#34: Chronic Pain Rehabilitation with Dr. Mark Kargela

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.

In today's episode, I interview physical therapist and ACL rehabilitation specialist, Dr. Wesley Wang, DPT. This episode covers much of the current research regarding ACL rehab and will be helpful to both individuals who have suffered an ACL injury or want to prevent one from happening and practitioners who treat patients who have undergone an ACL recontruction.  Wesley is a physical therapist at Healthy Baller, which is located in Rockville, MD. He specializes in treatment of sports injuries and ACL reconstructions. The majority of his patients are middle and high school athletes as well as athletes from various colleges across the country. Wesley's goal is to develop a trusting relationship with the patient while focusing on treating the source of the pain. Treatments prioritize regaining full mobility, strength and confidence to reduce the likelihood of suffering another injury. To learn more about Wesley's work, visit his Instagram account (@wesleywang.dpt) or his website.   

Today's episode covers sacroiliac or SI joint pain, which is a type of low back pain. The sacroiliac joints are two small synovial joints located on the right and left sides of the low back between the sacrum and the ilium bone of the pelvis. These joints are surrounded by numerous ligaments, which makes them very strong and capable of supporting body weight. Because of their joint shape and the surrounding ligaments, the sacroiliac joints move very little, but are thought to account for a small percentage of back pain cases. Pain associated with sacroiliac joint irritation is usually located on one side of the low back and may radiate into the buttock or back side of the thigh. If you believe you may experiencing pain originating from one or both of your sacroiliac joints, the exercises shown in the video may help.  https://youtu.be/s2bqEP1O6_s?si=MSDpabHhBI58Jae9 Reference: Laslett M. Evidence-Based Diagnosis and Treatment of the Painful Sacroiliac Joint. J Man Manip Ther. 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582421/ Here are a few exercise tools that can help you recover from this type of pain. SI Stabilization Belt: https://amzn.to/4gYmkpE Trigger Point Ball: https://amzn.to/3Ibw0LJ Loop Bands: https://amzn.to/3G3D6QS *My new book contains comprehensive rehab programs for the 50 most common injuries and pain issues, including one for sacroiliac joint pain. Click the link below to learn more and order a copy! https://a.co/d/1q3BjgP  

In Today's episode, I interview clinician, entrepreneur and inventor, Pete Holman. Pete is a physical therapist, Certified Strength & Conditioning Specialist (CSCS), international presenter, author, fitness product inventor and former US National TaeKwonDo champion living in Colorado. He graduated from the University of Colorado with a Master’s of Science degree in Physical Therapy in 1997 and went on to work at the renowned Aspen Sports Medicine clinic prior to opening up his own private practice in 2001. His client list has included Fortune 500 hundred business owners from Jones Apparel, Progressive Insurance & Fiji water, as well as, Hollywood stars including Ed Bradley and Kevin Costner. Pete’s dedication to advancing the fitness industry and his entrepreneurial spirit has inspired him to create multiple products that impact fitness enthusiasts and athletes worldwide. His first product, The Functional Training Rack, was licensed to Perform Better in 2008 and inspired “hoop” platforms for current stability ball rack designs. His second product, the RIPCORE-FX, was acquired by TRX and is now referred to as the TRX Rip Trainer. The Rip Trainer has grossed over $30 million in worldwide sales and can be seen in commercial gyms and sports performance centers around the world. Next, seeing a need for Golf specific training modalities, Pete partnered with GolfForever and iterated the Rip Trainer into the GolfForever Swing Trainer (the world’s first 2 in 1 Golf training aid.) With custom handles and coaching zones, a lightweight aluminum shaft and weighted ball heads for overspeed training, the Swing Trainer has quickly become the number one Golf training aid sold in Golf Galaxy, PGA Superstores and Dicks Sporting Goods. Endorsed by pro Golfers Scottie Scheffler, Ryan Palmer and Justin Leonard, the Swing Trainer is poised to revolutionize fitness training for Golfers! In 2018, Pete designed the first ever plate loaded Hip Thrust machine called the Glute Drive. He approached industry leading giants and the Nautilus Glute Drive was spawned. The Glute Drive is Nautilus’s number one selling commercial strength product, selling over 3000 units a year. Pete’s latest product is the world’s first Loaded Carry/Sled Push combo machine. Growing up on a small farm in Littleton Colorado, Pete hauled road base, concrete, railroad ties and manure around the farm. He attributed his grip, hip and core strength, which later lead to him becoming a US National TaeKwon-Do champion, to his Farm Strong work. He brought the concept to Escape Fitness and the Escape Barrow was created. Pete works tirelessly on developing education, programming and products that will have a positive impact on health and fitness worldwide. To learn more about Pete's work, visit his website at the following link. 

