Evaluation and Treatment of

Shoulder Pain
By Jared Powell
Bio

● Physiotherapist
● PhDc
● Educator
● Amateur sportsman
● Mission is to modernise our
understanding of shoulder
pain + pathology
Modules

01. 02. 03.

Module 1 Module 2 Module 3
History and context Subacromial Structure, posture and
impingement and surgery
scapular dyskinesis

04. 05. 06.

Module 4 Module 5 Module 6
Exercise, manual therapy Predictors of clinical The future
and diagnostic labels outcomes
Module 1
History and context
Learning objectives
1. Understand the
history of Physiotherapy
and how this has
influenced current MSK
clinical practice
History
• Modern Physiotherapy has roots in Swedish gymnastics and massage
therapy
• Initially working in hospitals and under the direction of physicians,
progressing to private practice
• As a result of our ties to physicians, hospitals, massage and
manipulation, clinical reasoning in Physiotherapy is very much
embedded within a biomedical framework

Per Henrik Ling

 Body as machine + dualism

Descartes?

Stilwell et al 2019
For the shoulder, this often takes the form of:
• Tightness of muscles, fascia, nerves, capsules etc.
• Weakness of muscles
• Alterations in movement profiles of the shoulder complex and thoracic
spine
• Pathoanatomical findings on imaging
• Postural abnormalities
• Asymmetries of any kind
• Immobility of joints
What next…we must apply an intervention to
correct the impairment!
• Strengthen
• Stretch
• Mobilize + manipulate + massage
• Glide
• Centralize the humeral head
If there is any clinical improvement it must
be directly due to MY intervention!

Post hoc reasoning

IS IT ALL SO CLEAR?
• Let’s embark on a journey through the “known” shoulder universe,
looking at various dogmatic clinical presentations and their evidence.
• Our focus will be the clinical presentation of rotator cuff-related
shoulder pain (RCRSP) – a justification of this term to come later
Module 2
Subacromial impingement and scapular dyskinesis
Learning objectives
1. Understand the influence of scapular
dyskinesis on the development and
resolution of rotator cuff related
shoulder pain

2. Explain the evidence as it relates to

the reliability and validity of visual
observation of scapular kinematics
Subacromial impingement

The “rock star” of non-traumatic shoulder pain

Charles Neer,
MD
 In 1972 Neer argued the primary
cause of shoulder pain was attrition
of the SS tendon and SAB due to
abrasion under the overlying
acromion.

In 1983 Neer stated “95% of

rotator cuff tears are caused by
impingement”.

Lewis, J 2018
Neer, C 1983
 Neer was near certain SAI
caused pain AND led to
the vast majority of
rotator cuff tears.

A CLINICAL SPECTRUM
that had to be corrected.

Neer, C 1983
 The fix??
The anterior acromioplasty surgery
(which Neer invented)

Millions of people have

undergone this procedure
since its inception

Lewis, J 2018
 SAD surgery
increased by 746%
from year
2000 - 2010.
 This rationale changed the course of
how “subacromial impingement” was
managed for the next 50 years!

For context, the scientific

rigour of Neer’s studies are
equivalent to a blog post in
2020.

Lewis, J 2018
The “known” facts of SAI
 Approx. 50% of healthy shoulders
IMPINGE when you raise your
arm!

Lawrence et al 2019
Lawrence et al 2017
Most shoulders “impinge” at 30-
60 degrees elevation, not 70-
120!

Lawrence et al 2019
No difference in rotator cuff tear rates or
functional outcome between the 2 groups
after 9-14 years!
There is conflicting evidence concerning the association
between acromial morphology/morphometry and
rotator cuff pathology

Chalmers et al 2017
Andrade et al 2019
Beard et al 2018
Functional outcomes at 12 months
Similar results observed in FIMPACT trial –
but followed up for 5 years!
 2019

“SAD surgery does not display any superiority Vs

placebo (efficacy) nor exercise therapy
(effectiveness) and is associated with more
adverse events”
Subacromial impingement
• Need NOT to be corrected for pain and function to improve
• Inconsistent relationship between acromion and rotator cuff pathology
• Impingement is probably a normal variant in human shoulders
• Surgery to correct impingement is not superior to placebo surgery or
exercise therapy
• Subacromial impingement as a valid and accurate diagnosis is
untenable
Scapular dyskinesis
• The theory:
• Deviation in scapular motion from “normal” rhythm may cause the onset of
shoulder pain influencing the size of the subacromial space
Do people with RCRSP display alterations in
scapular kinematics?
• Altered scapular kinematics is a common finding in people with RCRSP
– exact prevalence rates vary but is probably upwards 50% (Ludewig et al
2000)

