The Shoulder Physio Podcast

Jared is joined by Professor Chad Cook who is one of the great researchers and academics in the field of physical therapy. Chad is clear and cogent voice on many topics but I especially love his more recent work on treatment mechanisms, which will form the basis of this episode. Enjoy. Key resources Musculoskeletal Treatment Mechanisms: A Puzzle That May Never Be Fully Solved Cook CE et al. Specific and shared mechanisms mediating pain intensity and functional outcomes in chronic neck pain. Pain Manag. 2026 Jul;16(7):799-808. doi: 10.1080/17581869.2026.2658063. Cook CE et al. Personalizing rehabilitation approaches: Moderator analyses of manual therapy and exercise effectiveness in individuals with chronic neck pain: Secondary analysis of the SS-MECH trial. Musculoskelet Sci Pract. 2026 Sep 22;86:103665. doi: 10.1016/j.msksp.2026.103665. Register for the complete shoulder online course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 Chad on LinkedIn: Jeremy…

Jared is joined by Professor Jeremy Lewis who really needs no introduction but we will give him one just for fun. Jeremy is a researcher, educator, physiotherapist, and one of the biggest names in musculoskeletal rehabilitation. In this episode Jeremy discusses his journey in cementing the fact that subacromial impingement syndrome is a "clinical illusion" and a fundamentally flawed concept. This one is not to be missed. Key resources Lewis, J. S. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? Physical Therapy Reviews, 16(5), 388–398. https://doi.org/10.1179/1743288X11Y.0000000027 Register for the complete shoulder online course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 Jeremy on Instagram: @jeremy.s.lewis Jeremy on LinkedIn: Jeremy Lewis See our Disclaimer here: The Shoulder Physio - Disclaimer

The supraspinatus is one of the most misunderstood muscles in the human body. This episode aims to correct that. Key resources Reed D, Cathers I, Halaki M, Ginn K. Does supraspinatus initiate shoulder abduction? J Electromyogr Kinesiol. 2013 Apr;23(2):425-9. doi: 10.1016/j.jelekin.2012.11.008. Epub 2012 Dec 21. PMID: 23265661. Boettcher CE, Ginn KA, Cathers I. Which is the optimal exercise to strengthen supraspinatus? Med Sci Sports Exerc. 2009;41(11):1979–1983. Wattanaprakornkul D, Cathers I, Halaki M, Ginn KA. The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. J Sci Med Sport. 2011;14(5):376–382. Kinsella R, Pizzari T. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review. Shoulder Elbow. 2017;9(2):112–126. Register for the complete shoulder online course Melbourne workshop details Connect with Jared: Jared on Instagram:…

A peanut isn't dangerous until it meets someone who can't tolerate it. Same with the upright row exercise. This episode scrutinises the "worst exercise for your shoulder" claim by tracing it back to a theory that's already dead, then shows what determines outcome: the person lifting. Shock. Horror. Key resources Bahr, R. (2016). Why screening tests to predict injury do not work — and probably never will: a critical review. British Journal of Sports Medicine, 50(13), 776–780. Marsh, C.E., et al. (2020). Fitness and strength responses to distinct exercise modes in twins: Studies of Twin Responses to Understand Exercise as a THerapy (STRUETH) study. The Journal of Physiology, 598(18), 3845–3858. Stern, B.D., Hegedus, E.J., & Lai, Y.C. (2020). Injury prediction as a non-linear system. Physical Therapy in Sport, 41, 43–48. Powell, J. (2024). An essay on the upright row... and peanuts. The Shoulder Physio Blog. (Source essay this episode is adapted from.) Register for the complete shoulder online course Melbourne…

Jared is joined by Tim Cook who is Senior Lecturer in Physiotherapy at the University of Chichester, Advanced Physiotherapy Practitioner in the NHS, and doctoral researcher to discuss their new paper with Prof. Jeremy Lewis in the Journal of Manual & Manipulative Therapy: "Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle." Tim explains what pushed him to question routine strength testing in busy clinical practice, despite guidelines recommending it, and the pair dig into whether weakness is a cause of shoulder pain, a consequence of it, or something else altogether. They look at what subacromial anaesthetic injection studies reveal about pain versus true force output, and Tim reframes the classic "weak and painful shoulder" as the "flexible but painful shoulder," drawing parallels to other oversimplified clinical narratives like posture and core stability. They also make the case for when strength testing can still earn its keep; patient engagement,…

