Thoracic Outlet Syndrome: Diagnosis & Treatment Strategies

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. Rehab Science Book YouTube video References 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 Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database Syst Rev. 2014;(11):CD007218. doi:10.1002/14651858.CD007218.pub3 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 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. Resources 📘 Rehab Science Book on Amazon 🎥 Rehab Science YouTube Channel References 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 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 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

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

Today's episode covers a case I saw in the clinic in which a patient presented with symptoms consistent with a calf muscle strain, but ended up having a blood clot or deep vein thrombosis (DVT). Deep Vein Thrombosis or DVT describes a situation in which a blood clot (thrombus) forms in one of our deep veins. In many instances, this occurs in the calf region and happens after a person has undergone a surgical procedure. Typical symptoms include pain, swelling and warmth in the region. Besides surgery, blood clots can occur when we have been sedentary for extended periods (plane flight, bed rest after an injury, etc). DVTs can become a life-threatening if they break loose and move through the blood stream to the lungs. This situation is referred to as a pulmonary embolism (PE) and blocks blood flow to a portion of the lungs. If you enjoyed this episode, please consider following my podcast on Apple Podcasts or Spotify by clicking the 'follow' button. Also, if you would consider leaving a 5-star review for the podcast, it would mean a lot to me. Thank you!

In today's episode, I speak with orthopedic physical therapist, content creator and entrepreneur, Dr. Caleb Burgess. Caleb is a licensed Doctor of Physical Therapy, a certified specialist in Orthopedic Physical Therapy through the American Board of Physical Therapy Specialties, and a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. In 2014, Caleb received his Doctorate in Physical Therapy (DPT) from Azusa Pacific University. The next two years he completed a Residency in Orthopedic Physical Therapy and then a Fellowship in Sports and Orthopedic Physical Therapy through Kaiser Permanente Southern California. This advanced training allowed him to become an expert in musculoskeletal conditions both related to the general and athletic populations. Furthermore, as a strength and conditioning specialist, Caleb is qualified to help people develop and achieve higher level performance based goals that extend beyond traditional rehabilitation. To learn more about Caleb's work, visit his instagram account (@dr.caleb.burgess) or his website.