SLAP Tears of the Shoulder: What They Are and How They’re Treated
Rehab Science
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...
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When Shoulder Blade Pain Is Actually Coming From Your Neck
Rehab Science
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...
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Navigating a Rotator Cuff Tear — Rehab or Surgery?
Rehab Science
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...
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Thoracic Outlet Syndrome: Diagnosis & Treatment Strategies
Rehab Science
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,...
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Trapezius Myalgia: Diagnosis & Treatment Strategies
Rehab Science
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...
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Proximal Hamstring Tendinopathy: Diagnosis and Treatment Strategies
Rehab Science
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...
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Pain Free Performance with Dr. John Rusin
Rehab Science
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...
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Cervical Radiculopathy: Diagnosis & Treatment strategies
Rehab Science
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...
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Chronic Pain Rehabilitation with Dr. Mark Kargela
Rehab Science
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...
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Supraspinatus Tendinopathy: Diagnosis & Treatment Strategies
Rehab Science
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. ...
info_outlineSciatica is a umbrella term that refers to pain and/or altered sensation (numbness, tingling, heaviness) that travels into the sciatic nerve distribution or that of one of the lumbosacral nerve roots that makes up the sciatic nerve (L4-S3).
Sciatica is caused by an irritation or inflammation of the sciatic nerve or one of the nerve roots that forms the sciatic nerve. It is often seen with disc bulges and herniations and spinal stenosis. Sciatica can also be caused by spondylolisthesis and, in rare cases, spinal tumors.
Sciatica has a lifetime incidence of 10-40%, so many of us will experience this issue at some point in our lifetime.
Sciatica is diagnosed via clinical testing such as the straight leg raise and slump tests and a description of symptoms that fits with the sciatic nerve’s motor and sensory distributions.
Sciatica is typically aggravated with lumbar flexion (bending forward), rotation or twisting of the spine and coughing.
Treatment typically involves initially reducing acute symptoms with ice and heat, NSAIDs, avoiding provocative positions and activities (usually lumbar flexion) and muscle relaxants, in some cases.
Rehab revolves around behavior modification, short courses of spinal mobilization and/or manipulation, nerve mobilizations and therapeutic exercises that target the hip and trunk with a primary emphasis on reducing neural irritation (centralization). Usually, mobility exercises help most initially and then strengthening exercises are added later.
Most cases resolve in 4-6 weeks. If symptoms don’t improve after 6-8 weeks or there is a progressive loss of motor function (muscular weakness), then imaging may be helpful to rule out more severe disc bulges or herniations and other potential tissue causes.
Clinicians should lookout for red flags such as progressive LE weakness, loss of bowel or bladder function, saddle paresthesia as these can point to acute neurological deficits.
Here are links to YouTube videos that can help if you are experiencing sciatica right now.
Sciatic Nerve Mobilization Exercises