In this episode of The Shoulder Physio Podcast, I am joined by Rich Willy, PhD to discuss bone stress injuries. Rich is one of the foremost experts in the world on bone stress injuries, and it was a real pleasure to sit down with him for an hour to chat all things bone.

Bone stress injuries can be quite common in athletic populations and the consequences of a poorly managed bone stress injury can be severe. As such, it is so important to be able to accurately detect a bone stress injury, know how to manage it, and give appropriate advice and education around what causes it and what is their probably prognosis. Rich gives us a masterclass on all of this and much more. 

Don't miss this wonderful episode with Rich Willy, PhD.

Key Papers:

Nunns M et al. Four biomechanical and anthropometric measures predict tibial stress fracture: a prospective study of 1065 Royal Marines. Br J Sports Med. 2016 Oct;50(19):1206-10. doi: 10.1136/bjsports-2015-095394. Epub 2016 Jan 8. PMID: 26746906.

Warden SJ, Edwards WB, Willy RW. Preventing Bone Stress Injuries in Runners with Optimal Workload. Curr Osteoporos Rep. 2021 Jun;19(3):298-307. doi: 10.1007/s11914-021-00666-y. Epub 2021 Feb 26. PMID: 33635519; PMCID: PMC8316280.

McLellan M, Allahabadi S, Pandya NK. Youth Sports Specialization and Its Effect on Professional, Elite, and Olympic Athlete Performance, Career Longevity, and Injury Rates: A Systematic Review. Orthop J Sports Med. 2022 Nov 4;10(11):23259671221129594. doi: 10.1177/23259671221129594. PMID: 36353394; PMCID: PMC9638532.

Tenforde AS, Outerleys J, Bouxsein ML, Buckless CG, Besier T, Davis IS, Bredella MA. Metatarsal Bone Marrow Edema on Magnetic Resonance Imaging and Its Correlation to Bone Stress Injuries in Male Collegiate Basketball Players. Orthop J Sports Med. 2022 Jan 17;10(1):23259671211063505. doi: 10.1177/23259671211063505. PMID: 35071655; PMCID: PMC8777350.

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Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Rich on Twitter: @rwilly2003

Rich on Instagram: @montanarunninglab

Rich's website: www.montanarunninglab.com

See our Disclaimer here: The Shoulder Physio - Disclaimer

In this episode of The Shoulder Physio podcast, I am joined by Chris Neason and Claire Samanna to discuss their recently published randomised controlled trial exploring running as a treatment for chronic low back pain. 

Chronic low back pain is widely believed to be one of the biggest contributors to years lived with disability. As such, it is a problem that needs attention, and part of this is identifying effective treatments. Typically, exercise is a recommended and effective treatment for persistent low back pain, and this can include resistance exercise, pilates, yoga and many other movement based approaches. But what about good old fashioned jogging, could this work? Listen to find out!

Don't miss this wonderful episode with Chris Neason and Claire Samanna.

Key Papers:

Neason C, Samanna CL, et al. Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial. Br J Sports Med. 2024 Oct 7:bjsports-2024-108245. doi: 10.1136/bjsports-2024-108245. Epub ahead of print. PMID: 39375007.

Natoli A, Jones MD, Long V, Mouatt B, Walker ED, Gibbs MT. How do people with chronic low back pain perceive specific and general exercise? A mixed methods survey. Pain Pract. 2024 Jun;24(5):739-748. doi: 10.1111/papr.13354. Epub 2024 Feb 20. PMID: 38379359.

Check out the Shoulder Physio Online Course here

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Chris on Twitter: @chris_neason

Claire on Instagram: @claire_thelowbackpain_ep

Claire on Twitter: @claireLsamanna 

See our Disclaimer here: The Shoulder Physio - Disclaimer

In this episode of The Shoulder Physio podcast, I am joined by Dr John Kuhn, who is an orthopaedic surgeon and researcher from the United States. Doctor Kuhn and his colleagues, through the MOON shoulder group, have published several high impact studies investigating the management of individuals with rotator cuff tears and the results of these studies have caused some controversy (good controversy, that is). 

Rotator cuff tears are ubiquitous in musculoskeletal health care. They are both common and often burdensome, so it is important that shoulder surgeons and physiotherapists can agree on best practice management, for the betterment of the individual with the rotator cuff tear. So do John and I agree or not? Listen to find out. 

Don't miss this wonderful episode with Doctor John Kuhn.

Key Papers:

Kuhn et al; MOON Shoulder Group. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013 Oct;22(10):1371-9. doi: 10.1016/j.jse.2013.01.026. Epub 2013 Mar 27. PMID: 23540577; PMCID: PMC3748251.

Dunn WR et al; MOON Shoulder Group. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016 Aug;25(8):1303-11. doi: 10.1016/j.jse.2016.04.030. PMID: 27422460.

Kuhn JE et al. The Predictors of Surgery for Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears Change Over Time: Ten-Year Outcomes of the MOON Shoulder Prospective Cohort. J Bone Joint Surg Am. 2024 Sep 4;106(17):1563-1572. doi: 10.2106/JBJS.23.00978. Epub 2024 Jul 9. PMID: 38980920.

Kuhn, 2023. Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

John's Research Gate profile

See our Disclaimer here: The Shoulder Physio - Disclaimer

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 

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Leanne on Twitter: @leannebisset

See our Disclaimer here: The Shoulder Physio - Disclaimer

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 

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Tim on Twitter: @TimGabbett

Tim on Instagram: @gabbetttim

See our Disclaimer here: The Shoulder Physio - Disclaimer

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.

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Caitlin on Twitter: @caitlin_jones

See our Disclaimer here: The Shoulder Physio - Disclaimer

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.

Cliniko free trial, click here!

Shoulder Physio Online Course

Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Rachelle on Twitter: @RachelleBuchbin

Rachelle on google scholar 

Ian on google scholar

See our Disclaimer here: The Shoulder Physio - Disclaimer

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.

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

See our Disclaimer here: The Shoulder Physio - Disclaimer

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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Connect with Jared and guests:

Jared on Instagram: @‌shoulder_physio

Jared on Twitter: @‌jaredpowell12

Amy on Twitter: @awmcdevittDPT

See our Disclaimer here: The Shoulder Physio - Disclaimer

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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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