Is there really one correct way to move? For decades, clinicians and coaches have acted like there is. In this episode, we prosecute that idea. We start in a 1930s Soviet forge, where Nikolai Bernstein filmed blacksmiths and found their hammer strikes landed in the same spot every time, despite every joint angle differing swing to swing. That's "repetition without repetition." From there we bring in Mark Latash's motor abundance: why your nervous system treats extra degrees of freedom as a resource, not a problem, and what that means for scapular "dyskinesis," core stability cues, and fear-based rehab language. We close with a practical clinical translation for coaches and clinicians. Plus: a quick update on my next in-person workshop, The Complete Shoulder Workshop, Melbourne 17 October. Key resources Low M. A Time to Reflect on Motor Control in Musculoskeletal Physical Therapy. J Orthop Sports Phys Ther. 2018 Nov;48(11):833-836. doi: 10.2519/jospt.2018.0614. PMID: 30381024. Latash ML. The bliss (not the…

The question of allowing pain, or avoiding it, during exercise based rehab remains contentious and uncertain. So, like any good scientist, we (led by Ivy Tran) studied the evidence-base and sought an answer to this clinical conundrum to help not just you, but us too! What did we find? Listen to the episode to find out. Key resources Tran I et al. Effectiveness of Painful Versus Nonpainful Exercise on Pain Intensity, Disability, and Other Patient-Reported Outcomes in Adults With Chronic Musculoskeletal Pain: An Updated Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2025 Smith BE et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

What is a physiotherapist? Strip away the hands, the exercises, the modalities, what's left? In this episode I argue that the "fixer" identity, the clinician who finds what's broken and corrects it, isn't where our profession came from. It's something that was selected into us through a century of professional politics and reductionist thinking. Drawing on the history of physiotherapy, Newell's constraints framework, self-determination theory, and Gopnik's gardener, I make the case for a different identity: the clinician who sets the conditions for an active, adaptive person to recover and even flourish. Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

Burnout in our profession is widespread, with most studies reporting prevalence between 8 and 23 per cent, and up to 65 per cent of recent graduates planning to leave physiotherapy within ten years. In this episode, drawing on a recent editorial in the Journal of Physiotherapy by Ky Wynne, I lay out the empirical picture and challenge the dominant framing that burnout is a problem of individual resilience. I share my own story of burning out two years into clinical practice, what shifted before anything else did, and the disposition I've come to see as the antidote to the slow erosion the current climate produces. Key resources Wynne K. Burnout in physiotherapy. Journal of Physiotherapy. 2026;72:87–90. https://doi.org/10.1016/j.jphys.2025.12.009 Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

Is more always better? Is there a dose response effect of exercise for musculoskeletal pain? Should exercise be just like a medication, where the dose has to be sufficient in order for it to elicit a therapeutic effect? These are the questions we contend with on this episode of The Shoulder Physio Podcast. Key resources Lawford BJ, Hinman RS, Spiers L, Kimp AJ, Dell'Isola A, Harmer AR, Van der Esch M, Hall M, Bennell KL. Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis. Arthritis Care & Research. 2024. Liang X, et al. The Best Exercise Modality and Dose for Reducing Pain in Adults With Low Back Pain: A Systematic Review With Model-Based Bayesian Network Meta-analysis. JOSPT. 2024. Malliaras P, Johnston R, Street G, Littlewood C, Bennell K, Haines T, Buchbinder R. The efficacy of higher versus lower dose exercise in rotator cuff tendinopathy: A systematic review of…

The FIMAGE study scanned both shoulders of 602 adults from the general population using high-resolution 3-Tesla MRI. Only 7 had a structurally normal rotator cuff. In this episode, I walk through what the study found, why 78% of full-thickness tears were in people with no shoulder pain, and what happens to the diagnostic value of a scan when the finding it detects is near-universal. I challenge the assumption that prevalence equals normality, explore why the word "tear" imports a trauma narrative into what is usually a degenerative process, and make the case that imaging findings deserve a smaller seat at the clinical reasoning table than we've historically given them. Key resources Ibounig T et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. 2026 Apr 1;186(4):406-414. doi: 10.1001/jamainternmed.2025.7903. PMID: 41697693; PMCID: PMC12910452. Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep…

In this episode, I walk through my recent JOSPT paper arguing that no single treatment modality has proven itself superior for musculoskeletal pain and that the profession should stop pretending otherwise. Drawing on Isaiah Berlin's distinction between the hedgehog and the fox, I make the case for treatment pluralism: the idea that multiple interventions can lead to recovery, and that rigid allegiance to any one approach is not supported by the evidence. Key resources Powell et al 2026. Many Paths to Recovery: The Case for Treatment Pluralism. JOSPT. DOI: https://www.jospt.org/doi/10.2519/jospt.2026.13992 Register for the complete shoulder online course Register for my Brisbane workshop Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

