Thoracic Outlet Syndrome Botox: How Scalene Injections Lead to 1st Rib Removal

Your history of injuries, surgeries, or even the number of car accidents you’ve had over your lifetime is different than the next person in line for thoracic outlet syndrome Botox.

Yet the path to what got you to where you’re considering Botox injections for your scalene muscles has been similar to everyone else with neurogenic thoracic outlet syndrome (TOS).

When your brain recognizes the threat of instability has been replaced with stability, the muscles that are compressing the bundle of nerves that go beneath your collarbone (clavicle) will relax more than they have in a long, long time.

Is this your first time reading that muscles underperform?
Right now, as you read this, you have underperforming muscles that are neurologically incapable of pulling their weight optimally. (i.e., muscles that are neurologically inhibited.)
Underperforming muscles are the reason your muscles are tight in the first place. 
Once the neurological input to the underperforming muscles is restored, those muscles will be fully capable of providing stability.

Before your emotion, social, or ego defaults kick in, which is what, in most cases, leads to Botox scalene injections or a 1st rib resection, or a scalenectomy—pause for a moment—and think again.

When Daryl Morey, the general manager of the NBA’s Houston Rockets at the time, wrote the foreword to Michael Lewis’s The Undoing Project, he said this about the human mind: “…[it] was just bad at seeing things it did not expect to see, and a bit too eager to see what it expected to see.” He went on to say, “Confirmation bias is the most insidious because you don’t even realize it is happening…” 
When practitioners pretend that stretching and releasing muscles is productive, your conscious mind experiences both approaches completely differently than your brain perceives them.
Because stretching and releasing muscles fail to change the threat of instability that your brain perceives, remodeling itself isn’t attainable. (i.e., neuroplasticity)
When You Don’t Know What You Don’t Know
To wrap your head around how backward thoracic outlet syndrome treatment is today: ~99% of practitioners deemed qualified to work with your muscular and skeletal systems lack the skill set to differentiate underperforming muscles from those that are actually tight.

You can’t have muscles that are tight without also having muscles that are underperforming.

One or more of your scalene muscles could be underperforming and not tight. Up until today, your scalenes have gone unchecked.
Whether it’s Botox injections or a scalenectomy, the future state of your anterior and middle scalenes is literally based on a guess.  Sadly, the fate of your 1st rib will also be determined by the next best guess.
Combine the incomplete information you’re left to go on for thoracic outlet syndrome Botox treatment with the fact that you don’t know what you don’t know, and what you have is a recipe that ends with two of the worst-case scenarios you could have: 1st rib recession, or even worse—a scalenectomy. (i.e., your anterior and/or middle scalenes are removed, leaving only your posterior scalene intact.)

Whether you know it or not, you’re stuck in an echo chamber of voices with first-layer knowledge, which includes the practitioners who are said to be the best at removing 1st ribs, something that, when the root cause is addressed, is rarely necessary.

While decompressing the bundle of nerves that go underneath your collarbone has been the focus for the practitioners tasked with solving thoracic outlet syndrome, I’m confident when I tell you, chasing muscle tightness, compressed nerves, and pain serves as a distractor for everyone involved— including you.

Outside of having luck at a time when you need it more than ever, you’re most certainly on a path that leads to getting your 1st rib removed.

From where I sit, what leads to having your 1st rib removed looks a lot like throwing everything practitioners can come up with at the pain and tightness you’ve experienced—hoping something (anything) will stick.
Chasing symptoms and sensations, failing to change what your brain perceives, in other words.
The external force of stretching, for example, whether it’s a push or a pull, causes muscles to underperform, leading to increased joint instability. For this reason, muscle tightness and compensation increase.
Whereas the external force of applying pressure to muscles that lie on top of one another with the mindset that some variation of massage is going to release a muscle causes instability, muscle tightness, and compensation to increase.
If you’ve used a foam roll, the external force of your body weight collected everything that was above the self-massage tool.

Because you weren’t emphasizing an underperforming muscle more than any other muscle, you, unknowingly, increased instability, and as a result, muscle tightness.

