The long head of biceps tendon and superior labrum can get a hard time in throwing athletes and patients that fall on their arm or shoulder. This can result in long head of biceps tendon pathology or SLAP tears, and cause ongoing shoulder pain.

A lot of our shoulder tests are non-specific, and are unable to identify particular structures that are irritated or painful in the shoulder. In the case of the long head of biceps (LHB) tendon and slap tears, there are a few useful tests that in combination with a good history can help you identify when the structures are involved in your patient's shoulder pain.

In episode 77 of the Physio Edge podcast, Jo Gibson, Shoulder Specialist Physio and David Pope discuss anterior shoulder pain, LHB pathology and SLAP tears. You will discover:

• Anatomy of the long head of biceps tendon and superior labrum
• Why the anatomy is important, and may be different to what you learnt at university around the biceps tendon and bicipital groove
• The clinical presentation and relevant history of patients with SLAP lesions and LHB tendon pathology
• Which patients are more likely to get SLAP tears following trauma
• Special tests that may help you identify LHB pathology and SLAP tears
• What information imaging gives us
• When to request imaging for your shoulder pain patients
• Different groups of patients that develop LHB pathology
• Rehabilitation of LHB tendon pathology and SLAP tears
• When to specifically target the LHB tendon, and when to target the surrounding structures for best results
• Other areas to consider in your rehab beyond the shoulder
• How the kinetic chain can impact shoulder pain
• How someone's hop distance can influence their shoulder pain
• How to start treatment of someone with an irritable LHB tendon
• Important education components to include in your treatment
• Time frames - How long do these injuries take to recover?
• Which patients are suitable for surgical management?
• Different types of surgery for LHB tendon pathology
• Which SLAP tear patients should have conservative treatment?
• How suprascapular nerve involvement can present following traumatic shoulder injury, and how to identify patients with suprascapular nerve compression

Links of Interest

• Free Shoulder assessment videos with Jo Gibson - a series of three evidence-based videos to get you great results with shoulder pain

• Free sports injuries videos including the AC joint with Jo Gibson

• Download and subscribe to the podcast on iTunes

• Jo Gibson on Twitter - @ShoulderGeek1

• Let David Pope know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Like the podcast on Facebook
• Infographics by Clinical Edge
• Courses - Steps to Success

Articles associated with this episode:

• Hendy et al. 2012. Cross education and immobilisation: mechanisms and implications for injury rehabilitation
• Kibler et al. 2009. Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder
• McCreesh et al. 2017. Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy
• Parle et al. 2017. Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?
• Saithna et al. 2016. Shoulder Arthroscopy Does Not Adequately Visualize Pathology of the Long Head of Biceps Tendon
• Schroder et al. 2017. Sham surgery versus labral repair or biceps tenodesis for type II SLAP lesions of the shoulder: a three-armed randomised clinical trial
• Taylor et al. 2017. The "3-Pack" Examination Is Critical for Comprehensive Evaluation of the Biceps-Labrum Complex and the Bicipital Tunnel: A Prospective Study

Exercise videos

• Thoracic rotation exercise
• Dynamic rotation exercise

Other episodes of interest:

• PE 043 - Sporting Shoulder with Jo Gibson
• PE 031 - Unruly scapular assessment and retraining with Ann Cools

There are a lot of myths around footwear, and your patients with running injuries will often blame an "incorrect shoe" choice for their injury, or believe that getting the "right shoe" will help resolve an injury. Are running shoes the cause of, and solution to running injuries?

What advice should you give your patients when they ask that inevitable question "Do you think I need to get new shoes?", closely followed by "What shoe do you think I should run in?"

In Physio Edge podcast episode 76 with Tom Goom, you will also discover:

• What footwear should your runners and injured runners wear?
• Footwear questions you need to ask your running injury patients
• Does footwear change gait patterns?
• Can footwear contribute to injury?
• What footwear may contribute to or help in your treatment of Achilles tendinopathy
• What is heel-toe drop and how is this important?
• Does footwear affect ground reaction forces, and how does this relate to bone stress injuries and plantar fasciopathy?
• Is minimalist or barefoot running helpful or harmful?
• Can runners safely transition to barefoot or minimalist running?
• Is footwear the key to resolving running injuries?
• Shoe prescription
• Recommendations when buying new shoes
• Footwear considerations for specific pathologies
• When should runners change their shoes?

