Andy Barker’s Post

Let's cut to the chase...
 You do not like treating shoulders, right?

 I know this because it is the joint I get asked the most questions about.

 From finding the right diagnosis...

 Explaining this diagnosis and a prognosis to your patient...

 And knowing what treatments and rehab to use for shoulder pain patients is hard! I blame University!

 Seriously, like me, I bet you were taught to diagnose largely by using special testing.

 Helpful when the tests are good...

 Like the Lachman's test at the knee...

 Or anterior draw test at the ankle...

 But not so good at the shoulder.

 Shoulder special tests are poor.

 They have low sensitivity and low specificity...

 In simple terms meaning they are poor at actually diagnosing what the tests are meant to test...

 Or put another way...

 They are a waste of your time and effort to even use in the first place. If you are reliant upon on special tests to find the right diagnosis with your shoulder pain patients...

 Then you are always going to struggle! 

 The shoulder is a more complicated joint in many ways than other joints like the knee or ankle, due to it's more complex structure and anatomy...

 With so much going on in such a tight space.

 But this does not mean you can’t still get great patient results…

 Even without a clear shoulder diagnosis. All this week I will be giving you some of my biggest tips to help you make sense of shoulder pain symptoms... And giving you some simple strategies to help you get even the most complex shoulder pain patients out of pain... And back to full fitness... Even as a young and inexperienced shoulder physio! Keep your eyes peeled! In the meantime... Get my FREE shoulder pain PDF... ‘5 Breakthrough Steps To Confidently Treat The Shoulder Right Every Time, Avoid Mistakes & Stop You Feeling Less Adequate Than Other New Grads’ Just head to www.newgradphysio.com to download this FREE resource right away. Any problems getting access, just let me know and I will send you a copy over! Hope it helps! Andy The New Grad Physio Mentor #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

Good Article worth a read Accelerated and Conservative rehab protocols following ACL repair RTP at 6 or 12 months ? Graft healing needs at least 12 months RTP should always be based on attaining goals and function prior to progressing load and degree of on field technical and tactical difficulty Rehab must include neuromuscular training and cognitive drills to supplement S&C, sprints and plyometrics https://lnkd.in/eM3WfKVG.

External cuing. There are not many silver bullets in the rehab profession. Why? It is challenging to account for numerous variable when looking at an outcome. Cuing can help us attend or focus on the task at hand. External cuing to learn or relearn motor skills is without question superior to internal cuing (Wulf, 2013). This means you will learn better if, for example, you don’t focus on what muscles to ‘activate’ or trying to feel specific body parts. Instead, have the environment ask that skill of you. What about pain? While it is not clear what role pain plays in the ability to motor learn, research indicates it may be negative (Galgiani, 2021). Particularly, in that it negatively affects real time working memory and you’re ability to acquire new skills (Galgiani, 2021). What does this mean? To improve your performance when developing motor skills, have your focus be on the external environment. To improve learning, minimise pain experienced during the task. If you want to improve upper back flexibility, an external cue will be more productive than an internal. In this video I demonstrate how using a medicine ball can help with building upper spinal extension and spinal flexion. Extension in particular is challenging for many. Let the ball teach you how to move here! How long will it take? Animal studies indicate that cortical reorganisation will take some time to consolidate learning of new skills (Matsuzaka et al., 2007)! https://lnkd.in/gWyK9Db8

Getting on top of shoulder pain (and keeping it at bay) is one of a new grad physio’s biggest challenges! A few shoulder stretches… Scapula stability exercises… Or theraband external rotations don’t cut it for most shoulder injuries. You know what I am talking about, right? Here’s what you need to do instead… #1 Don’t Push Into Pain There are some injuries you can load into pain, like some tendon issues and injuries like a lateral ankle… But shoulders are typically not one of these injuries. The often do not respond well to loading into pain, as they irritate the shoulder, causing an increase in your patient’s symptoms… Something that your patient will not thank you for!!! But don’t get this wrong… This does not mean you have the rest the shoulder and be uber cautious and conservative. Complete the opposite. The shoulder needs to be loaded to get better. You just need to know what exercises to do to find the right balance between loading the injured area… But not push it too far so that you flare up your patients shoulder symptoms. Easier said than done right? Need some help with your shoulder pain patients? Then just send me a DM with the word ’SHOULDER’ and I’ll send you over my most popular shoulder pain resource for FREE. Hope it helps, Andy Barker The New Grad Physio Mentor PS. Keep your eyes out for my next couple of emails that will have some more top tips to help you make sense of... And manage different shoulder pain problems! #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

Making Special Tests ‘Special’ I am not too sure who gave special tests the their name as you know as well as me… That many of the special tests we use day in and day out, are not that special!   Some of key tests at the shoulder for example, like the empty can test and Hawkins-Kennedy test are ¢#@%.   They lack specificity and sensitivity which in real terms means they are not great at actually helping you find the right patient diagnosis.   Sticking with the shoulder...

Assessing shoulder range of movement and identifying a painful arc is actually more sensitive to diagnose a sub-acromimal pain problem than both the Empty can and Hawkins-Kennedy test!   Don’t believe me?   I looked at all the evidence and it is true!!!

