Episodit
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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
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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 hereConnect with Jared and guests:
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Tim on Twitter: @TimGabbett
Tim on Instagram: @gabbetttim
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Puuttuva jakso?
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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.
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Caitlin on Twitter: @caitlin_jones
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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.
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Connect with Jared and guests:
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Rachelle on Twitter: @RachelleBuchbin
Rachelle on google scholar
Ian on google scholar
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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 intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial. Br J Sports Med. 2024 May 2;58(10):538-547. doi: 10.1136/bjsports-2023-107793. PMID: 38637135.2.
2. Lawford BJ et al. How Does Exercise, With and Without Diet, Improve Pain and Function in Knee Osteoarthritis? A Secondary Analysis of a Randomized Controlled Trial Exploring Potential Mediators of Effects. Arthritis Care Res (Hoboken). 2023 Nov;75(11):2316-2327. doi: 10.1002/acr.25140. Epub 2023 Jun 15. PMID: 37128836; PMCID: PMC10952828.
3. Marriott KA et al. Are the Effects of Resistance Exercise on Pain and Function in Knee and Hip Osteoarthritis Dependent on Exercise Volume, Duration, and Adherence? A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2024 Jun;76(6):821-830. doi: 10.1002/acr.25313. Epub 2024 Apr 15. PMID: 38317328.
4. Bailey DL, Holden MA, Foster NE, et al. Defining adherence to therapeutic exercise for musculoskeletal pain: a systematic review. British Journal of Sports Medicine 2020;54:326-331.
5. Nicolson PJA, Hinman RS, Wrigley TV, Stratford PW, Bennell KL. Self-reported Home Exercise Adherence: A Validity and Reliability Study Using Concealed Accelerometers. J Orthop Sports Phys Ther. 2018 Dec;48(12):943-950. doi: 10.2519/jospt.2018.8275. Epub 2018 Jul 27. PMID: 30053792.
The Shoulder Physio Online Course is on sale for a limited time!Connect with Jared and guests:
Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
Kim on Twitter: @kimbennell
The Centre for Health, Exercise and Sports Medicine (CHESM): @CHESM_unimelb
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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 CE. Cracking the code: unveiling the specific and shared mechanisms behind musculoskeletal interventions. Arch Physiother. 2023 Jul 6;13(1):14. doi: 10.1186/s40945-023-00168-3. PMID: 37415258; PMCID: PMC10327381.
2. Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, George SZ. Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. J Orthop Sports Phys Ther. 2018 Jan;48(1):8-18. doi: 10.2519/jospt.2018.7476. Epub 2017 Oct 15. PMID: 29034802.
3. Silvernail JL, Deyle GD, Jensen GM, Chaconas E, Cleland J, Cook C, Courtney CA, Fritz J, Mintken P, Lonnemann ME. Orthopaedic Manual Physical Therapy: A Modern Definition and Description. Phys Ther. 2024 Mar 8:pzae036. doi: 10.1093/ptj/pzae036. Epub ahead of print. PMID: 38457654.
4. 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.
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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, Manchester, UK: part 3. Br J Sports Med. 2017 Dec;51(24):1713-1723. doi: 10.1136/bjsports-2017-098717. Epub 2017 Nov 6. PMID: 29109118.
3. Powers CM, Ho KY, Chen YJ, Souza RB, Farrokhi S. Patellofemoral joint stress during weight-bearing and non-weight-bearing quadriceps exercises. J Orthop Sports Phys Ther. 2014 May;44(5):320-7. doi: 10.2519/jospt.2014.4936. Epub 2014 Mar 27. PMID: 24673446.
4. Crossley KM, Stefanik JJ, Selfe J, Collins NJ, Davis IS, Powers CM, McConnell J, Vicenzino B, Bazett-Jones DM, Esculier JF, Morrissey D, Callaghan MJ. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016 Jul;50(14):839-43. doi: 10.1136/bjsports-2016-096384. Epub 2016 Jun 24. PMID: 27343241; PMCID: PMC4975817.
