Avsnitt
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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.
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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
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Saknas det avsnitt?
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Is more always better? Is there a dose response effect of exercise for musculoskeletal pain? Should exercise be just like a medication, where the dose has to be sufficient in order for it to elicit a therapeutic effect?
These are the questions we contend with on this episode of The Shoulder Physio Podcast.
Key resourcesLawford BJ, Hinman RS, Spiers L, Kimp AJ, Dell'Isola A, Harmer AR, Van der Esch M, Hall M, Bennell KL. Does Higher Compliance With American College of Sports Medicine Exercise Prescription Guidelines Influence Exercise Outcomes in Knee Osteoarthritis? A Systematic Review With Meta-Analysis. Arthritis Care & Research. 2024.
Liang X, et al. The Best Exercise Modality and Dose for Reducing Pain in Adults With Low Back Pain: A Systematic Review With Model-Based Bayesian Network Meta-analysis. JOSPT. 2024.
Malliaras P, Johnston R, Street G, Littlewood C, Bennell K, Haines T, Buchbinder R. The efficacy of higher versus lower dose exercise in rotator cuff tendinopathy: A systematic review of randomised controlled trials. Archives of Physical Medicine and Rehabilitation. 2020.
Powell JK, Lewis J, Schram B, Hing W. Is exercise therapy the right treatment for rotator cuff-related shoulder pain? Uncertainties, theory, and practice. Musculoskeletal Care. 2024.
Powell JK, Lewis JS. It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation. British Journal of Sports Medicine. 2025.
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Jared on Instagram: @shoulder_physio
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The FIMAGE study scanned both shoulders of 602 adults from the general population using high-resolution 3-Tesla MRI. Only 7 had a structurally normal rotator cuff. In this episode, I walk through what the study found, why 78% of full-thickness tears were in people with no shoulder pain, and what happens to the diagnostic value of a scan when the finding it detects is near-universal. I challenge the assumption that prevalence equals normality, explore why the word "tear" imports a trauma narrative into what is usually a degenerative process, and make the case that imaging findings deserve a smaller seat at the clinical reasoning table than we've historically given them.
Key resourcesIbounig T et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. 2026 Apr 1;186(4):406-414. doi: 10.1001/jamainternmed.2025.7903. PMID: 41697693; PMCID: PMC12910452.
Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11;359(11):1108-15. doi: 10.1056/NEJMoa0800777. PMID: 18784100; PMCID: PMC2897006.
Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. doi: 10.1056/NEJM199407143310201. PMID: 8208267.
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In this episode, I walk through my recent JOSPT paper arguing that no single treatment modality has proven itself superior for musculoskeletal pain and that the profession should stop pretending otherwise.
Drawing on Isaiah Berlin's distinction between the hedgehog and the fox, I make the case for treatment pluralism: the idea that multiple interventions can lead to recovery, and that rigid allegiance to any one approach is not supported by the evidence.
Key resourcesPowell et al 2026. Many Paths to Recovery: The Case for Treatment Pluralism. JOSPT. DOI: https://www.jospt.org/doi/10.2519/jospt.2026.13992
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I posted a meta-analysis showing PRP doesn't beat saline for tennis elbow. The regenerative medicine community came for me, hard. This episode walks through the incident, what the evidence states, why the comparator you choose determines the conclusion you reach, and what the pushback reveals about incentives in musculoskeletal medicine.
References
Antunes Júnior et al. (2026). Platelet-rich plasma does not improve pain or function in patients with lateral epicondylitis as compared with placebo: A meta-analysis of randomized clinical trials. American Journal of Sports Medicine.
Coombes BK et al. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: A systematic review of randomised controlled trials. The Lancet, 376(9754), 1751–1767.
Gosens T et al. (2011). Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. American Journal of Sports Medicine, 39(6), 1200–1208.
Kamble P et al. (2023). Is ultrasound (US)-guided platelet-rich plasma injection more efficacious as a treatment modality for lateral elbow tendinopathy than US-guided steroid injection? A prospective triple-blinded study with midterm follow-up. Clinics in Orthopedic Surgery, 15(3), 454–462.
Krogh TP et al. (2013). Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: A randomized, double-blind, placebo-controlled trial. American Journal of Sports Medicine, 41(3), 625–635.
