How Physical Therapy Can Treat Thoracic Outlet Syndrome

suSymptoms can start out somewhat vague. Pain may be felt in the neck and shoulder accompanied by tingling in the hand, particularly if a lot of time is spent at a computer. Hand and shoulder pain may worsen, while patients may begin to feel coldness in their fingers. Thoracic outlet syndrome may start out benign enough, but if left untreated, patients conditions may deteriorate to the point of decreased ability to work and participate in their day-to-day life.

What is Thoracic Outlet Syndrome?

Thoracic outlet syndrome (TOS) is a condition which symptoms include:

  • Numbness in fingers
  • Pain in shoulder, neck and arm
  • Impaired and sometimes discoloration of the extremities

TOS is caused by compression of nerves and/or blood vessels in the upper chest. The thoracic outlet(TO) refers to the exiting passage for those nerves and blood vessels out of the chest into the upper extremities. The TO is bordered by muscles, bone and other tissues and any issue that results in muscle, bone, and other tissues border the thoracic outlet. Any condition that results in swelling of these tissues can cause thoracic outlet syndrome. Thoracic outlet can be caused by poor posture, extensive computer work, weightlifting, however it must be noted that sometimes no sometimes there is no detectable cause.

How to Treat Thoracic Outlet Syndrome

  1. Posture Training: The first protocol in treating TOS is assessing postural problems in day-to-day activities, work and at rest to reset the posture as needed in order to decrease the pressure on the thoracic passage.
  2. Manual Therapy: The focus of manual therapy is increasing range of motion in the shoulder girdle and the 1/2 ribs. This will also aid in the patient’s ability to maintain the postural adjustments of the posture training.
  3. Transcutaneous Electrical Nerve Stimulation or TENS: TENS or EMS is a pain treatment modality that uses low voltage electric current which causes the local release of neurotransmitters such as serotonin which block pain signals in the brain.
  4. Kinesio Tape: In addition to the useful benefits Kinesio tape have in pain relief, swelling reduction and improvement in lymph function; Kinesio tape is also useful for helping patients maintain proper posture.
  5. Therapeutic Exercise: In order for patients to be able to maintain proper posture to relieve the pressure, they must have the strength and flexibility to do so. In addition to exercises done in a physical therapy session, home exercise programs using exercises such as thoracic extension and rowing are necessary for successfully treating thoracic outlet syndrome.

TOS is one of those diagnoses that start out more as an annoyance. However, if left untreated, it can become a source of disability and need for surgical intervention. In our computer and technology driven lifestyles, patient’s posture continue to degrade putting most patient populations at risk for developing TOS. It’s important for patients to understand that treatment is available and early intervention is key.

How Physical Therapy Can Treat Sciatica Caused by Low Back Pain

vBack pain is the second most common symptom-related reason for physical therapy in the United States. Up to 84% of adults have low back pain at some time in their lives, with sciatica affecting up to 40% of those with low back pain. The long-term outcome of low back pain is generally favorable, but persistent symptoms affect millions of individuals. Sciatica accounts for approximately 5% of people with back pain who go on disability, and for up to 75% of the costs associated with low back pain. Noninvasive intervention, such as physical therapy is an important tool that can play a significant role in reducing healthcare costs.

What is Sciatica?

The term sciatica describes the symptoms of leg pain-and possibly tingling, numbness or weakness-that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of the leg.

Sciatica is not a medical diagnosis-it is a symptom of an underlying medical condition, such as a lumbar herniated disc, degenerative disc disease, or spinal stenosis. Sciatica is often characterized by one or a combination of the following symptoms:

  • Constant pain in only one side of the buttock or leg (rarely can occur in both legs)
  • Pain that is worse when sitting
  • Leg pain that is often described as burning, tingling or searing (vs. a dull ache)
  • Weakness, numbness or difficulty moving the leg or foot
  • A sharp pain that may make it difficult to stand up or to walk

How to treat Sciatica Symptoms caused by Low Back Pain

    1. Ultrasound: Ultrasound is often recommended before stretching of the piriformis muscle. Ultrasound is a form of deep heating in which sound waves are applied to the skin and penetrate into the soft tissues. Ultrasound is especially useful in relieving acute episodes of pain and may enhance tissue healing.


    1. TENS: TENS, or transcutaneous electrical nerve stimulation, is a back treatment modality that uses low voltage electric current to relieve pain. TENS is effective for treatment because it causes the local release of neurotransmitters such as serotonin to block the pain signals in the brain.


    1. Iontophoresis: Iontophoresis provides a means of administering medication transdermally using a low, direct electrical current to drive it to the involved tissues of the low back. Frequently, it is used to administer anti-inflammatory medications to local tissues. A secondary benefit for iontophoresis is the electrical current itself that can immediately reduce symptoms by blocking pain receptors.


    1. Traction table: Lumbar traction using a traction table operates under the theory that separation of the lumbar vertebrae will decrease impingement of the spinal nerves as well as decrease pressure between the discs.


  1. Low Level Laser Therapy: Low Level Laser Therapy helps relieve muscle tension, spasms, inflammation, fluid retention, aches, stiffness, and pain. Other benefits of LLLT include improved circulation (blood and lymph), general flexibility, range of motion, and increased tissue elasticity (ex: scar tissue). In a study published in The Australian Journal of Physiotherapy, results showed that Low Level Laser Therapy combined with exercise drastically reduced pain and increased lumbar range of motion in patients complaining of severe low back pain.

