The Shoulder Physio Podcast

Associate Professor Amy McDevitt discusses the evolving causal explanations of manual therapy, emphasizing the importance of understanding mechanisms and therapeutic alliance. From historical biomechanical viewpoints to contemporary neurophysiological aspects, the conversation delves into the complexities of how manual therapy works. The episode sheds light on the quest for a deeper understanding of interventions benefitting patients.

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

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