I posted a meta-analysis showing PRP doesn't beat saline for tennis elbow. The regenerative medicine community came for me, hard. This episode walks through the incident, what the evidence states, why the comparator you choose determines the conclusion you reach, and what the pushback reveals about incentives in musculoskeletal medicine. References Antunes Júnior et al. (2026). Platelet-rich plasma does not improve pain or function in patients with lateral epicondylitis as compared with placebo: A meta-analysis of randomized clinical trials. American Journal of Sports Medicine. Coombes BK et al. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. The Lancet, 376(9754), 1751–1767. Gosens T et al. (2011). Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. American Journal of Sports…

The argument that AI replaces "the science" while clinicians should "lean into the art" has become common across healthcare. In this episode, I explain why I think both sides of that framing get it wrong, and why the art vs. science debate was always a false dichotomy that AI has simply made harder to ignore. I draw on four thinkers to make the case: Michael Polanyi on tacit knowledge, Donald Schön on reflective practice in the swampy lowlands, Aristotle on phronesis, and Herbert Dreyfus on the limits of artificial intelligence. Together, they point toward a different answer, that what makes a clinician an expert isn't information retrieval or technical craft, but practical wisdom: the capacity to think with another person under conditions of uncertainty. Register for the complete shoulder online course Register for my Brisbane workshop Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

In this episode of The Shoulder Physio Podcast, we discuss why musculoskeletal clinicians are, at their core, knowledge workers. Not in the corporate buzzword sense, but in the truest sense: professionals whose value comes from the quality of their thinking, not the techniques in their toolkit. We explore why knowledge compounds but repetition doesn't, why information alone fails to change behaviour, and why trust is far more than a soft skill. If you've ever wondered what actually separates a good clinician from a great one, this episode is for you. Register for the complete shoulder online course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

Physiotherapist and PhD researcher Laura Anderson just published a paper arguing that "medial tibial stress syndrome" is a 'garbage' name that's been freaking runners out and leading to terrible treatment for decades. Her proposed replacement? Load-Induced Medial Leg Pain (LIMP). Yes, LIMP, pun not intended. The Problem: "Tibial stress" makes everyone think bone stress injury → stress fracture → panic → rest for months Clinicians still aggressively massage shins until they're bruised People rest for months and it comes right back when they start running again It's one of the most common running injuries and we have almost zero quality research on it What It Is: Not a bone stress injury on a fracture continuum Doesn't get worse if you keep running (unlike actual bone stress injuries) We honestly don't know exactly what tissues are involved (probably multiple) Imaging usually shows nothing useful The fix? Tune in. Register for The Complete Shoulder online course Key papers: MTSS needs a new name - Laura's LIMP…

In this episode, I discuss our recently published BJSM editorial “It’s Not All About Strength” ; what the paper argues, why we wrote it, and what the evidence says about mechanisms of exercise-related pain relief in musculoskeletal conditions. I then turn to the reaction. Not to name names or settle scores, but to examine what the response reveals about how we handle criticism, uncertainty, and challenges to familiar explanations in rehabilitation science. This episode is about evidence, mechanisms, cognitive comfort, and why letting our theories (ideas) be criticised is essential for progress. Register for The Complete Clinician here Key paper: It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

In this episode, Jared Powell is joined by Dr. Jackson Fyfe, exercise scientist and Senior Lecturer at Deakin University, to explore the science and practicality of resistance training across the lifespan. They unpack everything from how kids can safely lift weights to how older adults can maintain muscle health and longevity. Jackson also shares insights from his research on training dosage, hypertrophy, minimal effective dose, and how resistance and aerobic exercise can (and should) coexist. This conversation spans from myth-busting (“weights stunt growth”) to deep physiological insights about muscle as an endocrine organ. It’s a clear, evidence-based discussion that reminds us why lifting weights might just be the most underrated health intervention available. Key topics include: Why resistance training matters at every age The health benefits beyond muscle and strength How little training you can do and still get results Strength vs hypertrophy, what actually matters? Combining cardio and lifting:…

In this episode, Jared announces the launch of The Complete Clinician, a new mentorship and education community for MSK professionals who want more than recycled CPD. He explains why this platform exists, what’s inside, and who it’s designed for. From monthly PhD-level lectures to the Brew & Review journal club, structured learning modules, and The Clinician’s Compass, this is a second education for those who refuse to be average. Jared also shares a quick update on the upcoming 2nd Edition of The Complete Shoulder, set to release in mid-November, with refined content, updated evidence, and new modules. Launch Date: October 15 Check it out! Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