If you would love to get better results with running injuries, the podcast handout contains the key take-home messages for you. You can download it here.

To complement this podcast and improve your treatment of runners, Tom Goom and I have created three awesome free Achilles tendinopathy rehab videos. This is a series of three evidence-based videos to help you master Achilles treatment. CLICK HERE to get your free access to these videos

Links of Interest

• Free Achilles tendinopathy rehabilitation in runners videos with Tom Goom - a series of three evidence-based videos to get you great results with achilles tendinopathy

• Download and subscribe to the podcast on iTunes

• Download your free podcast handout on treatment of calf pain in runners
• Tom Goom on Twitter
• Let David Pope know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Like the podcast on Facebook
• Infographics by Clinical Edge
• Get your free trial Clinical Edge membership
• Tom Goom's website & courses
• Tom on Facebook Live

Related posts

• Physio Edge 065 - Differential diagnosis of calf pain in runners with Tom Goom
• Physio Edge 064 What is causing calf pain in runners and how can you assess it with Tom Goom
• Physio Edge 062 How to treat plantar fasciopathy in runners with Tom Goom
• Infographic - How to treat plantar fasciopathy in runners with Tom Goom
• Physio Edge 061 How to assess & diagnose plantar fasciopathy in runners with Tom Goom
• Infographic - How to assess & diagnose plantar fasciopathy in runners with Tom Goom
• Physio Edge 060 Plantar fasciopathy in runners with Tom Goom
• Infographic - Plantar fasciopathy in runners with Tom Goom
• Infographic - Plantar fasciopathy imaging & education with Tom Goom

Research associated with this episode

• Esculier et al. 2015. A consensus definition and rating scale for minimalist shoes.
• Fuller et al. 2017. Six week transition to minimalist shoes improves running economy and time-trial performance.
• Kong et al. 2009. Running in new and worn shoes: a comparison of three types of cushioning footwear.
• Mallisoux et al. 2015. Influence of heel to toe drop of standard cushioned running shoes on injury risk in leisure time runners: a randomised controlled trial with 6 month follow up.
• Nigg et al. 2015. Running shoe and running injuries: myth busting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’.
• Salzier et al. 2016. Injuries observed in a prospective transition from traditional to minimalist footwear: correlation of high impact transient forces and lower injury severity.

Tendinopathy patients may present for treatment with an ultrasound or MRI report in hand, unsure how you can help them, or how they can possibly recover when they have so much tendon pathology. To add insult to injury, they may even have a partial tendon tear on their imaging report thrown into the mix. How do imaging results impact your treatment and your patient's recovery? Are the imaging findings relevant to their pain?

In this Physio Edge podcast with Dr Sean Docking (Physiotherapist, PhD), you will explore what information imaging actually provides in your tendinopathy patients, how to explain imaging to your patients, and whether partial tendon tears identified on imaging will effect your treatment. You will also discover:

• Who develops tendon pathology
• If patients have tendon pathology on imaging, is this responsible for their symptoms, or will it cause future tendon pain
• Asymptomatic tendon pathology in sports people
• How tendon pathology can actually be linked to better performance
• Can we prevent tendon pathology
• The advantages and disadvantages of different imaging types, including
• MRI
• Ultrasound
• Ultrasound tissue characterisation (UTC)
• Why a thickened tendon may actually be helpful in recovery
• How can we actually diagnose tendinopathy
• When is imaging useful
• Differential diagnosis of Achilles pain, including
  • Achilles tendinopathy
  • Paratenonitis
  • Plantaris associated tendinopathy
• Partial tendon tears, the accuracy of identification, and how they impact your treatment

