Manage Shoulder Pain in A Honest & Non-Bullshit Way in Physiotherapy: A Candid Critic's Voice

In the world of medicine, there is always a critical shortage of effectiveness in treatments, but there is never lack of stupidity. Even worse is that a stupid idea could soon become an echo chamber which in turn isolates the blind believers from the real world, thus the desired constant advance of medical science & technology is rendered impossible.

Stupid Stuff in Musculoskeletal Medicine

Particularly in musculoskeletal medicine world:

• “… musculoskeletal clinicians have invented treatments for conditions that may not exist or be readily detected (such as trigger points, sacral torsions), and they have developed and perpetuated treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) that do not conform to current research evidence” (Lewis J al, 2018).
• The biomechanical model (BMM) for “the effectiveness of manual therapy in the treatment of pain makes many unproven assumptions, has many obvious demonstrated flaws and lacks prior biologic plausibility and thus, should seriously be questioned” (Wellens F et al, 2010).

Voices for Reform

In 2018, the British Journal of Sports Medicine in an editorial strongly voiced: "Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Current Approach to Musculoskeletal Pain Is Failing …" (Lewis J et al, 2018).

The leading author of the editorial is Professor Jeremy Lewis, who is also a consultant physiotherapist working in the UK-NHS.

Since 1990s, in many medical fields including physiotherapy, self-critiques and calls for reform have become a stronger and stronger voice. The reason is that “The public are increasingly aware of health professions’ fallibilities, and are far more skeptical about their claims to be the best people to manage the health of the population” (Nicholls, D.A, 2018, 2021).

A Pungent Critic Advocator for Reform

In physiotherapy community, Adam Meakins, a sports physiotherapist working in the NHS and private practice in the UK, is one of the most followed reform advocators across all social media platforms.

Meakins has lectured for Brunel University on their undergraduate physiotherapy program, and is also actively involved in several clinical research projects and has published papers in peer-reviewed journals on manual therapy, frozen shoulder & shoulder symptom modification.

He is particularly known for his strong views, opinions, and occasionally stronger language which has irritated many of his PT fellows. As an anonymous PT on reddit.com put it: “Adam Meakins... A lot of people don't like him because he's completely unapologetic about it, but as Falcon says: he's outta line but he's right.”

A Reformer's Fighting against Stupidity

Meakins's main philosophy, in his words, is “to do the simple things really well and dont get distracted by all the fancy complex bullshit that's rarely needed but riddles the profession”. Meakins calls the stupidity in physicotherpy field “the fancy complex bullshit”.

I am not a PT. But as a health care practitioner, I found Meakins' strong voices against the bullshit or stupidity which is stifling or suffocating a profession applies to many other healthcare professions, although I would like to use “stupid echo chambers” in place of the word “b...t”.

Management of Shoulder Pain without Bullshit

Meakins teachs the course “Painful Shoulder Complex not equals Complicated” online. He desribes his course as “evidence-based, person centred, no bullshit, approach to assessing and treating all types of painful shoulder issues in all types of people!”

I noticed he always presents his ideas based on extensive research of scientific evidences (data from RCTs).

According to his website, through learning his course, one can expect to get at least the following benefits:

Managing Misinformation

Includes...

• The landscape of healthcare misinformation
• The basics of critical thinking
• Spotting bullshit better
• Managing misinformation in others 
• Case Study: Misinformed Mavis
• Practical Tasks

Using The Evidence

Includes...

• What is and isn't evidence-based practice
• How to read and review research better
• How to use research with others better
• How to share research with others better
• Case Study: Non Evidence-based Eric

Changing Minds

Includes...

• The basics of motivational interviewing
• Managing resistance to change in others
• Facilitating change in yourself and others
• Making changes that matter and stick

Increased Confidence

In how to assess, treat, and manage painful shoulders.

Assessment Skills

Learn how to communicate, build rapport, earn trust, and conduct a full and thorough assessment

No Silly B--S

Just simple, honest, practical, evidence-based advice and info.

A Brief of The Course

According to Meakins' website, this course takes an in-depth, honest, realistic, and pragmatic look at the most common causes and solutions of painful shoulders, from professional athletes to the general population.

Whom This Course Will Benefit

According to Meakins' website, this course is suitable for all rehab professionals and therapists regardless of their professional titles or personal experience who want a straight forward, no-nonsense, sensible way to assess and treat painful shoulders.

To Whom This Course Is Open

This program is open to...

Physiotherapists

Osteopaths

Chiropractors

Sports Therapists

Exercise Physiologists

Soft Tissue Therapists

Athletic Trainers

Personal Trainers

S & C Coaches

And anyone else who works with people in pain.

The Fee

A Honest Disclaimer: No Quick Fixes or Miracle Cures Promised

As a disclaimer, the honest reformer further warned his followers: This course doesn't promise quick fixes or miracle cures, but instead gives you the confidence to manage painful shoulders with some simple practical tools that you can use immediately.

Deeper Thinking

In my view, the biggest contribution of Meakins' endeavor is that he smashed out a crack in the bullshit echo chamber which has tightly isolated his beloved profession into delusion from the real world.

I like Meakins' pungency & candidness because they sting. It delivers a much-needed slap across the face of health-care providers particularly in musculoskeletal field, a slap we need to rouse us from our stupid or bullshit delusion which has brought the development of medical science and technology to a halt.

Irritated with Meakins' pungency or not, we all wish our medical science & technology will constantly advance to benefit at least ourselves and our loved ones.

References

Lewis J et al, Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? Br J Sports Med 2018;0:1–2.

Meakins S, Painful Shoulder Complex Not Equals Complicated with Adam Meakins. Adammeakins.com (accessed on Nov. 29, 2024)

Nicholls, D. A. (2018). The End of Physiotherapy. Oxon/New York: Routledge.

Nicholls, D.A., Physiotherapy Otherwise, Auckland University of Technology. December 14, 2021

Wellens F et al, The traditional mechanistic paradigm in the teaching and practice of manual therapy : Time for a reality check . Published 2010 Medicine