In this candid and wide-ranging conversation, Dr Jared Powell is joined once again by Professor Peter O’Sullivan, one of the most influential voices in musculoskeletal care. Pete unpacks the rationale and findings of the landmark RESTORE trial published in The Lancet, which provides some of the most compelling evidence to date for cognitive functional therapy (CFT) in people with chronic low back pain. He discusses how CFT works, its philosophical divergence from traditional “find-it, fix-it” approaches, and how it centres the patient’s experience, goals, and context. You’ll also hear: A simple explanation of the 3 pillars of CFT The real-world training model used in the RESTORE trial The importance of behaviour change, flare-up planning, and self-efficacy What to do when CFT “doesn’t work” Pete’s reflections on burnout, clinician support, and the importance of community A behind-the-scenes look at the Evolve Pain Care Academy: a new initiative to democratize pain education globally This episode is packed…

In this solo episode of The Shoulder Physio Podcast, Dr Jared Powell explores a deceptively simple question: How much benefit does rotator cuff surgery need to provide to be considered worthwhile? Jared explores a new 2025 study by Harrison Hansford and colleagues, which uses a clever benefit–harm trade-off approach to quantify what patients actually want from surgery. This episode challenges the way we interpret research, the limits of "statistical significance," and the need for truly patient-centred decision-making. If you're still recommending surgery after failed physio without asking what makes it worthwhile to the person in front of you, this one’s for you. Key topics include: The concept of the smallest worthwhile effect Is “does it work?” the wrong question? Shared decision-making and expectation alignment How the evidence stacks up (or doesn’t) Why patient-defined outcomes matter more than p-values Check out the Shoulder Physio Online Course here Connect with Jared: Jared on Instagram:…

In this episode of The Shoulder Physio Podcast, Dr Jared Powell sits down with Dr Mervyn Travers, physiotherapist, S&C coach, and researcher, to explore one of the most compelling frameworks in contemporary pain science: active inference. They discuss how this predictive brain model helps explain persistent musculoskeletal pain, why traditional exercise-based interventions might miss the mark, and how clinicians can use movement and context to shift a patient’s pain experience. Merv blends philosophy, neuroscience, and clinical pragmatism in a way that's accessible, challenging, and highly relevant. Key talking points: What is active inference and how does it relate to predictive processing? The role of prior beliefs, culture, and clinical language in shaping pain Movement experimentation as a tool for model updating and recovery Why it’s time to rethink how we prescribe exercise in pain rehab Clinical implications from landmark studies within the field that lend themselves to active inference A call for…

In this episode, Jared Powell sits down with Professor Gordon Guyatt, the physician and researcher who coined the term evidence-based medicine (EBM). They unpack the origins of EBM, why it’s often misunderstood, and how it continues to shape modern healthcare. Rather than being rigid or formulaic, EBM is about integrating the best evidence with clinical expertise and—crucially—patient values and preferences. 🎙 Key talking points: The surprising history behind the creation of EBM Why randomised trials matter—and when they’re not enough How to practice medicine in the face of low-certainty evidence The role of shared decision-making in everyday care Why acknowledging uncertainty is a sign of strength, not weakness How EBM is sometimes misunderstood or misused What the future holds for EBM—including education in schools 🎧 A must-listen for anyone navigating the grey zones of clinical care. Key Papers: Professor Guyatt has too many high impact papers to mention and he has one of the highest H-Index scores in the…

In this episode of The Shoulder Physio Podcast, Dr. Jared Powell sits down with Dr. Charlotte Ganderton, a physiotherapist, researcher, and senior lecturer at RMIT University. Charlotte shares insights from her latest research on gluteal tendinopathy, breaking down common misconceptions about imaging, corticosteroid injections, and the infamous clam exercise. From understanding the role of compression in tendinopathy to discussing effective treatment strategies, this episode is packed with clinically relevant takeaways for musculoskeletal healthcare professionals. Tune in to hear Charlotte’s perspective on how education, exercise, and progressive loading can make all the difference in patient outcomes. 🔹 What is gluteal tendinopathy and how does it differ from other tendon issues? 🔹 Should we rethink the role of imaging and injections? 🔹 Is it finally time to ban the clam? 🔹 Practical treatment strategies for improving patient care. If you're looking to refine your approach to gluteal tendinopathy, this is…

In this episode of The Shoulder Physio Podcast, I am interviewed by my wife, Tara, about my recently completed PhD. For the past 7 years of my life I have been engaged in a research based PhD investigating the causal mechanisms underpinning the effectiveness of exercise therapy for rotator cuff related shoulder pain. This research program has produced 6 published pieces of research that is contained with the thesis. In this episode I briefly discuss the premise of the thesis, its main findings, and recommendations for future research. I also gives some tips and tricks and to prospective PhD or current PhD students which may help their journey. Don't miss this episode with myself, Dr Jared Powell, and my wife, the amazing Tara Powell. Buckle up! Key Papers: Powell JK, Lewis JS. Rotator Cuff-Related Shoulder Pain: Is It Time to Reframe the Advice, "You Need to Strengthen Your Shoulder"? J Orthop Sports Phys Ther. 2021 Apr;51(4):156-158. doi: 10.2519/jospt.2021.10199. PMID: 33789431. Powell JK, Schram B, Lewis…

