Physio Edge podcast

September 2018
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Thu, 13 September 2018

Physio Edge 084 Running injury treatment - tendinopathy, MTSS, total hip replacement & high BMI patients. Q&A with Tom Goom

How can you manage lower limb tendinopathy in your patients that like to run? Can runners with medial tibial stress syndrome (MTSS) continue to run? Can patients with high BMI or following total hip replacement run?

Physiotherapists Tom Goom and David Pope answer your questions on how to assess and treat patients with running-related injuries in this Q&A conducted live, including:

How can you manage post-run morning stiffness?
What are the important aspects when managing load?
How can you treat Achilles tendinopathy patients with decreasing tolerance to running and walking, and increasing pain?
Differential diagnosis for Achilles pain
Proximal hamstring tendinopathy
- What exercises can be used?
- Is a feeling of tightness normal, and how can this be addressed?
- Are stretches helpful?
- When can deadlifts and Romanian deadlifts (RDL's) be used?
Patellar tendinopathy - how can you manage a runner that is not willing to decrease running volume even temporarily?
Peroneal tendinopathy
Running vs rest in female distance runners with chronic hamstring origin injuries
Patellar tendinopathy
Medial tibial stress syndrome (MTSS)/Shin splints treatment
Working at marathons or running events - How can you help your runners with ITBS or PFP finish a race?
Can runners return to running following total hip replacement?
Is running harmful for patients with high body mass index (BMI) when they want to reduce weight?

To improve your skills and results with low back pain patients, CLICK HERE for your free access to 3 videos with Tom Goom on "How to assess low back pain in runners and athletes"

Links associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_084_Running_injury_treatment_-_tendinopathy_MTSS_total_hip_replacement__high_BMI_patients._QA_with_Tom_Goom.mp3
Category:general -- posted at: 7:44pm AEST

Thu, 6 September 2018

Physio Edge 083 Running gait retraining, strengthening, glutes & ITB syndrome. Q&A with Tom Goom

What are the key components when assessing and treating runners? Should your treatment of running injuries focus on glutes? How can your runners schedule their training to improve recovery?

Physiotherapists Tom Goom and David Pope answer your questions on how to assess and treat patients with running-related injuries, including:

The key concepts when assessing and treating running injuries
Gait retraining programs
The best ways to change running technique
Does gait retraining cause fatigue?
Is gait retraining suitable in painfree runners?
What are the most important elements to prevent injury in runners?
Scheduling to improve recovery from injury. When should your runner run, and when should they rest?
Can we increase leg stiffness when running? Does increasing leg stiffness reduce injury risk?
Strengthening for runners
Do glutes become underactive or "not fire properly"?
Does improving glute strength improve running mechanics?
Calf tears - how can you treat these?
What tests can you perform for your runners calves?
Do runners have "stiff hips", and does it matter?
Can you help runners with meniscal tears?
How can you treat ITB syndrome?
Is barefoot running helpful or harmful?
Should we run in only 1 shoe if we want to win a race?

To improve your skills and results with low back pain patients, CLICK HERE for your free access to 3 videos with Tom Goom on "How to assess low back pain in runners and athletes"

Links associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_083_Running_gait_retraining_strengthening_glutes__ITB_syndrome._QA_with_Tom_Goom.mp3
Category:general -- posted at: 6:17pm AEST

Fri, 3 August 2018

Physio Edge 082 Achilles tendinopathy treatment - the latest research with Dr Seth O'Neill

Achilles tendinopathy treatment - what is the latest research, and how can it help your treatment? What is the best way to treat Achilles tendinopathy (AT)?

Over the years our treatment of tendinopathy has evolved significantly. You may remember rubbing tendons with ultrasound or our thumbs in years gone past, and stretching the painful area or muscle-tendon complex. If you did, you may also remember the number of people that didn't really improve or develop the load tolerance to return to activity with this approach, supported by research demonstrating the lack of effectiveness of this approach.

We progressed to the golden era of loading, initially using eccentric training. Additional research emerged on the benefits of heavy slow resistance in tendinopathy treatment, closely followed by the importance of load management demonstrated in research on soft tissue injuries. In 2015 and 2016 Rio et al. released promising preliminary research utilising isometric holds in patellar tendinopathy patients, and we have extrapolated and used isometric holds with many different types of tendinopathy.