• Scapular dyskinesis is observed in 61% of all overhead athletes and

about 1/3 of non-overhead athletes (Hogan et al 2020)
• Scapular dyskinesis is also commonly observed in people without pain
(Plummer et al 2017)
Is scapular dyskinesis a risk factor for future
shoulder pain/injury?
• The evidence is mixed – one paper suggests the presence of SD
increases the risk of future shoulder injury by 43% (Hickey et al 2018)
Is scapular dyskinesis a risk factor for future
shoulder pain/injury?
• Several studies falsify the assumption that scapular dyskinesis is a
significant risk factor for future shoulder pain/injury
Interestingly
• An external load increase of >60% was associated with 2x higher
chance of developing shoulder pain the following week irrespective of
biomechanical variables
• If you had an observed scapula dyskinesis or reduced external rotation
strength AND your external load INCREASED by >20% then this was a
risk factor for developing shoulder pain
• Does a scapular dyskinesis reduce the threshold to injury?
Do scapular focused interventions correct
scapular kinematics?
• If we identify a scapular dyskinesis, then what?
• We correct it, right?!
Do scapular focused interventions correct
scapular kinematics?
• Scapular focused interventions can effectively reduce pain and
increase function
• There is NO EVIDENCE they will positively influence or normalize
scapular kinematics!
And another thing…
• It is clinically impossible to exclusively strengthen “scapular muscles” at
the expense of the rotator cuff and vice versa

The best rotator cuff exercise is the

best scapular exercise!
Do SFA confer benefit to general
approaches?
• SFA approaches may be statistically superior to general approaches
at 6 weeks (but clinically insignificant)
• There is no difference at 3 months
Scapular assessment…valid and reliable?
• Visual observation of scapular kinematics is unreliable and unable to
rule in/out shoulder pathology
• Scapular motion alterations might not provide any additional
examination benefit in diagnosing shoulder pain
Scapular assessment…valid and reliable?

Clinicians display confirmation bias when assessing

people with shoulder pain – we want to see a scapular
dyskinesis to explain their pain!
Scapular dyskinesis summary
• The presence of a scapular dyskinesis is common in people with RCRSP
• It is also highly prevalent in the general population
• Its very prevalent in overhead athletes
• It probably isn’t an important isolated risk factor for future pain
• There is no strong data to suggest we must normalize scapular
mechanics to increase pain and function
• The visual observation of scapular kinematics is unreliable and not
helpful for diagnosis of RCRSP
Module 3
Structure + posture + surgery
Learning objectives
1. Understand the relationship between 3. Explain when shoulder surgery might
shoulder structures, posture and the be indicated
experience of rotator cuff related
shoulder pain

2. Describe the evidence for subacromial

decompression surgery and rotator cuff
repair surgery Vs non-surgical
management.
Shoulder structures…
• A controversial topic, strangely.
• Let’s look at the evidence as it relates to RCRSP
What happens when we MRI both shoulders
in someone with unilateral RCRSP?
• Symptomatic shoulder:
• Rotator cuff tendinopathy = 90%
• Partial thickness tear = 25%
• Full thickness tear = 5%
• Subacromial fluid = 55%
• ACJ alterations = 90%
• Type 2/3 acromion = 83%
• Labrum alterations = 43%
• Asymptomatic shoulder:
• Rotator cuff tendinopathy = 89%
• Partial thickness tear = 21%
• Full thickness tear = 1%
• Subacromial fluid = 56%
• ACJ alterations = 90%
• Type 2/3 acromion = 82%
• Labrum alterations = 42%
 A famous study suggests
• Pathological findings of the shoulder are found in 96% of
asymptomatic men

Girish et al 2011
Can pathology affect function?
• A recent study by Mihata et al 2019 suggested 50% of college
baseball players exhibit a partial thickness rotator cuff tear and had
no associated pain or weakness
• Mihata suggests a partial thickness rotator cuff tear is superfluous to
the experience of pain
Hell, pathology is even detected in
adolescent baseball players