I wrote about this in my FREE shoulder PDF...
  ‘5 Breakthrough Steps To Confidently Treat The Shoulder Right Every Time.’   Head here to pick up your free copy… >>> newgradphysio.com   But back to special testing.

When you are choosing to use special tests, you need to ensure that they are going to be useful...

And actually help you nail the right patient diagnosis.   This week I will reveal 3 of my biggest special test tips to help you get the most out of your special testing...

Nail the right patient diagnosis...

So you know the exact patient problem you are dealing with. Keep your eyes out for my first post tomorrow! PS. Here is the link to my FREE Shoulder Pain PDF just in case you missed it… >>> newgradphysio.com #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

Just because your patient has shoulder pain does not mean they have a shoulder problem… And need shoulder rehab. WTF Andy! I had a patient just yesterday in the clinic complaining of left shoulder pain for the last 3 months, yet it was not his shoulder that was the problem… But his left elbow! In short, he had flared his left elbow on holiday carrying his youngest child a lot, developing a distal bicep problem. This had seemingly fixed itself up, however, a month after the elbow pain, the shoulder on the same side started to hurt. The body is clever like that. It will find a way around a problem. It will compensate. In this case the shoulder, and specifically his left anterior deltoid and pec minor were doing more work, to help out the bicep problem. Initially, this is a good strategy, as it allows the body to keep functioning, but… If not addressed it causes issues longer term, just like this patient’s shoulder pain. The last physio he saw rehabbed his shoulder and gave him all the usual shoulder rehab exercises… But he did not get better, because… His shoulder was not the problem. If your shoulder pain patient is not improving, make sure to check that another issue elsewhere is not driving the problem. Hope this helps, Andy Barker The New Grad Physio Mentor PS. Being able to make sense of this patient’s injury stated with the subjective assessment… And the ability to be able to identify previous injuries that might have been contributing to his shoulder pain… Before testing out these assumptions in the objective assessment. Would you know how to work out if a patient’s elbow issue (or some other injury) was causing their shoulder pain, or not? Need some help? Head here and I’ll show you how to do this… https://lnkd.in/gGyB8aHF #newgradphysio #newgradphysiomentor #newgrad #newgrads #physiotherapy #physio #physicaltherapy #students #therapy #MSK #physiotherapist #studentphysiotherapist #physiostudent #sportstherapy #studentphysio #sportsrehab #learning #cpd #sportsphysio #mentor

A great paper by Smith et al. (2021), shown to me by Jake Mulley, provides a clearer picture of a return to sport protocol for an acute lateral ankle sprain. Their approach used a three-round Delphi survey approach in order to develop a more well-rounded understanding of how diverse health professionals approached this injury. It highlights that the "PAASS" factors must be considered when addressing this injury: - Pain Severity - Ankle Impairments - Athlete Perception - Sensorimotor Control - Sport/Functional Performance There are 16 items used to assess PAASS including some of the following: - Sport-specific activities - Pain severity during sports participation - Ankle ROM - Ankle muscle strength - Hopping - Agility - Completion of a full training session Although informative and useful for rehabbing your athletes, it must be noted that athletes themselves were not addressed in this study, nor did it mention what test(s) they would use to assess the aforementioned 16 items, leaving it up for interpretation. #ankle #anklesprain #physiotherapy #returntoplay #rehabilitation

"Expectation without education is frustration." - Jared Halverson How can we expect our patients to follow our treatment plans if we do not sufficiently explain the why and the how behind them? It will inevitably lead to frustration. "If you can't explain it to a six-year-old, you don't understand it yourself." - Albert Einstein Do we understand normal and pathological gait well enough to explain to a person with little-to-no understanding of the details of human gait why a patient with a neurological condition is ambulating the way they do? Can we then explain how our orthotic intervention and related treatment plan will address their gait abnormalities and help them achieve their goals? If we do understand and if we can explain it simply, are we taking the time required to do so? In my experience, orthotists could improve quite a bit in this realm of patient care. I promise it will be worth every extra minute and effort. #oandp #orthoticsandprosthetics #patienteducation

Today I had to return to the spinal unit where I spent the last 2 months of my hospital-based rehab after neck-down paralysis. The place I had many dark ‘4am moments’ of despair and created puddles of tears as a scared newly-injured patient. However, today’s visit wasn’t an emotional challenge. Quite the opposite. Why? What did I do then that allows me to be ok about it now? Of course, it’s never one thing in isolation but the thing that stands out at the top of my list is the act of reframing a scenario. Questions like: 👉What are the facts of this situation (objectively)? 👉What can I and can’t I affect right now? 👉What do I have to accept and what is the opportunity so I know where to focus, not waste my energy? Of course, everyone is unique and therefore every response to every challenge is unique. For me, reframing my most challenging moments or when tough decisions needed to be made allowed me to reclaim some control over an often spiralling-out-of-control scenario… and it helped me move forward. A word to the wise… Practice reframing in the good times. Start today! Get good at it before you need it. #Challenge #ForcedChange #CrisisRecovery Alt Text: Landscape photo of Horatio's Garden at Royal National Orthopaedic Hospital (RNOH) NHS Trust with several mature trees, bushes, a wide meandering path and a water feature. It wasn’t there when I was an in-patient but is a wonderfully zen space that new patients find comforting.

How To Make Sure You Get Comprehensive ACL Rehab