In Physio Edge podcast episode 82 with Dr Seth O'Neill, you will discover:

Are isometric holds effective with Achilles tendinopathy patients?
What is the most effective treatment for AT?
What does the latest research on the treatment of AT reveal?
Is relief of pain with isometric holds necessary to make a diagnosis of tendinopathy?
What assessment tests can you perform to diagnose AT?
How can you assess patient calf strength?
How can you differentially diagnose other conditions including Plantaris involvement, insertional AT, talocrural impingement or neural irritation?
How can you explain AT to your patients?
What exercises can you include in your treatment?
Exercise progressions you can use
When are eccentrics a useful addition to a treatment program?
When can patients start, continue or progress a walking or running program?
How can you incorporate the biopsychosocial model into your treatment?
Is dorsiflexion range of movement important?
Is stretching an effective treatment for tendinopathy?
Are ice, massage or ESWT useful?
When is imaging useful?
How can you treat insertional Achilles tendinopathy?

Download this podcast now to improve your results with Achilles tendinopathy

Dr Seth O'Neill completed a MSc in Musculoskeletal Physiotherapy, followed by a PhD focused on Achilles tendon disorders. Seth is a lecturer in Physiotherapy at the Universities of Leicester and Coventry, and has a Physio private practice in Nottingham, UK.

Click here to download your FREE podcast handout

Click here to register for this FREE webinar "Anterior knee pain and the impact of load" with Lee Herrington

Click here to register for this FREE webinar "Accelerated conservative management of medial knee injuries" with Chris Morgan

Links associated with this episode:

Articles associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_082_Achilles_tendinopathy_treatment_-_the_latest_research_with_Dr_Seth_ONeill.mp3
Category:general -- posted at: 2:35pm AEST

Thu, 19 July 2018

Physio Edge 081 How to treat ankle syndesmosis injuries with Chris Morgan

Ankle syndesmosis injuries following forced ankle dorsiflexion and lateral rotation of the foot require very specific management and rehabilitation to achieve great treatment outcomes. If you approach management of ankle syndesmosis injuries in the same manner as a lateral ankle ligament injury it will likely result in long term pain and dysfunction for your patients.

In the previous episode of the Physio Edge podcast - How to assess ankle syndesmosis injuries, Chris Morgan and David Pope explored how to assess and diagnose ankle syndesmosis injuries (ASI).

In this new Physio Edge podcast - "How to treat ankle syndesmosis injuries with Chris Morgan (Arsenal 1st Team Physiotherapist in the English Premier League), you will discover how to manage different grades of ASI, including:

Grade 1 syndesmosis injury management

Initial injury management
How long should you immobilise a Grade 1 injury for?
What weight bearing should be allowed in the initial stages?
Taping techniques that can be utilised during return to running, training and play
- Rehab - initial exercises and progressions
How much pain is acceptable during return to training?
Return to sport timeframes & how you and your athlete can decide when RTP is appropriate
When can contact be initiated?

Grade 2 syndesmosis injuries

Grade 2 injury management and immobilisation
Which players are likely to require arthroscopy to confirm instability, and subsequent stabilisation surgery?
Why rehabilitation of stable grade 2 injuries is different from grade 1 injuries
Which movements you need to restrict
How to maintain lower limb musculature and minimise muscle atrophy should be performed
Additional general conditioning your patient should perform during the early phase of rehab
How to incorporate an Alter G treadmill into rehab
Occlusion training for lower limb conditioning
How to modify rehab if you do not have access to an Alter G
Timeframes and criteria to assess when your patient can remove their immobilisation boot
Tests to perform at each stage of rehab
When and how should dorsiflexion range be improved?
Timeframes and criteria to meet prior to return to running
Exercise progressions and variations
Return to play markers and tests you can use
What to do when a player still reports a ‘nipping’ at the front of the ankle after 6 weeks and is having difficultly achieving full dorsiflexion

Unstable injuries - Grades 2b, 3 and 4

Management of unstable injuries
Post-surgical immobilisation and management
Common return to play timeframes

Click here to download your podcast handout

To accurately grade your patients ASI and prescribe the most appropriate rehab I strongly recommend listening to Physio Edge podcast episode 80 – How to assess ankle syndesmosis injuries with Chris Morgan prior to this podcast

CLICK HERE to register for the free webinar - Medial knee injuries with Chris Morgan

Medial knee injuries often occur in snow sports, or other sports when landing or being tackled. Different areas of the medial knee can be injured, including the deep, superficial, proximal or distal fibres of the MCL and medial knee. Depending on the injured structures, patients will either cope with a more aggressive treatment approach and early return to sport, or require a more conservative approach. How can you know the rehab approach your individual patient requires?