The Compounding Cycle of Compensation
There’s compensatory motion, and then there’s quality motion (that you haven’t had in some time).
Do you remember a time when you moved your shoulder in a certain direction, and you heard a consistent crack?
The point at which you heard the crack indicates that certain muscles are neurologically incapable of providing stability. (i.e., joint instability)
If you can’t relate to the previous example, you’ve more than likely seen someone intentionally crack their neck or lower back; the crack consistently occurs in a position where there’s instability at the spinal joints.
Note to the learner: When you move your shoulder in a wide circular path, as you would in the breaststroke or backstroke, there’s motion at several joints. Looking at joint motion globally, you’re able to look straight ahead, and the motion of your arm drives motion throughout your entire spinal column, with the joints in your feet being the last to move. (i.e., pronation and supination)
For your shoulder to take this circular path of motion, your clavicle moves at two joints, and every one of the ribs that form your rib cage allows for motion at its respective joints. The two joints that allow your collarbone to move also give your shoulder blade (scapula) the ability to move in multiple directions. 
Upstream Thinking to Save The Day
Underperforming muscles are the reason for joint instability. When your brain perceives an unstable joint, it calls upon muscles to tighten to restrict motion into a position it senses as being vulnerable to an injury.
Before you experienced the symptoms that go along with neurogenetic thoracic outlet syndrome, the root cause of joint instability had gone unaddressed for years.
Compensation, in other words, accumulates.
A note for learners: I align what I do with two principles of human function: (1) to have more mobility (joints) and flexibility (muscles); first, your brain has to recognize the level of stability that can only come from muscles that are fully capable of generating the internal force to contract optimally. And (2), to have more stability out to your extremities, your brain has to first recognize that what was done in the session increased the stability of the muscles that are responsible for postural control of your spine. 
•  Jump to read how I worked with a recent TOS client
First-Layer Knowledge Everywhere You Turn
As you continue reading, I’ll argue that when practitioners use the word “relax” to describe how your scalenes will be after thoracic outlet syndrome Botox injections, it’s manipulative. Because nothing could be further from the truth!

Botoxed scalenes aren’t relaxed, tight, or underperforming. The truth is, your scalenes are temporarily paralyzed.

As if you haven’t been through enough already, thoracic outlet syndrome Botox most certainly takes more than it gives.
After Botox scalene injections, the muscles responsible for cervical and thoracic spinal stability are temporarily weakened, to the point of paralysis, leaving the target muscles completely out of commission and unable to perform their roles for 3 to 4 months.
In Maria Konnikova’s book, The Confidence Game: Why We Fall For It…Every Time, she writes this about the persuasive power of narrative, “…they [psychologists] found that the more a story transported us into its world, the more we were likely to believe it. All of it—even if some details didn’t quite mesh.”
Why Practitioners Use Botox Before First Rib Removal
The strangest thing about Botox for your scalenes being the next-best guess is that when those muscles are paralyzed, your brain will do what it’s been doing all along: tighten muscles to protect your joints from going into positions it perceives to be vulnerable to injury.

Because instability increases after thoracic outlet syndrome Botox, your brain’s strategy to find stability changes, which often times, has you feeling symptoms you didn’t feel before the procedure.

Whack-a-mole, in other words.

Even when millions of dollars are at stake, as it is with pitchers in Major League Baseball (MLB), the team’s medical staff, who, more often than not, make decisions from a position of first-layer knowledge for the entirety of their careers, recommend seeing the specialists who are in the business of removing 1st ribs, something that again, is rarely necessary when the root cause is addressed.
To reinforce the point I made in the section titled, “Upstream Thinking to Save The Day,” regardless of how you feel about your practitioners’ qualifications, social status, and the care you receive, your brain, which is completely separate from any story your conscious mind comes up with, ensures that muscle tightness and the resulting nerve compression resume.
To change course and increase the chances of avoiding scalene muscle Botox, stop stretching and releasing muscles that the vast majority of practitioners with first-layer knowledge can’t confirm are tight. Instead, do what increases stability.
If what you’re doing, in other words, doesn’t increase stability, it’s not going to change the threat of instability that your brain perceives, making it not worth doing.
A note for learners (who are interested in professional sports): Quin Priester, the most recent MLB pitcher to have his 1st rib removed in Dallas, had this to say: “When the brain and arm are communicating the right way because of the nerves that are pinching in there, it makes it nearly impossible to actually create a result that’s repeatable,” he said. “It was great that we had gotten the pain to go away with the nerve blocks, but essentially, we couldn’t alleviate all the symptoms.”

