Thoracic Outlet Syndrome

By: Meredith Lewis, SPT


You may have been told by your physician or physical therapist that you have thoracic outlet syndrome (TOS). This may seem unfamiliar and might sound like a daunting diagnosis, but in reality it can be a simple condition that is easily resolved with physical therapy. Here is some information on the condition, its causes and symptoms, and what you can do to treat it.


The thoracic outlet: An area of tissue, muscle, and bone from the base of the side of your neck to your shoulder. Many structures are in this very small compartment, and the area decreases in size with arm, neck, and body movements and to when you take deep breaths.1


Thoracic outlet syndrome (TOS): Occurs when those structures start to compress either your nerves or your blood supply.


Causes: TOS is usually caused by repetitive overhead arm movements, such as throwing and reaching. You are also susceptible to developing TOS if you have had trauma to your neck, such as with whiplash.


Symptoms: The most common symptoms of TOS are pain, numbness, and tingling in your arm and hand. You may have noticed a feeling of weakness in one arm compared to the other, especially after lifting or reaching overhead.1 There are three different types of TOS, and each has a different treatment plan that your physical therapist will implement based on your symptoms.


Neurogenic TOS: Occurs when the nerves that come from your neck are compressed by muscles, bones, or other tissues in between your neck and the shoulder-girdle area. This is by far the most common type of TOS, as 96% of cases are due to nerve compression.1


Arterial TOS: Occurs when the artery that goes from your heart to your arm is compressed and causes decreased blood flow to your arm and hand.1


Venous TOS: Occurs when the vein that takes blood from your hand to your heart is compressed and the blood in your hand is not able to fully return back to your heart.1


Physical therapy: The main exercises you will be performing in clinic include stretches for your neck and shoulder muscles, posture exercises to promote a more upright and proper posture, strengthening exercises for your back muscles to help keep you in that upright posture, and breathing exercises to help you breathe without depending on your neck muscles as much.1


Physical therapists are well trained in the treatment of thoracic outlet syndrome and will help you get back to your normal day-to-day activities with less pain, numbness, and tingling in your arm.


For more information about TOS, please feel free to contact our PTs at



1. Hooper et al. “Thoracic Outlet Syndrome: A Controversial Clinical Condition.” Part 1: Anatomy, and Clinical Examination/Diagnosis. Journal of Manual and Manipulative Therapy. 2010; 18(2), 74–83.


Hamstring Injuries

By: Tim Abel, PT, DPT, OCS


With the injury of Buffalo Bills running back LeSean McCoy, many people are talking about how hamstring injuries recover.


Here Are Some Facts on Recovering from a Hamstring Injury:


  • Research has found hamstring reinjury rates to be as high as 50% in some studies. Proper rest, recovery, and prevention is key to avoiding reinjury.

  • An individualized rehabilitation program can allow athletes to return to play relatively quickly and safely. A combination of progressive agility and trunk stabilization and/or progressive running and eccentric strengthening have been shown to be effective in returning athletes to their sports.

  • Typical gym equipment exercises do not adequately prepare people for playing their sports. There needs to be sport-specific training, such as agility drills, plyometrics, and speed work, to reduce the risk of injury.

  • Returning to play before the hamstring muscles regain proper explosive strength will put athletes at a higher risk for injuries like ACL (anterior cruciate ligament) tears.


Physical therapists are experts in hamstring injuries and can help evaluate and treat them.


If you’ve been diagnosed with a hamstring injury, feel free to contact us at


What Do You Do after You Get a Concussion?

By: Drew Jenk, PT, DPT


People who have been diagnosed with a concussion require both physical and cognitive rest. If they delay following their medical provider’s orders for such rest, it may prolong their recovery from a concussion. A private medical provider’s orders for avoidance of cognitive and physical activity and for a graduated return to activity should be followed, and those recovering from concussion should be monitored at home, school, and work. In addition, children and adolescents are at increased risk for delayed recovery and for severe, potentially permanent disability (e.g., early dementia, also known as chronic traumatic encephalopathy) or even death if they sustain another concussion before fully recovering from the first concussion. Therefore, it is imperative that an individual is completely recovered before fully resuming activities that may result in another concussion. Best practice warrants that, whenever there is a question of safety, a medical professional err on the side of caution and hold an athlete out for a game, the remainder of the season, or even a full year until he or she is fully recovered.


