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What does a shoulder actually need to do to perform at a high level in tennis? In the first episode of our High Performance Shoulder series, Margie Olds is joined by Dr Natalie Myers to explore the biomechanics and physical demands of the tennis shoulder. Natalie takes us beyond the glenohumeral joint and into the whole kinetic chain. The tennis serve is a complex, highly sequenced movement — and changes at the feet, knees, pelvis or trunk can alter the forces experienced at the shoulder. The conversation gets particularly practical: Can clinicians actually assess this in the clinic? Natalie discusses her work translating 3D biomechanical research into an observational assessment of the tennis serve, including foot position, knee bend, pelvic and trunk rotation, sequencing and timing. Simple clinical measures such as the countermovement jump, medicine-ball throw and trunk rotation can also provide useful information about the athlete. The discussion then turns to shoulder pain and injury across the lifespan — from growth-plate injuries in young players and partial-thickness cuff findings, through to posterior instability and age-related rotator cuff changes. And finally, Margie and Natalie tackle a particularly important question for clinicians: Should we really be trying to restore symmetrical shoulder rotation in tennis players? Natalie explains why loss of internal rotation can be a normal adaptation to overhead sport, the role of humeral retrotorsion, and why external rotation — rather than internal rotation — may sometimes be the more important movement to consider. 🔑 Key Takeaways for Clinicians Start beyond the shoulder. The tennis serve depends on force generation and sequencing through the feet, lower limbs, pelvis and trunk.Foot position matters: Natalie suggests it is one of the first things clinicians should observe when watching a player serve. Reduced knee bend and altered timing between pelvic and shoulder rotation can increase forces at the shoulder. You don't necessarily need a biomechanics laboratory. Slow-motion video and a structured observational approach can provide clinically useful information. Counternovement jump, rotational medicine-ball throw and trunk rotation are simple measures Natalie has used alongside observational serve assessment. In younger tennis players, keep growth-plate injury high on the differential diagnosis — particularly in athletes around 10–14 years presenting with shoulder pain. Posterior shoulder instability deserves a place on the clinician's radar, given the repeated horizontal adduction and internal rotation demands of tennis. Reduced internal rotation on the serving side isn't automatically pathological. Some change is a normal adaptation to repeated overhead loading. Humeral retrotorsion matters. Athletes who begin overhead sports while their growth plates are open can retain greater retrotorsion, allowing more external rotation but less internal rotation. Trying to restore internal rotation without considering these bony adaptations may be inappropriate — and Natalie raises the possibility that excessive posterior shoulder stretching could potentially contribute to posterior instability. The bigger message: before treating a tennis player's shoulder, understand the adaptations and whole-body demands that allow that shoulder to perform. To Follow Natalie Myers: LinkedIn: ⁠https://www.linkedin.com/in/natalielmyers02/⁠ Research gate: ⁠https://www.researchgate.net/scientific-contributions/Natalie-L-Myers-2069143815⁠ Natalie’s Research Myers et al., 2016. Volume based internal training program for elite tennis players ⁠https://pmc.ncbi.nlm.nih.gov/articles/PMC5089352/⁠ Myers et al., 2019. The Sony Smart Tennis Sensor accurately measures external workload in junior tennis players ⁠https://journals.sagepub.com/doi/abs/10.1177/1747954118805278⁠ Myers et al., 2017. ⁠Reliability and validity of a biomechanically based analysis method for the tennis serve https://pmc.ncb

When there is more than one reasonable treatment option, who should make the decision? In this episode of Glenohumeral Gurus, Margie Olds is joined again by physiotherapist and researcher Tash Maher — this time to explore shared decision-making and what it actually looks like in clinical practice. Shared decision making isn't simply giving patients the evidence and asking them to choose. And it isn't the clinician deciding what they think is best and asking the patient to agree. Instead, Tash describes a collaborative process where clinicians bring their clinical expertise, evidence and understanding of benefits, harms and uncertainty, while patients bring their experiences, circumstances, values and preferences. The conversation explores the Elwyn Three-Talk Model — Team Talk, Option Talk and Decision Talk — as a practical scaffold clinicians can use without turning the consultation into a script. Tash also shares findings from her qualitative research into shared decision-making following ACJ injuries. One particularly important message emerges: Offering choice isn't the same as supporting choice. Some patients want considerable involvement in decisions. Others want more guidance from their clinician. And simply presenting the options and saying “it's up to you” can leave patients feeling unsupported or even abandoned. Margie and Tash discuss clinical bias, communication, health literacy, previous healthcare experiences and why asking “What matters to you?” may fundamentally change the consultation. 🔑 Key takeaways for clinicians: Shared decision-making is most relevant when there is more than one reasonable option. Make patients explicitly aware that there is a choice to be made. Don't assume you know what matters to someone based on age, activity or other characteristics. The Elwyn Three-Talk Model provides a simple clinical scaffold: Team Talk → Option Talk → Decision Talk. Discuss more than benefits and risks — consider uncertainty, financial burden, time away from work and practical consequences.