​Have you experienced shoulder pain? There might also be some neck pain or arm pain? Perhaps even pins and needles or numbness in the hand and fingers? You may be experiencing a condition call Thoracic Outlet Syndrome (TOS) and you aren’t alone! This condition effects up to 12 in a hundred people(1) and can often get misdiagnosed as neck pain or a muscular shoulder injury.

To understand TOS first we must understand what the thoracic outlet is, and what passes through it. The thoracic outlet is a passageway between the neck and the shoulder and allows important things like nerves, veins and arteries to pass through. Birth defects, injuries and muscle tightness can cause compression of these structures, especially in compromising positions like neck or arm movements which can in turn cause pain.

​​Getting treatment is a critical part of TOS recovery because these things rarely occur for no reason. The most common contributor we see is posture related, so using this as an example a person with postural related TOS is likely to keep provoking the issue and is likely to make things worse without treatment.

​So what’s the first step to getting it under control? Well lucky for you, you’re already halfway there! The first step includes education and understanding the syndrome, from there identifying triggers and contributing factors will be a key component.

A tailored assessment and treatment will find the root of the problem and address it, whether it’s a muscle imbalance, tight muscles or a postural contribution. Our anatomy knowledge is key.

​When you consult with a physiotherapist, we will work with you to provide an adequate explanation of the nature and prognosis of TOS. In the early stages, we will work with you to keep you physically active and doing activities that are important to you. We will combine activity with relief manual therapy and easing position and therapeutic movements for you to do at home.

Controlling the shoulder blades and arm is important in establishing normal muscle recruitment and control in the resting position. Mastering the basics means then working on the arms away from the body and above the head where the stabilising muscles have to work harder.

Once relief has been achieved, you are taken through sports and technique drills to see you back on your A game!

It has been an interesting couple of months, with a lot of trying times. This has meant for us, a time to try more. So that is just what we have been working on. TELEHEALTH.

It isn't for everyone who needs physiotherapy and we will more than readily tell people when they need to have face to face contact with one of our physiotherapists.

• We expected that people would be current on our lists and opt totally for online services - Check
• We expected that perhaps we would see people come in face to face and then go online and vice versa- Check

The results have been beyond expectation with people really getting a lot out of their Telehealth consultations

 have provided Telehealth Physiotherapy to a twenty year old man, isolating with his grand-parents on a farm in southern NSW. Coming in for treatment was not an option and he had several months of mid back pain radiating to the right rib cage.

It hurt to twist and bend, which is not so useful on a farm and it was uncomfortable to sleep. Anti-inflammatories offered little comfort. Happily, scans showed nothing abnormal and nothing to worry about. His mid back and ribs had jammed, but this created awful aching through the flank, the back and into the lower abdomen.

How can a physiotherapist help form a laptop in Melbourne?

The plan is like any assessment. We talk and get the clinical impressions of the problem. After being a physiotherapist for thirty years and having Specialist Musculoskeletal Physiotherapy training, I can recognise presentations quickly and have way to test my hypothesis. That is what we did together.

I got him to perform the movements I normally assess, look at the tasks and positions that caused the grief. In place of my hands, I then used a belt he had to isolate the movement to specific parts of the back and ribs to find where it was eased by blocking movement elsewhere.

The next step was to use the belt as self treatment, to mobilise the joints in the right direction and teach exercises just as I would in the clinic. We improved using chairs, blankets and pillows as props to gradually increase range.

After 5 visits, the pain had markedly improved and still improving with the exercise routine. Both he and I found this really encouraging, that Telehealth isn't just a novelty. And it reinforced just how much we physiotherapists can help people by teaching how to do their specific exercise programme properly.

So, it is a trying time, but we will keep trying to help people every way we can. 

It has been a tough couple of months and we wish everyone, health during this time.
We have more info on Telehealth here:

Your movement partner
Jayce