Low back pain is an expensive drain on healthcare and individuals. When left untreated low back pain can go on to cause further problems, such as sciatica, thus increasing its detrimental effect. Physical therapy is a time and cost-effective way to combat the effects of sciatica and low back pain, helping patients get back to the task of living their lives pain-free.

How to Test for Patients at Risk for Falls

e3It’s the time of year when fall risks for patients increase, particularly those that live in climates prone to snow and ice. Regrettably, once someone has fallen and sustained an injury helping alleviate their risk of falling is added to treating the sometimes prohibitive injury (broken hip, for example).

There are several fall risk assessment tests used in physical therapy which can help pinpoint patients that are at a higher risk for falls and require help. Once trained in the application of the tests, none of the tests take long to administer, making them efficient and allowing for the focus to turn towards lowering the risk for falls within the same physical therapy session.

Timed Up and Go (TUG)

This simple test helps identify patients who are at higher risk for falls and may have gait problems. Using a timer, patients are seated in a straight-backed chair and told to get up without using their arms, walk across the floor about ten feet, turn and return to sit in the chair. Patients who don’t have balance problems can perform this test in less than 10 seconds. Conversely, patients with difficulties may require more than 30 seconds.

Get Up and Go Test

This test requires training in order to administer to patients, but this test helps assess a patient’s risk of falling and those who may have balance deficits. Taking only 5 minutes to administer, the Get up and Go Test measures dynamic balance along with gait speed and functional capacity for daily activities.

Berg Balance Scale (BBS)

The Berg Balance Scale test also requires training to administer and takes about 15-20 minutes. This test rates a patient’s ability to keep their balance while doing specific daily activity related tasks. The tests rate not only rates balance, but also lower and upper extremity strength.

Dynamic Gait Index

The Dynamic Gait Index takes about 15 minutes to administer and rates a patient’s likelihood of falling. Physical therapists are trained in 8 areas of gait in order to test the ability of a patient to modify their gait when changing tasks

Tinetti Performance Oriented Mobility Assessment (POMA)

This is another task-oriented test which can be used to rate a patient’s gait and balance. The 15 minute test is used to test a patient’s ability to maintain balance while performing daily activity tasks. A patient’s ability to balance is rated along with their lower and upper body strength.

After assessing a patient for their fall risk, treatment will focus on lowering that risk. Using tools such as gait trainers, balance pads and balls on balance platforms, along with strength building using active/passive trainers, patients will not only lower their risk of falls, but gain confidence in their abilities to ambulate through their day to day.

Winter time and the risk of falls can create isolation along with fear and an inability for patient’s to perform their necessary daily tasks. It’s important to identify those at higher risk for falls and encourage them to seek help so they can not only maintain their lifestyle, but continue to live independently.

How to Prevent Injury for Physical Therapists

trIt goes without saying treating patients is a physical job. Not only is extensive knowledge required, but physical strength and stamina are a large part of being successful when working in physical therapy. That being said, treating patients can take a toll on a therapist’s body, putting them at risk for the very issues patients come to be treated for. What’s wonderful about physical therapy are the array of modalities available that are time-efficient and powerful, helping keep physical therapists feeling their best in order to deliver the top quality patient care throughout their career.

Preventative measures are important in insuring longevity within a physical therapist’s career. Here’s a list of some of the most common complaints physical therapists can experience and some simple reminders to help take care of these issues before they become chronic problems.

Top 5 Physical Therapists Physical Complaints

  1. Low Back Pain: Physical therapists spend a lot of time on their feet, leaning over a treatment table and mobilizations patient’s body which can lead to low back pain. In addition to using proper body mechanics remembering to apply heat or ice as needed can help reduce low back pain.
  2. Carpal Tunnel: Extensive manual therapy in addition to mobilizations can lead to overuse of the hands and wrists. Some of my favorite modalities for hand and wrist pain are paraffin wax, ultrasound, in addition to cold compression therapy.
  3. Neck pain: Again, leaning over clients leads to a forward head posture which can create neck pain. Making sure to stretch as well performing chin tucks throughout the day will help maintain a neutral posture. When neck pain occurs, using ice in addition to a traction table can help alleviate pain.
  4. Foot Pain: All that time on the feet means it makes sense there would be some pain at the end of the day. Wearing supportive shoes, taking breaks and doing a quick treatment in a heated whirlpool will help decrease the pain and pressure experienced in the feet.
  5. Hip pain: Another common complaint, hip pain is most likely caused by a number of factors. Luckily, a lot can be alleviated by stretching, using Combination Therapy and kinesio taping to increase the stability of the hip joint.

All of these problems are pretty common complaints among therapists in the clinic. Luckily, treatment using the available modalities, in addition to quality foot-care, therapeutic exercise and stretching can be efficient in resolving these issues and perhaps most importantly be done solo. Meaning, therapists don’t have to wait for the time to get on another therapists schedule to treat any issues they experience throughout the workday.

There is a belief that people in the health field, don’t take care of themselves because they are so busy taking care of other people. While this sounds very noble, that practice won’t help a practitioner sustain themselves or their career. Prevention and dealing with issues as they occur go a long way towards keeping a long, thriving career helping others and maintaining vibrant health.