“ No immediate intervention” or monitoring can also be a legitimate option. Patients want different levels of involvement. Shared decision-making does not mean clinicians should become neutral or withhold their expertise. Previous healthcare experiences and the language clinicians use can strongly influence treatment preferences. Offering choice is not the same as supporting choice.A patient may not be ready to decide during the first consultation. Creating space to think, discuss options with family and return with questions can be part of good decision-making. Shared decision-making shouldn't be an additional five-minute task at the end of an assessment — it can reframe the whole consultation. Tash's three simple take-homes: make the choice visible, ask what matters, and use your expertise to support the patient. For more details from Natasha Maher, check out her google citations here: https://scholar.google.com/citations?user=grN6T1wAAAAJ&hl=en Follow Margie Olds on Social Media: Facebook ⁠⁠⁠https://www.facebook.com/shouldereducation/⁠⁠⁠ Instagram ⁠⁠⁠https://www.instagram.com/margieolds/ ⁠⁠⁠ LinkedIn ⁠⁠⁠https://www.linkedin.com/in/margie-olds-51586920/⁠⁠⁠ Twitter X ⁠⁠⁠https://x.com/margie_olds⁠⁠⁠ Website ⁠⁠⁠www.margieolds.com⁠⁠⁠

Hormones influence every tissue in the body—but how much do they really matter when it comes to shoulder rehabilitation? In this episode of the Glenohumeral Gurus Podcast, I sit down with Dr Nicky Keay, sports and dance endocrinologist, to explore the fascinating relationship between hormones, female physiology and shoulder health. Using the journey of a female athlete across her lifespan, we discuss how hormonal changes influence collagen, tendon health, joint laxity, muscle function and injury risk—and what this means for clinicians treating shoulder conditions. Whether you're working with adolescent athletes, pregnant women, perimenopausal patients or older adults, this episode provides practical insights into how endocrine health may influence rehabilitation and clinical decision-making. 🦴 Key topics discussed ✅ Why hormones affect every musculoskeletal tissue—including the shoulder ✅ How oestrogen, progesterone and testosterone influence collagen and tendon health ✅ Hormonal fluctuations across the menstrual cycle and their clinical relevance ✅ Pregnancy, joint laxity and shoulder stability ✅ Perimenopause and menopause: what changes occur in tendon, muscle and bone? ✅ Frozen shoulder and its relationship with metabolic and hormonal health ✅ Rotator cuff pathology and the emerging role of hormones in tendon adaptation ✅ RED-S (Relative Energy Deficiency in Sport) and the consequences of low energy availability ✅ Practical clinical considerations when assessing female athletes and active women 🎯 Clinical Takeaways • Hormones regulate tissue adaptation, collagen turnover and musculoskeletal health throughout life. • Shoulder conditions should be considered within the wider context of endocrine and metabolic health—not simply as isolated mechanical problems. • Hormonal changes during puberty, pregnancy and menopause may influence shoulder stability, tendon capacity and rehabilitation progression. • Screening for menstrual health, energy availability and endocrine risk factors may provide valuable clinical information in female patients. • Understanding the biological context of your patient allows for more individualised rehabilitation and better-informed conversations. This episode provides an accessible introduction to a rapidly evolving area of sports medicine and shoulder rehabilitation, highlighting why clinicians should consider the whole person—not just the shoulder—when assessing and treating musculoskeletal conditions. 🎧 Whether you treat shoulder instability, rotator cuff pathology, frozen shoulder or overhead athletes, this conversation will challenge you to think more broadly about the role of hormones in clinical practice. Follow Nicky Keay here: Website address (with details appointments etc) ⁠https://nickykeayfitness.com/appointments/ ⁠Link for PEAQ ⁠https://mypeaq.streamlit.app/⁠Link for book ⁠https://hhhp.neocities.org⁠ ⁠https://www.linkedin.com/in/nickykeay/⁠ ⁠www.nickykeayfitness.com⁠ ⁠https://hhhp.neocities.org⁠ Follow Margie Olds on Social Media: Facebook ⁠⁠⁠https://www.facebook.com/shouldereducation/⁠⁠⁠ Instagram ⁠⁠⁠https://www.instagram.com/margieolds/ ⁠⁠⁠ LinkedIn ⁠⁠⁠https://www.linkedin.com/in/margie-olds-51586920/⁠⁠⁠ Twitter X ⁠⁠⁠https://x.com/margie_olds⁠⁠⁠ Website ⁠⁠⁠www.margieolds.com⁠⁠⁠

After four episodes exploring frozen shoulder from different perspectives, it's time to bring it all together. In the final episode of our Frozen Shoulder Series, I sit down with specialist shoulder physiotherapist Dr Angela Cadogan to unpack the biggest lessons, unanswered questions and clinical implications emerging from the latest frozen shoulder research. Together we review the key themes from the series and discuss how current evidence is changing the way we think about frozen shoulder—from pathology and diagnosis through to imaging, injections, exercise and patient education. Angela shares practical insights from both clinical practice and research, helping clinicians make sense of a condition that remains one of the most challenging shoulder presentations we see. Key topics discussed: ✅ What we currently understand about the pathology of frozen shoulder ✅ Why frozen shoulder is more than a simple inflammatory condition ✅ The role of fibrosis, myofibroblasts and capsular thickening ✅ Pain-dominant versus stiffness-dominant presentations ✅ Early diagnosis and the potential role of ultrasound imaging ✅ Why patient education may be one of our most powerful interventions ✅ Primary versus secondary frozen shoulder – does it matter clinically? ✅ How metabolic, hormonal and psychosocial factors influence recovery ✅ Managing patient expectations throughout the course of the condition Clinical Takeaways • Frozen shoulder appears to be a complex systemic condition rather than simply a shoulder problem. • Understanding the pathological stage may help guide treatment decisions. • Early identification remains one of the biggest challenges in clinical practice. • Patient education and reassurance can have a profound impact on confidence and recovery. • Pain-dominant and stiffness-dominant presentations often require different management approaches. • The future of frozen shoulder management may lie in earlier recognition and intervention. This episode serves as a practical summary of the latest thinking in frozen shoulder and highlights how research is continuing to reshape our understanding of this frustrating condition. Whether you've listened to the entire series or are joining us for the first time, this conversation provides a comprehensive clinical update on where we currently stand with frozen shoulder in 2026. 🎧 Enjoy the final episode of our 5-Part Frozen Shoulder Series. For more information about Angela's projects, check out the following: Shoulder Academy link: www.shoulderacademy.co.nz https://learning.physioacademy.courses/pages/shoulder LinkedIn: https://www.linkedin.com/in/drangelacadogan/ Website: https://www.drangelacadogan.co.nz/about.html Margie Olds Socials Facebook https://www.facebook.com/shouldereducation/ Instagram https://www.instagram.com/margieolds/ LinkedIn https://www.linkedin.com/in/margie-olds-51586920/ Twitter / X https://x.com/margie_olds

Is frozen shoulder really a shoulder problem? In Part 4 of our Frozen Shoulder Series, I sit down with Italian physiotherapist and researcher Dr Fabrizio Brindisino, whose PhD explored the psychosocial impact of frozen shoulder and the factors that influence recovery. While much of the discussion around frozen shoulder focuses on pain, stiffness and range of motion, Fabrizio's work highlights a much broader picture. We explore how frozen shoulder can affect mood, sleep, work, family roles, social support and overall quality of life—and why these factors deserve more attention in clinical practice. We discuss the findings from his qualitative and prospective research, including how patient expectations often differ from clinician priorities, the impact of kinesiophobia and catastrophising on recovery, and why education and communication may be some of the most powerful tools clinicians have. Key topics discussed: ✅ Patient expectations versus clinician priorities ✅ The psychological and social impact of frozen shoulder ✅ Why night pain and loss of function affect much more than the shoulder ✅ Kinesiophobia and its influence on disability outcomes ✅ Catastrophising, fear and uncertainty in recovery ✅ The importance of education and therapeutic alliance ✅ Why frozen shoulder should be approached as a whole-person condition ✅ When physiotherapists should consider involving other healthcare professionals Clinical Takeaways • Frozen shoulder can affect every aspect of a person's life—not just shoulder movement. • Patients often prioritise pain relief and function, while clinicians may focus on reassurance and education. • Kinesiophobia appears to be an important predictor of disability and should not be overlooked. • Effective communication and shared decision-making are critical for improving engagement and adherence. • A comprehensive, patient-centred approach may be more effective than focusing solely on the shoulder itself. Whether you're a clinician treating frozen shoulder regularly or simply looking to better understand the person behind the condition, this episode offers valuable insights into the biopsychosocial factors that influence recovery. 🎧 Enjoy Part 4 of our 5-Part Frozen Shoulder Series. Follow Fabrizio Brindisino: LinkedIn: / fabrizio-brindisino-41aa1762 ResearchGate: https://www.researchgate.net/profile/... Instagram: / fabriziobrindisino

In Part 3 of our frozen shoulder series, I sit down with Dr Pablo Policastro, physiotherapist, researcher and educator from Buenos Aires, Argentina. Pablo recently completed his PhD exploring the role of the rotator cuff in frozen shoulder and shares some fascinating insights into muscle guarding, shoulder stiffness and the complex interaction between biology, pain and behaviour. We discuss why frozen shoulder may be much more than a capsular problem, how changes in range of motion challenge traditional assumptions about stiffness, and what current research can (and can't) tell us about the role of the rotator cuff. Pablo also explains his work investigating muscle architecture using ultrasound and why understanding muscle guarding may be an important piece of the frozen shoulder puzzle. Key topics discussed: ✅ What sparked Pablo's interest in the rotator cuff's role in frozen shoulder ✅ The concept of muscle guarding and why it matters clinically ✅ Why some patients gain range of motion much faster than expected ✅ Rotator cuff architecture, pennation angle and muscle thickness research ✅ The challenges of studying subscapularis in frozen shoulder ✅ The influence of fear, expectations and psychosocial factors on movement restriction ✅ Why frozen shoulder should be viewed as more than just a shoulder problem ✅ Clinical tips for reassessment, diagnosis and patient management One of the most thought-provoking discussions centres around a simple question: If the capsule is truly stiff and contracted, why do some patients show dramatic improvements in movement over a very short period of time? Whether you treat frozen shoulder regularly or only occasionally, this episode will challenge some assumptions and provide a fresh perspective on one of the most frustrating shoulder conditions we see in practice. 🎧 Enjoy Part 3 of our 5-part frozen shoulder series.

