Shoulder Physio

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Shoulder Physio by Jared Powell is a shoulder physiotherapy telehealth service that aims to provide simple and effective treatments for people with shoulder pain

16/01/2026

The best head to head trial of exercise Vs corticosteroid injection has been published.

The SIX shoulder study.

Well done to the authors.

12/01/2026

Comment CUFF and I will send you the link to the masterclass.

A free 40 minute lecture on rotator cuff tears.

The rotator cuff bible released for free :)

09/01/2026

Short term, medium term, long term, who cares, it’s the same result.

05/01/2026

Just published in BJSM.

I’m late to the party in promoting my own work but happy others have done the job for me. I was on holiday :)

The reaction to this paper has been interesting and I will have a full podcast episode on this out next week. It offers a window into the state of our profession.

It’s now near enough untenable to espouse strength as a main mechanism of pain relief for MSK pain.

It’s still a noble pursuit, but it’s not a valid mechanism to reduce pain, as per the current evidence.

This neat editorial represents the culmination of 8 years working on this topic and I think it is a useful contribution to the literature. Enjoy :)

17/12/2025

Is it any more complicated than that?

Not according to Prof Phil Glasgow who is this month’s Mastermind in The Complete Clinician.

16/12/2025

I’ve tried nasal strips for running and was underwhelmed. A company wanted me to market them but I couldn’t without trying them. The evidence is equally underwhelming.

They make sense: open the nose, reduce resistance, improve airflow, perform better.

The problem is that when you actually pool the evidence, the performance benefit disappears. A 2021 systematic review and meta-analysis found no meaningful improvements in VO₂max, heart rate, or perceived exertion during exercise in healthy individuals.

Yes, nasal strips increase nasal patency. They make breathing feel easier. But “feels better” is not the same as “performs better.”

They’re low risk, cheap, and not banned. If you like them, that’s absolutely fine. Go for your life.

Sometimes the most annoying ideas are the ones that sound plausible enough to stick around long after the data says otherwise.

10/12/2025

“What I cannot create, I do not understand.” This quote was found on Feynman’s office chalk board at the time of his death.

In the information age, it is easy to confuse familiarity with mastery. We mistake the ability to recognize a concept for the ability to wield it.

But true education isn’t about archiving facts; it is about the capacity to reconstruct a concept from the ground up.
If you can’t build the logic chain yourself, mentally or physically, you are merely renting the knowledge. You don’t own it.

This applies heavily to how we consume science. To be clear: you do not need to conduct a randomized controlled trial to understand one. There are brilliant clinicians who have never published a paper, just as there are researchers who struggle in the clinic.

However, to truly understand the evidence, you must possess the mindset of a builder. You must be able to “reverse-engineer” the study.
• Don’t just read the conclusion; trace the methodology that led there.
• Don’t just memorize the rule; derive the principle.

When you can reconstruct the argument, you move from superficial awareness to deep, veridical understanding.

09/12/2025

Thinking about the sensitivity and specificity of tests can be confusing and is routinely one of the most common questions I get asked.

In the context of shoulder special tests, which are limited, I like to think more about likelihood ratios, which considers both sensitivity and specificity metrics.

A different argument is the true utility of special tests above and beyond a standard physical exam., however that is outside the remit of this post.

What I want to elucidate in this post is what sensitivity, specificity and likelihood ratios are and what they mean in practice.

03/12/2025

The most unethical thing in surgery? Operating without evidence. According to Professor Ian Harris, who is himself an orthopaedic surgeon.

We often hear the argument that surgical placebo trials (sham surgeries) are unethical because they expose the control group to risk without benefit.

But that logic is backwards.

What is TRULY unethical is performing invasive procedures on thousands of patients every year without high-quality evidence that the procedure outperforms a placebo.
Placebo trials shouldn’t be avoided, they should be mandatory.

This talk will be available only in The Complete Clinician. Link in bio.

02/12/2025

Have you seen this go viral yet?

This image is about to be everywhere. It is the perfect visual to prove that “Back Pain is Complex.”

But before you share it, let’s not just take it at face value. You need to know what you are actually looking at.
This is a new meta-model by Cholewicki et al. (2025). They asked 29 world experts to draw maps of what they believe drives Low Back Pain, then mashed them into one giant network.

The result is a “hairball” of 1,161 connections.
My thoughts:
1️⃣ I love the complexity. This map is likely “directionally correct.” It visually nails the truism that pain is not just a loose screw or a bad disc.
2️⃣ But... this is NOT a map of biology. It is a map of opinions. It represents the consensus of the field, not the mechanism of the human body.

Appreciate the complexity but don’t confuse a map of beliefs with a map of reality.

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Sunshine Coast, QLD

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http://www.shoulderphysio.com/

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Shoulder management - the vision.

Hello. My name is Jared, a musculo-skeletal physiotherapist from the Gold Coast, Queensland, Australia. I have a special interest in shoulder pain and I am pursuing my PhD in this area through Bond University. I teach shoulder pain to Doctor of Physiotherapy students at Bond University and run shoulder pain workshops nationally, in Australia and internationally.

The management of shoulder pain is in the midst of a revolution. New research has challenged accepted dogmatic beliefs on the best management of many shoulder conditions, including: rotator cuff pain (tears and tendinopathy), frozen shoulder and shoulder instability.

My aim is to deconstruct the new research, make it simple and actionable, and present it to the community at large. Persistent shoulder pain heavily impacts quality of life measures in many who suffer with any of the various pathologies that cause pain to arise from the shoulder region. Therefore, simple and effective management strategies are needed to reduce the suffering associated with shoulder pain.

My philosophical approach to shoulder pain management focuses heavily on education and exercise, as this is where the bulk of the evidence exists. However, my approach is adaptable based on the person in front of me. We, as human beings, are all different and will respond differently to certain interventions. My task is to find the best management plan for the unique individual who has chosen to work with me.