In this free webinar with Chris Morgan (1st Team Physiotherapist with Arsenal FC), you will explore:

Applied anatomy of the medial knee
Mechanism of injury, presentation and diagnosis of medial knee injuries
How you can differentiate between deep, superficial, proximal, distal and Grade 1, 2 and 3 clinical injuries
How imaging findings correlate with your clinical findings
MRI grading (radiological versus clinical)
How you can perform an objective assessment
How function, pain and instability impact your treatment
Accelerated vs more conservative treatment - how can you choose the ideal approach for your patient?
Are PRP injections appropriate?
Rehabilitation principles you can use with your medial knee injury patients
Ligament loading
Which bracing and weight bearing regime should you utilise?
What should you do when your patient has joint laxity?
Is pain during rehab acceptable?
Should you overload OR "under load to overcome"?

You can CLICK HERE to access this free webinar

Links associated with this episode:

Articles associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_081_How_to_treat_ankle_syndesmosis_injuries_with_Chris_Morgan.mp3
Category:general -- posted at: 12:15pm AEST

Thu, 5 July 2018

Physio Edge 080 How to assess ankle syndesmosis injuries with Chris Morgan

Ankle syndesmosis injuries, also known as a high ankle sprain, commonly occur during high impact tackles or collisions that involve forced lateral rotation of the foot in ankle dorsiflexion. Syndesmosis injuries can be missed in the early stages as the degree of pain and swelling may not reflect the severity of the injury. Early diagnosis of syndesmosis injuries is key in preventing persistent pain, disability and limited ability to return to play or activity.

In Physio Edge podcast episode 80, English Premier League Physiotherapist Chris Morgan, and David Pope explore how to assess and diagnose ankle syndesmosis injuries (ASI), including:

Questions you need to ask when your patient has had an ankle injury
What is an ASI?
What symptoms will your patient report following ASI?
Ligaments and structures that are often involved in an ASI
What is a "peeling injury", and how does this influence the structures that are injured?
Common mechanism of injury
How to assess, diagnose, classify and grade ASI
How to differentiate between stable and unstable ASI
Which tests can you perform to accurately diagnose ASI?
Differential diagnosis
Which injuries are likely to require surgical intervention, and which injuries may be managed conservatively?
When imaging is useful
What type of imaging to perform
Identifying underlying chondral lesions
Early management strategies

CLICK HERE to download your podcast handout

Upcoming podcast - How to treat ankle syndesmosis injuries with Chris Morgan

A subsequent podcast with Chris Morgan will discuss in detail how to treat ankle syndesmosis injuries . Download this podcast now to improve your assessment and diagnosis of ankle syndesmosis injuries.

Free webinar - Medial knee injuries with Chris Morgan

Chris Morgan's Physiotherapy roles in English Premier League with Liverpool and Crystal Palace have provided him with a lot of experience treating acute injuries, including the ankle and knee. To help you take advantage of this experience, Chris is presenting a Clinical Edge webinar on medial knee injuries. In his webinar Chris will discuss:

• Presentation of medial knee injuries
• How imaging findings correlate with clinical findings
• How to progress your rehabilitation and return players to performance
• Incorporating change of direction and trunk control into rehabilitation

You can CLICK HERE to access this free webinar

Links associated with this episode:

Articles associated with this episode:

Morgan et al. 2014. Conservative management of syndesmosis injuries in elite football

Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, Fischer DA. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot & ankle international. 2012 May;33(5):371-8.

Sman AD, Hiller CE, Rae K, Linklater J, Black DA, Nicholson LL, Burns J, Refshauge KM. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med. 2015 Mar 1;49(5):323-9.

