In today's episode, I speak with Dr. Mark Kargela, a seasoned clinician and educator, about chronic pain—its complexity, its impact, and how practitioners can better support patients struggling with it. The discussion focuses on shifting clinical approaches from tissue-centric models to ones that integrate contemporary neuroscience and lived experience.

Key topics include:

• Understanding Chronic Pain: The conversation defines chronic pain not simply by duration (e.g., beyond three months), but as a biopsychosocial phenomenon that fundamentally changes the nervous system. Dr. Kargela emphasizes that chronic pain is often not a direct marker of tissue damage, but a protective output of the nervous system influenced by biology, psychology, and social factors.

• Pain Neuroscience Education (PNE): Both clinicians stress the importance of PNE in helping patients reframe their pain experience. Teaching people how pain works can reduce fear and catastrophizing, improve self-efficacy, and set the foundation for graded movement and recovery.

• Central Sensitization and Nervous System Dysregulation: The discussion highlights how sensitized neural pathways can perpetuate pain even in the absence of tissue pathology. Techniques that modulate the nervous system—such as breathing, sleep optimization, gentle movement, and mindfulness—are presented as key therapeutic tools.

• Limitations of Traditional Biomedical Models: Dr. Kargela critiques overly mechanical approaches that chase tissue “damage” or perfect biomechanics, advocating instead for approaches that validate patient experiences and support behavior change.

• Clinician Takeaways: The episode encourages health and fitness professionals to:

  • Ask better questions that uncover contributors to a person’s pain narrative.

  • Shift from “fixing” people to coaching them toward resilience.

  • Recognize that empathy, listening, and patient-led goals are central to helping people move forward.

To learn more about Mark's work, visit his social media accounts and website below.

Instagram: Modern Pain Care

YouTube: Modern Pain Care

Pain Courses for Clinicians

The supraspinatus is one of the four muscles that make up the rotator cuff, originating from the supraspinous fossa of the scapula and inserting onto the greater tubercle of the humerus. Its primary function is to initiate shoulder abduction and contribute to dynamic stability of the glenohumeral joint, particularly by resisting excessive superior translation of the humeral head. Due to its position and role, the supraspinatus is highly susceptible to mechanical compression beneath the acromion, especially in individuals with poor scapular control or altered rotator cuff coordination.

Research suggests that supraspinatus tendinopathy and tears are among the most common sources of rotator cuff-related pain, particularly in overhead athletes and older adults. However, not all supraspinatus pathology is symptomatic, emphasizing the importance of assessing strength, movement patterns, and pain reproduction rather than relying solely on imaging findings when determining clinical relevance.

Several studies have shown that rotator cuff tears can be observed on MRI when testing people who are asymptomatic (pain-free), which means they may simply be a normal age-related change. However, if you have pain and limited shoulder function and have evidence of a rotator cuff tear or tendinopathy on imaging, then your symptoms and the image may be correlated.

Here is one study you might like to read if you want to learn more about this research.

When treating supraspinatus tendon tears and tendinopathy, physical therapists focus on pain management, restoring shoulder function, and strengthening the rotator cuff and scapular stabilizers. Early rehab emphasizes activity modification, isometric exercises, and gentle mobility work to reduce pain and maintain range of motion. Scapular control exercises help optimize shoulder mechanics, while posterior capsule stretching may be included if tightness contributes to impingement. As symptoms improve, progressive strengthening of the rotator cuff, particularly in external rotation and abduction, helps restore tendon resilience and function.

In later rehab stages, eccentric loading, plyometric drills, and functional training are introduced to improve tendon capacity and dynamic stability, especially for individuals returning to overhead activities. Education on load management, proper movement mechanics, and long-term maintenance exercises is essential to prevent recurrence. While partial tears and tendinopathy often respond well to conservative care, full-thickness tears may require surgical consideration, followed by a structured rehabilitation program.

Here is a video from my YouTube channel that covers a few exercises that often help people suffering from supraspinatus pain and dysfunction.

I hope the tips in this podcast were helpful and you feel better equipped to treat supraspinatus issues! Besides the YouTube video I linked in this episode, my book contains comprehensive programs for the 50 most common orthopedic conditions, including rotator cuff injuries. The programs are broken into three phases and include exercises that can be used to help prevent injuries as well as help you recover from an injury. If you want to learn more about my book, visit my website or click the Amazon link.

Thanks for reading and I hope you have a great day!

Dr. Tom

In today's podcast episode, we are going to look at a condition called gluteal tendinopathy, which is a common cause of lateral hip pain due to an irritation of two of the gluteal tendons (gluteus medius & gluteus minimus).

Previously, this type of pain was thought to be caused by trochanteric bursitis, but more recent research has shown that bursitis only accounts for approximately 20% of these cases (see references below). The majority of lateral hip pain cases are now thought to be due to gluteal tendinopathy or irritation of the gluteal tendons where they attach on the side of the hip (greater trochanter).

Risk factors for developing gluteal tendinopathy include: female gender (4:1 female to male ratio), increased body mass index (BMI), excessive hip adduction during walking/running, prolonged hip flexion (sitting) and weak hip abductors muscles (especially gluteus medius and minimus).

Treatment of this disorder is similar to other tendinopathies in that the focus is on gradually loading and strengthening the gluteal tendons via resistance training exercises that target the hip abductor muscles. These types of exercises not only improve the working capacity of the muscles and their tendons, but also help reduce tendon pain.

My YouTube video below includes a a few exercises that typically help people suffering from gluteal tendinopathy.

YouTube Link

Here are a couple of articles that you can read to learn more about this disorder.

1. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083-1086.

2. Pianka MA, Serino J, DeFroda SF, Bodendorfer BM. Greater trochanteric pain syndrome: Evaluation and management of a wide spectrum of pathology. SAGE Open Med. 2021.

3. Ladurner A, Fitzpatrick J, O'Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med. 2021;9(7):23259671211016850.

I hope the information in this episode was helpful and you feel better equipped to treat gluteal tendinopathy related pain. Besides the YouTube video I linked, my book contains comprehensive programs for the 50 most common orthopedic conditions, including one for gluteal tendinopathy. The programs are broken into three phases and include exercises that can be used to help prevent injuries as well as help you recover from an injury. If you want to learn more about my book, visit my website or click HERE to view the book on Amazon.

Thanks for reading and I hope you have a great day!

Dr. Tom