Sports injuries virtual conference

As mentioned in this episode Sean presented at the 2017 Sports Injuries virtual conference. His main conference presentation on tendinopathy and imaging discusses:

• The research around the use for imaging
• A framework for when and when not to use imaging
• How to explain imaging findings to patients

You can get immediate access to his presentation, and presentations from 13 of the leaders in sports injuries by CLICKING HERE

Download this podcast and subscribe on iTunes

Links associated with this episode:

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• Enrol on the 2017 Sports Injuries virtual conference
• Twitter - @SIDocking
• Sean Docking - La Trobe University website
• Sean Docking - Research gate
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership

Articles associated with this episode:

Alfredson. 2011. Midportion achilles tendinosis and the plantaris tendon

Brown et al. 2011. The COL5A1 gene, ultra-marathon running performance and range of motion

Docking et al. 2016. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC).

Docking et al. 2015. Tendinopathy: Is imaging telling us the entire story?

Lieberthal et al. 2014. Asymptomatic achilles tendinopathy in male distance runners

McAuliffe et al. 2016. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis

Simpson et al. 2016. At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis

Other episodes of interest:

PE 068 - Lower limb tendinopathy loading, running and rehab with Dr Pete Malliaris

PE 042 - Treatment of Plantaris and achilles tedninopathy with Seth O’Neil

PE041 - Plantaris involvement in achilles tendinopathy with Dr Christoph Spang

Femoroacetabular impingement (FAI) may contribute to hip and groin pain, buttock pain, pelvic or low back pain and referred pain into the thigh. Is conservative management effective in patients with FAI, or is surgery required? If we can treat FAI conservatively, what is the best treatment, and how can you tailor your treatment to your individual patients?

In episode 74 of the Physio Edge podcast with Dr Joanne Kemp you will discover:

• What is FAI, and how can you identify it?
• Common clinical presentations
• Key subjective questions to ask
• Types of FAI morphology and how they are identified
• Is FAI just a normal finding?
• How you can perform an objective assessment in patients with FAI
• Differential diagnosis
• Components you need to include in your conservative treatment for FAI
• Which objective markers to use when treating FAI
• How to address common impairments in your rehabilitation, including strength, functional tasks, cardiovascular training and range of movement
• When to refer for a surgical opinion
• Outcomes of surgical treatment
• Future risk of developing OA in presence of FAI

Sports Injuries virtual conference presentation

As mentioned in this episode Joanne will be part of the Sports Injury virtual conference. Her pre conference presentation will discuss FAI and the diagnostic process in more detail. Her subsequent conference presentation will be available on 9-10 December 2017, with access for up to 12 months following the conference, and will discuss:

• Conservative management of FAI
• Specific exercise progressions you can use
• Return to sport for athletes

Enrol on the 2017 Sports Injuries virtual conference by CLICKING HERE

Download this podcast and subscribe on iTunes

Links associated with this episode:

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• Enrol on the 2017 Sports Injuries virtual conference
• Twitter - @JoannaLKemp
• Joanna Kemp - Research gate
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• LaTrobe Sports and Exercise Medicine Research Blog
• Twitter - @LaTrobeSEM
• GLA:D Australia
• Lake Health Group

Articles associated with this episode:

Griffin et al. 2016. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

Articola et al. 2014. A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players. A Prospective Study With Minimum 2-Year Follow-up.

Other episodes of interest:

• Physio Edge 054 - Hip and groin pain part 2 with Benoy Matthew
• Physio Edge 053 - Hip and groin pain part 1 with Benoy Matthew
• Physio Edge 009 - Lateral hip pain with Dr Alison Grimaldi
• Physio Edge 004 - Hip injuries and labral tears with Nicole Hamilton

Strengthening is not commonly used in neck pain treatment and rehabilitation, however athletes may place large demands on their neck during training and play that require a high level of strength or endurance.

When should you include strength training in your rehabilitation? What patients will benefit from strength training? How can you incorporate strengthening into your treatment?

