"Shoulder special tests are not that special"

"For the vast majority of [shoulder] conditions...its probably impossible to be certain exactly where the symptoms are coming from"

We speak with Dr. Jeremy Lewis (PhD, FCSP, Consultant Physiotherapist, Professor of Musculoskeletal Research) about rotator cuff shoulder pain, including issues relating to shoulder special tests, medical imaging, and research which reports that, for most people, exercise is as effective as surgery. 

To connect with Jeremy, visit his website http://www.londonshoulderclinic.com or follow him on twitter @JeremyLewisPT

00:25 Can you give us a brief background?

01:33 Can you describe each of the following hypotheses, how they started, and what the research supports?:

01:42 - Shoulder impingement

06:22 - Rotator cuff tears

07:23 - Shoulder special tests

09:56 - Shoulder imaging and pain

12:32 - Shoulder surgery 

14:14 - Posture and shoulder pain

16:24 Why do you think that all of these hypotheses are still prevalent despite the research?

18:13 How did you come to question these hypotheses and how have they changed your practice?

19:10 Do you think that clinicians should change their practice based on the research?

20:37 Do you think that we should abandon the traditional shoulder special tests in assessments?

22:01 Do you think there is such thing as a bad shoulder exercise?

23:05 What about exercises people do in the gym that aren’t considered functional positions? (E.g. Behind the neck military press)

25:06 Can you explain your shoulder symptom modification procedure and how you incorporate it into an assessment?

28:18 Does the shoulder symptom modification procedure drive your management decisions?

29:10 How do you explain a shoulder issue to a patient who wants a specific diagnosis?

30:47 Do you feel is the biggest mistake that clinicians make when dealing with the shoulder? 

31:39 Are there any specific kinetic chain factors you assess that may influence the shoulder?

33:29 What are some psychosocial factors that contribute to shoulder outcomes?

35:27 Can you share one interesting and little known fact about the shoulder?

36:51 What are some unknowns about the shoulder that you hope will be answered in future research?

38:57 How can people learn more about you?

Posture is important, but do we overemphasize its importance when it comes to injuries and pain?

We speak with Dr. Greg Lehman (BKin, MSc, DC, MScPT) to explore when biomechanics and posture are important and when they're not. Greg also shares current research on the relationship between biomechanical factors and pain, challenging common beliefs of both patients and clinicians.

To connect with Greg, visit his website http://www.greglehman.ca or follow him on twitter @greglehman

00:26 Can you introduce yourself?

00:55 What got you interested in biomechanics and pain science?

01:46 What are common beliefs among both patients and clinicians regarding posture, biomechanics and pain?

02:53 When do you feel biomechanics and posture are important vs not important?

04:20 What does the research support?

05:31 What are your thoughts on structural abnormalities (e.g. Scoliosis, leg length discrepancy) and their relationship to pain?

06:53 Should clinicians abandon the biomechanical model?

08:07 What is the non-biomechanical reason why posture can change pain?

09:55 If someone is in pain, why does changing posture help reduce it?

10:58 What are the biggest mistakes clinicians make when educating patients about their pain?

12:27 If I was a patient, how would you educate me on why changing my posture can help to decrease my pain?

13:11 Can you give us a patient success story?

13:56 Can you give a patient failure story?

14:54 Do you think biomechanics become more important for high level performance once a patient is out of pain?

16:40 Can you give some specific examples of high-level athletes or sport movements that don’t follow the normal “efficient” movement pattern?

18:07 What are you thoughts on movement assessment systems?

19:12 Can you talk a bit about your workbook?

20:10 What do your days look like now? What are you involved in?

21:03 How can people find out more about you?

"I can't run, I have arthritis"

"It hurts to bend forward because of my bulging disc"

People are always blaming their pain on their medical imaging results, but how much do your x-ray and MRI findings actually correlate with your pain?

We speak with physiotherapist, Dr. Bahram Jam, about common medical imaging results, their correlation with pain, and how to incorporate these results into your practice. We also discuss the impact of imaging on the healthcare system and the over-medicalization of pain, which can lead to poorer patient outcomes. 

To learn more about Dr. Bahram Jam, read his clinical articles, and download a free VOMIT poster (now titled "Medical Imaging: The Untold Truth"), visit his website www.aptei.ca

00:27 Can you introduce yourself?

01:03 Can you share your story of your evolution as a clinician? 

02:49 Do you believe that everyone should get medial imaging for an injury? 

04:10  How do you incorporate medical imaging results into your patient care?

05:25 Do medical imaging findings correlate with pain? 

06:40 Are there any good research studies that support this?

07:50 For a specific patient, how do you determine if a structural abnormality on the scan is relevant and either a concern or cause of their pain?

08:42 What are common mistakes that clinicians make when it comes to interpreting medical imaging results?

09:45 Can you give us examples of imaging results that may be irrelevant?

11:38 In your experience, has there been a change in how physicians order and use imaging in musckuloskeletal medicine?

13:29  Does the amount of medical imaging have an impact on the healthcare system? 

15:51 In your experience, what are patients’ thoughts and attitudes towards imaging?

16:59 As a patient, if I’ve had a scan that shows abnormal findings, should I be worried?

18:47 What language do you use to describe imaging/assessment findings to the patient?

22:10 Does language influence pain?

22:50 What are common mistakes that clinicians make with patient communication?

23:57 When is it ok to use a pathoanatomical explanation for pain?

25:14 Can you share a story of a memorable patient experience that is relevant to our discussion?

27:41 Can you tell us about your book

30:07 Can you tell us about your VOMIT poster?

32:06 How can people find out more about you?