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T4 Syndrome - Identify, Explain, & Manage a Common but Peculiar Diagnosis

T4 Syndrome - Identify, Explain, & Manage a Common but Peculiar Diagnosis

T4 Syndrome - Identify, Explain, & Manage a Common but Peculiar Diagnosis

This course includes
1:22:42 of Course Material (View)
Lifetime access after purchase
Certificate of completion


This course presents a thorough peer-reviewed and empirical evidence examination of the clinical phenomenon known as T4 Syndrome.

As a diagnostic label, T4 Syndrome is very poorly understood and some even suggest that it is either exceptionally rare or not a real diagnosis.

However, a reasonable dive into the available published evidence in conjunction with firsthand accounts from an expert orthopaedic clinician lead to the unavoidable conclusion that T4 Syndrome is both very real and ubiquitous. In fact, regardless of what setting you work in, it is highly likely that in your current clinical practice patients are already presenting with symptoms related to this bizarre but understandable diagnosis.

If you want to learn how to identify which patients are experiencing T4 Syndrome as well as how to successfully address their impairments then this course is for you. Additionally, patients with T4 Syndrome symptoms are likely to benefit greatly from this presentation.


Learning Objectives

  1. Become familiar with the Autonomic Nervous System as it relates to T4 Syndrome
  2. Understand two theories that potentially explain why autonomic nervous system symptoms can manifest in a musculoskeletal condition
  3. Review the history of who first described T4 Syndrome
  4. Review three decades worth of evidence demonstrating the pathophysiological relationship between the spine and autonomic nervous system symptoms
  5. Present clinical patterns associated with T4 Syndrome
  6. Learn a diagnostic and clinical formula that can be used in the evaluation and management of patients with T4 Syndrome



This online course is for physiotherapists, physiotherapist assistants, chiropractors, massage therapists, physicians, physician assistants, nurse practitioners, nurses, patients, and anyone else interested in understanding what T4 Syndrome is, how to identify it, and how to manage it clinically.


What's Included

  1. Brief introduction to and overview of the autonomic nervous system
  2. An evidence-based, theoretical explanation of what T4 Syndrome is
  3. Review of the history of who first reported T4 Syndrome
  4. Exhaustive review of what the evidence says about the application of orthopaedic manual therapy and its effects the autonomic nervous system
  5. Discussion about the variable clinical patterns of T4 Syndrome based on reports from textbooks, peer-reviewed case studies, and one orthopaedic expert’s clinical practice
  6. A clinical approach to identifying and managing T4 Syndrome successfully
The instructors
Stephen Shaffer

Dr. Shaffer is a bilingual (English-Spanish) clinical specialist, educator, and scientist with seventeen years of experience in the physiotherapy profession. After graduating with a master’s degree in physiotherapy he went on to complete residency, fellowship, and academic doctoral training in advanced orthopedics. Initially, he spent years traveling the United States as a traveling physiotherapist but currently works in private practice in Ontario, Canada. During his career he has specialized in the evaluation and management of spinal, extremity, jaw, and headache disorders. Additionally, his professional experience has involved extensive time managing chronic pain as well as both complex and rare cases. In clinical practice he places an emphasis on research-informed evaluation and management as well as manual therapy, clinical reasoning, and shared decision-making. Dr. Shaffer prides himself on making sound decisions on behalf of his patients and strives to ensure that they gain maximal benefit from their healthcare experiences.

In addition to clinical practice, Dr. Shaffer is a researcher with experience on topics related to the temporomandibular joint (TMJ) and advanced practice physiotherapy rights. He also has experience teaching post-professional courses on cervical spine, jaw, and headache disorders. Currently, he is an active member of the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT; and is credentialed through the Canadian Academy of Manipulative Physiotherapy (CAMPT; When not busy with these activities, Dr. Shaffer leads a team of contributors for the AAOMPT Podcast (, an interview show that addresses a wide array of topics related to orthopedics, and serves as a peer reviewer for an array of scientific journals.

Course Material included in this course
  • Handout - T4 Syndrome
  • Shaffer SM T4 Syndrome - Identifying, Explaining, and Managing a Common but Peculiar Diagnosis January 2020 (Handout)
  • Video Lectures - Introduction
  • Part 1 - Introduction
  • Part 2 - Outline and Qualifying Statements
  • Feedback
  • Video Lectures - Background Content
  • Part 3 - Autonomic Nervous System Review
  • Part 4 - What is T4 Syndrome
  • Part 5 - The History of Describing T4 Syndrome
  • Part 6 - Orthopaedic Manual Physical Therapy (OMPT) and the ANS – What Does The Evidence Tell Us?
  • Part 7 - Clinical Patterns of T4 Syndrome
  • Feedback
  • Video Lectures - Examination and Management of T4 Syndrome
  • Part 8 - Diagnostic and Clinical Formula
  • Part 9 - Examination and Management Techniques 1
  • Part 10 - Examination and Management Techniques 2
  • Part 11 - Examination and Management Techniques 3
  • Part 12 - Examination and Management Techniques 4
  • Part 13 - Examination and Management Techniques 5
  • Part 14 - Examination and Management Techniques 6
  • Part 15 - Examination and Management Techniques 7
  • Part 16 - Examination and Management Techniques 8
  • Feedback
  • Video Lectures - Conclusions
  • Part 17 - Prognosis, Summary, and Conclusion
  • Feedback
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