Treatment of Long Thoracic Nerve Dysfunction

Introduction

In this previous post, I discussed long thoracic nerve (LTN) pathology. In this poat we’ll explore what soft tissue treatments might be helpful to address this problem. The primary treatment goal for most LTN pathologies is reducing mechanical load on the nerve. Reducing the mechanical load is crucial whether it is a compression or tension pathology. A comprehensive client history and thorough physical exam will help you determine the most effective treatment strategy for optimal results.

Nerve injuries are unlike the many common muscle injuries that massage therapists most commonly treat. These injuries often require longer healing times, mainly when the adverse force has been applied to the nerve for an extended period. Nerve tissue heals slowly, so symptom relief may take months or even years or more in some cases. During recovery, clients should avoid aggravating activities like carrying heavy loads or anything that puts pressure on the top of the shoulder, such as heavy straps.

Treatment Approaches

The first step in nerve pathology treatment is removing or reducing the offending activity. Here, the massage practitioner plays a vital role as an educator, helping the client find strategies to reduce mechanical compression or tension loads. In some cases, removing the offending force loads is sufficient for treatment. Again, the results may be slow because of the slow healing time of nerve tissue and the potential nerve sensitization.  

Massage can be quite helpful in addressing this condition along with removing offending activities and forces. As noted in the post describing the condition, the LTN can be compressed between the anterior and middle scalene muscles and the brachial plexus.

LTN compression between the anterior and middle scalene muscles often results from muscle hypertonicity or taut bands. The primary goal is to reduce muscle tightness without further irritating the nervous system. The muscles respond well to various compression techniques, but these same techniques may compress the nerve and further irritate it. An effective way to treat the scalene muscles without putting adverse compression on the LTN is with a gentle skin gliding technique. This approach may go by several names but is most commonly called myofascial release.

Position the client supine with their head slightly turned to the opposite side. You may also include slight lateral flexion to the affected side. This position reduces tensile load on the affected scalenes.  Place your fingertips at the superior and inferior ends of the muscle. Apply a gentle pulling force, separating your hands, and hold for about two minutes or until the client feels a beneficial change in sensation (Image 1). The helpful response is usually an increased sense of relaxation of the affected muscles. After holding that position, slowly release the pulling force between your hands.

Slowly releasing pressure allows the brain to adapt to new muscle sensations, potentially leading to longer-lasting effects. After releasing pressure, gently move the client’s head back to a neutral position, avoiding overstretching the treated muscles. These gentle movements help retrain neuromuscular patterns without triggering the brain’s protective responses.

A similar technique can target other muscles along the long thoracic nerve’s path. Position one hand near the base of the neck and the other near the distal end of the clavicle. Apply gentle traction between your hands for about two minutes (Image 2). Gradually release the traction and guide the neck and shoulder through comfortable ranges of motion, encouraging pain-free movement patterns.

Lower portions of the long thoracic nerve may experience binding and restriction along the lateral rib cage.  These restrictions can be addressed with the client in a side-lying position. Have the client hold one arm across their body and use the other hand to secure the drape, exposing the lateral rib cage.

To mobilize the nerve and prevent entrapment, use one or both hands to push the skin across the lateral rib cage, holding for a few moments (Image 3). Then, slowly release and push in a slightly different direction (more superior or inferior). This perpendicular pushing and pulling of the skin relative to the nerve’s direction helps free it from adjacent tissue restrictions (Images 3 & 4).

 

Conclusion

The nervous system’s complex anatomy reveals numerous sites where nerves are vulnerable to excessive compression or tension. While conditions like carpal tunnel syndrome, thoracic outlet syndrome, and nerve root compression often dominate discussions of nerve-related disorders, they represent only a fraction of the potential nerve compression problems throughout the body. To learn more about how to help your clients with long thoracic nerve compression and numerous other challenges, join us in our orthopedic medical massage courses!