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Thoracic Outlet Syndrome (TOS)

Thoracic Outlet Syndrome (TOS) is a difficult condition to describe as the symptoms are variable. TOS is caused by compression of the nerves and/or blood vessels as they leave the neck to enter the upper limb.

TOS causes pain, pins and needles, and sometimes numbness down the arm and into the hands and fingers (usually the little and ring fingers).  A feeling of weakness or heaviness of the upper limb may also be felt as well as pain in the neck, shoulder blade, chest and facial region.  Rarely symptoms of colour changes and / or swelling in the hand may also be present.   Usually pain is aggravated by holding the arm up in a raised position for prolonged periods (such as hanging up the washing), carrying things by your side, sitting for a prolonged period of time (such as using the computer) or lying on your side at night. So with this long list of aches and pains and other assorted symptoms, which may or may not be present, TOS can be a difficult condition to diagnose.

The cause of TOS is usually multifactorial and can be a combination of the way you were born (such as an extra rib in your neck, which isn’t that uncommon) and acquired factors (such as muscle weakness due to overuse, trauma or poor posture).  The pain is usually created by the shoulder girdle drooping, creating a pulling force on either the nerves or blood vessels of the upper limb (or a combination of both nerves and blood vessels being involved).

Your doctor and physiotherapist will assess you to determine what is contributing to your TOS symptoms and this may involve some further tests.


Most often TOS can be very well treated with a combination of shoulder blade taping or bracing, shoulder girdle strengthening exercises and postural correction. Some of these exercises and taping techniques are very specific and need to be closely supervised by your physiotherapist and doctor.  Some modification of activities may be required for a short period until symptoms are under control.

Usually patients are significantly improved within 3 months provided they are correctly managed and comply with the advice and exercises from their treating practitioners. In some patients an ongoing home exercise programme is required.

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Scheuermann’s Disease

In adolescents bones are still maturing, including the vertebrae of the spine. Scheuermann’s disease refers to an abnormality in the growth of the vertebrae, where the front of the vertebrae does not grow as quickly as the back leading to wedging of the vertebrae. This usually occurs in the thoracic spine (the upper back) and may have varying degrees of severity.


  • Pain in the upper or mid back especially with sitting
  • Stiffness in the back
  • Increased curve in the upper back


  • Often unknown
  • Sudden growth spurt.

When do you see someone for help?

Your Physiotherapy4u Practitioner will be able to provide an accurate diagnosis and an appropriate management plan. Often this problem can require a Sports Medicine Doctor, Physiotherapist, and/or Podiatrist to assist.

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Do Discs Heal?

The intervertebral spinal disc remains one of the most intriguing and misunderstood structures in the human body.

The vast majority of the population will at some stage experience some back or neck injury, and a significant proportion of these will involve the intervertebral disc. However, there are still significant misconceptions about these types of injuries.

The intervertebral disc is of course made up of a thick fibrous layered outer coating called the annulus fibrosus, and the centre called the nucleus pulposa. It is fused to the end plates of the vertebra above and below and can move in all directions.

The nucleus itself is liquid in nature up until about the age of 17 in most people. At this stage the nucleus solidifies as part of natural development of the spine. The nucleus itself does not have direct blood supply, and annulus gains its blood supply through the surrounding blood vessels. Damage to the outer coating or end plate that causes bleeding into the nucleus, will result in a significant inflammatory response. Indeed bleeding into this area can in fact liquefy the solid nucleus in adults.

Other misconceptions can include the old adage a ‘slipped disc’. This of course is impossible due to the extremely strong fusion of the disc to the vertebral end plate.

Common injuries that can incur in a disc are a ‘prolapse’ and a ‘bulge’. The prolapse itself involves tearing of the outer coating of the annulus and can also involve the nucleus protruding through this ‘tear’.

A bulging involves tearing of the deeper layers of the annulus but not the outer coating. The analogy of an air bubble in a re-tread tyre on a car can be a useful description.

Damage to these structures causes an inflammatory reaction, and ongoing pain. But it is also the start of the healing process. If this inflammatory reaction is appropriately managed early, then most disc injuries should heal, as with any other structure. If it is poorly managed it can lead to painful restriction to movement, and long-term disability.

Early intensive treatment from the Doctor and Physiotherapist aimed at returning normal movement and function, and controlling the inflammatory response and pain, can have a dramatic impact on the fate of that injury.

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Beating Back Pain


At some stage in their lives eighty per cent of the population will experience back pain. To make matters worse, after the first incidence, eighty per cent will suffer a recurrence within twelve months. The good news is: recent research suggests that good control of your back muscles decreases the risk of hurting or re-injuring your back.

What is spinal stability?