In this episode of The Shoulder Physio Podcast, I am joined by Rich Willy, PhD to discuss bone stress injuries. Rich is one of the foremost experts in the world on bone stress injuries, and it was a real pleasure to sit down with him for an hour to chat all things bone. Bone stress injuries can be quite common in athletic populations and the consequences of a poorly managed bone stress injury can be severe. As such, it is so important to be able to accurately detect a bone stress injury, know how to manage it, and give appropriate advice and education around what causes it and what is their probably prognosis. Rich gives us a masterclass on all of this and much more. Don't miss this wonderful episode with Rich Willy, PhD. Key Papers: Nunns M et al. Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines. Br J Sports Med. 2016 Oct;50(19):1206-10. doi: 10.1136/bjsports-2015-095394. Epub 2016 Jan 8. PMID: 26746906. Warden SJ, Edwards WB, Willy RW.…

In this episode of The Shoulder Physio podcast, I am joined by Chris Neason and Claire Samanna to discuss their recently published randomised controlled trial exploring running as a treatment for chronic low back pain. Chronic low back pain is widely believed to be one of the biggest contributors to years lived with disability. As such, it is a problem that needs attention, and part of this is identifying effective treatments. Typically, exercise is a recommended and effective treatment for persistent low back pain, and this can include resistance exercise, pilates, yoga and many other movement based approaches. But what about good old fashioned jogging, could this work? Listen to find out! Don't miss this wonderful episode with Chris Neason and Claire Samanna. Key Papers: Neason C, Samanna CL, et al. Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial. Br J Sports Med. 2024 Oct 7:bjsports-2024-108245. doi:…

In this episode of The Shoulder Physio podcast, I am joined by Dr John Kuhn, who is an orthopaedic surgeon and researcher from the United States. Doctor Kuhn and his colleagues, through the MOON shoulder group, have published several high impact studies investigating the management of individuals with rotator cuff tears and the results of these studies have caused some controversy (good controversy, that is). Rotator cuff tears are ubiquitous in musculoskeletal health care. They are both common and often burdensome, so it is important that shoulder surgeons and physiotherapists can agree on best practice management, for the betterment of the individual with the rotator cuff tear. So do John and I agree or not? Listen to find out. Don't miss this wonderful episode with Doctor John Kuhn. Key Papers: Kuhn et al; MOON Shoulder Group. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9.…

In this episode of The Shoulder Physio podcast, I am joined by Leanne Bisset, who is the queen of tennis elbow, seriously. Leanne is an associate professor at Griffith University on the Gold Coast, Australia with a keen interest in upper limb tendinopathy. Leanne also has extensive experience as a clinician, which makes Leanne a balanced voice of reason. Tennis elbow is a common and often debilitating musculoskeletal condition however it often receives insufficient attention compared to other, more sexy, tendinopathies. This episode will change that as we explore all dimensions of tennis elbow, from diagnosis to differential diagnosis to pain mechanisms and of course treatment. Don't miss this wonderful episode with Leanne Bisset. Key Papers: Leanne's google scholar profile Check out the Shoulder Physio Online Course here Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Leanne on Twitter: @leannebisset Cliniko free trial, click here! See our Disclaimer…

In this episode of The Shoulder Physio podcast, I am joined by Tim Gabbett, who is the training load master. Tim has an incredible resume as both a coach and scientist and recently featured in the top 10 of a list ranking sports scientists from around the world. In this episode, we go deep into the training load literature and what it may mean for the clinician and coach. We discuss the rise of 'load management' in the cultural zeitgeist and whether this is a good or bad thing. Tim discusses his principles of training load management and also responds to some challenges of his work. Don't miss this wonderful episode with Tim Gabbett. Key Papers: Gabbett TJ The training—injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine 2016;50:273-280. Tim's google scholar profile Check out the Shoulder Physio Online Course here Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Tim on Twitter: @TimGabbett Tim on…

In this episode of The Shoulder Physio podcast, I am joined by Caitlin Jones, who has recently published a world first randomised placebo controlled trial in the Lancet journal on opioids for acute neck and low back pain. In this episode Caitlin discusses why they chose to do this trial, the results and their possible clinical implications. Caitlin also responds to various critiques of the trial with aplomb. Don't miss this enlightening episode with Caitlin Jones. Key Papers: Jones CMP et al. OPAL Investigators Coordinators. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet. 2023 Jul 22;402(10398):304-312. doi: 10.1016/S0140-6736(23)00404-X. Epub 2023 Jun 28. Erratum in: Lancet. 2023 Aug 19;402(10402):612. doi: 10.1016/S0140-6736(23)01681-1. PMID: 37392748. Check out the Shoulder Physio Online Course here Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Caitlin on Twitter: @caitlin_jones…

