JOSPT Insights

Today’s guest—Dr Thomas Ibounig—who led the paper, “Rotator Cuff Imaging Abnormalities in Asymptomatic Shoulders: A systematic review” explores how prevalent abnormal MRI findings are in asymptomatic shoulders, and how the prevalence changes by population.

The systematic review is an exemplar of what musculoskeletal rehabilitation clinicians can learn from accepting what we don’t know!

Chelsea and Marquis wrap up the chat by thinking about how physical therapists can take the systematic review findings into account when educating and referring patients with shoulder pain.

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RESOURCES

Rotator cuff imaging abnormalities in asymptomatic shoulders systematic review: https://www.jospt.org/doi/10.2519/jospt.2025.13611

More on the SCRUTINY (Systematic Review of Shoulder Imaging Abnormalities in Asymptomatic Adults) project: https://www.ficebo.com/project/scrutiny

Psychological factors can be prominent for people with tendinopathy–so how do you pick up on them? How might psychological factors guide your plan of care? Today, physiotherapist Jack Mest (University of Canberra), is your guide to understanding how best to screen for important psychological factors, and how to address them in the clinic.

Jack Mest is a PhD candidate, studying psychological factors associated with persistent tendinopathy and psychologically informed approaches in Achilles tendinopathy rehabilitation.

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RESOURCES

Psychological factors in people with and without persistent tendinopathy: https://www.jospt.org/doi/10.2519/jospt.2025.13307

Scoping review of psychological factors in tendinopathy: https://www.jospt.org/doi/10.2519/jospt.2022.11005

JOSPT Insights ep 255: what if clinicians trusted people in pain? With Joletta Belton & Ben Darlow: https://pod.link/1522929437/episode/ZjcwNTljYzMtMjI5Ny00NWI2LWJjNzMtYzlkZTA3ZjVhODcz

The Covid pandemic was an inflection point for many aspects of health care, including turbocharging uptake of virtual models of care.

Telerehabilitation was around before Covid, of course, but the past few years has seen it in a far more prominent place in health care systems. There's also increasing research evaluating different telerehabilitation interventions.

Dr Bruno Saragiotto (University of Technology Sydney) studies telehealth for chronic pain conditions, artificial intelligence and implementing digital solutions in health care. Today he joins JOSPT Insights to discuss the present and future of technology for improving outcomes in musculoskeletal rehabilitation.

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RESOURCES

Internet-based self-management for chronic pain (ReabilitaDOR Trial): https://www.jospt.org/doi/10.2519/jospt.2025.13418

Effectiveness of activity trackers and smartphone apps for increasing physical activity: https://www.jospt.org/doi/10.2519/jospt.2026.13825

Physiotherapy Evidence Database (PEDro): https://pedro.org.au/

In episode 258, Drs Ruth Chang and JP Caneiro explain the results of trials testing cognitive functional therapy (CFT). They explored what CFT is and how it might help people in pain.

In today's episode, Dr Caneiro (Curtin University; Evoolve Pain Care Academy) joins the JOSPT Insights community again to explain what is involved in learning the patient-centred CFT approach.

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RESOURCES

Evoolve Pain Care Academy: https://evoolvepaincare.academy/

Videos, infographics and written resources for clinicians: https://evoolvepaincare.academy/clinician-resources

All clinicians know the challenge and opportunity that comes with tailoring clinical decisions to the person in front of you. While it's helpful to have clinical practice guidelines to give you a starting point and to reduce unwarranted variation in practice, of course every patient is different!

Today, Dr Trevor Lentz (Duke University) explains the concept of clinical phenotyping, which is another way of identifying patterns in your clinical practice, and guiding your clinical decisions.

Clinical phenotyping has been suggested as a way of tailoring musculoskeletal care in practice, although its implementation in practice has been patchy - Dr Lentz explains some of the reasons why.

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RESOURCES

Psychological phenotyping in osteoarthritis: https://www.jospt.org/doi/10.2519/josptopen.2025.0177

OSPRO yellow flags tool: https://www.jospt.org/doi/10.2519/jospt.2016.6487

Clinical framework for screening yellow flags: https://www.jospt.org/doi/10.2519/jospt.2021.10570

STarT MSK research programme review: https://pubmed.ncbi.nlm.nih.gov/37490570/

Last week we explored how people with pain move. Drs Ruth Chang and JP Caneiro explained cognitive functional therapy, or CFT, as an approach to helping people in pain explore their beliefs with curiosity. Today, we take the discussion further, exploring what CFT could do for your practice.

Dr Chang is a postdoctoral research fellow at Curtin University in Perth, Australia, and a specialist musculoskeletal physiotherapist. Dr Caneiro is a specialist physiotherapist, Adjunct Senior Clinical Researcher at Curtin University, and Director and Educator at Evoolve Pain Care Academy.

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RESOURCES

RESTORE trial: https://pubmed.ncbi.nlm.nih.gov/37146623/

Patterns of change in forward bending, and pain self-efficacy during CFT: https://www.jospt.org/doi/10.2519/jospt.2025.13114

Relationship between forward bending and improvement in pain and disability during CFT: https://www.jospt.org/doi/10.2519/jospt.2024.12727

Network meta-analysis of tailored exercise therapies with or without psychological interventions: https://www.jospt.org/doi/10.2519/jospt.2025.13281

If cognitive functional therapy hasn't been on your radar, it's likely only a matter of time. There's an increasing number of trials studying the effects of cognitive functional therapy. In a network meta-analysis published in January 2026 in JOSPT, the authors found that cognitive functional therapy topped a list of 27 different interventions for reducing disability in people with chronic non-specific low back pain.

