George Powell

@TomBroback Thanks for the reply Tom. I’m really intrigued to understand your perspective on how physical therapy can help this. Are we thinking generic pain modulation effects through exercise? Sleep hygiene coaching? Sleep position awareness?

@GPowellPhysio Better sleep is the byproduct of what we are aiming for. We are not sleep doctors, but getting someone to sleep on their side with less shoulder pain is something we can help with.

Every therapist asks about pain levels. "On a scale of 1 to 10..." But pain levels don't tell you what matters most to your patients. Ask these instead: • What can't you do right now that you want to do? • What are you avoiding because of this injury? • What does getting better actually mean to you? You aren't treating shoulder pain. You're helping them sleep through the night so they're not exhausted at work. You aren't treating knee pain. You're helping them get on the floor with their grandkids. When you understand what brought them to rehab, you understand the impact you'll have. And you can set goals that actually motivate them to do the work.

@Matthew_Rupiper Broadly speaking, what are the other options you would typically give if the expectation is exclusively pain modulation in a physio clinic? What influences your decision making in this scenario?

Yes & I’m honest about it. “I can’t fix your pain. I can help you do XYZ with/despite the pain. The pain may get better & it may not. If that’s something you’re interested in, I’m the person to see. If not, I can give you other options.” It’s how I’d want to be treated

@AdamMeakins Thanks for sharing mate. We should always be goal-focused of course, but curious - should mechanotherapy guide ex choice? For example, favouring weight-bearing ex over swimming to maintain cartilage health in knee OA? Is that where some exercises could be considered better/ best?

🧐BEST EXERCISES🧐 Everyone’s got the “magic bullet” exercise these days… Isometrics? 💥 Best for pain! Eccentrics? 🦸 Best for tendons! Motor control? 🧠 Best for movement! Functional Patterns? 🤡 Best for circus tricks! Except… they’re not. 👉 Isometrics don’t consistently reduce pain 👉 Eccentrics aren’t superior for tendinopathy recovery 👉 Motor control exercises don’t magically fix motor control 👉 Functional Patterns don’t do much of anything The evidence shows most rehab exercises are pretty non-specific in how they work. They’re more a Swiss Army knife than a surgical scalpel Why? Because pain, strength, coordination, and performance are complex, variable, and influenced by about 1000 other things besides the tempo of your calf raise or position of your scapula! What matters more when using exercise is: ✅ Getting people moving more or differently ✅ Loading tissues sensibly ✅ Building confidence ✅ Being consistent Not whether you picked the perfect exercise from the magic rehab menu. 💬 “It’s not the exercise, it’s what the exercise does for the person.”

@PracticeMoving @DudleyGroupNHS We assigned 9 patients to 1:1 due to leg pain concerns, so only around 30% actively opted against group assessment. Interesting stuff!

Interesting stuff here at @DudleyGroupNHS as we pilot a new low back pain (LBP) pathway. Lots of clever elements involved, but the headline is this: when offered the choice between 1:1 or group assessments, 12 out of 31 patients chose group assessment Hat tip to @GPowellPhysio

@GregLehman @DerekGriffin86 What MSK pathology would you not apply this too and why? Keen to understand the evidence base and rationale behind why certain types of exercise can be superior to others for particular MSK pathologies.

@GPowellPhysio @DerekGriffin86 I would not

Resistance exercise is often promoted as the superior form of exercise for knee OA. Many trials have challenged this idea. In this RCT, yoga was equally as effective. Without a no treatment group, we can't be sure we aren't see natural hx. @GregLehman jamanetwork.com/journals/jaman…

@GregLehman @DerekGriffin86 I’m curios, would you shelve this narrative for all MSK pathology, or is this exclusive to knee OA?

@DerekGriffin86 Looks like the same improvements in pretty much every trial. The idea that certain exercise programs are superior needs to be shelved. Yet, there are still editorials saying people should be doing “neuromuscular” exercise

Excited to see how some would misinterpret this as ‘accurate diagnosis doesn’t matter’

@GPowellPhysio 😂😂😂 great comeback against 10 men…nearly cocked that up in Europe’s 2nd tier competition 😉

What a come back for United! Now 5-4 up…baffling man, looked over at 2-4

@DerekGriffin86 @BillingMartin @CraigLiebenson @neiljlangridge @k8purcellphysio Great debate! If pain limits function, restoring function should be the goal imo. But if there’s no functional issue and the aim of physio Rx is exclusively for pain relief, I’m curious to understand the rationale for referring such pt’s to a physio/ ‘movement expert.’

@BillingMartin @CraigLiebenson @neiljlangridge @k8purcellphysio Pain relief AND functional empowerment. Many people with pain function well but pain relief is still a goal. We also need to acknowledge that function is often significant impaired as a direct result of pain.

physiotherapyjournal.com/article/S0031-… @neiljlangridge @k8purcellphysio excellent paper has reminded me of other papers on this subject that I believe are must reads. I believe this is no longer a "why", but more of a "how/when" discussion, and key to implement much needed change 1/

@tomjones_9 @HJT96_ Mate, those are very tame celebrations imo 😂

@HJT96_ @GPowellPhysio you at Crispin (a) when you revenge the 12 year old that beat you?

Me after hitting Double 1 to beat my mate in the pub

@AdamStenman @k8purcellphysio @Physio_James @adamdobson123 From my perspective, it boils down to honesty. Assuming serious pathology has been excluded, NS Dx are better equipped to embrace uncertainty, and help mitigate the deleterious effects of misnomers when providing a specific Dx to a pt that you know could be wrong.

@k8purcellphysio @Physio_James @adamdobson123 Yeah but they might not have cuff related pain also? And why would treatment of "partial supra tear" and RCRSP differ? Tbh I feel stupid AF here because I just can't grasp why NS diagnosis are better or even what classifies as NS diagnosis.

I'll bite. Imo the "functional limitation-diagnosis" is something that destroys our profession. We need to call things what they and use the same nomenclature as other providers in MSK. Use ICD-10 or 11. Be as precise and clear as possible and be OK to make mistakes.

@physiojack How many signs on the SCREENDEM tool are needed to warrant further investigation? If no consensus, what signs are most sensitive?

Questions about Rheumatology in MSK practice. Go 👇👇👇

There is absolutely NO point being a great rehab specialist or manual therapist if you cant develop trust and respect with patients! Before worrying about mastering the skills of rehab or manual therapy, first perfect the art of communication and building relationships!

Brilliant virtual open day hosted by @TherapyDudley. I’m really excited about the latest developments happening @DudleyGroupNHS. Thank you to all those involved in hosting this event.

Mine and @GSPowell97 thoughts on the virtual AHP day in this months newsletter @DGFTAHPCouncil @DudleyGroupNHS. This was a great day to be able to experience as a student, so inspiring and has really broadened my understanding of AHPs in practice. #AHPs #physiostudent #placement