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Pokohiwi Mārōrō - the Otago Shoulder Health (OtShoH) Project

About the Research

Gisela Sole 2020 imageShoulder pain is complex. Injury may or may not cause pain. We also need to consider how general health, well-being and lifestyle influence pain. Lastly, we need to consider how the brain and nerves process information from the shoulder and elsewhere in the body with past experiences, the ‘neuroscience’ or biology of pain.

Shoulder pain associated with rotator cuff related shoulder pain (sub-acromial pain syndrome) is common in middle-aged and older adults. That pain can  lead to long term shoulder pain, stiffness and weakness, and limit self-care, physical activity, and work-related tasks. In younger and older individuals, shoulder dislocations can limit their sports and work for extended periods.

Patient understanding of their injury and of pain is critical for pain self-management. Besides understanding the possible injury (if present), we also need to understand how pain is influenced by possible stressors of life, other health disorders (such as diabetes, or being overweight), general physical activity and lifestyle factors.

This research explores how we use patient education as part of rehabilitation for patients with persistent shoulder pain and their whānau. In parallel, we are exploring how shoulder pain changes movement patterns and behaviour. We use a combination of qualitative studies that seek participation and input from patients and clinicians, and laboratory-based studies. We are planning projects that are relevant for clinical practice and to improve health and well-being for patients with shoulder pain.

Specific objectives of current and future studies include:

  • Developing resources that can be used by patients and clinicians as part of rehabilitation for rotator cuff related pain, in collaboration with patients and clinicians.
  • Enhancing flexibility and access to physiotherapy for individuals with shoulder pain.
  • Improving self-confidence of individuals to manage their shoulder pain, stay active and lead a healthy lifestyle.

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Research funding

Sole G, Swain N, Samaranayaka A, Perry M, Ribeiro DC, Roy JS (2021). The effectiveness of manual therapy with pragmatic multi-modal physiotherapy for rotator cuff syndrome: a pilot randomized, non-inferiority controlled trial. Stanley Paris Research Fellowship: $100,000
  Updates: This study is now recruiting participants to take part in our trial in Dunedin and Christchurch.  See our study page for more information. 

Sole G, Swain N, Calder A, Acker R, Pons T, Wassinger C, Longnecker N (2020). Patient education and self-management for painful shoulders. Health Research Council Activation Grant: $27,023 .  
  Updates: As an output from this funding and prior research we partnered with TurboWeb Design to produce a website to better support people living with shoulder pain.

Sole G, Olds M, Wassinger C (2020). Factors influencing anxiety and fear of re-injury following glenohumeral dislocation: patients’ perspectives. New Zealand Manipulative Physiotherapy Association: $4,344

Sole G, Ribeiro D, Perry M, Swain N, Wassinger C (2017). Feasibility of neuroscience-informed physiotherapy for persistent shoulder pain. Jack Thomson Arthritis Grant: $23,699

Sole G, Perry M, Ribeiro D, Swain N, Wassinger C (2017). My shoulder has a brain: patient and physiotherapists’ perspectives of a psychologically-informed rehabilitation approach for shoulder pain. Physiotherapy New Zealand Scholarship Trust Fund: $4,206

Sole G, Ribeiro D, Jayakaran P, Wassinger C (2015). A neuroscience approach to pain management for patients with rotator cuff syndrome: a case series. Physiotherapy New Zealand Scholarship Trust Fund $2,990; New Zealand Manipulative Physiotherapists Association: $4,670; Total: $7,660

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Research students

Honours students

Rosey Acker (2019): Patients’ perspectives a neuroscience-integrated physiotherapy programme for rotator cuff related shoulder pain.

Karen Meehan (2017): Advice and patient education in physiotherapy management of patients with rotator cuff-related pain: a scoping review and focus group study

Melissa Gillespie (2016): Rotator cuff syndrome: patients’ understanding and experiences of their pain.

PHTY 650 students

Roger White (2020). Psychosocial and clinical self-reported outcomes of patients presenting to specialist shoulder physiotherapy clinics: a retrospective analysis


White RJ, Olds M, Cadogan A, Betteridge S, Sole G (2022). Shoulder pain, disability and psychosocial dimensions across diagnostic categories: profile of patients attending shoulder physiotherapy clinics. New Zealand Journal of Physiotherapy, 50:6-20

Meehan K, Wassinger C, Roy JS, Sole G (2020). Seven key themes in physical therapy advice for patients living with subacromial shoulder pain. A scoping review. Journal of Orthopeadic and Sports Physical Therapy. 50:285-29

Wassinger CA, Lumpkins L, Sole G (2020). Lower extremity aerobic exercise as a treatment for shoulder pain. International Journal of Sports Physical Therapy, 15:74-80

Sole G, Maçznik A, Ribeiro D, Jayakaran P, Wassinger C (2020). Perspectives of participants with rotator cuff-related pain to a neuroscience-informed pain education session: an exploratory mixed method study. Disability and Rehabilitation, 42:1870-1879

Gillespie M, Mącznik A, Wassinger C, Sole G (2017). Rotator cuff-related pain: patients’ understanding and experiences. Musculoskeletal Science and Practice 30:64-71

Spall P, Ribeiro DC, Sole G (2016). Electromyographic activity of shoulder girdle muscles in patients with symptomatic and asymptomatic rotator cuff tears: a systematic review and meta-analysis. Physical Medicine and Rehabilitation, doi: 10.1016/j.pmrj.2016.02.015

Ribeiro DC, Falla C, Shemmell J, Sole G (2016). Shoulder muscle activity during the modified dynamic relocation test and side-lying shoulder external rotation: a cross-sectional study on asymptomatic individuals. Journal of Manual and Manipulative Therapy, doi: 10.1080/10669817.2016.1157945.