In episode 73 of the Physio Edge podcast, we explore the role of neck strengthening with Kay Robinson, Physiotherapist working with Australian sailing, and previously with the British Olympic Skeleton team.

In the podcast you will discover:

• Objective assessment of patients with neck pain
• Range of movement and strength tests you can use with your neck pain patients
• How to assess neck strength in your patients
• Indications for strength training
• Is strength training suitable in the early stages of neck pain rehabilitation?
• Early-stage cervical spine rehabilitation exercises you can use
• Exercise progressions to improve neck strength
• Neck strengthening in concussion
• Is neck strength training suitable for whiplash patients?
• Aspects incorporated into a typical neck strengthening program

Kay Robinson will also be presenting at the 2017 Sports Injury virtual conference. Her conference presentation on neck strengthening will discuss:

• How to incorporate neck training into rehabilitation post injury
• Neck strengthening for injury prevention
• How to make exercise patient or sport specific
• Other consideration with neck training
• Case studies

Download this podcast and subscribe on iTunes

Links associated with this episode:

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• Enrol on the 2017 Sports Injuries virtual conference
• Kay Robinson on Twitter - @kaylourob
• Kay Robinson at Total Physiotherapy
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• Book - Sports Injury Prevention and Rehabilitation: Integrating Medicine and Science for Performance Solutions
• High-Performance Training for Sports

Articles associated with this episode:

Durall. 2012. Therapeutic Exercise for Athletes With Nonspecific Neck Pain: A Current Concepts Review.

Falla et al. 2003. An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion.

Falla et al. 2007. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting.

Jull et al. 2009. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain.

Other episodes of interest:

PE 013 - Cervical Spine Artery and VBI Testing with Roger Kerry

5 Minute Physio tip - Manual therapy for the cervical spine - Is there any evidence?

5 Minute Physio tip - Contraindications and red flags to cervical spine manual therapy.

Injured athletes like to recover and return to play as quickly as possible, and we need to balance return to play against impaired strength, performance and risk of reinjury. Initial injury rehabilitation often commences with isometric exercises, progressing into concentric/eccentric style exercises when isometric tests are pain-free. Finally high load eccentric exercises such as the Nordic hamstring are introduced for their positive effects of increased strength, fascicle length and reduced injury risk.

High level and eccentric exercises are often avoided in the early stages of rehab, for fear of aggravating the injury. What if we could commence higher-level and eccentric exercises safely at an earlier stage? Would this impair or accelerate your patients' recovery?

In this podcast with Jack Hickey, currently completing a PhD with the QUT/ACU hamstring injury research group, we explore an accelerated hamstring injury rehabilitation program, and how this can be implemented with your patients. You will discover:

• The limitations of traditional rehabilitation
• What is the evidence for only using isometric exercises in the early stages of rehab
• Why eccentric exercises are commonly thought of as too high a load for initial rehab
• More modern rehabilitation programs for hamstring strain injuries, including the Askling (2013), Aspetar (2017) and Mendiguchia (2017) programs
• An accelerated rehab program, introducing higher-level and eccentric exercises at an early stage
• How often high-level exercises need to be performed
• Which exercises you can use with your hamstring injury patients
• How to know when to progress your patient's exercises
• When you can start your patient's rehabilitation
• When your patients can return to running
• How to progress your patience through a return to running program
• When your patients are suitable for return to sport

Download this podcast and subscribe on iTunes

Links associated with this episode:

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• Jack Hickey
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• ACU open access hamstring journal repository
• Dr David Opar on Twitter
• Dr Anthony Shield
• Dr Morgan Williams
• Dr Matthew Bourne
• Nicol van Dyk
• Rod Whiteley
• Nirav Maniar
• Ryan Timmins

• Dr Steve Duhig

• Sliding discs to use in hamstring slider exercises in your clinic - available in Australia. Use the code "clinicaledge" to get 20% off your order (at the above link, not applicable on Amazon)

• Amazon (outside Australia)- Sliding discs to use in hamstring slider exercises

Other episodes of interest:

