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.

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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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YouTube video

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

In this episode of the Rehab Science podcast, Dr. Tom Walters, DPT, breaks down one of the most common sources of neck and shoulder discomfort—trapezius myalgia. Often experienced as persistent tightness or aching in the upper trapezius muscle, this condition affects individuals who spend long periods sitting, working at a computer, or holding static postures under stress.

Dr. Walters discusses the underlying anatomy and biomechanics of the trapezius, highlighting how postural overload, fatigue, and nervous system sensitization contribute to chronic discomfort. He explains why passive strategies like stretching alone may be insufficient, and emphasizes the role of progressive resistance training in improving muscle function and reducing symptoms. The episode concludes with practical movement strategies, rehab principles, and key behavioral tips for lasting relief.

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1. Andersen LL, Jørgensen MB, Blangsted AK, et al. Effect of physical training on pain sensitivity and trapezius muscle morphology in females with trapezius myalgia: randomized controlled trial. J Appl Physiol (1985). 2008;105(4):1128-1134. doi:10.1152/japplphysiol.90391.2008

2. Larsen CM, Hansen M, Hansen EA. Effectiveness of strength training versus stretching exercises for the treatment of trapezius myalgia: a randomized controlled trial. Scand J Work Environ Health. 2013;39(2):143-150. doi:10.5271/sjweh.3320

3. Blangsted AK, Søgaard K, Hansen EA, et al. The effect of physical coordination training on posture, muscle activation, and musculoskeletal symptoms in office workers. Scand J Work Environ Health. 2008;34(1):55-65. doi:10.5271/sjweh.1194

In this episode of the Rehab Science Podcast, Dr. Tom Walters discusses proximal hamstring tendinopathy (PHT), a common condition affecting athletes, particularly runners and lifters. He explains the anatomy, biomechanics, and causes of PHT, emphasizing the importance of understanding the condition as a sensitivity issue rather than inflammation or a tear. The episode covers diagnostic strategies, effective rehabilitation techniques, and treatment options, highlighting the significance of gradual loading and physical therapy in recovery.

Takeaways

Proximal hamstring tendinopathy (PHT) is common among active individuals.
Chronic mechanical overload is a primary cause of PHT.
Symptoms often worsen with activities involving hip flexion and knee extension.
Diagnosis is typically clinical and does not require imaging.
Physical therapy is the cornerstone of PHT treatment.
Gradual resistance training is essential for tendon healing.
Rest alone will not lead to healing of tendinopathies.
Education and movement-based care are crucial for recovery.
PHT can be frustrating but responds well to proper rehab strategies.
Most individuals can return to full activity without surgery.

YouTube Link

Amazon Book Link

Chapters

00:00 Introduction to Proximal Hamstring Tendinopathy
02:55 Understanding the Anatomy and Biomechanics
06:09 Signs, Symptoms, and Diagnosis
08:49 Rehabilitation and Treatment Strategies
15:08 Medical Interventions and Final Thoughts

In this episode of the Rehab Science Podcast, Dr. Tom Walters interviews Dr. John Rusin, a physical therapist and injury prevention specialist. They discuss the concept of pain-free performance, which is a movement system designed to help individuals transition from pain to optimal performance.

Dr. Rusin shares his background in professional athletics and how it shaped his approach to training and rehabilitation. The conversation delves into the importance of individualized training, movement quality, and the six foundational movement patterns. They also explore the significance of movement screens and assessments, the six-phase warm-up sequence, and the structure of Dr. Rusin's new book on pain-free performance.

In this conversation, John Rusin and Tom Walters delve into the intricacies of movement patterns and performance training. They discuss the importance of creating a comprehensive movement program that caters to individual needs, assessing movement patterns for optimal performance, and the significance of a non-dogmatic approach to training. The conversation emphasizes understanding movement quality, spinal neutrality, and the necessity of individualized training to liberate movement and enhance overall performance.

Visit the links below to learn more about John's certification program and his new book:

Pain Free Performance Specialist Certification

Pain Free Performance Book

In this episode of Rehab Science, Dr. Tom Walters, DPT, breaks down cervical radiculopathy—a common condition involving compression or irritation of the nerve roots in the neck. He explores the relevant cervical spine anatomy, including how disc herniations or degenerative changes like bone spurs can narrow the neural foramina and impinge nerve roots, leading to symptoms that radiate from the neck into the arm and hand. Dr. Walters reviews hallmark symptoms such as radiating pain, numbness, tingling, and muscle weakness, and discusses how these typically follow a dermatomal distribution depending on the affected cervical level.

Dr. Walters also explains the clinical examination process for diagnosing cervical radiculopathy, including provocative orthopedic tests and the role of imaging like MRI when necessary. He outlines both medical and physical therapy approaches to treatment—ranging from anti-inflammatory medications and injections to targeted rehab strategies like cervical traction, neural mobilization, postural correction, and strengthening exercises. The episode wraps up with practical advice for managing this condition through movement-based rehabilitation.

YouTube Video with Exercises

Nerve Mobilization Exercises

Amazon Book Link

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