The Milwaukee Brewers will be satisfied with Priester coming back the same or better than when he had to undergo surgery for thoracic outlet syndrome.

That said, I’m thinking they’d be even happier not to pay him millions of dollars while he’s out for 8 to 10 months.
Most professional teams have ownership and management that, like you, don’t know what they don’t know. So, of course, without realizing it, the practitioners who work with their athletes (assets) have maintained a status quo level of care for decades.
Most professional teams have a staff of practitioners who rely on their age-old stretches that provide no benefit whatsoever, hands-on massage techniques that increase mobility without increasing stability, and, lastly, dynamic exercises that increase compensation.
Since the staff for most professional teams doesn’t have the skill set to identify which muscles are underperforming, when they choose exercise before addressing pre-existing muscle imbalances, the only muscles that get stronger are the ones capable of pulling the weight, thereby increasing compensation. 

Look No Further Than Muscle Contractability
You can feel tight muscles. But what you can’t feel are muscles that are underperforming. (i.e., neurologically inhibited muscles)
If you have rounded shoulders or a forward head position, for instance, your shoulder blades and collarbones are off from the start, a clue that muscles can’t perform their role at the right time.
With 15 years of experience teaching kinesiology (the study of human movement), and over 31 years of hands-on experience as a licensed massage therapist and 18 years working as a personal trainer at the highest level, I’ve been on a different path.
For example, I recently worked with a female who had thoracic outlet syndrome on both sides.
Instead of assuming her muscles were tight, which lacks scientific rigor and confirms a bias, I identified the muscles that were neurologically incapable of performing at their best.
From there, I used a deep tissue massage technique to restore neurological input to muscles that were underperforming. Then I applied massage to the tendinous attachments that connect the underperforming muscles to her spine.
In the first three sessions, I didn’t focus on her rounded shoulders. Instead, I focused on increasing the stability of her cervical and thoracic spine.
Because her brain recognized that her spinal muscles were fully capable of performing their role to the best of their ability, something that wasn’t possible for some time, she was an inch taller. As a result, her shoulder girdle (scapulae and clavicles) was positioned differently on her rib cage, which is an extension of her thoracic spine.
A note for learners: The tightness you feel is real. But it’s due to the threat of instability that your brain perceives. Because practitioners chase pain and muscle tightness, and pretend they’re doing more than that, the underlying cause of muscle tightness goes unaddressed. 
One clue that led to figuring out which spinal muscles were underperforming for my client, who told me that I was her last stop before having both of her 1st ribs removed, was her answer to this question I asked her in her first session, At the end of the day, do experience pain and tightness, between your shoulder blades at the end of the day. Her answer to my question was, Yes.
Because the pull of gravity had been winning for some time, the muscles that were pulling the weight of the underperforming muscles were fatiguing as she went through her day. Depending on how taxing her workday was determined the time of day that she’d feel the area between her shoulder blades.
Over the years, I’ve had many female clients tell me that many practitioners have attempted to alleviate the pain between their shoulder blades or, in some cases, underneath their shoulder blade, but nothing worked for longer than 24 hours. 
Stretching and massage geared towards releasing muscles doesn’t hold because, beyond your conscious awareness, your brain recognizes that the threat of instability has been erased. Hardwired to protect you from injuring yourself further, it lays down muscle tightness all over again. (i.e., rinse and repeat.)
If you were able to visualize what my client with bilateral thoracic outlet syndrome experienced, the space that was created in her thoracic outlet wasn’t due to stretching or releasing muscles. 
Instead, the approach was in alignment with two principles of human function: (1) to have more mobility (joints) and flexibility (muscles); first, your brain has to recognize the level of stability that can only come from muscles that are fully capable of generating the internal force to contract optimally. And (2), to have more stability out to your extremities, your brain has to first recognize that what was done in each and every session increased the stability of the muscles that are responsible for postural control of your spine.