As others have noted, the "no pain, no gain" approach is the worst to observe for TOS sufferers, in my opinion. A supposed star PT at MGH (part of Dr. Donahue's team) caused a severe flare-up that lasted about a month when she insisted that I continue doing shoulder shrugs during a session. I had stopped b/c of immediate symptoms caused by engaging traps and neck muscles, explained why I stopped and she told me to "keep doing the shrugs." Stupidly, I followed her direction.