Physio Edge podcast

The sternoclavicular joint (SCJ) can cause pain locally, or refer into the neck and shoulder. With a relatively high incidence of serious and potentially life-threatening pathology at the SCJ, it’s important to diagnose the source of SCJ pain. In this (Facebook live/video/podcast) with Jo Gibson (Clinical Physiotherapy Specialist ), you’ll discover:

  • How to identify and diagnose the SCJ as the source of pain
  • Where does the SCJ commonly refer pain to?
  • What pathologies cause SCJ pain
  • What activities & movements commonly reproduce pain in the SCJ?
  • Who develops SCJ pain?
  • Which differential diagnosis (DDx) are important to identify, including
    • localised osteoarthritis (OA)
    • rheumatoid arthritis
    • septic arthritis
    • atraumatic subluxation
    • seronegative spondyloarthropathies
    • gout, pseudogout
    • SC hyperostosis
    • condensing osteitis
    • Friedrich’s disease/avascular necrosis
    • condensing arthritis
    • Friedrich’s disease and
    • ‘SAPHO’ (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome
  • How does DDx impact prognosis?
  • What role does imaging have with the SCJ?
  • SCJ Imaging - MRI vs CT vs Xray.
  • If pain refers down to the anterior chest, what other structures may be involved?
  • Tietze syndrome at the costochondral junction.
  • Costochondritis - who develops it, is there a mechanism of injury?
  • Red flags you need to be aware of around the SCJ
  • Case study of an SCJ patient where a potentially life-threatening illness was identified
  • Other red flags - infection, HIV, septic arthritis, diabetes, ankylosing spondylitis, gout
  • What investigations are important for SCJ pain patients?
  • What are realistic expectations for prognosis and resolution of SCJ symptoms?
  • How can you rehab patients with SCJ pain?
  • Costochondral joint pain
  • Rehab following clavicular ORIF
  • When is arthroscopic release suitable in frozen shoulder patients

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Have you ever wanted to improve your patients strength, but weren't sure about the best way to go about it? What exercises should you use? How many sets, reps and sessions per week should you ask your patients to complete? Strength levels often start to decline with pain or after an injury, from neuromuscular inhibition, swelling, inflammation or joint laxity (Hopkins & Ingersoll, 2000; Rice & McNair, 2010). Unfortunately strength doesn't always return as quickly as it disappears, and neuromuscular inhibition can carry on (Roy et al, 2017).

In this podcast with Dr Claire Minshull, we dive into the role of strength and conditioning in rehab, and explore:

  • Why building strength is an important part of rehab
  • How can you build strength effectively and efficiently?
  • Do 8-12 rep sets or 3-5 rep sets build greater strength?
  • How many sets of an exercise should your patient perform?
  • How frequently do patients need to perform their exercises?
  • Is maximal loading necessary in rehab?
  • Which patients should use lower load exercises?
  • Will strength training make endurance athletes slow and muscular, or improve running economy?
  • "Functional exercises" vs strength exercises
  • When should exercises target strength, and when can you use "functional exercises"?
  • What is power training, and what exercises help to develop power?
  • When should power training be used?
  • What lifting cues can you use with beginning lifters e.g. in deadlifts?
  • Patients with knee osteoarthritis:
    • What is an effective exercise strategy for patients with knee osteoarthritis (OA)?
    • What important factors do you need to incorporate in your pain education?
    • How can you start a strengthening program?
    • What exercises can you use?
    • What pain levels are acceptable during exercise?
    • How can you know if your exercises are appropriate for each patient?
    • What braces or supports can you use to make unicompartmental knee OA more comfortable and able to exercise?

 

CLICK HERE to download your podcast handout

Dr Claire Minshull also presented two online courses for Clinical Edge members to further develop your strength & conditioning skills and confidence. You can get access to these online courses with your free trial membership.

What is in Dr Claire Minshull's webinar?

