Phillies’ Zack Wheeler Thoracic Outlet Surgery the Role of Physical Therapy
By Dr. John Mishock, PT, DPT, DC
Philadelphia — In a move that has given Phillies fans pause, ace pitcher Zack Wheeler was recently diagnosed with venous thoracic outlet syndrome (TOS) and is slated for season-ending decompression surgery. What does this condition mean for a high-performance athlete, and why does physical therapy still matter?
What Is Thoracic Outlet Syndrome (TOS)?
Thoracic outlet syndrome occurs when neurovascular structures—nerves, arteries, or veins—are compressed as they pass between the neck and shoulder area. The venous type, as in Wheeler’s case, involves compression of the subclavian vein, which can lead to blood clots, swelling, and shoulder or arm heaviness.
Wheeler’s timeline:
• On August 18, he underwent a minimally invasive procedure (thrombolysis) to remove a clot near his shoulder.
• By August 23, the diagnosis was confirmed, and decompression surgery was recommended, with a 6–8 month recovery window expected.
The Vital Role of Physical Therapy for Thoracic Outlet Syndrome
Neurogenic TOS (the most common subtype) often responds well to conservative care, where physical therapy is the first line of defense. PT aims to:
- • Improve posture and upper-body mechanics
- • Stretch and relax tight muscles (pectoralis, scalene, sternocleidomastoid)
- • Strengthen scapular and shoulder stabilizers
- • Educate patients about posture and ergonomics
- • Use techniques like nerve gliding to relieve compression
- • Cervicothoracic stabilization exercises
- • Manual Therapy to the muscles around the neck and mid-back
In many cases, especially neurogenic TOS, adequate PT can lead to significant symptom relief and functional improvement.
When Surgery Becomes Necessary
When symptoms are severe or involve vascular compromise—as with clots—surgery becomes necessary. In Wheeler’s venous TOS, decompression often involves:
- • First-rib resection
- • Scalenectomy (muscle removal)
- • Venolysis (freeing the vein from scar tissue)
These procedures aim to relieve compression and restore normal blood flow. However, surgery carries potential risks and requires a robust post-op rehabilitation plan.
A Dual-Phase Recovery: PT Before and After Surgery
Although Wheeler’s case requires surgery, physical therapy remains critical before and after intervention:
1. Pre-surgery: PT helps maintain shoulder mobility and posture, potentially reducing symptom severity or improving outcomes.
2. Post-surgery rehab: A structured PT program—typically 6 to 9 months long—guides return to activity, focusing on range-of-motion, strength, and gradual throwing progression.
How This Matters for Athletes and Everyday Patients
Wheeler’s diagnosis and treatment path serve as a reminder:
- • Timing matters: Early recognition of symptoms like arm heaviness or swelling can lead to effective PT intervention—especially for neurogenic TOS.
- • Athletic mechanics involving repetitive overhead motion (like pitching) can predispose to TOS. Addressing posture and muscular imbalances is key for prevention.
- • Comprehensive care, combining PT and, when needed, surgical intervention, offers the best outcomes for vascular cases.
Bottom line: For the majority of TOS patients—especially those with neurogenic presentations—physical therapy is the cornerstone of treatment. In cases like Wheeler’s involving vascular compression, surgery is necessary. Whether you’re an athlete or someone experiencing upper extremity symptoms, seeking timely evaluation and a tailored physical therapy plan is essential
We can help!
If pain is limiting you from doing the activities you enjoy, give Mishock Physical Therapy a call: locations in Gilbertsville (610-327-2600), Skippack (610-584-1400), Phoenixville (610-933-3371), Boyertown (610- 845-5000), Limerick (484-948-2800) at www.mishockpt.com or request your appointment by clicking here.
Dr. Mishock is one of only a few clinicians with doctorate-level degrees in both physical therapy and chiropractic in the state of Pennsylvania. He has also authored two books; “Fundamental Training Principles: Essential Knowledge for Building the Elite Athlete”, “The Rubber Arm; Using Science to Increase Pitch Control, Improve Velocity, and Prevent Elbow and Shoulder Injury” both can be bought on Amazon or train2playsports.com.
