Jared Powell
@JaredPowell12
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MSK physio. PhD candidate. Interested in the shoulder. I like to think all problems are soluble.
Gold Coast, Queensland
Joined March 2015
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Our latest paper is now published:
Is exercise therapy the right treatment for rotator cuff-related shoulder pain? Uncertainties, theory, and practice.
Open access.
@JeremyLewisPT
@Dr_Ben_S
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Neuroscientist talking about tibs and sciatica and posture. It’s pure chaos
Tib raises
Game-changer
You should try these
Great warm-up for leg day
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Being a physio is hard. We must consider everything from the cell to society and the philosophical paradigm underpinning it all. We are the polymaths of health care 🤩
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‼️ Just published. Do we need to reframe our explanation and understanding of "strengthening" for RCRSP? 💪
@JeremyLewisPT
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Pop physiotherapy is not real physiotherapy:
•We don’t realign joints with our hands or gadgets
•We don’t break up adhesions in soft tissue
•We’re not all sports physios
•We don’t all dry needle and use Ktape
•We’re confused by pain too
•We don’t all love yellow theraband
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Physiotherapy seems full of idea cults. Several of which respond to critique with maximum defence. I feel like this needs to change for real progress
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Pro tip: you don’t have to intervene.
Not everyone needs a page full of exercises, or PNE or CFT, or manual therapy or a referral. Some might be happy hearing “this condition has a favourable natural Hx, as you were”.
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Level 1 evidence suggests I love my newborn son more than I thought possible. Further research will not change this conclusion 🥰
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Physiotherapy is such a young profession, especially in a formalised scientific sense. Is it really so surprising that we don’t have all the answers yet?
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Should we stop demonising elastic resistance bands too? I vote yes.
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Maturing in physio is realising most things are never as bad or as good as they’re made out to be
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An excerpt from my podcast with
@ProfDavidHunter
on the descriptor ‘wear and tear’. Listen to the whole podcast for more context please :)
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It’s arrived down under. A gargantuan effort from
@JeremyLewisPT
and all other contributors. Stoked to be part of it
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I'm easing back into strength training after a 5 year hiatus (kids, covid, PhD, motivation, golf) and in reviewing the literature I re-read this lovely narrative. Recommend.
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Knee OA is a wild place:
1. Saline is as good as GLAD approach
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For a 50 year old with a large to massive rotator cuff tear undergoing tendon repair surgery - the probability that their repair will remain 'healed' at 12 months is 50%. This worsens decade upon decade thereafter
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I bought a new mattress today. My wife couldn’t help but tell the salesman I was a physio. Cue “so you’d know about how important sleeping with a neutral spine is then”. Me (dying) “yeah, nah”.
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There’s a growing movement to downplay the impact of research on clinical practice. My practice has been influenced substantially by research. Here are a selection of historical papers that have made me stop and reflect in relation to RCRSP:
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It's here and it's spicy! A YouTube debate on lifting technique and low back pain between
@GregLehman
and Andrew Lock. Must see viewing 🍿🍿
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A dichotomy in physiotherapy: 1) think pain is simple and give complex exercise. 2) think pain is complex and give simple exercise. I like the latter
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Interesting paper - 70% of universities surveyed believe their pain curricula is adequate and 74% of graduates believe they were not adequately prepared to treat persistent pain
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The fact we have a massage machine called a ‘physio gun’ is highly problematic if we want to change the cultural narrative of what physio really is
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Our latest paper is now published online ahead of print
@PTJournal
. It's open access ad infinitum. Instead of a long winded thread, see next for a neat infographic summarising the paper. Or, because it's open access, you can read it long form :)
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Is it just me or is the
@BrazJPhysTher
consistently putting out some of the best and most interesting research
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I got literal hate mail for this viewpoint when it was published, which I enjoyed. A few years later, the premise is now mostly incontrovertible. Crazy the speed of progress at play here.
Rotator Cuff–Related Shoulder Pain: Is It Time to Reframe the Advice, “You Need to Strengthen Your Shoulder”?
👀👀👇👇
@JaredPowell12
@JeremyLewisPT
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Placebo response and effect in randomized clinical trials: meta-research with focus on contextual effects
"Approx. half of the overall treatment effect in RCTs seems attributable to contextual effects rather than to the specific effect of treatments".
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Physio's often 'feel' a proclivity to act when sometimes careful watching and waiting may be preferable. I still struggle with this urge with almost every patient.
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Rotator cuff tear severity correlates with shoulder function when the full thickness tear exceeds 2.5cm
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We should strive to move from, "does it work"?
To:
“What works, for whom, in what respects, to what extent, in what contexts, and how?”
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I love the reporting of individual outcomes along with group means - just look at the variable response to education and the 2 exercise regimens for RCRSP. What could have no effect for one person could literally cure the next, across all 3 treatments!
