In conservative management of thoracic outlet syndrome, which of the following is NOT recommended?

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The key idea is that managing thoracic outlet syndrome conservatively aims to reduce compression by improving posture, increasing flexibility, and retraining the shoulder girdle, while avoiding strategies that could worsen the space for neurovascular structures. Correcting posture helps align the shoulder girdle so the space beneath the clavicle and first rib isn’t chronically narrowed. Gently lengthening tight muscles through targeted stretching—especially scalene and pectoralis minor/major regions—reduces anterior pull and rib elevation that contribute to compression. Manual therapy supports these goals by releasing myofascial restrictions and improving joint mobility around the shoulder girdle and upper ribs, which can further relieve pressure on the neurovascular bundle.

Strengthening the pectoral muscles, on the other hand, can counteract these goals. A stronger chest tends to pull the shoulders forward and downward, increasing anterior tilt and protraction of the scapula, which can narrow the thoracic outlet and worsen symptoms. Instead, emphasis is placed on strengthening scapular stabilizers (like the serratus anterior and lower/middle trapezius) to promote proper scapular motion and space for neurovascular structures during movement.