fully recovered by her next session.

Most of the soreness she felt were at the shoulders, and mostly from exercises she hadn’t done in years!

To her surprise. No headaches. No low back pain for two weeks. Her arms however were fatiguing pretty fast during her exercises.

We made a few tweaks in her program for the 3rd and 4th week.

During her follow up visit on the third month of her rehab, as soon as she walked in. She stopped and said.

“By the way, I was able to carry my son all day on Monday without my hands falling asleep. This is the first time that’s ever happened.”

You could see the joy in her face! Her smile said it all!

You can’t beat that feeling.

Within 15 weeks she was no longer experiencing recurring headaches, or low back pain. Her arms were no longer falling asleep when she was driving. She was able to carry her now 40 lb. son around the house without her hands going to sleep.

Her TOS isn’t cured, it’s managed. She still gets some numbness and tingling in her arms when doing overhead movements, like cleaning the top shelf of the pantry and keeping her arms above her head for more than 3 minutes.

Over the last year, we’ve had a few flare ups. But nothing we weren’t able to manage together.

Here’s what her initial treatment in-office looked like:

In-office care:

• IMES Dry Needling to trapezius, levator scap, pec major and rotator cuff

  • 8-10 minutes with alligator clips

  • visible muscle contraction to patient comfort

• Dry Needling to scalenes and SCM

  • twirling stimulation every minute

  • 5 minutes per side

• P+S to paraspinals of the c/s and t/s

  • elected for manual therapy in these areas due to sensitivity reasons.

• Progressive movement coaching for full spine strength and mobility

  • bodyweight for the first 4 weeks.

  • resistance introduced at the end of the first 4 weeks

• Full spine adjustments

As of last week after working together for 14 months, she’s lost 12 lbs (not part of her goals) without focusing on her nutrition, and has increased her strength significantly! Wouldn’t be fair to give you percentage as it would be over 400% due to the limitations she had been placed on. I’ll give you a few examples. She’s gone from curling 3-5lbs to completing sets at 20-25lbs. From bodyweight lunges, to 30lbs on each hand (total of 60 lbs) and from barely able to do any shoulder press, to completing 4 sets of 15 reps (90 seconds of work) with 10lbs!

She is a totally different person today than who I met 14 months ago. She is confident in her body and understand that we are not after perfection, but continued progress.

This hasn’t been an easy to manage case. There were a lot of ups and downs throughout the last 12 months. We only got to where we are today by understanding the roller coaster of a ride of what it takes to improve health and performance.

Progress isn’t linear.

When you expect the dips, you are one step ahead. If you don’t expect dips, you don’t understand the human experience and you are a fool.

Until our next issue!

In health and strength,

P.S. The FCW Mastermind is a 6 week program developed to help you develop a strong and scalable foundation in the healthcare business.  Get your name in the waitlist. More information to come next week.