The Shoulder Physio Podcast

 AI is a direct threat to all knowledge work, MSK rehab included. We must take action. This episode announces the launch of The Irreplaceable Clinician. Its a course for MSK clinicians about how to flourish in the age of AI. See The Irreplaceable Clinician here Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

Jared is joined by Professor Chad Cook who is one of the great researchers and academics in the field of physical therapy. Chad is clear and cogent voice on many topics but I especially love his more recent work on treatment mechanisms, which will form the basis of this episode. Enjoy. Key resources Musculoskeletal Treatment Mechanisms: A Puzzle That May Never Be Fully Solved Cook CE et al. Specific and shared mechanisms mediating pain intensity and functional outcomes in chronic neck pain. Pain Manag. 2026 Jul;16(7):799-808. doi: 10.1080/17581869.2026.2658063.  Cook CE et al. Personalizing rehabilitation approaches: Moderator analyses of manual therapy and exercise effectiveness in individuals with chronic neck pain: Secondary analysis of the SS-MECH trial. Musculoskelet Sci Pract. 2026 Sep 22;86:103665. doi: 10.1016/j.msksp.2026.103665.  Register for the complete shoulder online course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 Chad on LinkedIn: Jeremy Lewis See our Disclaimer here: The Shoulder Physio - Disclaimer

Jared is joined by Professor Jeremy Lewis who really needs no introduction but we will give him one just for fun. Jeremy is a researcher, educator, physiotherapist, and one of the biggest names in musculoskeletal rehabilitation.  In this episode Jeremy discusses his journey in cementing the fact that subacromial impingement syndrome is a "clinical illusion" and a fundamentally flawed concept. This one is not to be missed. Key resources Lewis, J. S. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? Physical Therapy Reviews, 16(5), 388–398. https://doi.org/10.1179/1743288X11Y.0000000027 Register for the complete shoulder online course Connect with Jared and guests: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 Jeremy on Instagram: @jeremy.s.lewis Jeremy on LinkedIn: Jeremy Lewis See our Disclaimer here: The Shoulder Physio - Disclaimer

The supraspinatus is one of the most misunderstood muscles in the human body. This episode aims to correct that. Key resources Reed D, Cathers I, Halaki M, Ginn K. Does supraspinatus initiate shoulder abduction? J Electromyogr Kinesiol. 2013 Apr;23(2):425-9. doi: 10.1016/j.jelekin.2012.11.008. Epub 2012 Dec 21. PMID: 23265661. Boettcher CE, Ginn KA, Cathers I. Which is the optimal exercise to strengthen supraspinatus? Med Sci Sports Exerc. 2009;41(11):1979–1983. Wattanaprakornkul D, Cathers I, Halaki M, Ginn KA. The rotator cuff muscles have a direction specific recruitment pattern during shoulder flexion and extension exercises. J Sci Med Sport. 2011;14(5):376–382. Kinsella R, Pizzari T. Electromyographic activity of the shoulder muscles during rehabilitation exercises in subjects with and without subacromial pain syndrome: a systematic review. Shoulder Elbow. 2017;9(2):112–126.   Register for the complete shoulder online course Melbourne workshop details Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

A peanut isn't dangerous until it meets someone who can't tolerate it. Same with the upright row exercise. This episode scrutinises the "worst exercise for your shoulder" claim by tracing it back to a theory that's already dead, then shows what determines outcome: the person lifting. Shock. Horror. Key resources Bahr, R. (2016). Why screening tests to predict injury do not work — and probably never will: a critical review. British Journal of Sports Medicine, 50(13), 776–780. Marsh, C.E., et al. (2020). Fitness and strength responses to distinct exercise modes in twins: Studies of Twin Responses to Understand Exercise as a THerapy (STRUETH) study. The Journal of Physiology, 598(18), 3845–3858. Stern, B.D., Hegedus, E.J., & Lai, Y.C. (2020). Injury prediction as a non-linear system. Physical Therapy in Sport, 41, 43–48. Powell, J. (2024). An essay on the upright row... and peanuts. The Shoulder Physio Blog. (Source essay this episode is adapted from.)   Register for the complete shoulder online course Melbourne workshop details Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