  • How to incorporate strength development in your rehab programs
  • How to progress strength in rehab
  • Exercise progressions and regressions to maintain a strength focus
  • Case study examples taking you through how to apply S&C principles with your patients

Download and subscribe to the podcast on iTunes
Listen to the podcast on Spotify
Improve your confidence and clinical reasoning with a free trial Clinical Edge membership, and get access to the online courses on S&C with Dr Claire Minshull
Let David know what you liked about this podcast on Twitter
Review the podcast on iTunes
Like the podcast on Facebook
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Versus Arthritis

Articles associated with this episode:

Campos et al. 2002. Muscular adaptations in response to three different resistance-training regimens: specificity of repetition maximum training zones.

Hall et al. 2018. Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial.

Jorge et al. 2015. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial.

Latham et al. 2010. Strength training in older adults: the benefits for osteoarthritis.

Teixeira et al. 2018. Effect of resistance training set volume on upper body muscle hypertrophy: are more sets really better than less?

Uusi-Rasi et al. 2017. Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial.


Manual therapy (MT) comes in all shapes and sizes - mobilisation, manipulation, mobilisation with movement, soft tissue massage, instrument assisted massage, muscle energy techniques, pointy elbows pressed into flesh and more. Patients (often) love it, and it's a popular treatment modality with therapists. Debate rages, and myths and misconceptions surround MT. Could the time we spend performing MT be better spent elsewhere? How does MT work? Is it worth using if treatment effects are short lived? Is it just used as revenue raising by therapists, while creating reliance on passive therapies?

Is MT evidence-based? Is it worth including in our treatment? Which patients may benefit from MT, and which patients you should steer away from MT?

In this podcast, clinical researcher, physical therapist and Professor at Duke University, Dr Chad Cook, we discuss the evidence around MT, myths and misconceptions, how MT works, and using your clinical reasoning to decide when and how to utilise MT.

You'll discover:

  • What are the arguments against manual therapy?
  • Do the arguments against MT have merit?
  • Does MT break up scar tissue or adhesions, correct alignment of joints, or put them back into place?
  • Do we have evidence that MT creates reliance on passive therapies?
  • Evidence for and against MT
  • How to use clinical reasoning with MT
  • How MT works - potential mechanisms
  • What MT is NOT doing
  • How to explain MT to your patients
  • Clinical reasoning
  • Identifying pain adaptive and non pain adaptive patients
  • How MT can help identify patients with a better or worse prognosis
  • How many sessions of MT should patients receive?
  • How to select MT techniques
  • Does MT cause harm and patient reliance?
  • How to identify patient treatment expectations
  • How to help change patient expectations

Articles associated with this episode:

Bialosky et al. 2009. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model.

Bialosky JE, Bishop MD, Penza CW. Placebo mechanisms of manual therapy: a sheep in wolf's clothing?. journal of orthopaedic & sports physical therapy. 2017 May;47(5):301-4.

Cook et al. 2014. Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain?

Cook et al. 2013. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial.

Cook et al. 2012. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?

Cook. 2011. Immediate effects from manual therapy: much ado about nothing?

Deyle et al. 2005. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program.

Goss et al. 2004. A Cochrane review of manipulation and mobilization for mechanical neck disorders.

Learmann et al. 2014. No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator.

Rubinstein et al. 2011. Spinal manipulation therapy for chronic low back pain.

Schneider et al. 2014. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain.

Traeger et al. 2018. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain.


When your patient has heel pain with their first few steps in the morning, after sitting for a while or at the start of a run, a diagnosis of plantar heel pain (PHP) or plantar fasciopathy might jump straight to the top of your list. How will you treat your patients with PHP? How long will it take? How can you explain PHP, the rehab and recovery to your patients?

In this podcast with Henrik Riel (Physiotherapist, researcher and PhD candidate at Aalborg University) we take a deep dive into PHP, and how you can treat it, including:

  • How to describe plantar heel pain to your patients
  • How to explain to your patient why they developed PHP, recovery timeframes and rehab
  • Plantar fasciitis, plantar fasciopathy, plantar heel pain? What's the most appropriate terminology?
  • Differential diagnosis for PHP including
    • Neuropathic pain
    • Fat pad irritation, contusion or atrophy
    • Calcaneal stress fracture
    • Other diagnoses
  • How to systematically perform an objective assessment and diagnose PHP
  • Assessment tests to identify factors contributing to your patients pain
  • Whether your patients require imaging
  • How long PHP takes to recover
  • What factors affect your patients prognosis and recovery times
  • How to differentiate your treatment for active or sedentary patients
  • Whether your patients can continue to run with PHP
  • Factors that may hinder the recovery of your sedentary patients, and how to address these
  • Whether your patients should include stretching in their rehab
  • Types of strengthening to include in your rehab - isometric, isotonic or otherwise
  • How many sets and reps should your patients perform of their strengthening exercises
  • Whether orthotics are useful
  • Corticosteroid injections - do they help or increase the risk of plantar fascia rupture?

