Understanding Pain: Why It's More Than Just Tissue Damage

Pain isn't just physical—it's a complex interplay of biology, emotions, and social factors. Are you aware of how this affects your pain? In our latest podcast, Dr. Rachel Zoffness, PhD, breaks down the biopsychosocial model of pain. She explains that pain is not just about anatomy or injuries; it's a mix of biological, psychological, and sociological factors.  Understanding this can empower you to take control of your pain management. It's not just about pills or procedures; it's about recognizing the emotional and social components that play a role in your experience of pain. Pain is a ubiquitous human problem. Everyone deserves to understand what's happening in their body and how to address it holistically. Check out the full episode for more insights! 

SLAP tears refer to injuries of the superior labrum of the shoulder, where the long head of the biceps tendon attaches to the glenoid. These tears are commonly identified on imaging, particularly in overhead athletes and aging populations, but their presence does not always explain pain or dysfunction. The shoulder relies heavily on soft tissue structures for stability, and the biceps–labral complex is exposed to significant load during overhead and deceleration activities. Importantly, labral changes are frequently seen in asymptomatic individuals, highlighting that structural findings alone do not equate to symptoms. Clinically, SLAP tears may present with deep shoulder pain, discomfort during overhead activity, clicking sensations, or fatigue with repeated use, though symptoms often overlap with other shoulder conditions. Diagnosis is challenging, as no single clinical test is highly accurate and imaging frequently reveals incidental findings. Meaningful diagnosis requires correlating symptoms, functional limitations, and activity demands rather than relying on imaging alone. From a treatment standpoint, conservative management is the first-line approach for most individuals. Rehabilitation focuses on restoring shoulder strength, scapular control, and load tolerance rather than "fixing" the labrum itself. While surgery may be appropriate in select cases, many people experience meaningful improvement with well-structured physical therapy. This episode explores how education, progressive loading, and evidence-based rehab strategies can help individuals return to function, even in the presence of a diagnosed SLAP tear. Link for my book: https://amzn.to/3Ld7ssd Link for my app: https://rehabscience.com/membership/ YouTube SLAP rehab video: https://youtu.be/FwiDJ6hoaYo?si=924NiLBuqPxBri0g  

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.  Follow & Learn More YouTube: YouTube.com/rehabscience Instagram: Instagram.com/rehabscience Website: Rehabscience.com Newsletter: Rehabscience.com/subscribe 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. 🔗 Resources 📘 Rehab Science: How to Overcome Pain and Heal From Injury 🎥 Rotator Cuff Rehab Exercises on YouTube 🌐 Rehab Science App

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