• PE 071 - Hamstring strengthening, lengthening and injury prevention with Dr David Opar
• PE 019 - Hamstring strength, flexibility and injury reduction with Dr Kieran O’Sullivan
• PE016 - Preventing hamstring injuries with Dr Kristian Thorborg

Articles associated with this episode:

• Askling et al. 2013. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols
• Aspetar Hamstring Protocol
• Hickey et al. 2016. Criteria for Progressing Rehabilitation and Determining Return-to-Play Clearance Following Hamstring Strain Injury: A Systematic Review
• Jacobsen et al. 2016. A combination of initial and follow-up physiotherapist examination predicts physician-determined time to return to play after hamstring injury, with no added value of MRI.
• Järvinen et al. 2007. Muscle injuries: optimising recovery.
• Mendiguchia et al. 2017. Hamstring rehab for football players.
• Silder et al. 2013. Clinical and Morphological Changes Following 2 Rehabilitation Programs for Acute Hamstring Strain Injuries: A Randomized Clinical Trial

Hamstring injuries are the most common injury in football and AFL, and we can help our patients strengthen their hamstrings while significantly reducing their risk of injury with the right exercise program. What are the best exercises to use to strengthen and lengthen the hamstrings, and to prevent hamstring injury?

In this Physio Edge podcast with Dr David Opar, we discuss hamstring injury prevention, which athletes will benefit, which exercises to use, the most important aspects of each exercise and how to incorporate these with your athletes. You will discover:

• What does the latest research around hamstring exercises and injury reveal?
• Which players are most at risk of hamstring injury?
• How can we prevent hamstring injuries?
• How does hamstring muscle architecture adapt to training, and how does this relate to your exercise selection or prescription?
• How can we increase hamstring muscle fascicle length?
• How can we tailor our patients hamstring program based on whether they are preseason, in-season, uninjured or previously injured?
• Which exercises are important in hamstring rehabilitation and prehabilitation?
• How can you start and progress a hamstring injury prevention program?
• How quickly do patients lose their hamstring gains, and how much maintenance do they need to perform?
• What happens to hamstring muscle strength and flexibility following injury?
• What neuromuscular inhibition happens following hamstring injuries, and how can we address this in our rehab?

There has been a lot of great research performed recently on hamstring injuries, and to share this and help you with your hamstring injury patients, we have invited Dr David Opar to present at the upcoming Sports Injuries virtual conference in December 2017. You can access six free preconference sports injury presentations by CLICKING HERE.

Links

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• ACU open access hamstring journal repository
• Dr David Opar on Twitter
• Dr Anthony Shield
• Dr Morgan Williams
• Dr Matthew Bourne
• Nicol van Dyk
• Rod Whiteley
• Nirav Maniar
• Jack Hickey
• Ryan Timmins
• Dr Steve Duhig

Articles associated with this episode:

• Bourne et al. 2017. Impact of exercise selection on hamstring muscle activation.
• Opar et al. 2015. Eccentric hamstring strength and hamstring injury risk in Australian footballers.
• Petersen et al. 2011. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men’s Soccer.
• Timmins et al. 2015. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study.
• Timmins et al. 2016. Architectural Changes of the Biceps Femoris Long Head after Concentric or Eccentric Training.
• van Dyk et al. 2016. Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort Study.

Athletes with groin pain will commonly play with pain until the end of the season, and rest during the off-season in the hopes this will aid in their recovery. Unfortunately this offseason rest period rarely results in recovery, and athletes head into the preseason with long-standing groin pain and an extended recovery period.

In this episode of the Physio Edge podcast with Dr Adam Weir , you will discover how to treat adductor related groin pain (ARGP) and complex patient presentations with multiple areas of pathology or pain.