Oeding JF et al. (2025). Platelet concentration explains variability in outcomes of platelet-rich plasma for lateral epicondylitis: A high dose is critical for a positive response — A systematic review and meta-analysis with meta-regression. American Journal of Sports Medicine, 53(10), 2489–2496.
Orchard JW. (2025). Rock, paper, scissors: Resolving the conflicting results of randomized trials involving corticosteroid, platelet rich plasma (PRP) and placebo injections. JSAMS Plus, 5, 100081.
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The argument that AI replaces "the science" while clinicians should "lean into the art" has become common across healthcare. In this episode, I explain why I think both sides of that framing get it wrong, and why the art vs. science debate was always a false dichotomy that AI has simply made harder to ignore.
I draw on four thinkers to make the case: Michael Polanyi on tacit knowledge, Donald Schön on reflective practice in the swampy lowlands, Aristotle on phronesis, and Herbert Dreyfus on the limits of artificial intelligence. Together, they point toward a different answer, that what makes a clinician an expert isn't information retrieval or technical craft, but practical wisdom: the capacity to think with another person under conditions of uncertainty.
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In this episode of The Shoulder Physio Podcast, we discuss why musculoskeletal clinicians are, at their core, knowledge workers. Not in the corporate buzzword sense, but in the truest sense: professionals whose value comes from the quality of their thinking, not the techniques in their toolkit. We explore why knowledge compounds but repetition doesn't, why information alone fails to change behaviour, and why trust is far more than a soft skill. If you've ever wondered what actually separates a good clinician from a great one, this episode is for you.
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Physiotherapist and PhD researcher Laura Anderson just published a paper arguing that "medial tibial stress syndrome" is a 'garbage' name that's been freaking runners out and leading to terrible treatment for decades.
Her proposed replacement? Load-Induced Medial Leg Pain (LIMP).
Yes, LIMP, pun not intended.
The Problem:
"Tibial stress" makes everyone think bone stress injury → stress fracture → panic → rest for monthsClinicians still aggressively massage shins until they're bruised People rest for months and it comes right back when they start running againIt's one of the most common running injuries and we have almost zero quality research on itWhat It Is:
Not a bone stress injury on a fracture continuumDoesn't get worse if you keep running (unlike actual bone stress injuries)We honestly don't know exactly what tissues are involved (probably multiple)Imaging usually shows nothing usefulThe fix? Tune in.
Register for The Complete Shoulder online courseKey papers:MTSS needs a new name - Laura's LIMP paper
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Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Laura's clinic: The Injury Clinic
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In this episode, I discuss our recently published BJSM editorial “It’s Not All About Strength” ; what the paper argues, why we wrote it, and what the evidence says about mechanisms of exercise-related pain relief in musculoskeletal conditions.
I then turn to the reaction.
Not to name names or settle scores, but to examine what the response reveals about how we handle criticism, uncertainty, and challenges to familiar explanations in rehabilitation science.This episode is about evidence, mechanisms, cognitive comfort, and why letting our theories (ideas) be criticised is essential for progress.
Register for The Complete Clinician hereKey paper:It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief
Connect with Jared and guests:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
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In this episode, Jared Powell is joined by Dr. Jackson Fyfe, exercise scientist and Senior Lecturer at Deakin University, to explore the science and practicality of resistance training across the lifespan.
They unpack everything from how kids can safely lift weights to how older adults can maintain muscle health and longevity. Jackson also shares insights from his research on training dosage, hypertrophy, minimal effective dose, and how resistance and aerobic exercise can (and should) coexist.
This conversation spans from myth-busting (“weights stunt growth”) to deep physiological insights about muscle as an endocrine organ. It’s a clear, evidence-based discussion that reminds us why lifting weights might just be the most underrated health intervention available.
Key topics include:
Why resistance training matters at every age
The health benefits beyond muscle and strength
How little training you can do and still get results
Strength vs hypertrophy, what actually matters?
Combining cardio and lifting: interference or synergy?