Ribeiro DC, Castro M, Sole G, Vicenzino B (2016). The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: a repeated measures study on asymptomatic shoulders. Manual Therapy 22:101-108

Fyhr C, Gustavsson L, Wassinger C, Sole G (2015). The effects of shoulder injury on kinaesthesia: a systematic review and meta-analysis. Manual Therapy, 20:28-37

Sole G, Osborne H, Wassinger C (2015). The effect of experimentally-induced subacromial pain on proprioception. Manual Therapy, 20:166-170

Sole G, Osborne H, Wassinger C (2014). Electromyographic response of shoulder muscles to acute experimental subacromial pain. Manual Therapy, 19:343-348

Wassinger CA, Sole G, Osborne H (2013). Clinical measurement of scapular upward rotation in response to acute subacromial pain. Journal of Orthopaedic and Physical Therapy, 43:199-203

Ho CC, Sole G, Munn J (2009). The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Manual Therapy 14:463-474

Brandt C, Sole G, Krause MW, Nel M (2007). An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint. Manual Therapy 12:3-11

Sole G (2003). A multi-structural approach to treatment of a patient with sub-acromial impingement: a case report. Journal of Manual and Manipulative Therapy 11(1) 49-55


Sole G, Stein J, Calder A, Pons T, Swain N, Acker R, Wassinger C, Longnecker N (2022) Pokohiwi Mārōrō-Otago Shoulder Health. Website created to provide information for people with shoulder pain.


Sole G, Swain N, Perry M, Wassinger C. Moving beyond the shoulder: a feasibility trial to integrate holistic patient education with usual physiotherapy. World Physiotherapy Congress Online, 8th to 10th April 2021.

Shoulder360 : Navigating between clinical practice and research. Symposium presented by CHARR, January 2020, School of Physiotherapy, University of Otago, Dunedin.

Jones JF, McGrath J, Clayton A, Buehler M, Sole G, Wassinger CA Common Shoulder Pain Websites: An Assessment of Content Quality, Bias, and Readability. American Physical Therapy Association Combined Sections Meeting. Washington, D.C., January 23-26, 2019.

Meehan K, Perry M, Wassinger C, Sole G. Physiotherapists’ perspectives on the use of advice and education for patients with rotator cuff-related pain. Physiotherapy New Zealand biennial conference, Dunedin, New Zealand, 14-16th September 2018.

Sole G. Biomechanics and Neurosciences: conflict or concordance for musculoskeletal disorders? Invited speaker at the Physiotherapy New Zealand biennial conference, Dunedin, New Zealand, 14-16th September 2018

Sole G, Mącnik A, Ribeiro DC, Jayakaran P, Wassinger C. “It’s about our whole”: responses of participants with rotator cuff-related pain to a neuroscience pain education session. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18)

Gillespie M, Mącnik A, Wassinger C, Sole G. Rotator cuff-related pain: patients’ understanding and experiences. Podium presentation at the NZ Manipulative Physiotherapists Association, Rotorua, 19/20 August 2017 (Abstract book p 18) Won the “Best Presentation” award at the conference.

Roy JS, Michener L, Cools A, Sole G, Struyf F. Why rotator cuff tendinopathies become chronic. Member of this international Focussed Symposium that was accepted by the World Confederation of Physical Therapy (WCPT) conference, Cape Town, 2-4 July 2017.

Gillespie M, Mącznik, Wassinger C, Sole G (2016). Rotator cuff related pain: patients’ understanding and experience. Presentation at Otago Medical School Research Society Masters/Honours meeting, November 2016. Abstract published in the proceedings, NZ Medical Journal (2017), 130 (1448).

Research team

Project lead: Associate Professor Gisela Sole

Co- researchers:

Associate Professor Nicola Swain (Department of Psychological Medicine, University of Otago)
Professor Nancy Longnecker (Department of Science Communication)
Dr Ally Calder (School of Physiotherapy, Christchurch)
Rosey Acker (School of Physiotherapy Clinics, Dunedin)
Dr Margie Olds, (Registered Physiotherapy Specialist – Musculoskeletal; Auckland Shoulder Clinic)
Dr Tracey Pons, (Registered Physiotherapy Specialist – Pain)  
Dr Ricky Bell, Bodyhealth Physiotherapy Ltd, Hamilton

International collaborators:

Prof Jean-Sébastien Roy (Laval University, Canada)
Associate Professor Craig Wassinger (Doctor of Physical Therapy Program, Tufts University, USA)

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