In Part 2 of this frozen shoulder series, Margie Olds continues the conversation with Michel Mertens and Dr Angela Cadogan, focusing on one of the most debated topics in frozen shoulder management: exercise and rehabilitation.Drawing on Michel’s PhD research, the discussion explores what the evidence actually says about exercise therapy for frozen shoulder — including insights from a systematic review and meta-analysis examining the effectiveness of exercise across different studies.The conversation tackles key clinical questions:• Should strengthening be included in frozen shoulder rehabilitation?• Does the timing of exercise matter across different stages of the condition?• What role do injections, hydrodilatation, or nerve blocks play?• And how should clinicians tailor treatment for individual patients?The group also discusses the importance of matching treatment to the stage of pathology, avoiding overly aggressive stretching in the early inflammatory phase, and the value of education, movement, and consistent messaging across healthcare providers.This episode highlights the importance of person-centred care, encouraging clinicians to move beyond rigid protocols and adapt treatment based on irritability, patient goals, and individual health factors.________________________________________🔑 Key Takeaways for Clinicians• Exercise therapy appears beneficial for improving pain, range of motion, and disability in frozen shoulder.• Evidence suggests exercise is helpful regardless of the exact program, although supervised exercise may offer slightly greater benefits.• Many studies use standardised programs, but future research should focus on stratified and person-centred approaches.• In the early inflammatory stage, movement should stay within the pain-free range to avoid worsening capsular restriction.• More aggressive stretching and mobilisation may be more appropriate later, once irritability decreases.• Corticosteroid injections appear most effective early, before significant stiffness develops.• Imaging is not routinely necessary unless red flags or alternative diagnoses are suspected.• Consistent messaging across clinicians is essential — conflicting advice can increase patient anxiety and slow recovery. For more information about Dr Michel Mertens LinkedIn: https://www.linkedin.com/in/michel-mertens University Antwerp: https://www.uantwerpen.be/en/staff/michel-mertens/ For more information about Dr Angela Cadogan: Shoulder Academy link: www.shoulderacademy.co.nz https://learning.physioacademy.courses/pages/shoulder LinkedIn ⁠⁠https://www.linkedin.com/in/drangelacadogan/⁠⁠ Website:⁠⁠ https://www.drangelacadogan.co.nz/⁠⁠ For more information about Margie Olds: Facebook https://www.facebook.com/shouldereducation/ Instagram https://www.instagram.com/margieolds/ LinkedIn https://www.linkedin.com/in/margie-olds-51586920/ Twitter X https://x.com/margie_olds Website www.margieolds.com

Frozen shoulder is one of the most common — and frustrating — conditions clinicians see in shoulder rehabilitation. But how well do we really understand it? In this episode of Glenohumeral Gurus, Margie Olds is joined by co-host Dr Angela Cadogan and Dr Michel Mertens to unpack the clinical course, diagnosis, and early management of frozen shoulder. Drawing on Michel’s PhD research, the discussion explores why frozen shoulder is so difficult to diagnose early, how irritability levels may guide treatment, and why the traditional belief that frozen shoulder is a “self-limiting condition” may not be entirely accurate. The conversation also dives into emerging ideas about the underlying mechanisms of frozen shoulder — including the role of systemic health, low-grade inflammation, metabolic conditions such as diabetes, and psychosocial factors. With Angela contributing both clinical expertise and the perspective of someone who has experienced frozen shoulder herself, this episode blends research, clinical reasoning, and real-world insights for clinicians managing this challenging condition. This is Part 1 of a two-part series on frozen shoulder with these guests, focusing on diagnosis, prognosis, and early management. Part 2 with these guests, focuses on rehabilitation of frozen shoulder. We will then dive into the role of the rotator cuff in frozen shoulder with Pablo Policastro (#43), and psychosocial factors in frozen shoulder (#44). Then a final wrap up session with Angela Cadogan (#45). ________________________________________ 🔑 Key Takeaways for Clinicians • Frozen shoulder can only be diagnosed once range-of-motion restriction is present, making early diagnosis challenging. • Early clinical suspicion may be possible, but currently no reliable early diagnostic tool exists. • Traditional phase models (3–4 phases) may be less clinically useful than thinking about pain-dominant vs stiffness-dominant stages. • Irritability levels (high, moderate, low) may be more helpful for guiding treatment intensity. • In the early inflammatory stage, movement should stay within pain-free range to avoid increasing capsular restriction. • Education and reassurance may play a major role in early recovery and preventing worsening stiffness. • Frozen shoulder may be linked to systemic factors, including diabetes, metabolic health, and low-grade inflammation. • Psychosocial factors such as pain catastrophising and pain