Pain between the shoulder blades is often blamed on tight muscles, poor posture, or a stubborn "knot" that just won't go away. But in many cases, that pain isn't coming from the shoulder blade region at all.

In this episode of Rehab Science, Dr. Tom Walters explains how irritation of the cervical spine and lower cervical nerve roots can refer pain into the interscapular region. You'll learn why local treatments often provide only temporary relief, how neural anatomy explains these referral patterns, and how rehabilitation interventions can address the true driver of symptoms.

This episode is especially relevant for anyone who spends long hours at a computer, experiences upper back or shoulder blade pain that changes with neck movement, or wants a clearer understanding of how referred pain works.

Here is a YouTube video with a few exercises that can help with this type of pain.

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If you found this episode helpful, consider subscribing and sharing it with someone who deals with ongoing neck or shoulder blade pain.

In this episode of the Rehab Science podcast, Dr. Tom Walters, DPT, breaks down everything you need to know about rotator cuff tears—from anatomy and injury mechanisms to decision-making around rehab versus surgical repair. Dr. Walters explains the role of the four rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and why the supraspinatus tendon is most often affected. He also discusses the difference between partial and full-thickness tears, and how imaging findings don't always predict pain or function.

Listeners will learn when rehabilitation is the preferred approach and when surgical repair may be necessary. Drawing on current research and clinical experience, Dr. Walters emphasizes the value of progressive strengthening, scapular stabilization, and load management—highlighting that most people can recover full, pain-free function without surgery. The episode concludes with practical advice for restoring shoulder strength and confidence through movement.

• 📘 Rehab Science: How to Overcome Pain and Heal From Injury

• 🎥 Rotator Cuff Rehab Exercises on YouTube

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In this solo episode, Dr. Tom Walters breaks down thoracic outlet syndrome (TOS)—a condition caused by compression of the nerves and blood vessels as they pass from the neck into the arm. He begins with an introduction to the condition and explains the difference between neurogenic and vascular TOS, highlighting key symptoms that require urgent medical referral. Dr. Walters then discusses how to differentiate TOS from cervical radiculopathy, a common source of confusion in clinical practice, focusing on symptom distribution, aggravating positions, and relevant clinical tests. Finally, he outlines the most effective physical therapy interventions for neurogenic TOS, including postural retraining, mobility work, scapular strengthening, breathing strategies, and activity modification.

This episode is ideal for anyone interested in learning more about the anatomy, diagnosis, and rehab management of TOS, from clinicians to patients dealing with upper extremity pain and dysfunction.

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References

1. Illig KA, Donahue D, Duncan A, et al. Reporting standards of the Society for Vascular Surgery for thoracic outlet syndrome. J Vasc Surg. 2016;64(3):e23-e35. doi:10.1016/j.jvs.2016.04.039

2. Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014;(11):CD007218. doi:10.1002/14651858.CD007218.pub3

3. Gillard J, Perez-Cousin M, Hachulla E, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine. 2001;68(5):416-424. doi:10.1016/S1297-319X(01)00331-2

4. Balci AE, Balci TA, Cakir O, et al. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg. 2003;75(4):1091-1096. doi:10.1016/S0003-4975(02)04603-0