Articles associated with this episode:

Alshami et al. 2008. A review of plantar heel pain of neural origin: differential diagnosis and management.

Chimutengwende-Gordon et al. 2010. Magnetic resonance imaging in plantar heel pain.

Dakin et al. 2018. Chronic inflammation is a feature of Achilles tendinopathy and rupture.

David et al. 2017. Injected corticosteroids for treating plantar heel pain in adults.

Digiovanni et al. 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.

Hansen et al. 2018. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination.

Lemont et al. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.

Rathleff et al. 2015. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.

Riel et al. 2017. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on.

Riel et al. 2018. The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial.

Riel et al. 2019. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial.

Other Episodes of Interest:

PE 062 - How to treat plantar fasciopathy in runners with Tom Goom

PE 061 - How to assess and diagnose plantar fasciopathy in runners with Tom Goom

PE 060 - Plantar fasciopathy in runners with Tom Goom

PE 038 - Plantar fasciopathy loading programs with Michael Rathleff

PE 012 - Plantar Fascia, Achilles Tendinopathy And Nerve Entrapments With Russell Wright


When you love running or any other sport or activity, having to take time off with an injury is really frustrating. Your patients with an injury limiting their running will feel frustrated and be keen to keep running or get back to running as quickly as possible. We can make a huge difference in helping them return to running, but how do we do it?

It would be pretty simple if we could hand all of our running injury patients a standard return to running table with a list of set running distances, and send them on their way to just follow the program. The trouble is, it doesn’t work that way in real life.

Each of your patients will have different goals, and respond differently to rehab and increases in running, depending on their injury, irritability of their symptoms, their load tolerance, and a lot of factors. Since recipe-based approaches won’t work for a lot of patients, how can you tailor your rehab and guide your running injury patients through their return to running?

In this podcast with Tom Goom, we’re going to help you return your patients to running as quickly as possible, know which factors you need to address in your rehab, and how to tailor your rehab to each of your patients. You will explore how to:

  • Test whether your patient is ready to run
  • Find your patients ‘run tolerance’
  • Incorporate your athlete’s goals into their rehab
  • Use their pathology to guide return to running eg stress fractures or plantar fasciopathy
  • Use irritability to guide your load progression
  • Vary your treatment depending on the stage of their competitive season
  • Address strength, range of movement, control, muscle mass, power and plyometric impairments in their rehab program
  • Choose the number of exercises you use
  • Balance risk and reward to meet patients goals
  • Four key steps to return your patient to running
  • Use impact tests when assessing whether your patient is ready to run
  • Plan training structure and progression
  • Monitor return to running
  • Identify acceptable pain levels while increasing running

We will take you through four real patient case study examples so you can apply the podcast in your clinical practice, including:

  • Achilles tendon pain
  • Medial tibial stress syndrome (MTSS)/Shin splints
  • Calf pain
  • High risk tibial stress fracture

CLICK HERE to download your podcast handout

 

Other episodes of interest:


Squeezing a stress ball and strengthening with 0.5kg dumbells will only get you so far with your treatment of hand and wrist injuries, and soon enough you'll hit a wall with treatment results. How are you going to smash through that wall, and help your patients keep working or playing, or get back to it? If you've felt limited with your hand and wrist treatment and exercises, you'll love the treatment approach and strengthening exercises from the third and final podcast in this series with Ian Gatt.

