Physio Edge podcast (general)

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

Articles associated with this episode:

Other episodes of interest:


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 injuriesChris 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

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

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

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


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

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

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

Other episodes of interest:

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

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

Articles associated with this episode:

Exercise videos

Other episodes of interest:


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

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

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

 

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

Direct download: Physio_Edge_075_Tendinopathy_imaging_and_diagnosis_with_Dr_Sean_Docking.mp3
Category:general -- posted at: 5:13pm AEST

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

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:


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

 

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.


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