vigilance appear to change alongside pain intensity over time. • Frozen shoulder is not always self-limiting, with some patients reporting persistent symptoms for several years. For more information about Dr Michel Mertens LinkedIn: https://www.linkedin.com/in/michel-mertens University Antwerp: https://www.uantwerpen.be/en/staff/michel-mertens/ For more information about Dr Angela Cadogan: Shoulder Academy link: www.shoulderacademy.co.nz https://learning.physioacademy.courses/pages/shoulder LinkedIn ⁠https://www.linkedin.com/in/drangelacadogan/⁠ Website:⁠ https://www.drangelacadogan.co.nz/⁠ For more information about Margie Olds: Facebook https://www.facebook.com/shouldereducation/ Instagram https://www.instagram.com/margieolds/ LinkedIn https://www.linkedin.com/in/margie-olds-51586920/ Twitter / X https://x.com/margie_olds

In this episode of Glenohumeral Gurus, Dr Margie Olds is joined by Pradnya Gadkari to unpack the key motor learning concepts discussed in the recent conversation with Wieger Heijink — and to reflect on what they really mean for clinical practice. Together, they explore how traditional biomechanical, load-focused rehabilitation models sit alongside (and sometimes clash with) theories of reflex control, motor program theory, dynamic systems, and constraint-led rehabilitation. If you’ve ever wondered whether focusing on specific muscles, movement variability, or environmental constraints truly changes outcomes — this episode dives deep into that question. From reflex latency (M1, M2, M3) to implicit versus explicit learning, to ecological dynamics and constraint manipulation, this is a thoughtful and practical discussion about how we organise movement, build capacity, and help patients with shoulder instability move more confidently. This episode challenges us to rethink whether we are strengthening tissue — or reorganising movement. ________________________________________ 🔑 Key Takeaways for Clinicians • Reflexes are layered and task-dependent — not simply spinal responses. • Motor program theory may not fully explain adaptability or movement variability in injured populations. • Dynamic systems theory suggests movement emerges from the interaction of: o The individual (pain, fear, fatigue, mobility) o The task (speed, accuracy, direction) o The environment (surface, visual input, context) • Patients with shoulder instability may not be “novice learners” — but constrained experts limited by pain or fear. • Implicit cueing versus muscle-specific instruction may influence movement organisation differently. • Kinetic chain changes may reflect movement organisation rather than pure strength deficits. • Isometric loading may increase awareness and expand movement options — not just build muscle capacity. Ultimately, this episode encourages clinicians to blend approaches — maintaining load management while thoughtfully manipulating task and environmental constraints to guide better movement solutions. Follow: Pradnya Gadkari LinkedIn: https://www.linkedin.com/in/pradnya-gadkari-4770a6a/ Follow Dr Margie Olds LinkedIn ⁠I ⁠ www.linkedin.com/in/margie-olds-51586920/ Facebook⁠⁠ I ⁠⁠ https://www.facebook.com/shouldereducation Instagram⁠⁠ I ⁠ www.instagram.com/margieolds/ YouTube⁠⁠ I ⁠https://www.youtube.com/playlist?list=PLsmEfkmzVQerw9rmjMo5RTJNZLd8coRdO Website⁠ ⁠I ⁠ ⁠⁠⁠⁠https://margieolds.com/⁠⁠

What if the shoulder isn’t the problem… but the victim? In this first episode of a 3-part series with Dutch physiotherapist Wieger Heijink, we explore motor control, implicit learning, and why traditional, isolated shoulder exercises might be missing the bigger picture. This is not a “throw out the theraband” conversation. But it is a challenge to some of our most embedded assumptions. ⚠️ Important: These concepts are interesting and evolving. The research base in injured shoulder populations is still limited. But the ideas may change how you think about movement, pain, and rehabilitation. ________________________________________ 🔑 Key Concepts from Part 1 🧠 Movement is self-organising Learning to move isn’t purely cognitive. The body adapts through exploration within a task and environment — not through step-by-step instructions. 🔄 The shoulder is a complex dynamic system It’s non-linear. Small changes can create phase shifts in movement. A “tendon problem” may not be as simple as load-in = healing-out. 🎯 Implicit vs Explicit Learning • Explicit = “Keep your scapula down.” • Implicit = Give a task, let the system solve it. Research across sport consistently supports external focus and implicit strategies for learning and retention. 🌍 External Focus > Internal Focus Don’t focus on the body part. Focus on the outcome of the movement. Hit the target. Stay balanced. Solve the puzzle. 🧩 Constraints drive adaptation Rather than cueing muscles, manipulate the environment: • Change balance • Add perturbation • Alter task demands Let movement variability emerge. 