In today's podcast episode, I speak with physical therapist, chiropractor, researcher and educator, Greg Lehman. Greg has been in the rehabilitation field for more than 20 years. Following his undergraduate degree in Kinesiology, he was awarded the Canadian Society for Exercise Physiology Gold Medal for highest academic performance in Kinesiology. This degree allowed him to obtain certification as a Strength and Conditioning Specialist and Certified Fitness Appraiser and to work as a Strength and Conditioning coach for Sir Wilfrid University's Men's Basketball team and for Queen's University Women's Varsity Hockey Team. Greg's success in university resulted in being awarded a graduate scholarship (NSERC) to the University of Waterloo to be one of only two Masters students per year studying at the Occupational Biomechanics Laboratory, a world leader in Spine Biomechanics, exercise prescription and athletic performance. As a faculty member at the Canadian Memorial Chiropractic College, Greg developed a research program that produced more than 20 publications on exercise biomechanics, golf fitness and the science of manual therapy. He has taught more than 25 graduate students in Spine Biomechanics and Research Instrumentation and supervised more than 50 students and 20 undegraduate research theses. He was subsequently awarded a Researcher of the Year award by the Ontario Chiropractic Association. These days, most of Greg's time with patients is spent one-on-one using exercise, load/stress management, manual therapy techniques and education.  Both pain, injury and performance are influenced by a number of factors in an individual's life.  Greg's approach addresses the multitude of these contributors and he primarily works with my patients to come up with strategies where they are actively involved in their recovery. To learn more about Greg and his work, visit his website at the following link.

In today's episode, I talk with functional podiatrist, Dr. Emily Splichal, DPM. As a Podiatrist, Human Movement Specialist, and Global Leader in Barefoot Science and Rehabilitation, Dr. Splichal has developed a keen eye for movement dysfunction and neuromuscular control during gait. Originally trained as a surgeon through Beth Israel Medical Center in New York City and Mt Vernon Hospital in Mt Vernon, NY, in 2017 Dr. Splichal put down her scalpel and shifted her practice to one that is built around functional and regenerative medicine. Functional and regenerative medicine and the role of anti-aging science as it relates to movement longevity is where Dr. Splichal's passion is focused. Currently enrolled in a Fellowship for Anti-Aging and Regenerative Medicine from the American Academy of Anti-Aging Medicine (A4M), Dr. Splichal’s recommendations typically include PRP or stem cell therapy, photomodulation or red light therapy, dry needling or acupuncture, vitamin supplementation, sensory stimulation of the nervous system, fascial work and integrated exercises. If you are seeking answers outside of the conventional recommendations of orthotics and surgery Dr. Splichal may be able to offer you an innovative, comprehensive treatment option that is built on the foundation of functional medicine and functional movement. Her Functional Foot Programming stands out from any other Podiatrist and built around evidence-based principles in fascial fitness, foot to core sequencing, and barefoot stimulation. To make an in-person or virtual appointment with Dr. Splichal please contact 917.825.4297, email ([email protected]) or schedule directly online HERE