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Exercise programs are essential vehicles for achieving:

• Increased range of motion
• Retraction of the cervical muscles to correct the head-forward position
• Stretching of the thoracoscapular muscle groups

Poor posture is also related to poor aerobic conditioning due to poor or ineffective use of muscles that that aid in the efficacy of the cardiopulmonary system. Many groups of muscles in the back and chest are involved in breathing and if they are not functioning properly, the respiratory system is compromised in various ways, including:

• Insufficient chest expansion during inspiration
• Inefficient functioning of the cardiopulmonary system while at rest

Aerobic exercise is important for cardiovascular health. The most effective aerobic regimen is to start walking while maintaining proper posture (especially the head and neck) and proper breathing.

Conditioning of the various muscle groups should be addressed by the physician or physical therapist through a coordinated program of physical training and patient education focused on full compliance. Exercise should begin early in treatment but not be overly aggressive. It is important for the health professionals involved in treatment (e.g., physician, physical therapist) to regularly evaluate the patient's progress in order to ensure that proper muscle length and strength is maintained. Ultimately, the success of any treatment program depends on patient compliance to home exercise and behavior modification techniques.

In addition to exercise regimens, supplementary modalities which may ease the pain and loosen muscles include:

• Heat application to the painful muscles
• TENS (transcutaneous electrical nerve stimulation)
• Ultrasound

Equally important is awareness of sleep positions, especially if patients wake up in the morning with stiff neck, headache, and numbness in the arm, symptoms which may result from raising their arm above their heads during sleep. Patients need to be coached and taught how to prevent themselves from lying with arm positions which may be counterproductive to their treatment and advised regarding proper support for the cervical spine during sleep, including cervical pillow supports and other types of equipment.

In summary, there are some basic lifestyle modifications that patients with TOS should consider to control and relieve symptoms of the disorder:

• If you are obese, talk with your doctor about starting a safe and effective weight loss program
• If you do not already have an exercise program, talk with your doctor about developing a program to strengthen your muscles (particularly shoulder muscles)
• If you have poor posture, ask your doctor to suggest a postural training program
• Avoid sitting or standing for extended periods of time andtake frequent "stretching" breaks
• Avoid lifting heavy objects at work or at home
• Ask your doctor about work-site modifications that may be necessary to help you control your TOS symptoms while on the job
• Talk with your employer about implementing your doctor's recommendations for work-site modifications