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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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.

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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