Kyle Flood, PT, DPT, OCS, CSCS

Board Certified Orthopedic PT, DPT, CSCS Lift long and prosper

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@TMathSports The top is in. Time to load the puts.

[Liverpool FC @LFC]

Always our Egyptian King. Thank you for everything, Mo 👑

[Howard Luks MD @hjluks]

Bone Spurs Do Not Cause Shoulder Pain or Cuff Tears. Ten Years of Data Just Confirmed What Never Made Sense To Me.

It's amazing how many people are still told each year that they need shoulder surgery due to a bone spur.

This theory that the spur caused pain was called impingement. It never made sense…
We have tendinopathy and tears all around the body, which occur frequently and are never associated with bone spurs… why would the shoulder be different?

The bone spur as a cause of shoulder pain is a dead theory. Honestly... It's been dead for 20 years... but it just kept coming back to life.

For most of the past 25 years as a surgeon, patients came to me after being told they needed surgery to remove a bone spur. The explanation was easy: the spur was rubbing on the rotator cuff, causing pain and eventually tearing the tendon. The fix was to shave it down arthroscopically. Mechanistically, it makes sense, and the visuals are easy for patients to see.

The FIMPACT trial...
Patients with subacromial pain were randomized to arthroscopic subacromial decompression (bone spur removal), sham surgery, or supervised exercise therapy. The two-year results, published in 2018, showed no difference between surgery and sham.

The same group just published their ten-year follow-up. Still no difference. Over a decade of follow-up, removing the bone spur produced outcomes identical to those of a sham operation.

This is not a small study with a short follow-up being used to make a sweeping claim. It is ten years of rigorous data, and the authors are direct: arthroscopic subacromial decompression should not be offered outside of clinical trials. De-implementation in routine care is warranted.

The bone spur theory of rotator cuff disease is dead. It was never well-supported biologically, and the randomized, sham-controlled trial data have now buried it twice.

Reference: Paavola M et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: 10-year follow-up of a randomised, placebo surgery controlled clinical trial. BMJ. 2024.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@cloudstridetech When I started investing I had the goal of making 50k. Picked one stock, MSOS. I’m proud to say after this week I am 150k away from my goal.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@Matthew_Rupiper 8 years in and consistently humbled by these. Corticosteroid to help put the fire out, and try to modify aggravating factors to help aid in healing. Truly just entertaining them while their body heals.

[Howard Luks MD @hjluks]

After three decades as a knee surgeon, I can say this with confidence…. many people are far more limited by the story their MRI report tells them than by the condition of their meniscus or articulation cartilage.

[Howard Luks MD @hjluks]

Load Management:

When I talk about load management in the office, I can see the moment it lands the wrong way. People often hear “don’t do too much.” They hear restriction, caution, and many hear weakness. That is not what I intended.

Load management is not about doing less. It is about doing the right amount — and then building from there.

Tendons do not heal because we protect them indefinitely. They adapt because we challenge them. But they adapt on their timeline, not ours. When the load exceeds the capacity, they breakdown and become painful. When load is too low for too long, their capacity shrinks and they’re more susceptible to overuse injury. The sweet spot lives in between.

That middle ground is not avoidance. It is progressive exposure.

If your Achilles hurts, the answer is rarely “stop moving.” It is also rarely “push through it.” It should almost never be put in a boot! The answer is to adjust the load so the tendon can tolerate it, then gradually increase that demand. That might mean temporarily reducing volume, slowing down tempo work, or modifying range.

Think of it like strength training. You do not walk into a gym and deadlift your lifetime goal on day one. You pick a weight you can manage, stress the system, recover, and come back slightly stronger. Tendons are no different. The stimulus has to be enough to matter, but not so much that it overwhelms your ability to recover.

What I am trying to teach when I talk about load management is durability. It is the skill of matching stress to capacity and then expanding capacity over time. That requires honesty about where you are today, not where you were ten years ago or where you wish you were.

In midlife, especially, recovery becomes the governor. Aging is associated with a higher price for intensity and longer recovery time frames.

Cardiovascular systems adapt quickly. Connective tissues adapt slowly. If we ignore that reality, pain becomes the teacher instead.

Load management is not about shrinking your world. It is about expanding it safely. It is the difference between repeatedly flaring the same tendon for years and building the kind of resilience that lets you run, lift, hike, and play for decades.

The goal is never to do less. The goal is to build the capacity to do more.

[Howard Luks MD @hjluks]

Most shoulder pain = Have shoulders +/- menopause +/- type 2 diabetes (or IR), +/- thyroid disease, or any combination thereof.

Your MRI result doesn't matter nearly as much as you think it does. Every adult has cuff findings and labral tears.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@StackingWei @Nebraskangooner @DrJesseMorse That’s the dosing studied for neurological/cognitive benefits. Still need to see a lot more research done but seems promising.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@StackingWei @Nebraskangooner @DrJesseMorse It does use it. Does every person have utility at doses up to 20? Maybe not, but seems safe based on the evidence we have. Most well studied substance (that isn’t gear) on hypertrophy we have. Some people are non responders and notice no benefit.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@EricSJonz @Nebraskangooner @DrJesseMorse Negative chief, those are doses for neurological benefits 🤝. Creatine and sleep needs more research before we have strong opinions

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@Nebraskangooner @DrJesseMorse It’s safe, your body gets rid of what it didn’t use. Large studies show it is not toxic even in 20g doses. All those that talk about kidney issues are anecdotal.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@med_712 Empty can, tells you that someone’s shoulder hurts when you flex to 90 degrees and internally rotate them.

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@RobinhoodApp The amount I check this app to see if price go up is truly astonishing. My wife thinks I’m cheating on her because I’m always staring at my phone looking to see if I’m going to be eating ice cubes or filet mignon for dinner. Hope this answer is helpful

[Kyle Flood, PT, DPT, OCS, CSCS @kyleflood]

@interesting_aIl And horse shit narratives lmao