In this episode of The Shoulder Physio Podcast, I am joined by Rachelle Buchbinder and Ian Harris. Rachelle and Ian are academic doctors who still see and treat patients whilst also conducting high quality research. This conversation centres around the concept that modern medical care is sick. Over-treatment, over-diagnosis, junk science, and perverse incentives are just some of the issues plaguing modern medicine. As it happens, Rachelle and Ian have written a book on this exact topic! The book is provocatively titled "Hippocracy: how doctors are betraying their oath" and is available at the link below. I hope you enjoy this episode. Key Resources: 1. Hippocracy: how doctors are betraying their oath. 2. Harris IA, Sidhu V, Mittal R, Adie S. Surgery for chronic musculoskeletal pain: the question of evidence. Pain. 2020 Sep;161 Suppl 1:S95-S103. doi: 10.1097/j.pain.0000000000001881. PMID: 33090742. Cliniko free trial, click here! Shoulder Physio Online Course Connect with Jared and guests: Jared on Instagram:…

In this episode of The Shoulder Physio podcast, I am joined by Kim Bennell, a professor and research physiotherapist from the University of Melbourne. Kim has been involved in designing and implementing dozens of clinical trials over her many years of research and is a true giant of the physiotherapy profession. In this episode we discuss something novel. We venture into the world of physiotherapists providing dietary advice for people with knee osteoarthritis, which might be controversial. Kim has just published a landmark clinical trial on this very topic. We also delve into exercise for knee and hip osteoarthritis and whether there is an ideal dose or adherence level that leads to superior clinical outcomes. This is based on a recent review and there is some surprising results. Don't miss this enlightening episode with professor Kim Bennell. Key Papers: 1. Allison K et al. Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered…

In this episode of The Shoulder Physio podcast, I am joined by Amy McDevitt, an associate professor and clinician at the University of Colorado. Amy shared her perspective on manual therapy and the importance of unraveling the mechanisms behind this treatment approach. We discussed the evolving causal explanations of manual therapy, moving beyond antiquated notions towards a more contemporary and scientifically based explanation for how it many help people in pain. We delved into the complexities of how manual therapy works, from historical biomechanical viewpoints to more contemporary neurophysiological aspects. Amy highlighted the importance of considering contextual factors and therapeutic alliance, which may play a more significant role in patient outcomes than previously believed. Don't miss this enlightening episode that sheds light on the intricacies of manual therapy and the quest for a deeper understanding of how interventions work to benefit patients. Key Papers: 1. McDevitt AW, O'Halloran B, Cook…

Patello-femoral pain is a common, and at times, debilitating condition of the knee that can impact people across the lifespan. Professor Bill Vicenzino is a world leading expert on this topic and to that end I've enticed him onto the show to give us the ins and outs of this tricky condition. This is truly a must listen episode with a real pioneer of physiotherapy about a very common and important musculoskeletal condition. Key Papers: 1. Rathleff MS, Holden S, Krommes K, Winiarski L, Hölmich P, Salim TJ, Thorborg K. The 45-second anterior knee pain provocation test: A quick test of knee pain and sporting function in 10-14-year-old adolescents with patellofemoral pain. Phys Ther Sport. 2022 Jan;53:28-33. doi: 10.1016/j.ptsp.2021.11.002. Epub 2021 Nov 4. PMID: 34775189. 2. Powers CM, Witvrouw E, Davis IS, Crossley KM. Evidence-based framework for a pathomechanical model of patellofemoral pain: 2017 patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat,…

When a patient comes to see a physiotherapist, or any health care professional, how much better does that patient need to get to make a treatment worthwhile? This is an important question because we're constantly making treatment recommendations to patients, day in-day-out, but based on what? My guest for this podcast, Harrison Hansford, reckons a lot of our treatment decisions should be made with consideration of something called the Smallest Worthwhile Effect, which is actually surprisingly easy to understand. Enjoy! Key Papers: 1. Hansford HJ, Jones MD, Cashin AG, Ostelo RW, Chiarotto A, Williams SA, Sharma S, Devonshire JJ, Ferraro MC, Wewege MA, McAuley JH. The smallest worthwhile effect on pain intensity of nonsteroidal anti-inflammatory drugs and exercise therapy for acute and chronic low back pain: a benefit-harm trade-off study. J Physiother. 2023 Oct;69(4):240-248. doi: 10.1016/j.jphys.2023.08.006. 2. Abdel Shaheed C, Mathieson S, Wilson R, Furmage AM, Maher CG. Who should judge treatment effects…