🧵 Muscle synergies > isolated muscles Pain changes patterns across the whole system. Training one muscle in isolation may not restore the coordination problem underneath. ________________________________________ 🧠 Clinical Takeaways ✔️ We may be oversimplifying shoulder rehab by thinking linearly (tear → load → heal). ✔️ Pain alters global movement patterns — not just one muscle. ✔️ Consider using more task-based, externally focused challenges early. ✔️ Balance, variability, and problem-solving may restore fluid movement patterns. ✔️ Protect painful structures — but move everything else. ✔️ We don’t yet have strong injured-shoulder RCT evidence for this approach — but the motor learning principles are well established in sport science. ________________________________________ This episode lays the theoretical foundation. In Parts 2 & 3, we get practical — how to apply these ideas in shoulder rehabilitation. If you’ve ever wondered whether cueing “more lower trap” is the whole story… this one is worth your time. Follow Wieger Heijink LinkedIn: https://www.linkedin.com/in/wieger-heijenk-0584a924a/ Follow Margie Olds on Social Media: ⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠ ⁠I ⁠https://www.linkedin.com/in/margie-olds-51586920/ ⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠ I ⁠⁠https://www.facebook.com/shouldereducation/ ⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠ I ⁠https://www.instagram.com/margieolds/ ⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠ I ⁠https://studio.youtube.com/playlist/PLsmEfkmzVQerw9rmjMo5RTJNZLd8coRdO/videos ⁠⁠⁠⁠Website⁠ ⁠I ⁠ ⁠⁠www.margieolds.com

Protect, Perturb, Perform: The 3 P’s of Shoulder Rehab (Part 3) What if fear — not weakness — is the biggest constraint in shoulder rehab? In Part 3 of this series with Wieger Heijink, we dive deeper into constraint-led rehabilitation, co-contraction, and how to restore confidence and protection in athletic shoulders. This episode challenges the idea that instability is simply a strength problem — and reframes it as a coordination and constraint issue within a complex system. ________________________________________ 🔑 Key Themes in Part 3 ⚖️ Fear as a Constraint Fear narrows movement options. Patients aren’t “novice learners” — they’re skilled movers operating under constraint. 🎯 The Flow Zone Too easy → boredom. Too hard → anxiety. Rehab should sit in the sweet spot between skill and challenge. 🛡️ Co-Contraction as Protection Protection isn’t about one muscle firing. It’s about timely, efficient system-wide co-contraction during energy transfer. 🏃‍♂️ The 3 P’s of Training Protection • Perturbation – external instability • Time Pressure – fast reactions • Preflexes – automatic bracing responses Together, these improve protective timing and force rate development. 🔄 Energy Transfer & Direction Change In throwing, tackling, and overhead sport, risk occurs during change of direction — not just end range. Protection is about timing. 🧠 Skillful Variability “Repetition without repetition.” The goal isn’t rigid stability — it’s adaptable stability. ________________________________________ 🧠 Clinical Takeaways ✔️ Don’t confuse stiffness with protection. ✔️ Fear changes movement patterns — adjust difficulty to restore flow. ✔️ Early rehab can challenge the system without stressing the injured structure. ✔️ Use perturbations and time pressure to train protection. ✔️ Stability is about coordination and timing — not just muscle strength. ✔️ Expect your own performance to dip when trying new approaches — skill acquisition applies to clinicians too. ________________________________________ This episode wraps the series by moving from theory → rehab → advanced protection strategies. If Parts 1 and 2 made you question isolated strengthening… Part 3 gives you a framework for progression. And yes — there may be a unicycle involved. Follow Wieger Heijink LinkedIn: https://www.linkedin.com/in/wieger-heijenk-0584a924a/ Follow Margie Olds on Social Media: ⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠ ⁠I ⁠https://www.linkedin.com/in/margie-olds-51586920/ ⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠ I ⁠⁠https://www.facebook.com/shouldereducation/ ⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠ I ⁠https://www.instagram.com/margieolds/ ⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠ I ⁠https://studio.youtube.com/playlist/PLsmEfkmzVQerw9rmjMo5RTJNZLd8coRdO/videos ⁠⁠⁠⁠Website⁠ ⁠I ⁠ ⁠⁠www.margieolds.com

What if your shoulder rehab is too simple? In Part 2 of this series with Wieger Heijink, we move from theory into rehabilitation — applying implicit motor learning principles to real shoulder cases. This episode challenges the classic “tendon → load → heal” thinking and explores a more ecological, systems-based approach to recovery. ⚠️ These strategies are concept-driven and evolving. High-quality RCTs in injured shoulder populations are still lacking. But the principles may change how you design rehab tomorrow. ________________________________________ 🔑 Key Concepts in Part 2 🌍 Ecological Approach to Rehab Movement always happens within a task and environment. Rehab should reflect that. 🧠 Non-Linear Recovery You can’t give one exercise and expect a predictable outcome. The shoulder is a complex dynamic system. 🎯 Intention Drives Movement Patients need a task. Movement without intention lacks adaptation. ⚖️ Use Balance to Drive Adaptation By manipulating balance and environment: • You increase force rate development • You challenge coordination • You stimulate muscle synergies • You remove stiffness 🧩 Constraints Shape Learning Instead of cueing muscles: • Limit options • Change task demands • Alter speed or direction • Create “puzzles” Let the body reorganise itself. 