In the previous two podcasts with Ian we explored how you can take a great history, assess and diagnose wrist and hand injuries. You discovered types of grip strength and how to perform low and high tech grip strength assessment. In this new podcast with Ian Gatt you will discover how to use your assessment findings to develop a treatment plan, and how to develop your patients hand and wrist strength, plus:

  • Strength exercises can you use in your rehab of hand and wrist injuries
  • What pain level is acceptable during rehab exercises?
  • How many sets and reps should your patients perform of each exercise?
  • How can you reduce the pain your athlete experiences so they can perform their rehab exercises?
  • What finger strengthening exercises can you use?
  • Why is the proximal radio-ulnar joint (PRUJ) so important to treat with wrist and elbow injuries?
  • How can you treat the PRUJ?
  • How can you incorporate the kinetic chain into your hand and wrist rehab?
  • How and why would you want to use vibration as part of rehab, even if you don't have a vibration plate?
  • What manual therapy can you use with your hand patients?
  • How can you maintain your athletes skill and performance while taking them through a rehab program?
  • How should you adjust training volume or intensity with knuckle or Carpometacarpal joint (CMCJ) injuries?
  • Can boxers with CMCJ injuries continue to hit the bag?
  • What wrist positions and movements need to be limited during rehab and to prevent injury?
  • Why is wrapping your boxers hands properly so important?
  • How can you wrap your boxers hands?
  • What gloves are recommended for boxers?

Ian works with GB Boxing, which involves helping boxers recover from hand, wrist and other injuries. This podcast is therefore boxer-centric, however there are a lot of specifics, exercises & principles in this podcast that you can use with your hand & wrist patients.

Dive into this podcast, and pick up a lot of great ideas for your hand & wrist injury treatment.

 

CLICK HERE for your spot on a free shoulder assessment webinar with Jo Gibson, available soon.

Resources associated with this episode:

Other Episodes of Interest:


Your knuckles getting crushed in an overenthusiastic handshake by hands the size of watermelons isn't a fun experience. Do these knuckle-crushers know they're squeezing that hard, or do they just regularly snap pencils while taking notes, and wonder why pens and pencils are so fragile nowadays?

How much grip strength do you actually need, even if you're not planning on crushing any knuckles the next time you meet someone? How much grip strength do your patients need when recovering from a hand, wrist or upper limb injury?

Testing and building grip strength is a really important part of helping your hand, wrist, elbow pain and injury patients get back to work and day to day life. Gripping also pre-activates the rotator cuff, so you can use gripping as part of your patients shoulder rehab exercises.

Grip strength tests using handheld dynamometers (HHD)* test your "Power Grip", but this test doesn't assess thumb or pinch grip strength. There are two other grip strength tests that are pretty easy to perform, that are going to be better suited to some of your patients. What are they, and how can you test the different types of grip strength in your patients?

In this podcast with Physiotherapist (English Institute of Sport Boxing Technical Lead Physio) Ian Gatt, we discuss assessing and building grip strength, assessing hand and wrist injuries and more, including:

  • 3 different types of grip strength you need to measure in your hand and wrist patients
  • How grip strength measures help guide your assessment and prognosis
  • What is the "Power grip" and how is it useful?
  • How can you test thumb strength?
  • Low-tech, simple grip strength tests you can use in your clinic
  • The high-tech approach to grip strength testing
  • How strong should wrist flexors and extensors be?
  • How can you assess weight bearing tolerance of the hand and wrist?
  • Why your patient can have a painfree grip and still be painful with weightbearing on the hand
  • What exercises, weights and reps should you use following upper limb injury?
  • How can you accurately measure wrist range of movement?
  • How are the proximal radio-ulnar joint (PRUJ) and radio-humeral joint (RHJ) involved in hand and wrist injuries, and how can you assess these?

Like the tests demonstrated in the Clinical Edge online courses on Assessment & treatment of the elbow

 

CLICK HERE for your spot on a free shoulder assessment webinar with Jo Gibson, available soon.

Resources associated with this episode:

Video - How to wrap a boxer's hands with Ian Gatt

Loosemore et al. 2016. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad.

Other Episodes of Interest:

PE 088 - Combating hand and wrist injuries part 1 with Ian Gatt

PE 043 - Sporting Shoulder with Jo Gibson

PE 027 - Sports Injury Management with Dr Nathan Gibbs


Hand and wrist assessment and treatment can be overwhelming. There are a lot of tendons, ligaments and bones crammed into a small area, you need to worry about ligament and cartilage tears, rehabbing fine and gross motor control, strengthening, and then there are those fancy-looking splints you see. How would you like to get a better grip on hand and wrist injuries?