We're constantly told, even lectured, about the importance of exercise for most non-traumatic musculoskeletal pain presentations, shoulder pain included. We assume it works for all people across time and space, but is this true? Are there factors that might influence whether exercise will help an individual with shoulder pain or not? What are these factors and can we influence them? Listen on to hear Emily and Andrew from The Knowledge Exchange interview me about these very interesting questions. Key Papers: 1. Powell JK, Costa N, Schram B, Hing W, Lewis J. "Restoring That Faith in My Shoulder": A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff-Related Shoulder Pain. Phys Ther. 2023 Dec 6;103(12):pzad088. doi: 10.1093/ptj/pzad088. PMID: 37440455; PMCID: PMC10733131. The Shoulder Physio Online Course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Emily on Instagram:…

Every iconic scientist has a quote emphasising the importance of uncertainty and doubt that underpins the scientific attitude. This holds true as much for fundamental physics and biological science as it does for health science, probably far more so in the case of health science. For we are complex, non-linear creatures, each with different stories, backgrounds, contexts and circumstances. Because of this, clinical uncertainty is ubiquitous, it's everywhere, but this should not paralyse us according to my guest on this episode, Nathalia Costa, PhD. Enjoy. Key Papers: Costa N, Olson R, Mescouto K, Hodges PW, Dillon M, Evans K, Walsh K, Jensen N, Setchell J. Uncertainty in low back pain care - insights from an ethnographic study. Disabil Rehabil. 2023 Mar;45(5):784-795. doi: 10.1080/09638288.2022.2040615. Epub 2022 Feb 21. PMID: 35188845. Costa N, Mescouto K, Dillon M, Olson R, Butler P, Forbes R, Setchell J. The ubiquity of uncertainty in low back pain care. Soc Sci Med. 2022 Nov;313:115422. doi:…

Pilates exercise seems to help people with chronic low back pain...but how? What are the causal mechanisms underpinning the apparent effectiveness of Pilates? Does it activate the multifidus and transeversus abdominis muscles? Does it reduce fear and improve confidence? Both or neither? To shed some light on this question I have invited Lianne Wood on to the show, who, incidentally, has a paper on this very question! What a lovely coincidence. Key Papers: Wood et al 2023: Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Lianne on Twitter: @WoodwicksLianne Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

What exactly is a placebo effect? When you try and pin it down, it's confusing. Technically, it's something inert that produces an effect...how can there be an effect without a mechanism? Prof. Steve Kamper is here to help bring clarity to the issue. Key Papers: Kamper 2013: The placebo effect: powerful, powerless or redundant? Testa and Rossettini 2016: Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Steve on Twitter: @stevekamper1 Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

Science is ubiquitous. But what is it? Everyone talks about science and the significance of being scientific but nailing down just what this means for clinical practice in physical therapy is somewhat elusive. To clear all this up, I’m joined by the Science Pt, Erik Meira. Erik is a sharp and eloquent communicator about science and its application to physical therapy. You don’t want to miss this one. Key Papers: Powell JK et al. "Restoring that Faith in my Shoulder": A Qualitative Investigation of how and why Exercise Therapy Influenced the Clinical Outcomes of Individuals with Rotator Cuff-Related Shoulder Pain. Phys Ther. Cashin et al 2023 Mechanisms of exercise and education for low back pain Costa et al 2023 uncertainty in low back pain care Powell et al 2022 scoping review of exercise mechanisms for rotator cuff related shoulder pain Popper: The Logic of Scientific Discovery Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Erik on Instagram:…

Exercise for knee osteoarthritis is a non-negotiable and effective intervention, right? Well, maybe it’s not so clear. Evidence seems to be dropping every month challenging the privileged position that exercise occupies for managing knee osteoarthritis. Front and centre is the infamous DICSO trial, published in 2022, and this study will serve as the foundation for this debate. The debate features Marius Henriksen and Christian Barton and these two men engage in polite yet passionate intellectual battle with the aim of figuring out just what role exercise plays for managing people with knee osteoarthritis. Key Papers: Bandak et al 2022 DISCO trial Holden et al 2023 Exercise for hip and knee osteoarthritis Deyle et al 2023 physical therapy Vs corticosteroid for knee osteoarthritis What is the effect of saline injections for knee osteoarthritis Cochrane review exercise for knee osteoarthritis Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Marius on…

Tendinopathy: Is it a simple case of tendon overload that can be fixed with eccentric exercise or friction massage? What's the deal with inflammation? Is there a role for adjunct therapies such as biologics and medications? Can physios, surgeons and sports physicians ever get along when it comes to managing tendinopathy? My guest, Professor Neal Millar is here to let you know. Key papers: Millar et al 2021: Tendinopathy Cook and Purdam Continuum Model of Tendinopathy Rees et al 2014: Tendons--time to revisit inflammation Millar et al: Interleukin 17A– a Translational Target to Treat Supraspinatus Tendinopathy Connect with Jared and Neal: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Neal on Twitter: @tendonglasgow Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