Other episodes of interest:

PE 017 - Injury reduction with Dr Peter Brukner

PE 027 - Sports injury management with Dr Nathan Gibbs

Direct download: Physio_Edge_080_How_to_assess_ankle_syndesmosis_injuries_with_Chris_Morgan.mp3
Category:general -- posted at: 2:07pm AEST

Fri, 8 June 2018

Physio Edge 079 How to rehabilitate ACL injuries with Dr Lee Herrington

Following ACL injury, patients can have a smooth recovery with full return to sport and activity, or end up with ongoing knee symptoms and limited ability to perform the activities they love. How can you help your ACL injured patients have a great outcome?

In Physio Edge podcast episode 079, Dr Lee Herrington and David Pope explore how to make your ACL injury rehab successful, and provide you with a comprehensive guide to rehabilitate ACL injuries. You will understand how to take your patients from initial injury to return to sport, and develop the knowledge to help inform your patients decide with your patient whether surgical repair or conservative management is their best option.

You will discover:

Do ACL injuries require surgical management?
Which factors commonly affect whether people with ACL-deficient knees require surgery?
Common diagnostic errors in ACL injury patients
What are the key elements you need to include in your rehab of ACL injuries?
Conservative vs surgical management
Should your rehab focus on movement control, strength or skills?
How you should objectively assess your patients rehab progress?
What valid measurement tools can you use when assessing patient progress?
Are open-chain exercises safe, and should they be used in your rehab?
Most effective types of movement control and skill training
How to know when your patient should progress their exercises?
Which strength measures are important?
Which strength training exercises can you include?
When can running be commenced?
Running progressions you can use
What pain measures should you monitor throughout rehab?
Is pain during rehab ok?
How to return your patient to training and sport
What maintenance exercises should your patient continue after completing their rehab?

Related online courses

Advanced ACL rehab with Andrew Ryan

Other episodes of interest:

Click here to download the podcast handout

Links associated with this episode:

Articles associated with this episode:

Direct download: Physio_Edge_079_How_to_rehabilitate_ACL_injuries_with_Dr_Lee_Herrington.mp3
Category:general -- posted at: 6:29pm AEST

Tue, 15 May 2018

Physio Edge 078 High performance athlete management with David Joyce

How can you incorporate high performance elements into your sports injury rehab, to help your injured players and athletes become strong, fit, powerful and fast? How can you rehab a player to perform at a high level when they return to sport following injury?

In Physio Edge podcast episode 78, David Joyce shares how you can improve the performance aspects of your rehabilitation. You will discover some of the key elements when managing high performance athletes and sporting teams. If you work with injured athletes at an elite, recreational or junior level, or would like to work with a sports team, you will love this podcast.

In this podcast, David Joyce and David Pope discuss:

How to help athletes move from being a junior player to performing at an elite level
How to help players build tolerance and resilience to cope with high level sport
How to create "elite level people", not just "elite level players"
What makes a player likely to succeed?
Schedules and weekly programs you can use to prepare junior players
What load should a junior player perform during preseason relative to a senior player?
When players need to be exposed to higher loads
How to schedule training and running to prevent bony and soft tissue injuries
How many running sessions per week should players perform?
"Earning the right" to run at full speed
How to structure strength sessions do players perform
Incorporating plyometrics
What load measures are actually important
Important screening questions to ask your players
How to return injured players to high level sport
How many weeks of full training do ACL injured players require before return to play
Key tests to perform for your players
Tips when objectively testing athletes

CLICK HERE to download your podcast handout

Get your access to Sports Injury Assessment and Treatment FREE videos

Links associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_078_High_performance_athlete_management_with_David_Joyce.mp3
Category:general -- posted at: 4:10pm AEST

Fri, 9 February 2018

Physio Edge 077 Anterior shoulder pain, long head of biceps tendon pathology and SLAP tears with Jo Gibson

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

Articles associated with this episode:

Exercise videos

Other episodes of interest:

Direct download: Physio_Edge_077_Anterior_shoulder_pain_long_head_of_biceps_tendon_pathology_and_SLAP_tears_with_Jo_Gibson.mp3
Category:general -- posted at: 2:03pm AEST

Thu, 25 January 2018

Physio Edge 076 Footwear advice for running injuries with Tom Goom

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

Related posts

Research associated with this episode

Direct download: Physio_Edge_076_Footwear_advice_for_running_injuries_with_Tom_Goom.mp3
Category:general -- posted at: 8:13pm AEST

Mon, 11 December 2017

Physio Edge 075 Tendinopathy, imaging and diagnosis with Dr Sean Docking

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: