Carl Neal

[Carl Neal @Carlthephysio]

@PeteOSullivanPT Sounds and looks great. Have done your three day course in London and will definately be signing up to this. Any ideas on cost and timeframes of the skills and mentoring training when they become available

[Carl Neal @Carlthephysio]

@AdamMeakins I'm not sure rotator cuff related is all that specific it is saying the cuff is part of it. Still allows room for multifactorial discussion but also gives meaning to a rx approach which will help buy in.

[Carl Neal @Carlthephysio]

@AdamMeakins I'm sure we can assess movements but I'm also sure we can say which muscles are producing the majority of the force. A marginally weak serratus isn't going to lead to a more profound weakness of external rotation.

[Carl Neal @Carlthephysio]

@AdamMeakins Not sure I'm in agreement with your viewpoint however regardless how does avoiding the use of rcrsp and instead using non specific shoulder pain help the patient.

[Carl Neal @Carlthephysio]

@AdamMeakins That's quite an extreme case tho isn't it. If external rotation is weak and there is no major aberration of scapula movement then the likelihood is that infraspin and teres minor are weak no?

[Carl Neal @Carlthephysio]

@AdamMeakins You believe rotator cuff weakness is not something you can assess? In that case can you assess any muscle for weakness. Almost all movements will have synergist activity.

[Carl Neal @Carlthephysio]

@AdamMeakins I would say its producing most of the force yes. What are you proposing is active? Is resisted knee extension an adequate test of the quads?

[Carl Neal @Carlthephysio]

@AdamMeakins What would you say resisted external rotation assesses if not the rotator cuff?

[Carl Neal @Carlthephysio]

@JackAChew @TPMPodcast @physiojack @FrancescaPeplow @JLTHphysio @Ruuqie @mehab_jo @keithgraham @AdamMeakins @TheHipPhysio @kieranosull I mean it's not the worst the daily mail have published. Never heard of anyone applying heat with a hair dryer and cling film mind. Perhaps this is the answer I've been missing

[Carl Neal @Carlthephysio]

@1gregorross @MPearsonPO @physiojack @DerekGriffin86 @TPMPodcast Nice thread thanks

[Carl Neal @Carlthephysio]

@DerekGriffin86 Definately true especially in those consultations where there isn't time to unpack it further. Can't see much harm mentioning lifestyle change tho with exception of losing rapport.

[Carl Neal @Carlthephysio]

@physiojack @MPearsonPO @suzy_speirs Nice will give this a watch at some point in coming weeks.

[Carl Neal @Carlthephysio]

@MPearsonPO @suzy_speirs @physiojack Have you noticed any difference in outcomes in those two groups? Would you use it in someone with bicompartmental symptomatic oa but one side worse than the other?

[Carl Neal @Carlthephysio]

@DerekGriffin86 @physiojack Would agree the negative beliefs around oa are more prevalent but there are still some who do not believe it (often younger, often don't want to believe it due to the negative beliefs around it). Classic one this week with 1st Mtpj oa. Knowing what it is can inspire pts sometimes

[Carl Neal @Carlthephysio]

@MPearsonPO @suzy_speirs @physiojack Any experience @MPearsonPO of using a brace in a person with bilateral radiographic oa but unilateral symptoms?

[Carl Neal @Carlthephysio]

@physiojack @suzy_speirs @MPearsonPO Would you say radiographic changes are a risk factor for developing pain or symptoms? The evidence would suggest it's a more common finding in symptomatic patients suggesting joint disease is relevant to some degree. Don't know if that would effect the success of a brace though

[Carl Neal @Carlthephysio]

@DerekGriffin86 @physiojack @AdamStenman Would you posit that it is largely a placebo effect then. If it takes enough of load to reduce symptoms why couldn't it add enough load to produce symptoms.

[Carl Neal @Carlthephysio]

@DerekGriffin86 @physiojack Can't be certain, but you can select the right patient, prime them appropriately and educate them after. If it helps engagement that is surely only a good thing. A patient not believing the diagnosis and in turn the management plan isn't going to do well.