Physio Edge podcast

When you assess your patients shoulder movements, and notice a winging scapula, altered resting position or timing of scapula movement, do you need to treat it? Can we diagnose “Scapular dyskinesis”, and does it matter? How can you simplify your scapular assessment?

In this podcast, Jo Gibson (Clinical Physiotherapy Specialist) explores common beliefs and myths around the scapula, including:

  1. Abnormal scapular kinematics cause pain
  2. We can predict patients that are going to get shoulder pain
  3. Upper traps should be retrained to decrease their activation
  4. Scapular-based interventions are superior to rotator cuff based treatment
  5. There are reliable and valid ways to assess scapular movement

Alongside this mythbusting, you’ll explore:

  • Is there any point assessing the scapula?
  • Is scapular asymmetry normal or abnormal?
  • Is scapular dyskinesis a normal response to exercise or loading?
  • How accurate are we at identifying scapular dyskinesis compared to findings in laboratory studies of scapula movement?
  • What scapular findings will you commonly observe in patients with massive rotator cuff tears, nerve injuries & stiffness?
  • How does rotator cuff fatigue impact scapular movement?
  • How does fear avoidance and worry about particular movements impact muscle activity and movement?
  • When is increased upper traps activity helpful and beneficial?
  • Should we try to decrease upper traps activity in patients with C/Sp driven shoulder pain?
  • Can we preferentially target the scapular or rotator cuff with our exercises?
  • Do improvements in shoulder pain correlate with changes or “improvements” in scapular movement?
  • How do scapular assessment test (SAT) results impact your treatment and exercise prescription?
  • If the SAT improves pain, does that mean we should perform scapular based exercises?
  • Can we use scapular dyskinesia classification to stratify patients or guide our treatment?
  • Is there any reliability in scapular assessment?
  • Does the SAT simply identify those that have a favourable natural history ie are going to get better on their own regardless?
  • Do scapular treatments increase the subacromial space, and does this matter?
  • Is winging post-surgery (posterior stabilisation + labral repair) a product of surgery or does this need to be addressed?
  • How does incorporating the kinetic chain into rehab impact patient movement strategies, scapular and rotator cuff recruitment?
  • Are scapulothoracic bursae relevant to shoulder pain?
  • How can you address patient beliefs and fear avoidance around their shoulder pain?

Articles associated with this episode:

Direct download: 105._Scapular_dyskinesis_-_Does_it_really_matter_with_Jo_Gibson.mp3
Category:general -- posted at: 4:25pm AEDT

When your patient has leg, shoulder or arm pain, how can you identify if their pain is due to neural tissue compression, sensitisation or irritation? How can you differentiate whether pain is from neural tissue or local structures like nearby joints, tendons or muscles? What questions and objective tests will help you diagnose a neural tissue pain disorder (NTPD)?

In this podcast with Dr Toby Hall (Specialist Musculoskeletal Physiotherapist, FACP, PhD), you’ll discover:

  • Three types of neural tissue pain disorders, and how to identify each one
  • What is Peripheral nerve sensitisation (PNS)?
  • What clues in your subjective examination will help you identify PNS?
  • Why do nerves become inflamed or irritated?
  • How to identify & differentiate radiculopathy and radicular pain in patients with radiating limb pain.
  • Do all patients with NTPD have obvious neuro symptoms such as pins and needles, numbness or weakness?
  • Quick screening tests you can use in your assessment to identify PNS.
  • How to identify if your patients shoulder and arm pain is from neural tissue or from local shoulder structures.
  • How to diagnose a NTPD in patients with hip or leg pain.
  • How to perform passive neurodynamic tests such as the straight leg raise (SLR), upper limb neurodynamic test (ULNT), slump test and femoral nerve slump test.
  • What information does a positive or negative neurodynamic test provide?
  • Can we identify the location of a nerve lesion or irritation with our passive neurodynamic tests or palpation?
  • Initial PNS treatment options
  • Is exercise helpful or harmful in patients with PNS?
  • How can you palpate over neural tissue, and what information does this provide?
  • Do opioids provide pain relief, or prolong recovery in patients with NTPD?

This podcast is the first part in a two part series on neural tissue pain disorders with Dr Toby Hall. Part 1 (this podcast) guides you through the types of NTPD, and how to assess and diagnose NTPD. Part 2 (available soon) will take you through how to treat PNS.

I highly recommend listening to this episode (part 1) prior to part 2, to have a thorough understanding of when and how to treat PNS.

A young male patient woke with an acute onset of constant, shooting shoulder pain, is painful into abduction, reluctant to lift his arm, and feels like he’s losing shoulder strength. He has no recent history of injury. 

Can you diagnose this unusual cause of shoulder pain, based on this patient's symptoms and physical tests? What are your differential diagnoses and red flags to keep in mind with this patient? 

In this podcast, Jo Gibson puts your knowledge of shoulder pain and diagnostic skills to the test, and explores how you can treat patients with this diagnosis.

Articles associated with this episode:

Get access to free videos with Jo Gibson on diagnosis of shoulder pain at

Direct download: 103._An_unusual_cause_of_shoulder_pain_with_Jo_Gibson.mp3
Category:general -- posted at: 1:24pm AEDT