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. The Shoulder Physio Online Course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Harrison on Twitter: @HJHansford See our Disclaimer here: The Shoulder Physio - Disclaimer

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: @emwalker_exphys Andrew on Instagram:@navigatepainexphysio TKEX on Instagram: @theknowledgex Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

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_5 Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on Twitter: @‌jaredpowell12 Nathalia on Twitter: @nathaliaccosta1 Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

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: @‌erikmeirapt Erik on Twitter: @‌erikMeira Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

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 Twitter: @‌henriksen_mh Christian on Twitter: @‌DrChrisBarton Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer

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 trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

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: @shoulder_physio Jared on Twitter: @jaredpowell12 Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

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 John on twitter: @simplysportssci Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

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.... Connect with Jared: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Steph on twitter: @stephfilbay Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

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 

Feeling stiff is a familiar feeling for all of us. But does feeling stiff mean our joints are actually stiff? Or is there more to it. Tasha Stanton PhD is a clinical neuroscientist who has performed research directly addressing this question. This is a fascinating conversation and I hope you enjoy.  Key resources: Tasha's paper here Connect with Jared and Tasha: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Tasha on Twitter: @Tash_Stanton Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

The Nordic hamstring exercise has enjoyed mostly good press with respect to injury prevention effectiveness. That is until recently. Professor's Franco Impellizzeri and Kristian Thorborg kindly and clearly join me in conversation to help us understand the evidence for and against this exercise. Key resources: Impellizzeri Meta analysis: HERE Ishoi and Thorborg response: HERE Van Dyk systematic review: HERE Connect with Jared, Franco and Kristian: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Franco on Twitter: @francoimpell  Kristian on Twitter: @KThorborg Cliniko free trial, click here! See our Disclaimer here: The Shoulder Physio - Disclaimer 

I am joined by Connor Gleadhill to discuss causal inference. Connor is a PhD candidate exploring causal inference and is someone who speaks fluently about complex topics (must be the smooth Irish accent!). Causal inference is basically the pursuit of estimating how and why things happen. How do we determine causation - strictly through the randomised controlled trial or can we use observational evidence too? Can causal inference help us navigate a chaotic world? Key resources: COMPLEXITY: THE EMERGING SCIENCE AT THE EDGE OF ORDER AND CHAOS The Book of Why - Judea Pearl Hernan 2018 paper - The C Word Connect with Jared and Connor: Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Connor's Email: connorgleadhill@gmail.com Connor's Website: http://www.connorgleadhill.physio Connor on Twitter: @CGleadhill See our Disclaimer here: The Shoulder Physio - Disclaimer 

The biopsychosocial model is ubiquitous in modern health care but what is it at its core? Is it accurately described and used in research and clinical practice? To help make headway into these questions and more, I'm joined by Ben Cormack. Ben is a MSK therapist from England who has developed a special interest in the philosophy and implementation of the biopsychosocial in MSK health care.  Key papers mentioned in the show: Engel 1977 paper Ben's upcoming paper on the BPS model: Cormack et al 2022 The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiotherapy Theory and Practice. Stilwell and Harman 2019 Enactivism paper Mescouto 2020 Critical review of the biopsychosocial model  Gatchel 2007 The biopsychosocial approach to chronic pain Melbourne workshop details Melbourne Workshop, June 4, The Performance Centre Connect with Jared and Ben Ben on Twitter: @CorKinetic Ben on Instagram: @corkinetic Jared on Instagram: @shoulder_physio Jared on Twitter: @jaredpowell12 Watch the full conversation on Youtube here. Disclaimer These terms and conditions apply when you listen to The Shoulder Physio Podcast.  

Cognitive biases are as much of a problem as they are fundamental to the human condition. They exist, but can we mitigate them? What common cognitive biases afflict health care? Jarod and Jared shoot the s**t around these interesting questions. Melbourne workshop details:  Melbourne Workshop, June 4, The Performance Centre Jared Powell on Instagram: @shoulder_physio Jared Powell on Twitter: @jaredpowell12 Follow Jarod Hall on Instagram: @drjarodhallpt Watch the full conversation on Youtube here. Disclaimer These terms and conditions apply when you listen to The Shoulder Physio Podcast.