2.2.5 Structural issues

Thoracic Outlet Syndrome (TOS)
The lower traps and rhomboids are essential muscles responsible for scapular control and stability. Weakness in these muscles can lead to poor scapular control, which can result in chronically pronated shoulders and TOS.

Pronated shoulders occur when the shoulder blades “wing” and rotate forward, leading to a hunched posture. This can occur when the lower traps and rhomboids are weak and unable to maintain proper scapular alignment and is common in people with hypermobile Ehlers Danlos Syndrome (hEDS) metabolism. hEDS metabolism is described in the disease model as a "normal feature" whenever innate immune response pathways are activated and/or specific mineral deficiencies are present. The resulting forward shoulder position can cause tension and compression in the neck and shoulder region, leading to TOS.

TOS is a condition where the nerves, lymphatic thoracic duct and blood vessels that pass through the thoracic outlet become compressed, leading to pain, numbness, and weakness in the arm and hand. This can be bilateral or unilateral. Forward head position will further contribute to the progression of this syndrome. This can cause impaired immune response and water retention / lymphoedema.

To prevent TOS and other related conditions, it is essential to maintain proper scapular control and stability. This can be achieved through exercises that strengthen the lower traps and rhomboids, such as scapular retraction and shoulder blade squeezes. Additionally, maintaining good posture and avoiding activities that require prolonged shoulder and arm elevation can help prevent TOS, however when this position occurs during sleep, it can be hard to avoid.

Slipped Rib Syndrome, costochondritis and chest pain

Slipped rib syndrome, costochondritis, and worrying chest pain can all be downstream effects of a poorly seated rib – usually between T6–T8. When a rib is not properly aligned, it can cause thoracic instability, leading to overworked intercostal muscles and inflammation in the surrounding tissues. This is a common issue where hEDS metabolism is present.

Slipped rib syndrome occurs when a rib slips out of place and moves too easily, causing pain and discomfort. Costochondritis is inflammation of the cartilage that connects the ribs to the breastbone, which can also cause significant chest pain, which can mimic having a cardiac event.

When a rib is poorly seated, it can create an unstable environment for the intercostal muscles that are responsible for breathing. With mitochondrial dysfunction, these overworked muscles can become fatigued and inflamed, leading to scary chest pain and difficulty breathing.

It is wise to seek medical attention if you experience chest pain, as it can be a symptom of more severe conditions such as a heart attack or pulmonary embolism. However, if you have chronic chest pain that is related to slipped rib syndrome or costochondritis, treatment may include correcting the alignment of the rib and regular physical therapy, once any hEDS metabolism is corrected. Like any other resistance training, this tissue rehabilitation process will normally take weeks or months to complete.

A (free for the Born Free community) online posture rehabilitation course can be found here, using code: Free4Me - please carefully observe the modification to the advanced stretching technique for working around hEDS metabolism.