Physio Edge 088 Combating hand & wrist injuries part 1 with Ian Gatt

In this podcast with Physiotherapist (English Institute of Sport Boxing Technical Lead Physio) Ian Gatt, we discuss hand and wrist injuries in general, and dive into details on contact-related injuries encountered in boxing. If you treat patients that fall onto their hands and wrists, cop a blow to their fingers in ball sports, are boxers or martial artists, or just occasionally get involved in confrontations with walls or other immovable objects, you will enjoy this episode. You will explore:

  • How to take a comprehensive subjective history for hand and wrist pain patients
  • Questions you need to ask your hand and wrist patients
  • Identify likely diagnoses for your patients injuries based on their pattern of symptoms
  • When imaging is useful
  • Figure out if your patient is likely to have a quick or slow recovery
  • What is most important - pathology &structural diagnosis, biomechanics or function?
  • Common boxing or contact-related hand and wrist injuries
  • How to establish the severity of an injury
  • Carpometacarpal (CMC) joint injury management
  • Knuckle (Sagittal band) injuries
  • Bone stress injuries of the hand and wrist
  • Triangular fibrocartilage complex (TFCC) injuries, and why these are not as common now in contact sports

In the next two podcasts with Ian, we will explore how you can assess and treat these injuries

Resources associated with this episode:

Video - How to wrap a boxer's hands with Ian Gatt

Loosemore et al. 2016. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad.

Other Episodes of Interest:

PE 043 - Sporting Shoulder with Jo Gibson

PE 027 - Sports Injury Management with Dr Nathan Gibbs

 

Direct download: Physio_Edge_088_Combating_hand__wrist_injuries_part_1_with_Ian_Gatt.mp3
Category:general -- posted at: 1:16pm AEDT

A crunching tackle, flying headfirst off the bike onto your shoulder, or falling onto an elbow will often be enough to injure an acromio-clavicular joint (ACJ). When your patient walks in supporting their arm, or wearing a collar-and-cuff to offload their ACJ, how will you accurately assess and grade their injury? What will you include in your ACJ patient rehab to help them get back to full shoulder function and return to sport?

In Physio Edge podcast episode 87 with Dr Ian Horsley, Physio with English Rugby, English Institute of Sport and Olympic Team GB, we explore ACJ and clavicular injuries, including:

  • ACJ anatomy, and which ligaments are commonly injured
  • How to grade an ACJ injury
  • When to request imaging
  • Clavicular osteolysis
  • How to identify SLAP lesions that occur with ACJ injuries
  • How to assess patients with ACJ injury
  • Objective assessment tests to help your diagnosis
  • The role of the scapula in ACJ rehab
  • Common exercises you can use in rehab
  • Progressing ACJ rehab to prepare for return to sport
  • How to include return to contact in your rehab eg for rugby players
  • How much pain is ok during rehabilitation
  • Return to play timeframes with common
  • What do do when rehab is not progressing to plan
  • Clavicular fractures - conservative or surgical management
  • Ways to stimulate osteoblastic activity post fracture

CLICK HERE to download your free handout on AC Joint injuries

Resources associated with this episode:

Jacob et al. 2017. Classifications in Brief: Rockwood Classification of Acromioclavicular Joint Separations.

Robertson et al. 2016. Return to sport following clavicle factors: a systemic review.

Other Episodes of Interest:

PE 076 - Anterior shoulder pain, long head of biceps tendon pathology and SLAP tears with Jo Gibson

PE 067 - Shoulder special tests and the rotator cuff with Dr Chris Littlewood

PE 043 - Sporting Shoulder with Jo Gibson

PE 040 - Shoulder Simplified With Adam Meakins

PE 021 - Shoulder Pain With Dr Jeremy Lewis

Direct download: Physio_Edge_087_AC_Joint_injuries_with_Dr_Ian_Horsley.mp3
Category:general -- posted at: 5:08pm AEDT

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