52% of 10-12 year old baseball players

had pain free abnormalities of the shoulder
on MRI
Our highest quality evidence suggests:
• Not consistently associated with • Factors possible associated with
pain: pain:
• Rotator cuff tears • Progression of RC tear size
• Rotator cuff tendinopathy • Rotator interval and axillary recess
• Bursitis signaling for frozen shoulder
• ACJ or GHJ OA
• Rotator cuff calcification
• Acromial shape
So, structure is irrelevant?
• Not quite
• Progression of RC tear size is significantly associated with onset of pain
and might predict ‘failure’ of non-surgical Mx. Moosmayer et al 2019
• Some data suggests a full thickness RC tear is more often associated
with pain than no pain (4x more likely). Reilly et al 2006
• Biochemical alterations are detected in those with painful shoulders Vs
asymptomatic population.
“ ╸ Structures are
relevant for
shoulder pain, it’s
just not only about
structure!
Posture…

Must we target this

for pain resolution?
The thoracic spine and shoulder pain
• There is moderate evidence of no association between increased
thoracic kyphosis and shoulder pain.
• There is strong evidence that increased thoracic kyphosis will reduce
shoulder ROM but this is NOT associated with pain
Tight pectorals?
• There is no evidence of a relationship between reduced pectoralis
minor length and shoulder pain, function or decreased acromiohumeral
distance
• In fact, there is no difference in pec minor length between healthy
controls and those with shoulder pain
Tight levator scapulae muscle?
• There is no evidence of a relationship between reduced levator
scapular muscle length and shoulder pain, function or decreased
acromiohumeral distance
• In fact, there is no difference in levator scapulae muscle length
between healthy controls and those with shoulder pain
Scapular position?
• Scapular position may be altered in those with shoulder pain Vs those
without shoulder pain
• But the type of alterations are inconsistent
• In some it may be upwardly rotated, in others downwardly rotated etc.
• There is probably not a universal pathological scapular position that
causes pain and one that fixes pain.
Posture
• Research across the human body is challenging the notion of its
relationship to pain
• Remember that posture may be the result of pain or illness or suffering
and may not be the cause
Rotator cuff surgery
• The gold standard for shoulder pain relief – when looking through a
biomedical lens
• What is the evidence and when is it appropriate?
Surgery for non-traumatic RC tears
Surgery for traumatic RC tears
• Historically – this was an immediate referral to surgeon for timely RC
repair surgery
• A study by Ranebo et al 2020 has challenged this:
• People with small traumatic full thickness RC tears achieve equal outcomes with
non-surgical Mx compared to surgical Mx
Is RC surgery cost-effective?
• The cost of a RC repair surgery costs at least 2x more than non-
surgical Mx.
• Twice the cost with no associated improvement in clinical outcomes, on
average.
• In a time when overtreatment, overdiagnosis and over utilization of low
value interventions is rife, RC surgery has work to do to demonstrate its
clinical utility.
Rotator cuff surgery Vs Placebo surgery
• There is currently a study underway comparing actual RC surgery with
placebo RC surgery
• Watch this space
When might RC surgery be indicated
• Anterior and posterior disruption to the rotator cuff (i.e. supraspinatus
and subscapularis full thickness tears)
• Full thickness tear in younger individuals 40s/50s – due to high chance
of tear progression
• Trauma with associated full thickness tear?
• Failure to progress with non-surgical Mx (timeline?)
• Significant loss of strength due to tear
• The patient really wants surgery!
Subacromial decompression surgery
• SAD is basically untenable at this point due to not displaying
effectiveness (not better than non-surgical Mx) or efficacy (not better
than placebo surgery).
• This procedure should only be offered after failure of long term non-
surgical Mx.
Shoulder surgery
• Management of a person with non-traumatic shoulder pain should be
done in scaled manner.
• Starting with quality non-surgical care and progressing to more interventional
strategies as needed.
• Problems arise when patients are coerced or influenced to have
surgery early without adequate non-surgical Mx
• It is important to emphasise, for many people RC surgery is an
effective procedure. But does it justify the cost and risks when there are
valid alternatives?
Summary
• Shoulder structures ARE RELEVANT for the experience of shoulder pain but its
not only about structure!
• Postural factors of the shoulder are probably not of significant import for the
development of shoulder pain or capable of influencing clinical outcomes
• Rotator cuff repair surgery might not be clinically superior to non-surgical
Mx, on average
• Subacromial decompression surgery is untenable as a primary intervention
• Whether a patient is suitable for shoulder surgery must be determined in a
shared decision making manner – taking into account the evidence, cost,
individual preferences, goals, desires etc.
Module 4
Exercise + manual therapy + diagnosis
Learning objectives
1. Explain what the empirical evidence is
for the clinical effectiveness of exercise
therapy for the management of RCRSP