 Jared is joined by Tim Cook who is Senior Lecturer in Physiotherapy at the University of Chichester, Advanced Physiotherapy Practitioner in the NHS, and doctoral researcher to discuss their new paper with Prof. Jeremy Lewis in the Journal of Manual & Manipulative Therapy: "Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle." Tim explains what pushed him to question routine strength testing in busy clinical practice, despite guidelines recommending it, and the pair dig into whether weakness is a cause of shoulder pain, a consequence of it, or something else altogether. They look at what subacromial anaesthetic injection studies reveal about pain versus true force output, and Tim reframes the classic "weak and painful shoulder" as the "flexible but painful shoulder," drawing parallels to other oversimplified clinical narratives like posture and core stability. They also make the case for when strength testing can still earn its keep; patient engagement, expectation violation, building confidence, and sporting or return-to-performance populations such as ACL limb symmetry index, before turning to Goodhart's Law and the risk of chasing the test rather than the outcome, and why isolated isometric tests may not translate to real-world, endurance-based shoulder tasks. Tim closes out with an update on his PhD: a reliability RCT on strength and pain-free assessment currently in press, and an upcoming scoping review on the proposed mechanisms of exercise for RCRSP. Key resources Cook, T., Lewis, J., & Powell, J. (2026). Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle. Journal of Manual & Manipulative Therapy, 34(3), 193–198. https://doi.org/10.1080/10669817.2026.2663623 Register for the complete shoulder online course Melbourne workshop details Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 Tim on Instagram: @Timcookphysio See our Disclaimer here: The Shoulder Physio - Disclaimer

Is there really one correct way to move? For decades, clinicians and coaches have acted like there is. In this episode, we prosecute that idea. We start in a 1930s Soviet forge, where Nikolai Bernstein filmed blacksmiths and found their hammer strikes landed in the same spot every time, despite every joint angle differing swing to swing. That's "repetition without repetition." From there we bring in Mark Latash's motor abundance: why your nervous system treats extra degrees of freedom as a resource, not a problem, and what that means for scapular "dyskinesis," core stability cues, and fear-based rehab language. We close with a practical clinical translation for coaches and clinicians. Plus: a quick update on my next in-person workshop, The Complete Shoulder Workshop, Melbourne 17 October. Key resources Low M. A Time to Reflect on Motor Control in Musculoskeletal Physical Therapy. J Orthop Sports Phys Ther. 2018 Nov;48(11):833-836. doi: 10.2519/jospt.2018.0614. PMID: 30381024. Latash ML. The bliss (not the problem) of motor abundance (not redundancy). Exp Brain Res. 2012 Mar;217(1):1-5. doi: 10.1007/s00221-012-3000-4. Epub 2012 Jan 14. PMID: 22246105; PMCID: PMC3532046. Register for the complete shoulder online course Melbourne workshop details Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

The question of allowing pain, or avoiding it, during exercise based rehab remains contentious and uncertain. So, like any good scientist, we (led by Ivy Tran) studied the evidence-base and sought an answer to this clinical conundrum to help not just you, but us too! What did we find? Listen to the episode to find out.  Key resources Tran I et al. Effectiveness of Painful Versus Nonpainful Exercise on Pain Intensity, Disability, and Other Patient-Reported Outcomes in Adults With Chronic Musculoskeletal Pain: An Updated Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther. 2025 Smith BE et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017 Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

What is a physiotherapist? Strip away the hands, the exercises, the modalities, what's left? In this episode I argue that the "fixer" identity, the clinician who finds what's broken and corrects it, isn't where our profession came from. It's something that was selected into us through a century of professional politics and reductionist thinking. Drawing on the history of physiotherapy, Newell's constraints framework, self-determination theory, and Gopnik's gardener, I make the case for a different identity: the clinician who sets the conditions for an active, adaptive person to recover and even flourish. Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer

Burnout in our profession is widespread, with most studies reporting prevalence between 8 and 23 per cent, and up to 65 per cent of recent graduates planning to leave physiotherapy within ten years. In this episode, drawing on a recent editorial in the Journal of Physiotherapy by Ky Wynne, I lay out the empirical picture and challenge the dominant framing that burnout is a problem of individual resilience. I share my own story of burning out two years into clinical practice, what shifted before anything else did, and the disposition I've come to see as the antidote to the slow erosion the current climate produces. Key resources Wynne K. Burnout in physiotherapy. Journal of Physiotherapy. 2026;72:87–90. https://doi.org/10.1016/j.jphys.2025.12.009 Register for the complete shoulder online course Register for The Complete Clinician Mentorship Connect with Jared: Jared on Instagram: @‌shoulder_physio Jared on X: @‌jaredpowell12 See our Disclaimer here: The Shoulder Physio - Disclaimer