Today, Dr Ruth Chang (Curtin University, Australia) and Dr JP Caneiro (Curtin University; Evoolve Pain Care Academy) explain how cognitive functional therapy works and how to incorporate it into your practice.

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RESOURCES

RESTORE trial: https://pubmed.ncbi.nlm.nih.gov/37146623/

Patterns of change in forward bending, and pain self-efficacy during CFT: https://www.jospt.org/doi/10.2519/jospt.2025.13114

Relationship between forward bending and improvement in pain and disability during CFT: https://www.jospt.org/doi/10.2519/jospt.2024.12727

Network meta-analysis of tailored exercise therapies with or without psychological interventions: https://www.jospt.org/doi/10.2519/jospt.2025.13281

Manual therapy is one of those topics that seems to quickly descend to polarised debates in musculoskeletal rehabilitation. Today, we're talking about what manual therapy looks like and does in the 2020s.

Dr Jodi Young explains the mechanisms of manual therapy, the typical effects and why you might think about adding manual therapy as another tool in your physical therapy toolkit. Dr Young is the Director of Research for the Doctor of Science in Physical Therapy program at Bellin College in Green Bay, Wisconsin, where she mentors doctoral clinicians and helps turn clinical and educational research questions into meaningful, publishable research. She is also a fellow of the American Academy of Orthopaedic Manual Physical Therapists.

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RESOURCES

Modern definition and description of manual therapy: https://pubmed.ncbi.nlm.nih.gov/38457654/

Modern way to teach and practice manual therapy: https://pubmed.ncbi.nlm.nih.gov/38773515/

Living review of manual therapy mechanisms: https://pubmed.ncbi.nlm.nih.gov/40100908/

Unravelling the mechanisms of manual therapy: https://www.jospt.org/doi/10.2519/jospt.2018.7476

Developing manual therapy frameworks: https://www.jospt.org/doi/10.2519/josptopen.2023.0002

Integrating person-centred concepts and modern manual therapy: https://www.jospt.org/doi/full/10.2519/josptopen.2023.0812

How do patients believe manual therapy works? https://www.jospt.org/doi/10.2519/josptopen.2025.0149

Does it matter how you apply spinal manipulation? JOSPT Insights ep 221: https://pod.link/1522929437/episode/NmM0MTg4OGMtODMwMi00ZTA3LTg1NzUtYjY2ZjBiMThiZGUy

After Lindsey Vonn's sad early exit due to injury from the Milano-Cortina 2026 Winter Olympics, it feels like an apt time to revisit the latest consensus on managing knee injury, and supporting return to sport after complex meniscus injury and surgery.

Today, we continue the conversation on the latest consensus for managing acute and degenerative meniscus tears. We jump into non-surgical treatment, and all the return to sport considerations for athletes and active people with meniscus injury. Dr Arielle Giordano (University of Delaware) shares the results of the EU-US Meniscus Rehabilitation Consensus.

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RESOURCES

EU-US Meniscus Rehabilitation Consensus on prevention, non-operative treatment and return to sport: https://www.jospt.org/doi/10.2519/josptopen.2025.13539

DREAM trial primary report: https://pubmed.ncbi.nlm.nih.gov/38319181/

Should symptoms guide treatment choice in young patients? https://www.jospt.org/do/10.2519/jospt.blog.20240415/full/

Early surgery vs exercise therapy + education for traumatic and non-traumatic meniscus tears: https://www.jospt.org/doi/10.2519/jospt.2024.12245

Ep 224: Saving the meniscus: https://pod.link/1522929437/episode/NTg3YTgzZWUtYTZjZC00ZDYwLWI2OTAtYTczMzAzNTEyNzgz

Ep 192: DREAMing of better care for meniscus tears: https://pod.link/1522929437/episode/Yzk2YzkyOWItMDk1MS00YWZkLWI2MjQtNmRlYjIwZGJmOTg0

Trust is integral to the therapeutic relationship between patients and clinicians in musculoskeletal rehabilitation. But does that trust go both ways?

If you do a deep dive into the literature on trust, you'll find that it almost always talks about whether patients trust clinicians, not if clinicians trust patients. There's also an inherent bias built into the biomedical environment where so called 'objective' tests - the imaging, the bloodwork, the physical performance tests that clinicians administer - are prioritised over patients' lived experience and expertise, which is derided as 'subjective' and somehow less trustworthy.

Today's guests today invite you to join a revolution of starting from a place of trusting people with pain, and acknowledging the patient's expertise.

Joletta Belton is an author, advocate and patient engagement in research specialist, who makes sense of pain through science and stories. Dr Ben Darlow is a physiotherapy specialist and Professor of Primary Health Care at The University of Otago in Aotearoa/New Zealand.

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RESOURCES

Do we trust patients in pain viewpoint: https://www.jospt.org/doi/10.2519/jospt.2025.13725

Jo's substack (MyCuppaJo): https://mycuppajo.substack.com/

Framework for establishing connections in physiotherapy practice: https://pubmed.ncbi.nlm.nih.gov/29432058/