Show Notes
Jared is joined by Tim Cook who is Senior Lecturer in Physiotherapy at the University of Chichester, Advanced Physiotherapy Practitioner in the NHS, and doctoral researcher to discuss their new paper with Prof. Jeremy Lewis in the Journal of Manual & Manipulative Therapy: "Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle."
Tim explains what pushed him to question routine strength testing in busy clinical practice, despite guidelines recommending it, and the pair dig into whether weakness is a cause of shoulder pain, a consequence of it, or something else altogether. They look at what subacromial anaesthetic injection studies reveal about pain versus true force output, and Tim reframes the classic "weak and painful shoulder" as the "flexible but painful shoulder," drawing parallels to other oversimplified clinical narratives like posture and core stability.
They also make the case for when strength testing can still earn its keep; patient engagement, expectation violation, building confidence, and sporting or return-to-performance populations such as ACL limb symmetry index, before turning to Goodhart's Law and the risk of chasing the test rather than the outcome, and why isolated isometric tests may not translate to real-world, endurance-based shoulder tasks. Tim closes out with an update on his PhD: a reliability RCT on strength and pain-free assessment currently in press, and an upcoming scoping review on the proposed mechanisms of exercise for RCRSP.
Key resources
Cook, T., Lewis, J., & Powell, J. (2026). Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle. Journal of Manual & Manipulative Therapy, 34(3), 193–198. https://doi.org/10.1080/10669817.2026.2663623
Register for the complete shoulder online course
Melbourne workshop details
Connect with Jared:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
Tim on Instagram: @Timcookphysio
See our Disclaimer here: The Shoulder Physio - Disclaimer
More from The Shoulder Physio Podcast
Jared is joined by Professor Chad Cook who is one of the great researchers and academics in the field of physical therapy.
Jared is joined by Professor Jeremy Lewis who really needs no introduction but we will give him one just for fun.
The supraspinatus is one of the most misunderstood muscles in the human body. This episode aims to correct that.
A peanut isn't dangerous until it meets someone who can't tolerate it. Same with the upright row exercise. This episode scrutinises the "worst exercise for your shoulder" claim by tracing it back to a theory that's already dead, then shows what determines outcome: the person lifting. Shock. Horror.
Is there really one correct way to move? For decades, clinicians and coaches have acted like there is. In this episode, we prosecute that idea.