2. Describe why manual therapy or

therapeutic touch may be part of clinical
care package for RCRSP
Exercise for RCRSP: A panacea?
• Most watching this presentation will have a strong bias towards
exercise, me included.
• But, what is the hard evidence for exercise therapy to manage the
clinical presentation of RCRSP?
What do the Systematic reviews say?
Page et al 2016
• Exercise therapy +/- manual therapy may confer no additional benefit
for pain Vs placebo for RCRSP
• Results are based primarily on 1 high quality clinical trial – Bennell et al 2010
 The most recent SR reports:
• Progressive resistance exercise may be effective compared to non-
exercise interventions – but the size of this effect is of uncertain clinical
importance

Naunton et al 2020
This is no different to any other single
intervention for RCRSP
• Surgery
• Injections
• Manual therapy
• Exercise therapy
• Education
• Natural history
• Shock wave therapy
All show small to moderate effect sizes for RCRSP
So what do we do?
• We need a thorough experiment…
Is it fair to assume that
shoulder pain exists?
Is it fair to assume physiotherapy exists?
Is it fair to assume people may seek
help from a physiotherapist, chiro,
osteo, kinesiologist, exercise
physiologist for their shoulder pain?
Does the evidence base point towards a single
best intervention for RCRSP
Riddle me this, if physio exists and people with
shoulder pain exist, and people with shoulder
pain will likely visit a physio for help, what
should a physio do, based on the evidence?
What do clinical guidelines say?
• Exercise is the only universally recommended intervention for RCRSP
across all the clinical practice guidelines….
In defense of exercise: Patient centered care
• Person-centred care emphasises equal partnerships between
healthcare professionals and the persons they care for, in planning,
developing and accessing care to ensure it meets the person's needs
• Shared decision making is when clinicians and patients collaboratively
participate in making a health-related decision, having discussed the
options, the likely benefits and harms of each option, and considered
the patient’s values, preferences and circumstances
The right care
• The right care is care that is tailored for optimizing health and
wellbeing by delivering what is needed, wanted, clinically effective,
affordable, equitable, and responsible in its use of resources.
The right care and exercise
• It can be said, that exercise is:
• Affordable
• Equitable
• Responsible in its use of resources
• Carries minimal risk of harm
• Widespread secondary benefits
• Often needed
• Often wanted
• Modest clinical effects
Movement and the human condition
• Movement is built into the fabric of the human condition
• People with persistent pain often demonstrate a constraint in their
movement profile. This may manifest as:
• Kinesiophobia
• Avoidance of movements
• A more cautious/stiff movement strategy
• Preferentially loading other joints/tissues
• That we should not use movement to help someone move freely and
confidently again is nonsensical to me
Manual therapy for RCRSP
Why the controversy?
Manual therapy…
• There is no more controversial topic in physiotherapy than the clinical
utility of manual therapy
• However, I think the controversy is much ado about nothing
• Here are the facts…
Is manual therapy clinically effective for
RCRSP?

Manual therapy may decrease pain (small effect) Vs

placebo but it is unclear if it improves function
 How might it work?
• It probably isn’t
• Deactivating trigger points
• Breaking down adhesions
• Lengthening tissue
• Activating muscles
• Substantially increasing blood flow to the tissue
• It might:
• Desensitize bodily areas that are painful
• Make people feel better via the activation of opioid, oxytocin, and dopaminergic
pathways
• Communicate empathy, kindness from the clinician (many ways to do this, though)
• Help discriminate between safe and threatening sensations