@JeremyLewisPT
and co 👏
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This piece by the daily mail has gone viral and some believe it to be damning for Physios. There’s some truth to this, esp. the delivery of cookie cutter exercises and dismissive attitudes etc. But some of it is way off the mark…here’s my take
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External rotator strength deficits in non-athletic people with rotator cuff related shoulder pain are not associated with pain intensity or disability levels
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I had a wonderful conversation with
@PeteOSullivanPT
on his evolution of thought and research interests regarding low back pain. A real treat to talk to Pete and I reckon we can learn much from his journey!
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This retrospective cohort study found that a shoulder steroid injection was associated with a 7.44 fold increase in developing a rotator cuff tear in the following 3 years, compared to not having an injection. (MDPI - caution)
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I've started using AI to help find and synthesise research after being resistant for a while. It's early days and the tech is a bit clunky but there are some promising signs.
Here's 4 platforms that I use semi-regularly:
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After spending a couple of weeks in international transit, the definitive text on frozen shoulder by
@FilipStruyf
has arrived! Proud to have co-written the clinical examination section. Something nice and sentimental about a hard copy text.
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Terminating Corticosteroid Injection in Tendinopathy? Hasta la Vista, Baby
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Inflammatory cytokines mediate the effects of diet and exercise on pain and function in knee osteoarthritis independent of BMI
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Exercise is not a panacea for persistent pain but it is effective (small to modest effects). Comparative effectiveness is a different topic. Do we expect to ever find a one size fits all superior intervention for persistent pain?
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The authors deemed that a predominant focus on muscle strength as the mechanism through which to obtain improvements in pain and function from exercise therapy is likely ‘inappropriate in clinical practice'
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Knee OA is even more wild than I thought. Consider this study which reports that physical therapy is superior to IA corticosteroid injections at 12 months. So exercise can't out-perform saline injections but its got cortisone covered 🤷♂️
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The difference between scientific uncertainty and guru absolutism is stark. This needs to be seen to be appreciated 👀
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I'm doing my PhD remotely (from an office in my shed in rural Queensland) which can feel isolating as I am not part of a bustling learning community. Social media helps me feel some of this community, so thank you :)
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High rate of spontaneous healing of the ruptured ACL - observations from the KANON trial - those with a healed ACL do better
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Cool study here that should influence practice: doing a single knee extensor exercise appears to reduce the need for TKR surgery in those with knee OA but larger exercise doses are not more effective than smaller (2 sessions per week as good as 4 and 6)
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Just finished a great discussion with
@francoimpell
and
@KThorborg
on the Nordic hamstring exercise. Look out for it to be live on YouTube early next week!
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Every so often I re-read this paper by Plummer et al on identifying scapular dyskinesia and I am always mesmerised by its elegant and simple design. Do clinicians see what we want to see when assessing for movement faults?
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Such a powerful study. Whats happens when imaging does not provide a certain diagnosis?
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I think a conversation on the topic; “pain: sensation or perception?” would be helpful for the msk health community. I will host on my podcast. Who do you think I should invite on either side of debate?
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Underrated study - this program has been shown to reduce shoulder injuries but not via increasing strength - again there are alternative mechanisms!
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A real treat to spend an hour chatting with
@PeteOSullivanPT
. Pete details his evolution of thought as it pertains to low back pain and outlines the principal factors that instigated his intellectual shift.
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You’re right lat is tight, leading to insufficient firing of the glut - which caused your left traumatic sprained ankle when you mis-stepped off the curb
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A systematic review of clinical practice guidelines for rotator cuff disease - exercise is really the only universal recommendation.
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Exercise + manual therapy Vs exercise + sham manual therapy = no between group diff. **MDPI
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My 17 month old with that inherent perfect landing mechanics - and a nice lil applause at the end
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Has exercise overtaken manual therapy for what patients expect from physiotherapy? This paper suggests so and I'm here for it.
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In 1895 physics was declared a complete field. By 1930 quantum physics and relativity had reeked havoc on that certainty. This may happen in Physio research too. It appears, for now, like everything kinda works similarly for pain but I submit there are more discoveries to be made
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"Physiotherapy has always been about people feeling vibrant and alive, having hope for the future, and experiencing the joy of movement again. The best physiotherapy has always been transformative".
@DaveNicholls3
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Plz don’t say “I do them all as I go” because I will feel woefully inadequate. Thanks in advance
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Why do we normalise disagreement in the hard sciences (physics primarily) but demonise it in health science (physio etc.) where things are decidedly more complex?! (From a complex intervention perspective).
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Something I always like to reinforce to patients:
"Your trajectory is far more important than your current symptom state".
I find this helps with managing the psychology and emotions of symptom flares. This too will pass.
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"Any exercise program for RCRSP has the potential to help one individual, harm another or have no effect".
I had fun writing this sentence.
It always depends on the dynamic interplay between clinician-patient-exercise program.
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Most common elective orthopaedic surgeries are not backed up by readily available high quality evidence.