The truth about training to failure
Register for The Complete Clinician hereKey papers:Jackson's profile on research-gate
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Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Jackson on X: @jacksonfyfe
Jackson on LinkedIn
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In this episode, Jared announces the launch of The Complete Clinician, a new mentorship and education community for MSK professionals who want more than recycled CPD. He explains why this platform exists, what’s inside, and who it’s designed for. From monthly PhD-level lectures to the Brew & Review journal club, structured learning modules, and The Clinician’s Compass, this is a second education for those who refuse to be average.
Jared also shares a quick update on the upcoming 2nd Edition of The Complete Shoulder, set to release in mid-November, with refined content, updated evidence, and new modules.
Launch Date: October 15
Check it out!Connect with Jared:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
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In this candid and wide-ranging conversation, Dr Jared Powell is joined once again by Professor Peter O’Sullivan, one of the most influential voices in musculoskeletal care.
Pete unpacks the rationale and findings of the landmark RESTORE trial published in The Lancet, which provides some of the most compelling evidence to date for cognitive functional therapy (CFT) in people with chronic low back pain. He discusses how CFT works, its philosophical divergence from traditional “find-it, fix-it” approaches, and how it centres the patient’s experience, goals, and context.
You’ll also hear:
A simple explanation of the 3 pillars of CFT
The real-world training model used in the RESTORE trial
The importance of behaviour change, flare-up planning, and self-efficacy
What to do when CFT “doesn’t work”
Pete’s reflections on burnout, clinician support, and the importance of community
A behind-the-scenes look at the Evolve Pain Care Academy: a new initiative to democratize pain education globally
This episode is packed with practical insights, personal reflections, and a compelling vision for the future of musculoskeletal care.
Register for The Complete Clinician waitlist here Key papers:Listen to me, learn from me. Slater et al 2022.
The RESTORE trial 3 year follow-up
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Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Evoolve Pain Care
Pete X: @peteosullivanpt
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In this solo episode of The Shoulder Physio Podcast, Dr Jared Powell explores a deceptively simple question: How much benefit does rotator cuff surgery need to provide to be considered worthwhile?
Jared explores a new 2025 study by Harrison Hansford and colleagues, which uses a clever benefit–harm trade-off approach to quantify what patients actually want from surgery.
This episode challenges the way we interpret research, the limits of "statistical significance," and the need for truly patient-centred decision-making. If you're still recommending surgery after failed physio without asking what makes it worthwhile to the person in front of you, this one’s for you.
Key topics include:
The concept of the smallest worthwhile effect
Is “does it work?” the wrong question?
Shared decision-making and expectation alignment
How the evidence stacks up (or doesn’t)
Why patient-defined outcomes matter more than p-values
Check out the Shoulder Physio Online Course hereConnect with Jared:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
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In this episode of The Shoulder Physio Podcast, Dr Jared Powell sits down with Dr Mervyn Travers, physiotherapist, S&C coach, and researcher, to explore one of the most compelling frameworks in contemporary pain science: active inference.
They discuss how this predictive brain model helps explain persistent musculoskeletal pain, why traditional exercise-based interventions might miss the mark, and how clinicians can use movement and context to shift a patient’s pain experience. Merv blends philosophy, neuroscience, and clinical pragmatism in a way that's accessible, challenging, and highly relevant.
Key talking points:
What is active inference and how does it relate to predictive processing?
The role of prior beliefs, culture, and clinical language in shaping pain
Movement experimentation as a tool for model updating and recovery
Why it’s time to rethink how we prescribe exercise in pain rehab
Clinical implications from landmark studies within the field that lend themselves to active inference
A call for compassion, curiosity, and nuance in patient care
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Jared on Instagram: @shoulder_physio
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Merv website: Home - Optimise Rehab
Merv X: @mervtravers
Merv Instagram: @optimise_rehab
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In this episode, Jared Powell sits down with Professor Gordon Guyatt, the physician and researcher who coined the term evidence-based medicine (EBM). They unpack the origins of EBM, why it’s often misunderstood, and how it continues to shape modern healthcare.
Rather than being rigid or formulaic, EBM is about integrating the best evidence with clinical expertise and—crucially—patient values and preferences.