This podcast follows on from the Physio Edge podcast episode 69, where Dr Adam Weir and I discussed in detail how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

You will explore:

• Treatment of acute adductor strains
• Long term adductor related groin pain (ARGP)
• Is rest during the off season helpful or harmful for groin pain
• What pain level is ok during rehab exercises
• How can you describe ARGP to decrease patient fear
• Is ARGP a tendinopathy or different pathology?
• How to answer your patients when they ask how long until they can return to training (RTT) or return to play (RTP)?
• What is and how can you incorporate the Copenhagen Adductor exercise?
• Is there a role for passive treatment?
• Is hand held dynamometry useful during recovery?
• Treatment for adductor related groin pain (ARGP)
• Starting treatment
• Exercise progressions
• What criteria can you utilise for treatment progressions?
• What criteria can you use prior to allowing your patients to return to running, change of direction and RTP
• How to progress running and change of direction training
• Adductor to abductor strength ratios your athletes can achieve prior to RTP

Complex presentations

• How can you make a diagnosis and tailor your rehab when a patient has multiple areas of pain and positive tests eg ARGP plus Psoas related groin pain or Inguinal related groin pain?

• How your treatment program may evolve as your patient progresses through their rehab

Dr Adam Weir will be presenting at the upcoming Sports Injuries virtual conference on the assessment and treatment of Inguinal related groin pain. You can access his free preconference presentation, along with other free sports injury assessment and treatment videos AT THIS LINK

Links associated with this episode:

• Get your access to free Sports Injuries presentations
• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook
• Adductor protocol on Mobile devices
• Adductor protocol videos on Youtube

Articles associated with this episode:

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

Physio Edge 069 Adductor related groin pain, stress fractures and nerve entrapment assessment & diagnosis with Dr Adam Weir

Adductor related groin pain is the most common diagnosis for athletes with groin pain. In this episode of the Physio Edge podcast you will discover how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

Dr Adam Weir is a Sports Physician with a PhD on groin pain, the lead author for the Doha agreement meeting on terminology and definitions in groin pain in athletes, who currently shares his time between the Aspetar sports groin pain centre and the Erasmus University Hospital Academic Centre for Groin Injuries in Holland. Adam will take you through exactly how to perform an assessment around the hip and groin, how to interpret your findings and how to explain your diagnosis to your patients. You will explore:

• The common presentation and symptoms of someone with adductor related groin pain
• Structures that are commonly involved
• Aggravating and easing activities
• Area of pain, and new research highlighting unexpected pain referral areas from the adductor tendons
• Differential diagnosis
• Bone stress injuries around the hip and pubic bone
• Genitofemoral nerve entrapments - symptoms, diagnosis and treatment
• Red flags
• Acute versus chronic presentations
• Adductor related versus pubic related groin pain
• How to perform an assessment, including screening tests
• Tests you need to incorporate into your assessment
• Identifying and diagnosing all the structures contributing to a patient's symptoms
• What is the value of imaging and when should it be performed?

Links associated with this episode:

• Get your access to free Sports Injuries presentations
• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Erasmus University Hospital Academic Centre for Groin Injuries
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Articles associated with this episode:

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy.

How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with Dr Peter Malliaras in episode 68 of the Physio Edge podcast. We also explore:

• Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas?
• How will you identify tendinopathy or other structures that may be contributing to your patients symptoms?
• Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral
• Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement
• How can you measure your patients load tolerance?
• What categories of tendinopathy patients can you use to help differentiate your treatment?
• How can you rehabilitate patients with tendinopathy?
• What role does biomechanics have?
• What advice can you provide to your patients about load management, symptoms and flareups?
• When is it ok for your patients to continue or return to running?
• What strength tests should your patients be able to complete before returning to running?
• If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration?
• When are isometrics useful in your treatment?
• When can you start isotonic and plyometric exercises?
• How can you incorporate tendon neuroplastic training (TNT)?

Links associated with this episode

• Download your podcast handout
• Dr Peter Malliaras on Twitter
• Tendinopathy rehab blog with Dr Peter Malliaras
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Other episodes of interest:

• PE 046 - Proximal hamstring tendinopathy with Tom Goom
• PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil
• PE 023 – Lower limb tendinopathies with Dr Pete Malliaras

Articles associated with this episode:

• Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia

• Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy

• Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.

• Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.