🔄 Action–Perception Coupling The motor and sensory systems are inseparable. If there is no feedback — it’s not optimal learning. Exercises should allow the patient to know immediately: Am I doing this well? Or not? 🏆 Early Wins Matter Creating meaningful change in your first session: • Builds self-efficacy • Improves adherence • Strengthens therapeutic alliance ________________________________________ 🧠 Clinical Takeaways ✔️ Consider reducing isolated muscle cueing. ✔️ Increase task-based, externally focused challenges. ✔️ Use balance and environment to shape movement patterns. ✔️ Prioritise force rate development early — not just strength. ✔️ Protect painful structures — but move the system. ✔️ Ensure exercises contain feedback. And perhaps most importantly: 👉 If there’s no action–perception coupling… question the exercise. ________________________________________ This episode is practical, provocative, and likely to stretch your thinking. Part 3 continues the conversation, diving deeper into applying constraints, clinical decision-making, and real-world examples. If you’re curious about moving beyond therabands and into movement systems… this one is for you. Follow Wieger Heijink LinkedIn: https://www.linkedin.com/in/wieger-heijenk-0584a924a/ Follow Margie Olds on Social Media: ⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠ ⁠I ⁠https://www.linkedin.com/in/margie-olds-51586920/ ⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠ I ⁠⁠https://www.facebook.com/shouldereducation/ ⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠ I ⁠https://www.instagram.com/margieolds/ ⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠ I ⁠https://studio.youtube.com/playlist/PLsmEfkmzVQerw9rmjMo5RTJNZLd8coRdO/videos ⁠⁠⁠⁠Website⁠ ⁠I ⁠ ⁠⁠www.margieolds.com

Beyond Time-Based Rehab: Rethinking Bankart & Return to Sport (Part 2) Are we progressing shoulder instability rehab too quickly… and measuring the wrong things? In Part 2 of my conversation with Dr Kathryn Fahy, we step inside Aspetar — one of the world’s leading sports medicine hospitals — to explore how they are rebuilding their shoulder pathway from the ground up. This episode dives into post-Bankart rehabilitation, criteria-based progression, return-to-sport testing, and why simply waiting six weeks in a sling might not be the answer. ________________________________________ 🔑 Key Takeaways 1️⃣ Time alone is not enough Traditional protocols are heavily time-based. Kathryn challenges this approach and explores earlier mobilisation, clearer criteria, and better sequencing. 2️⃣ Motor control matters more than we think -Before strength. -Before power. -Before return to sport. Spending longer in the foundational motor control phase may improve long-term outcomes. 3️⃣ Active ≠ passive range is a red flag If athletes have passive range they cannot actively control — especially in high-risk ranges — they may be living in a “danger zone.” 4️⃣ Exit criteria > arbitrary timelines Aspetar is working toward clear phase exit criteria: Motor control → Strength → Power → Reactive power → Sport specific load. 5️⃣ Population matters -Hypermobile athletes. -High-contact footballers. -Throwers. Different cohorts demand different decisions — and not all research generalises. 6️⃣ Confidence drives outcomes Fear of instability remains a major barrier to return to play. Building athlete confidence — and clinician confidence — is central. ________________________________________ 🧠 What This Means for Clinicians • Slow down your early phase rehab. • Prioritise control before capacity. • Question purely time-based progression. • Measure what matters — not just what’s easy. • Be honest with patients: we don’t know everything. • Always have a Plan B. This episode is a reminder that shoulder rehab is still evolving — and that better questions may be more powerful than rigid protocols. Part 1 covered large rotator cuff tears and the Calmer Cuff pathway. Part 2 explores instability, progression, and return-to-sport decision making. If you work with shoulder athletes — especially contact or overhead populations — this one is for you. Check out the Aspetar shoulder journal that Kathryn co-edited. Aspetar Shoulder Edition: https://journal.aspetar.com/en/journals/volume-14-targeted-topic-the-athletic-shoulder Follow Kathryn Fahy: Linked In: https://www.linkedin.com/in/kathryn-fahy-0400a823/ Follow Margie Olds on Social Media: ⁠⁠⁠⁠⁠⁠LinkedIn⁠⁠⁠⁠⁠ ⁠I ⁠https://www.linkedin.com/in/margie-olds-51586920/ ⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠ I ⁠⁠https://www.facebook.com/shouldereducation/ ⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠ I ⁠https://www.instagram.com/margieolds/ ⁠⁠⁠⁠⁠YouTube⁠⁠⁠⁠⁠⁠⁠ I ⁠https://studio.youtube.com/playlist/PLsmEfkmzVQerw9rmjMo5RTJNZLd8coRdO/videos ⁠⁠⁠⁠Website⁠ ⁠I ⁠ ⁠⁠www.margieolds.com