🎙 Key talking points:
The surprising history behind the creation of EBM
Why randomised trials matter—and when they’re not enough
How to practice medicine in the face of low-certainty evidence
The role of shared decision-making in everyday care
Why acknowledging uncertainty is a sign of strength, not weakness
How EBM is sometimes misunderstood or misused
What the future holds for EBM—including education in schools
🎧 A must-listen for anyone navigating the grey zones of clinical care.
Key Papers:
Professor Guyatt has too many high impact papers to mention and he has one of the highest H-Index scores in the world (number 13 worldwide and number 1 in Canada). Here is his Google Scholar profile.
Check out the Shoulder Physio Online Course hereConnect with Jared and guests:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Gordon on X:@GuyattGH
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In this episode of The Shoulder Physio Podcast, Dr. Jared Powell sits down with Dr. Charlotte Ganderton, a physiotherapist, researcher, and senior lecturer at RMIT University. Charlotte shares insights from her latest research on gluteal tendinopathy, breaking down common misconceptions about imaging, corticosteroid injections, and the infamous clam exercise.
From understanding the role of compression in tendinopathy to discussing effective treatment strategies, this episode is packed with clinically relevant takeaways for musculoskeletal healthcare professionals. Tune in to hear Charlotte’s perspective on how education, exercise, and progressive loading can make all the difference in patient outcomes.
🔹 What is gluteal tendinopathy and how does it differ from other tendon issues?
🔹 Should we rethink the role of imaging and injections?
🔹 Is it finally time to ban the clam?
🔹 Practical treatment strategies for improving patient care.If you're looking to refine your approach to gluteal tendinopathy, this is an episode you don’t want to miss!
Key Papers:
Grimaldi A, Ganderton C, Nasser A. Gluteal tendinopathy masterclass: Refuting the myths and engaging with the evidence. Musculoskelet Sci Pract. 2025 Apr;76:103253. doi: 10.1016/j.msksp.2025.103253. Epub 2025 Jan 3. PMID: 39854929.
Check out the Shoulder Physio Online Course hereConnect with Jared and guests:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Charlotte on X:@C_Ganderton
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In this episode of The Shoulder Physio Podcast, I am interviewed by my wife, Tara, about my recently completed PhD.
For the past 7 years of my life I have been engaged in a research based PhD investigating the causal mechanisms underpinning the effectiveness of exercise therapy for rotator cuff related shoulder pain. This research program has produced 6 published pieces of research that is contained with the thesis. In this episode I briefly discuss the premise of the thesis, its main findings, and recommendations for future research. I also gives some tips and tricks and to prospective PhD or current PhD students which may help their journey.
Don't miss this episode with myself, Dr Jared Powell, and my wife, the amazing Tara Powell. Buckle up!
Key Papers:
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.
Powell JK, Schram B, Lewis J, Hing W. "You have (rotator cuff related) shoulder pain, and to treat it, I recommend exercise." A scoping review of the possible mechanisms underpinning exercise therapy. Musculoskelet Sci Pract. 2022 Dec;62:102646. doi: 10.1016/j.msksp.2022.102646. Epub 2022 Aug 8. PMID: 35964499.
Powell JK, Schram B, Lewis J, Hing W. Physiotherapists nearly always prescribe exercise for rotator cuff-related shoulder pain; but why? A cross-sectional international survey of physiotherapists. Musculoskeletal Care. 2023 Mar;21(1):253-263. doi: 10.1002/msc.1699. Epub 2022 Sep 11. PMID: 36089802.
Powell JK, Costa N, Schram B, Hing W, Lewis J. "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. 2023 Dec 6;103(12):pzad088. doi: 10.1093/ptj/pzad088. PMID: 37440455; PMCID: PMC10733131.
Powell JK, Lewis J, Schram B, Hing W. Is exercise therapy the right treatment for rotator cuff-related shoulder pain? Uncertainties, theory, and practice. Musculoskeletal Care. 2024 Jun;22(2):e1879. doi: 10.1002/msc.1879. PMID: 38563603.
READ THE WHOLE THESIS!
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Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
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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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Jared on Instagram: @shoulder_physio
Jared on Twitter: @jaredpowell12
Rich on Twitter: @rwilly2003
Rich on Instagram: @montanarunninglab
Rich's website: www.montanarunninglab.com
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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.
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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
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- Visa fler