Tommaso et al 2019
Is there value associated with it for RCRSP?
• A clinical trial found that those receiving manual therapy Vs those who
didn’t for RCRSP had no difference in clinical outcomes
• However, those receiving MT had a greater perceived improvement in
their symptomatology Vs those who didn’t
• This demonstrates a possible value in MT from a patients perspective
which shouldn’t be diminished
Does patient experience matter?
• A better patient experience can be associated with improved clinical
outcomes, better adherence to treatment plans and advice, and this
may not be simply captured with standard clinical outcome measures
• The provision of manual therapy could improve a patients experience
with physical therapy? Not always. Be judicious in its application.
Manual therapy: devil or panacea?
• Therapeutic touch is important in clinical practice
• This may or may not involve manual therapy for RCRSP
• It has the same amount of evidence from a clinical effectiveness
perspective as exercise therapy
• It can be used as an adjunct to exercise, advice, education etc.
• It’s not a low-value intervention that robs people of their internal locus
of control or self-efficacy
• Is there an intrinsic value associated with it?
• It can modulate pain but it will not materially alter shoulder structures.
Diagnostic labels for rotator cuff
disease
What term do we use?
Nomenclature options
• Rotator cuff disease
• Rotator cuff syndrome
• Rotator cuff tear
• RC tendinopathy
• RC tendinosis/tendonitis
• Subacromial bursitis
• RCRSP
• Subacromial impingement syndrome
• Weak and painful shoulder
• Non-specific shoulder pain
• Shoulder pain
• Subacromial shoulder pain
• Subacromial pain syndrome
Does the evidence base provide any clear
recommendation?
• A consensus paper in 2019 recommended the use of the term RCRSP
• RCRSP was proposed by Jeremy Lewis in 2016 as a middle ground
term
Why RCRSP?
• Traditional pathoanatomic diagnostic labels for shoulder pain have
been heavily challenged over the past 10 years.
• Not just because of the tenuous relationship between structure and pain
– but because of what the terms may MEAN TO A PATIENT
 What could patients think if
diagnosed with a rotator cuff
tear?
 “ ╸ Physio’s not going
to repair a torn
tendon

Malliaras et al 2021
 “ ╸ It’s a mechanical
issue that needs a
mechanical fix

Malliaras et al 2021
 “ ╸ I can’t fix the
tendon tear by
doing exercises

Malliaras et al 2021
What could patients think if
diagnosed with subacromial
impingement syndrome?
 “ ╸ It is the tendon being
caught by this piece of
bone and wearing it
away

Cuff and Littlewood 2018

 “ ╸ I can’t imagine how any
amount of physio is
going to shift this piece
of bone in my
shoulder.

Cuff and Littlewood 2018

 Pathoanatomical terms give rise to
pathoanatomical fixes
• We have empirical data that reports patients diagnosed with rotator
cuff tear or SAI have a higher perceived need for surgery and
imaging.
• Diagnostic labels can influence a patients perceived management plan
• A patients expectations and beliefs about their pain and subsequent
management are a big deal! (see next module)

Zadro et al 2021
RCRSP and subacromial shoulder pain
• These diagnostic labels might not be perfect and will probably evolve
over time
• These terms reflect more a location of symptoms as opposed to a
specific pathoanatomic structure
• These terms may validate a persons experience whilst not necessitating
rigid biomedical beliefs about treatment
Summary of module 4
• Exercise for RCRSP suffers from modest clinical effects, like everything
else
• Exercise might satisfy the “right care” criteria more than any other
intervention
• Manual therapy is just another intervention for RCRSP - its neither the
devil nor the saviour
• Diagnostic labels for RCRSP are tricky and ambiguous
• Terms such as SAI and rotator cuff tear should probably be phased out
• RCRSP and SSP might be adequate middle ground terms
Module 5
Predictors of clinical outcomes
Learning objectives
1. Describe what factors are associated
with clinical outcomes for RCRSP
What factors could predict clinical outcomes
for RCRSP?
• A full thickness rotator cuff tear?
• A partial thickness RC tear?
• Dimensions of the tear?
• Beliefs and expectations?
• Kinesiophobia?
• Anxiety and depression?
• Social determinants of health?
• Strength?
• Biomechanics?
Kinesiophobia
• Kinesiophobia is a bigger predictor of clinical outcomes after rotator
cuff surgery than structural characteristic of the tear
Social factors
• Being married
• Higher level education
Are significantly associated with better
outcomes for non-Sx Mx of RCRSP
Psychological factors
• Patient;
• Expectations of physiotherapy
• Self-efficacy levels
• Pain catastrophizing
• Kinesiophobia levels
Are significantly associated with clinical outcomes in people undergoing
physiotherapy
Structural factors
• Are infrequently associated with clinical outcomes
• Except for a progression of rotator cuff tear size (>1cm)
“ ╸ You’re scan is
not your destiny!
Strength
• Does baseline shoulder strength influence clinical outcomes?
• No evidence for this
• Although may prevent future shoulder injuries
• Must you get substantially stronger to improve pain and function?
• No – increases in strength do not mediate improvements in pain and function
 Function?
• High baseline disability and pain are associated with worse clinical
outcomes
• However, high pain self-efficacy, optimism and good expectations of
recovery can moderate this effect