5. Nimon G, Murray D, Sandow M, Goodfellow J. Natural history of anterior knee pain: a 14- to 20-year follow-up of nonoperative management. J Pediatr Orthop. 1998 Jan-Feb;18(1):118-22. PMID: 9449112.
6. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005 Jul;(436):100-10. doi: 10.1097/01.blo.0000172303.74414.7d. PMID: 15995427.
7. Holden S, Matthews M, Rathleff MS, Kasza J; Fohx Group; Vicenzino B. How Do Hip Exercises Improve Pain in Individuals With Patellofemoral Pain? Secondary Mediation Analysis of Strength and Psychological Factors as Mechanisms. J Orthop Sports Phys Ther. 2021 Dec;51(12):602-610. doi: 10.2519/jospt.2021.10674. PMID: 34847699.
8. Robertson CJ, Hurley M, Jones F. People's beliefs about the meaning of crepitus in patellofemoral pain and the impact of these beliefs on their behaviour: A qualitative study. Musculoskelet Sci Pract. 2017 Apr;28:59-64. doi: 10.1016/j.msksp.2017.01.012. Epub 2017 Feb 2. PMID: 28171780.
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Bill on Twitter: @Bill_Vicenzino
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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 as unimportant? J Physiother. 2023 Jul;69(3):133-135. doi: 10.1016/j.jphys.2023.04.001. Epub 2023 May 30. PMID: 37263906.
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Harrison on Twitter: @HJHansford
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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.
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Andrew on Instagram:@navigatepainexphysio
TKEX on Instagram: @theknowledgex
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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: 10.1016/j.socscimed.2022.115422. Epub 2022 Oct 3. PMID: 36215924.Costa N, Butler P, Dillon M, Mescouto K, Olson R, Forbes R, Setchell J. "I felt uncertain about my whole future"-a qualitative investigation of people's experiences of navigating uncertainty when seeking care for their low back pain. Pain. 2023 Jul 20. doi: 10.1097/j.pain.0000000000002975. Epub ahead of print. PMID: 37478013.Gibson, B. E. (2016). Rehabilitation : a post critical approach. CRC Press. Paul Christiaan Beenen, Dario Filiputti, Erna Rosenlund Meyer, Lidia Carballo-Costa, Patricia Maria Duarte de Almeida, Antonio Alves Lopes, Joost Egbertus Jacobus Lidwina van Wijchen & Alexandre Castro Caldas (2018) Epistemic beliefs as a determinant in evidence-based practice in physiotherapy – a Multi-Country (Europe) Cross-Sectional Online Survey Study, European Journal of Physiotherapy, 20:2, 85-91, DOI: 10.1080/21679169.2017.1374454
Rocca, E., Anjum, R.L. (2020). Complexity, Reductionism and the Biomedical Model. In: Anjum, R.L., Copeland, S., Rocca, E. (eds) Rethinking Causality, Complexity and Evidence for the Unique Patient. Springer, Cham. https://doi.org/10.1007/978-3-030-41239-5_5Connect with Jared and guests:
Jared on Instagram: @shoulder_physio
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Nathalia on Twitter: @nathaliaccosta1
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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
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Jared on Instagram: @shoulder_physio
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Lianne on Twitter: @WoodwicksLianne
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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
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Steve on Twitter: @stevekamper1
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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: @erikmeirapt
Erik on Twitter: @erikMeira
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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
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Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
Marius on Twitter: @henriksen_mh
Christian on Twitter: @DrChrisBarton
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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
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Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
Neal on Twitter: @tendonglasgow
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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
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Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
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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
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Franco on Twitter: @francoimpell
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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
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Jared on Twitter: @jaredpowell12
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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
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Jared on Instagram: @shoulder_physio
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John on twitter: @simplysportssci
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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 Bracing Method Trail....
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Steph on twitter: @stephfilbay
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