Your spine is made up of individual blocks of bone (vertebrae), stacked on top of each other, with flexible discs sitting in between the vertebrae. Joints between the vertebrae are stabilized by the way the bones meet each other, the ligaments that attach to vertebrae, and the surrounding muscular system. The muscles rely on the nerves to control the timing and the force of the muscle contractions.

When your stabilising systems aren’t working well the vertebrae may move too much on each other and cause pain and discomfort. Research, much of which has been conducted by Australian physiotherapists, has shown that joint stability is improved by very specific exercises that train the nerves and muscles around the spine.

Which muscles are important?

Muscles can be classified as either mobility or stability muscles. The stability muscles tend to be small and deep – close to the joints. They don’t produce much force or movement and if you don’t have a sore back they contract automatically just prior to movement commencing to provide stability.

After an injury, pain and swelling cause the stability muscles to be inhibited or “switched off”. Research has shown that these muscles do not automatically regain their stabilisation ability without specific retraining. It follows that for injury prevention, good coordination between the mobility and stability muscles is vital. This is sometimes referred to as core control.

Typically, the stability muscles are deep. Following injury, research has shown that specific exercises are needed initially to facilitate the stability muscles in isolation (very small effort exercises). Other exercises are then required to incorporate them into everyday activities such as sitting and walking. Often it takes time to isolate these muscles, particularly if you have back pain. The conventional sit-up and abdominal crunch do not regain the function of the stability muscles.

The stability muscles form a stable base from which movement can safely occur without damaging the joints. Even if you don’t currently have back pain it may be worth learning some exercises to help prevent future back injuries.



Back Tips For Shoppers

Your spinal cord relays thousands of messages a second and it is your backbone and muscles, which protect this delicate and very important human ‘super highway’. The two key areas are awareness and prevention.


As you collect your shopping and push your trolley around look out for potential problems:

  • Change direction slowly with your trolley.
  • Ask for assistance if reaching above your height for shelf items.
  • Look out for ‘slippery when wet’ signs – people still fall.
  • When standing still, rest one foot on the bottom of your trolley – it flattens and rests your back. Change legs frequently.
  • When loading your car tighten your stomach muscles, lift with two hands and avoid twisting as you lift.


Development of your full potential.

As we sit for up to 80% of our waking day – work, travel, entertainment and meals – our stomach muscles get very little usage. Traditionally we strengthen our stomach muscles (abdominals) by sit-ups and crunches. Today new exercises have been developed that are more specific and more effective.

Should you have ongoing or recurrent problems with back pain these exercises are essential. Talk to your Physiotherapist about an appropriate ABDOMINAL STABILISING PROGRAM.

A regular exercise program is also very beneficial. This may be walking, running, cycling or swimming. Aiming for 30-40 minutes 3 times a week is proving to be the best ‘prescription’ for heart disease, osteoporosis, general arthritis and for many medical problems. Ask your Physiotherapist how to get started.

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Back Pain: Exercise Or Rest?

Research conducted in 1987 by Dr Gordon Waddell in one of the most prestigious journals of spinal research, Spine, suggested there is little doubt that rest, and in particular prolonged bed rest is harmful in the treatment of low back pain.

In contrast there is no evidence that activity is either harmful or makes the problem worse. There are many studies demonstrating that controlled exercises will restore function, reduce distress and illness behaviour, facilitate a return to work and actually reduce pain. The main theme of the treatment of lower back pain has changed from rest to rehabilitation.

Therefore to get better from back pain: Move it or lose it

How does Physiotherapy treatment help back pain sufferers?

It is suggested that inactivity and especially bed rest cause substantial weakness and loss of tissue from the musculoskeletal system. These changes include a loss of bone, muscle and connective tissues, a reduction in muscle strength, endurance, physical fitness, and decreased joint ranges of movement in all individuals with reduced activity levels.

In the spine, the health of the joints and disc is dependant on repeated low stress movements. This is not surprising when we know that healthy joint cartilage requires regular mechanical loading and unloading to ensure the passage of the normal joint lubricating fluid and nutrients across joints and discs. The principle findings from animal research support this, demonstrating that degeneration of joint cartilage occurs when the joint is not moved or used. The regular loading and unloading of joint cartilages that occurs with physiotherapy treatment and exercises helps the process. In a similar fashion, the intervertebral disc, receives nutrition from fluid transfer primarily from the surrounding tissue.

Physiotherapy in the form of movement considerably assists disc nutrition and health. Especially when pain limits normal movement.

The major advances in treatment of back pain and other musculo-skeletal conditions in the last ten years have been based on intensive, early, active physical treatment. This approach has been shown to decrease pain, increase healing rate, and assist in a better result long term.