The Shoulder Physio Podcast – Details, episodes & analysis

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

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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.

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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

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

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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

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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

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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

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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

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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

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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

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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

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