Chester et al 2018
Shoulder biomechanics
• There doesn’t appear to be any evidence that baseline scapular
dyskinesis, thoracic spine posture, or any other biomechanical variables
predict clinical outcomes
• Although, a positive response to the scapular assistance test is
associated with better clinical outcomes
Summary module 5
• We need to look beyond things we can measure and observe in
determining who might improve with clinical Mx
• Social and psychological factors, more than physical and structural
factors, predict clinical outcomes
• This should be built into your patient interview and patient education
Module 6
The future of physiotherapy for RCRSP
Learning objectives
1. Describe what characteristics of
physiotherapy will rise to prominence in
the future for the management of rotator
cuff related shoulder pain
The future of physiotherapy for Mx of
RCRSP
Will physiotherapy exist in 50 years?
• Yes
• Will it be called physiotherapy? Probably not
• Will we merge with other allied health professions? Probably
• How will we help people with RCRSP?
Individuality + Patient Centered Care
• We will treat people as individuals
• We will not apply recipe based approaches or structured algorithms and
expect every patient to respond the same
• We will take into account:
• Beliefs and expectations of pain, physiotherapy, outcome etc.
• The relevant sociocultural factors a person is embedded in
• Are there specific psychological or behavioral factors you need to address?
• What does a person want, need, value for managing their shoulder pain. How does
this match with clinical guidelines?
• Equitable and accessible interventions relative to the person
• The relevant structures, physiology, biochemistry and biomechanics will still matter!
Coach not healer
• Our role will shift from ‘healer’ to coach/guide
• A patient will seek expert guidance on how to manage their
pain/injury and we can help guide that person back to their life
• This will involve knowing the empirical data as it relates to their presentation
• Pro’s and con’s of each intervention available for RCRSP?
• What is the natural history of non-traumatic RCRSP?
• What is a clinically and cost effective intervention for them?
• You will provide support, empathy and guidance but you will not ‘fix’ their
pain. You can be of tremendous help, but it’s ultimately not about you
• If relevant, educate and discuss lifestyle factors that may be contributing to
their situation
Communication + relationship experts
• Building trust, respect and rapport will be of primary import.
• You will collaboratively engage with a person to help them reach their
health goals
• You will not impose your biases and beliefs onto them (overly nocebic language
and beliefs etc.)
• You will efficiently refer on to other members of the MDT when
appropriate
Movement experts (nuanced)
• You will often prescribe or modify movement, exercise, physical activity
• You will appreciate there are many exercise (s) that can help people
with RCRSP
• S&C
• Motor control
• Stretches
• You will know how exercise can work for RCRSP - it’s not just
mechanical!
• You will know when biomechanics and strength and thoracic mobility
may be important and for whom
Health advocate
• You will have the confidence and training to speak on the benefits of a
healthy lifestyle, including:
• Sleep
• Exercise
• Nutrition
• Appropriate rest and load management
• The effect of stress on a biological system (internal load and external load)
• Be able to communicate what pain might be and how it may have emerged in
them (will be individual)
$$$$
• You will exist in a health care model that doesn’t prioritize
overtreatment and overdiagnosis or high volume patient visits
• You will be rewarded for providing value based care
• Guideline concordant care
• Patient centered care
• Cost effectiveness
• Patient experience and outcomes
Be a good clinician!
• Offer a diagnosis
• A prognosis
• Screen for sinister pathology
• Conduct a thorough patient interview and physical examination
• Ascertain goals
• Experiment with movement and gauge their reaction
• Provide therapeutic touch
• Be nice, genuine, make eye contact, remember their name, story etc.
• Can they self manage?
• What can you do for them?
Summary
• Physiotherapy is well placed to lead the management of RCRSP
• We must conquer the dogmatic beliefs and interventions that continue to
plague the profession
• Scapular kinematics
• Strength
• Posture
• Surgery
• Exercise
• Diagnostic labels and language
• Manual therapy etc.
• We should work towards providing value based care and call out the
excessive use of low value interventions and tests
Thank you
• Thanks for watching this Masterclass
• YOU have an important role to play in the modernization of clinical
care for people with RCRSP
• Find out more about me:
• Instagram: @shoulder_physio
• Website: www.jaredphysio.com
• Twitter: @jaredpowell12