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Peter I would love to interview you about your evolution in thinking on this topic. Would you like to come on the show and discuss? I reckon this would be of immense value to the MSK community
@PeteOSullivanPT
@AdamMeakins
Haha - my beliefs have changed to align with how I see the evidence. Good to see he stays up to date …..😜
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The knee replacement - some great outcomes and not so great outcomes. This is a very interesting qual study highlight the variable response to this ubiquitous surgery
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Resistance training and MSK pain thread:
I've engaged in resistance tr. for nearly 30 years - since a pre teen trying to emulate my older brother. The year I graduated physio school I read this review and it became the cornerstone of my practice.
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🚨 Physio's worldwide, help!?
We need you to complete this short survey (less than 10 mins) to help advance knowledge on the role of exercise for treating shoulder pain.
Every response matters.
Retweets welcome :)
@JeremyLewisPT
@Dr_Ben_S
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What landmark theory or paper, in your opinion, has helped our profession see further?
I offer:
@JeremyLewisPT
Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion
Chris Littlewood’s SELF trial
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Stu McGill saying he can ‘vacuum in’ some disc bulges with light manual traction - can the disc legends verify or refute this?
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Had the great man
@Bill_Vicenzino
on the pod today - he’s a leading expert in about 8 different conditions and has a h-index of 1000 (give or take). Thanks for the chat about knee cap pain mate and for your reflections on a marvellous career 👏
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Confession: when a person feels better after any intervention from myself (exercise, manual therapy, education) my immediate instinct is to neglect all confounders and attribute the success solely to my intervention… but at least I’ve learnt to scrutinise this instinct!
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Tendons! Where are we at and do surgeons, physios, and sports docs generally converge on common treatment advice? With
@TendonGlasgow
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Someone do this for physiotherapy please
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Read this today:
“You don’t have to choose between being scientific and being compassionate.”
― Robert M. Sapolsky, Behave: The Biology of Humans at Our Best and Worst
And it hit me like a tonne of bricks.
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Very much looking forward to being an impartial observer of a watershed conversation between
@chadcookpt
and
@AdamMeakins
on manual therapy. Only available on YouTube. Coming in the next few days... (will sparks fly)?
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Apparently not everyone likes watching hour long videos on YouTube - as such I’ve launched my YouTube show onto a podcast! Episode one is live and features
@JeremyLewisPT
philosophising about frozen shoulder
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"Biomechanical beliefs initiate a cascade of treatment decision making in terms of imaging decisions, intervention decisions and referral decisions and how such beliefs have an impact on how HCPs educate patients, thereby influencing their beliefs + Rx expec."
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Dad strength is isometrically holding your 3 month old (8kg - big boy) in a bicep curl position for 90 minutes every night whilst they doze off.
I couldn't do this with a standard 8kg weight.
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Again, this time for shoulder hypermobility, baseline treatment expectations and self-efficacy are associated with better clinical outcomes.
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Interesting study here: People in studies with shoulder pain in 'no intervention groups' change minimally over 3-6 months. People in 'usual care' groups demonstrate moderate improvement all the way up to 12 months (most imp. occurs early).
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@GregLehman
@jpcaneiro
latest paper includes a case study to demonstrate the principles of CFT applied to an individual - I found this quite helpful
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As I near the completion of my PhD - it's been a bloody long road. Here are some reflections and maybe some helpful tips for others:
1. If you get to the end of your first year of doing a PhD and you're utterly confused, you're doing it right!
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Why do self proclaimed 'free thinkers' often impose restrictions of thought onto their followers and anyone who dare ask questions?
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Not to mention our basic inability to reliably detect a scapula dyskinesis in the first place or materially change it…
Another great paper challenging the certainty postural assessment informs practice
Thanks
@PaulieSalamh
and team
🔓
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My PhD is mixed methods and, at the moment, I'm between writing a quant. and qual paper. It genuinely feels like I have a personality disorder trying to modify my 'philosophical worldview' based on the paper at hand 🫣. I should add, it's highly exciting.
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The confidence interval of the pooled effect/CI crosses the line of null effect - I'm no statistician but I thought this meant we can't be sure that the intervention under study was more effective than the comparator? Happy to hear from
@stevekamper1
@PatrickOwenPhD
or others :)
Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis
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Tolerance of dissent, openness to change, and distrust of dogmatism is the multifaceted foundation of science and therefore progress. We would do well to foster this in physio rather than denigrate it
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Contextual effects make up roughly 80% of mobilisation and manipulation treatment effect and nearly 50% of exercise therapy treatment effect 👀
Which portion of physiotherapy treatments' effect is attributable to contextual effects in people with musculoskeletal pain?: A meta-analysis of randomised placebo-controlled trials
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Across the board - lower back, PFPS, lateral hip pain, RCRSP and now Achilles we can’t say getting stronger is the best explanation for an improvement in pain/function. Loading and strengthening programs do something though, what? We’ve got a paper under review asking this Q.
If you get stronger your Achilles pain will go away, right? Let’s see what the evidence says. Thanks to
@myles_physio
taking me on his PhD journey
@DrChiversPaola
@tendonpain
@debenham_james
@SIDocking
@clare_ardern
@_JSAMS
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