Cognitive Rest

Cognitive rest requires that the individual who has suffered a concussion avoid participation in or exposure to activities that require concentration or mental stimulation. These include but are not limited to:

Playing computer or video games

Watching television


Reading or writing

Studying or doing homework

Taking a test or completing significant projects

Listening to loud music

Being exposed to bright lights


Physical Rest

Physical rest includes getting adequate sleep, taking frequent rest periods or naps, and avoiding physical activity that requires exertion. Some activities that should be avoided include but are not limited to:

Sports or activities that result in contact or collision and are high risk for re-injury

High-speed or intense exercise and sports

Any activity that results in increased heart rate or increased head pressure (e.g., straining or strength training)


It is extremely important for individuals who are recovering from a concussion to avoid these activities. Truly resting, both cognitively and physically, will allow the injury to heal and can better facilitate recovery.





In the Beginning – 2005

by: Lynn Steenberg, CEO


In January 2005, Sports PT was part of a unique arrangement with HealthSouth Corporation, an international healthcare organization. Due to a New York State law banning corporations from practicing medicine, Sports PT and HealthSouth were partners in the healthcare arena. Our full name was “Sports Physical Therapy of New York, PC, Managed by HealthSouth.” Through a management agreement, HealthSouth provided all the non-clinical support services for us (front-desk support, billing/collection, electronic medical records [EMR], human resources, real estate, etc.).


At that time, HealthSouth was in the midst of reorganization resulting from an accounting fraud scandal. This became our opportunity. In February, HealthSouth and I agreed to begin working to end our management agreement. Over the next four months, the Sports PT leadership team determined which of the 40 facilities would remain part of the organization. We worked diligently to re-create all the non-clinical services. This included purchasing all the equipment, assuming all leases, hiring all non-clinical personnel, implementing new EMR and billing/collection systems and new employee benefits programs, and much more.


On July 1, the management agreement with HealthSouth was terminated and the new Sports PT was born. We were comprised of 285 team members in 27 locations, from Buffalo to the tip of Long Island. The next six months were a whirlwind of activity. The leadership team wrote the Sports PT mission statement and established the values that still guide us today. By year’s end, Sports PT was caring for nearly 1000 patients per day!


How much did luck play a role in where we are today? Throughout my career, I have firmly believed that every challenge presents opportunity. I feel incredibly grateful for the support of the exceptional team of individuals (14 of whom are still here today) who helped make it all possible. In the book Great by Choice, author Jim Collins suggests that luck is really what we do with it. That is, luck is the sum of opportunity and preparedness. How true!


Concussions Are a “Pain in the Neck”!

By: Rebecca Korosi, ATC, PT, DPT


Literally! Much more often than not, when an individual sustains a concussion, a complaint of neck pain will accompany it. This is due to the head being directly connected to the neck. When a force or blow to the head occurs, the energy dissipates down into our necks. The force on our head can also cause our neck to move in an awkward position, thus stressing the neck’s ligaments, joints, soft tissue, and muscle. This is commonly referred to as a “whiplash” injury. Our muscles will oftentimes go into “defensive mode” after such an injury. This will feel as if the muscles around the neck are tight, especially the upper trapezius muscle, which sits right at the tops of the shoulders and attaches near the base of the skull. Another common complaint of concussion sufferers may be “knots” or trigger points in the muscles of the neck. This stems from the continuation of the body’s defensive mode, which causes these muscles to contract for protection. This then leads to over-activation of the muscles. In addition to neck pain, the stress to these tissues may cause a loss in range of motion of the neck, stiffness in the neck, pain that radiates down into the arms, headache, dizziness, poor memory, irritability, sleep disturbance, fatigue, and vertigo (the feeling of spinning).


It can be difficult to determine whether the neck has suffered a “whiplash” injury due to its ability to present itself very much like a concussion. Therefore, it is important to undergo a comprehensive exam by a healthcare professional who is efficient in the care of concussions to determine if the neck itself has also been injured after a concussion.


To read more on new research involving concussion, neck injury, and concussion with neck injury, click here:


References: Leddy, J. J., et al. (2014). “Brain or Strain? Symptoms Alone Do Not Distinguish Physiologic Concussion from Cervical/Vestibular Injury.” Clinical Journal of Sports Medicine 0 (0): 1–6.