In this episode of Glenohumeral Gurus, I sit down with Dr Kathryn Fahy — physiotherapist, researcher, and former elite performance clinician — to unpack her journey into large and massive rotator cuff tears… and why we might need to rethink how we manage them. Kathryn shares how her own experience as a post-op athlete sparked a career-long interest in shoulder rehab, leading her from Ireland to a PhD exploring conservative management for large rotator cuff tears. We dive into: • What the research actually says about exercise vs surgery in large/massive cuff tears • Why systematic reviews can mislead us if populations aren’t clearly described • The problem with poorly reported exercise interventions in research • Why listening to patients changed the direction of her PhD • The major gaps in care pathways for this cohort • And how this led to the development of the “Calmer Cuff” — a patient-centred clinical pathway designed to improve confidence, clarity, and decision-making This conversation challenges the idea that large cuff tears automatically equal surgery and highlights the importance of better education, better documentation, and better communication between clinicians, GPs, surgeons, and patients. Part 1 focuses on cuff tears and the Calmer Cuff pathway. In Part 2, we head to Aspetar to explore return-to-sport testing and performance rehab. If you work with shoulder pain — particularly large rotator cuff tears — this is one you won’t want to miss. Links from the show: Calmer Cuff: https://www.jospt.org/doi/full/10.2519/jospt.2025.13342 Consensus on Exercise Reporting Template (CERT): https://bjsm.bmj.com/content/50/23/1428 Follow Dr Kathryn Fahy: LinkedIn: https://www.linkedin.com/in/kathryn-fahy-0400a823/ Follow Dr Margie Olds. ⁠LinkedIn ⁠I ⁠ / margie-olds-51586920 Facebook⁠⁠ I ⁠⁠ / shouldereducation Instagram⁠⁠ I ⁠ / margieolds YouTube⁠⁠ I ⁠https://studio.youtube.com/playlist/P... Website⁠ ⁠I ⁠ https://margieolds.com/

In this episode, Margie speaks with Stacey Lalande, a shoulder physio, clinician–researcher, and incoming NIHR doctoral fellow. Stacey shares her evolving work on shoulder osteoarthritis (OA) — from understanding subgroups, to the gaps in current guidelines, to real-world issues navigating care. She also discusses instability arthropathy in younger patients, lifestyle contributors, the role of injections, and how clinicians can improve assessment and shared decision making. ________________________________________ 🔑 Key Takeaways 1. Shoulder OA is not a single condition — different pathways matter • Older adults often present with slowly progressive pain + stiffness. • Younger patients with instability arthropathy have a distinct traumatic pathway and different needs. • Lifestyle/metabolic factors (e.g., obesity, systemic inflammation) may meaningfully contribute — similar to hand OA where mechanical load isn’t the cause. 2. Current guidelines are borrowed from hip & knee OA — and may not fit • NICE OA guidelines are frequently applied to shoulders, but evidence informing them is almost entirely hip/knee. • Stacey’s work shows that physiotherapists report adhering to guidelines, yet patients describe difficulty navigating care and receiving vastly inconsistent advice. 3. Patients value accurate diagnosis + clear signposting more than anything • Qualitative findings show major gaps in: o getting a diagnosis o understanding what OA means o knowing where to find trustworthy information • Good education + guidance may outperform frequent in-clinic sessions for many patients. 4. Injections: practice is shifting, evidence is unclear • Suprascapular nerve blocks are increasingly used for pain relief—especially in older adults or when surgery isn’t appropriate. • Benefits appear meaningful for some, but optimal technique, dosing, and long-term consequences remain uncertain. • Steroid injections may provide temporary pain relief but may also accelerate cartilage degeneration. Shared decision making is essential. 5. Behavioural and lifestyle contributors should not be overlooked • BMI and systemic low-grade inflammation may contribute to symptom persistence. • This supports encouraging lifestyle modification (“control the controllables”), even though shoulder-specific evidence is limited. 6. Manual therapy + stretching may help some patients—mechanism unclear • Hands-on techniques likely assist by reducing muscle guarding or breaking the pain cycle. • Strengthening evidence is limited; range-focused programs may still have value. • Denmark feasibility studies suggest progressive exercise is possible and helpful, but larger trials are needed. 7. Shoulder replacement surgery is increasing—and happening in younger people • Reverse arthroplasty use is rising and now performed in younger age groups. • Recovery benchmarks: o Sling for ~4 weeks o “Good function” by 3 months o Peak recovery ~12–18 months • Pre-operative optimisation (strength, fitness, health) meaningfully improves outcomes. ________________________________________ 🧪 Clinical Pearls • Morning stiffness + pain with activity remain hallmark features. • Always obtain AP + axillary views to confirm diagnosis. • Instability arthropathy carries 10–20% higher OA risk after a dislocation. • Cuff status (intact vs cuff arthropathy) remains crucial for prognosis and management. • OT involvement is underused and can support work capacity + lifestyle modification. ________________________________________ 🩺 What This Means for Your Clinical Practice • Don’t assume all shoulder OA is the same — subgroup thinking improves care. • Provide diagnosis clarity, reinforce patient understanding, and offer high-quality resources. • Use shared decision making when considering injections or surgery; be transparent about risk–benefit balance. • Exercise programs should emphasise tolerance, range, and functional confidence See www.margieolds.com/podcast for resource links