Thoracic outlet syndrome (TOS)

TOS is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves, arteries, or veins in the lower neck and upper chest area.
TOS affects people of all ages, but when talking about an athlete, very often, this condition occurs in sports, such as baseball, swimming, volleyball, and other similar sports.

We can recognize three types of TOS:

– Neurogenetic TOS ( the most common condition)
– Venus TOS
– Arterial TOS

The symptoms of TOS include:

– Neck, shoulder and arm pain, numbness, or impaired circulation to the affected area.
– weakness
– tingling
– prickling
– swelling of hand, fingers, and arms
– decreased size of hand muscle

Symptoms depend on type TOS.

– Causes compress on a nerve, arterial, and veins could be: First rib ( cervical rib), old fracture of the clavicle, tumors, repetitive injury of shoulders, injury to neck and back (whiplash injury), a bad technique in sports activities, poor posture, stress…

Fix problem:

Step 1. Check type of TOS and patient history, old injury, symptoms, posture, sports activities.

Step 2. The specific test for TOS, as like Wright’s test, Adson test, Roos test, Eden test.

Step 3. We use different protocols, and it depends on types TOS. It could be NKT, PDTR protocol, Maitland, Mulligan protocols, Neuro protocols, or correct bad posture. Sometimes surgery is necessary for some specific situation.

Step 4. Strength exercise protocol because it’s the only way to fix the problem for a long time.

If you have this problem

Carpal tunnel syndrome

Carpal tunnel syndrome is a condition that causes pain, tingling, and numbness in the hand and arm.
The condition occurs when the median nerve is compressed as it travels through the wrist. The median nerve runs along an arm, goes through a passage in a wrist called the carpal tunnel, and ends in a hand. The median nerve controls the movement and feeling of all a fingers except the pinky finger. Women are likely to get this three times more than men.
It might be because they have a smaller carpal tunnel.

Carpal tunnel causes:

– Repetitive motion, like typing or any other wrist movements, when the wrist is bent for a longer time.
– Hypothyroidism, obesity, rheumatoid arthritis, diabetes, etc.

Carpal tunnel syndrome symptoms:

– burning, tingling, or itching numbness in a palm and thumb or an index and middle fingers.

– Weakness in a hand.

– Tingling that moves up into your arm.First symptoms are usually noticed when a person wakes up in the morning. This depends on how a person holds its hand while sleeping.During the day, the symptoms might get worse, while a person holds an object with a bent wrist, like driving or reading a book.

Carpal tunnel syndrome tests:

– Tinel sing
– Phalen’s test

Carpal tunnel syndrome protocol:

The first thing to decreases symptoms of carpal tunnel is a change of a lifestyle.
Decompression on anterior wrist tissues.
For this condition, we use different protocols as PNF, NKT, Neuro protocols, nerve glide exercises, mobility wrist exercises, strength training.

If you have this problem

Shoulder impingement syndrome

 Shoulder impingement is a cluster of symptoms with one common pain in the shoulder area or along the arm or shoulder blade. Very often problem with this condition is when an athlete has a lot of overhead activities. But this condition is prevalent in non-athletes.

The shoulder joint has a large range of motion and many structures are in or across the shoulder joint, and sometimes because of that some structures could be pressed and provoke pain.

There are 2 basic types of shoulder impingement:

– Subacromial/external impingement

-Internal impingement

All this is very important for fixing this problem as well as an understanding of shoulder anatomy.

Step 1

Healing starts with a patient history of injury. That can help us to find out the cause of the problem already from the first session.

Step 2

Observation and analysis of body posture is one of the leading causes of shoulder impingement and correction of that is mandatory for healing.

Step 3 

We can use different types of tests to find out which structures are damaged. For example, we can use a Painful arc test, Neer test, Hawkins Kennedy Test and Midland test for the shoulder.

Step 4

For treatment protocol, we can use NKT, PDTR, PNF, Mulligan, Maitland protocol, or some other physiotherapy protocols. In some cases,  electrotherapy laser can be helpful or shockwave therapy to decrease pain but the movement is in first place always. In some cases, surgery is necessary.

Step 5

Patient should exercise, focusing on muscle strength because it is the only way for absolute healing. 

If you don’t know which muscle group you should make stronger, we have an answer. We should exercise all muscle groups because each of them is very important and it will save us from injury.

Tennis elbow

      Tennis elbow is a condition that causes pain in the outer elbow and along the arm. The medical term for this condition is lateral epicondylitis. It means that tendons of some forearm muscles are inflamed. Very often causes of tennis elbow are an overload of tendons in the elbow. Usually by repetitive incorrect motions of shoulder. Causes of tennis elbow are rarely in direct connection to the elbow joint.  More often it is a consequence of bad posture or incorrect movement patterns. Problems with the tennis elbow can occur with athletes, non-athletes, and other people with bad posture.



-restricted movement



-Elbow pain relief with active and passive movements

-Correction of incorrect movement patterns (which caused an injury) during private personal training

-Avoid dumbbell exercises for strengthening your forearm muscles

The first step to healing the tennis elbow is assessment and testing. For diagnosis that we can use different tests. A very simple test is Mill’s test. This test is designed to maximally stretch and therefore provoke muscle extensor carpi radialis longus and brevis and produce pain on the lateral side of the forearm. The second step to healing is to practice some of the different protocols. For example, it could be NKT, PDTR RPR therapy, Maitland protocol therapy, or some of the other physiotherapies (electrotherapy, laser therapy…) for release patients of pain. Bear in mind that hypertrophy and rehabilitation exercises must follow the mentioned steps.

If you have this problem