Strengthening exercise is a popular and effective treatment for shoulder pain. But...is the benefit of strengthening exercise derived from getting stronger or are there other causal mechanisms underpinning the effect? Listen to find out! Key papers: Powell and Lewis 2021: Rotator Cuff–Related Shoulder Pain: Is It Time to Reframe the Advice, “You Need to Strengthen Your Shoulder”? Lewis and Powell 2022: Should We Provide a Clinical Diagnosis for People with Shoulder Pain? Absolutely, Maybe, Never! The Ongoing Clinical Debate Between Leavers and Retainers Hotta et al 2022: Causal mechanisms of a scapular stabilization intervention for patients with subacromial pain syndrome: a secondary analysis of a randomized controlled trial Messier et al 2022: Effect of High-Intensity Strength Training on Knee Pain and Knee Joint Compressive Forces Among Adults With Knee Osteoarthritis: The START Randomized Clinical Trial Connect with Jared: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Cliniko free…

Can we prevent injuries from happening? All of them? If we can't prevent ALL injuries should we move away from using the term prevention? Or is all this boring and irrelevant linguistic games that don't move the needle for clinical practice? I for one am fascinated by this discussion and I reckon you will enjoy it too. Franco, as always, has the ability to cut through fluffy opinions and statements with hardcore and unabashed science and I love it! Key papers: Prevention versus Risk Reduction or Mitigation Connect with Jared: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Franco on Twitter: @francoimpell Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

In this solo episode I discuss the evidence underpinning the use of platelet rich plasma injections for shoulder pain. Platelet rich plasma makes total sense on the surface, but do empirical findings support this? Should we continue down the pathway of research for platelet rich plasma, or move on? Should you recommend it in your practice? What do you say if a patient asks you about it? These are some of the topics we tackle in this short primer on platelet rich plasma for shoulder pain. I hope you enjoy. Key papers: Platelet rich plasma: from basic science to clinical applications by Foster et al 2009 Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears by Schwitzguebel et al 2019 Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears: A Double-Blinded, Randomized Controlled Trial Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial Connect with Jared: Jared on Instagram:…

In this episode I speak with eminent sport scientist and coach, John Kiely. John is infamous for challenging dogmatic training principles in sport science, chiefly periodisation theory. Our conversation starts with periodisation theory and then goes to some interesting locations, stopping momentarily at homeostasis, allostasis, general adaptation syndrome (GAS), predictive processing, the biomedical model, sets and reps and much, much more. If you prescribe exercise in any way, shape or form, please listen to this episode with the venerable John Kiely. Key papers: Periodisation theory: Confronting an inconvenient truth Periodisation paradigms in the 21st century: evidence-led or tradition-driven? Uncertainty and stress: Why it causes diseases and how it is mastered by the brain Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study Connect with Jared: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12…

An entrenched assumption in sport and exercise medicine/physiotherapy, going back decades, has been that ACL (anterior cruciate ligament) injuries DO NOT heal. Not ever. However, like many dogmatic beliefs in the health and fitness sector, this assumption appears to have been seriously wrong. Dr Stephanie Filbay joins me to discuss her latest paper about the healing capacity of the ACL and what this means for your clinical practice. Dr Filbay also teases some insights from the CROSS bracing trial, which is soon to be published. Be prepared to have some of your most tightly held beliefs seriously challenged in this episode. Key papers: Dr Filbay et al 2022. Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial Dr Filbay Lancet paper Surgery or rehabilitation for anterior cruciate ligament injury: where are we now? The KANON trial by Frobell et al 2010 Stay tuned for the Cross…

Osteoarthritis (OA) is a leading cause of pain and disability. OA is also seems to be associated with several myths and misconceptions about how it is caused and how it might be managed. To cut through some of this mythology, I invited Professor David Hunter on the show for a 'no holds barred' conversation. David is the number 1 ranked expert in the world on OA, so it should come as no surprise he is a wealth of knowledge and a clear communicator on the complexities of osteoarthritis. I hope you enjoy. Key papers: The START trial for knee OA The IDEA trial David's Lancet paper on OA Connect with Jared: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 David on twitter:@ProfDavidHunter Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

In this podcast, I discuss the scapula with Filip Struyf, PhD. Filip is a former guest on the show (episode 2) and I've pulled him back on the podcast to tackle the hard problems as they relate to the scapula. Specifically, in this episode we consider the question: "If we identify a scapula dyskinesis in our physical examination, should we attempt to rectify it?". Key Resources: Filip's fabulous 2013 paper here Connect with Jared and Filip: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Filip on Twitter: @Filip_Struyf Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer