👉Posterior to anterior or PA spinal mobilizations are one of my favorite techniques for treating patients with unilateral or one-sided back pain.

🔎When performing this technique, I start at the bottom of the lumbar spine (L5-S1) and work up one segment at a time until I reach the bottom of the thoracic spine (T12).

🧠This is done first as an assessment to determine if the patient’s symptoms can be reproduced with the mobilization pressure/movement. In many cases, familiar pain is reproduced at one or two spinal levels and then those levels are mobilized further.

✅When mobilizing (checkout the Thumb Saver tool to protect your thumbs) a painful level, small oscillations are delivered to the painful area at an intensity that is perceived to be therapeutic by the patient. I will usually perform the mobilization for 1-2 minutes and perform 3-5 sets of the technique.

Help - Hip Assymetry and Unflexible/Cramping when loaded.

I have a very noticeable difference in my hip flexibility tighter right vs left. I really realized this is a problem last month when doing 2-handed shield casts with a 10lb club while in the shin box position. I could do 13 shield casts in 30-seconds left to right vs just 3-5 right to left while struggling to avoid hitting my back on the back swing. Also, I do a Slam Ball program which is all about deep squatting and in the rock bottom position for 60 seconds that right hip tends to cramp after 40-50 seconds. Never the left side though.

Can you suggest any routines or

Particular exercises that would help with range and mobility in those hip areas?

I added 2 photos showing this particular exercise that exposes this severe assymtry and limitation. Photo 1 on left - is the left to right more mobile/no cramping and photo 2 - is right to left right side limited range, tight and cramps on prolonged deep weighted squats. Thank you for any ideas I am committed to overcoming this but regular stretching isnt working

🔎When the supraspinatus tendon sustains a large or “massive” tear, the issue isn’t just local tissue damage—it fundamentally alters how the shoulder moves and functions.

🧠The supraspinatus plays a key role in initiating shoulder abduction and, more importantly, in stabilizing the humeral head within the glenoid. When that stabilizing force is compromised, the biomechanics of the shoulder begin to shift.

👉Here’s what typically happens:

• Loss of humeral head controlWithout adequate supraspinatus function, the humeral head tends to migrate superiorly during arm elevation. This reduces the available subacromial space and increases mechanical compression of surrounding structures.

• Deltoid dominance without restraintThe deltoid continues to generate upward force, but without the counterbalance of the rotator cuff, that force becomes less efficient. Instead of producing smooth rotation, it drives excessive superior translation.

• Altered force couplingThe rotator cuff normally works as a coordinated unit. With a massive tear, this balance is disrupted, often leading to compensatory overactivity of the remaining cuff and scapular musculature.

• Functional limitationsPatients often report difficulty with overhead movements, weakness, and in more severe cases, an inability to actively elevate the arm (sometimes referred to as pseudoparalysis).

✅Over time, these changes can contribute to chronic dysfunction, pain, and even rotator cuff arthropathy if left unmanaged.

The ligamentum teres is one of the most overlooked structures in the hip joint.

Historically, it was thought to play a minimal role in function. But more recent research suggests it may contribute to hip stability, particularly in positions of deep flexion, adduction, and external rotation. It also appears to have a sensory role, meaning it may be a source of pain in some individuals.

Injuries to the ligamentum teres can occur with trauma, repetitive hip rotation, or underlying instability. Symptoms are often vague and may include deep groin pain, clicking, locking, or a sense of giving way.

Rehab should focus less on the ligament itself and more on improving overall hip stability and control. Strengthening the surrounding musculature, especially the deep hip rotators and glutes, is key.

📚The trapezius is one of the largest and most important muscles of the upper body, spanning from the base of the skull, down the cervical and thoracic spine, and out to the shoulder blade. It is divided into upper, middle, and lower fibers, with each region contributing to different movements and postural control.

🔎The upper trapezius helps elevate the shoulder blade, assist with upward rotation of the scapula, and contribute to neck extension and side bending. The middle trapezius primarily retracts the scapula, helping pull the shoulder blades back toward the spine. The lower trapezius helps depress the scapula and also plays a major role in upward rotation, especially during overhead arm movement.

🧠Functionally, the trapezius is critical for shoulder mechanics, neck support, and upper body stability. It works continuously during reaching, lifting, carrying, and maintaining posture, making it essential for efficient movement and reducing excess strain on the neck and shoulders.

Hi Tom,

Could you share some insight? After a trip and fall forward on my knees, I am having extreme pain behind the knee when in full flexion. The evening after it happened, the pain started at about 45 degree flexion. It has improved since the fall, doesnt hurt when standing or in extension. Now if I squat to get something from the floor, it really hurts.

The Journal of Orthopaedic and Sports Physical Therapy produces clinical practice guidelines (CPGs) that cover various common conditions and the evidence surrounding the treatment of that condition. In October of 2025, the hip osteoarthritis CPG was updated.

Here is a link for the article, in case you want to learn more about which interventions have the most research support for treating hip OA.

https://www.jospt.org/doi/10.2519/jospt.2025.0301

Hello, I am looking for information on hearing loss specifically in relation to neck issues. I have a client who has hearing loss and wears hearing aids in both ears. They've had "all the tests" but none of the tests give any clue what the cause of their hearing loss is. They do report a sore neck for the past 15 years which coincides with the duration of their hearing loss. They haven't been investigated for Eagle Syndrome. And haven't had their tonsils removed. They don't report any trauma to their head or neck. They are 48 years old. They are experiencing loss of confidence. I've tried literature searches but so far haven't found anything "helpful." 🙏 for any assistance, Caroline