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

05/03/2026

More evidence that PRP doesn’t really do what it claims to do.

Doesn’t out-perform placebo alone injections for tennis elbow.

Don’t bother.

04/03/2026

I’m often accused of being anti-surgery for broad spectrum MSK conditions.

This really couldn’t be further from the truth. I am anti bad science and clinical decisions being made solely on anecdote, tradition and mechanistic reasoning.

When a rigorous study is published showing surgery is more effective than non-surgical treatments, it makes my job so much easier.

Take this hip OA trial, for example. It clearly shows hip replacement surgery is superior to resistance training for people with SEVERE hip OA. This is great news for patients.

What does this mean? I think if someone with SEVERE hip OA tries exercise for a few months and is not happy with their progress, we should not delay a referral to an orthopaedic review. Simple.

This is the world in which surgeons and physios work collegially for the common good. How aspirational!

02/03/2026

New BMJ systematic review (37 studies, 9,341 participants):

After stopping GLP-1 medications like semaglutide (ozempic) and tirzepatide (mounjaro) people regained weight at ~0.8 kg/month, projecting a full return to baseline weight within 1.5 years.

All cardiometabolic improvements (HbA1c, blood pressure, cholesterol) followed the same trajectory. Real-world data suggests ~50% of people discontinue GLP-1s within 12 months.

Weight regain was faster after stopping medications than after behavioural programs, and adding behavioural support during or after medication use made no difference to the rate of regain.

25/02/2026

We’ve created a “super wicked” problem with manual therapy and its mechanisms of effect.

We got a lot of work to do to set the record straight.

24/02/2026

Strong work from Zhang et al; exercise increases shoulder strength in RCRSP, modestly. A much needed paper and kudos to the authors for getting it done.

But let’s calm the farm in leaping from “strength improved” to “strength explains recovery.” The authors state this explicitly.

Strength also improves when pain is reduced without exercise.

File under: Doing the thing improves the thing.

Disclaimer: getting strong is still a great thing.

19/02/2026

The FIMAGE study in JAMA says that rotator cuff changes are a normal part of healthy ageing.

In other news, water is wet.

In all seriousness, this is a great study that really verifies what we’ve known for some time.

17/02/2026

I’ve been seeing a number of patients with shoulder instability lately - many wanting advice about how best to proceed.

When it comes to re-dislocation there is a clear winner. But remember, re-dislocation is only one outcome of interest to patients. Important to tell the whole story.

13/02/2026

Has Claude just broken the fitness app industry?

Maybe not right away, but holy smokes it will.

So I’ve wrestled with ai, intellectually, for the last few years. I can both see its potential and downfalls. I hate it for writing, have concerns about its impact on the environment and economy, and the fact it’s basically being pioneered by a handful of blokes who are out of touch in Silicon Valley.

So this is not an endorsement as such, but a recognition that the technology has undergone a phase shift. The training wheels are off and what the future holds I have no idea!

What do you think?

, who inspired me to mess around with Claude and who’s idea it was to make a training app for my kids, has delivered a cerebral lecture for The Complete Clinician on this very subject. He discusses the pros, cons and use cases of ai in healthcare. Head to shoulderphysio.com for more details.

terrifying

11/02/2026

There are consequences to our explanations.

We should err on the side of education strategies that promote minimal medicalisation.

06/02/2026

Swimming and shoulder soft tissue changes go hand in hand.

So much so, that if you are an elite swimmer, there will almost always be some ‘pathology’ that turns up on a scan. Challenge is then, can we attribute pain causation to this pathology and do we need to treat it specifically?

Repeated cycles of loading to any living tissue will induce a fairly predictable response in that tissue. That’s mechanobiology 101. Often this may not need to be medicalised, but the pain itself may signal the body is not coping with the internal or external loading environment.

05/02/2026

FYI, giving people the most evidence-based treatment for frozen shoulder is not watchful waiting.

This is not to say I think physiotherapy is overly beneficial in the early stages of frozen shoulder, it really isn’t.

I think our value lies in proper and timely diagnosis, which is easier said than done, guiding an evidence based treatment plan (which includes an injection), and then supporting the patient in their sometimes pretty horrible journey.

03/02/2026

Some musings on learning and behaviour change.

behaviourchange

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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.