ACL injuries result in significant time away from sport and distress for patients. The variety of management options, from surgical intervention to non-surgical management and rehabilitation protocols, often makes us uncertain when educating and helping patients choose the most appropriate care for their needs and goals.

Recently, a pioneering non-operative ACL injury management pathway called the “Cross bracing protocol” has been pioneered and developed by Dr Tom Cross and Tom’s father (the late Orthopaedic surgeon) Dr Merv Cross. This protocol offers a promising alternative for patients with ACL injuries who are suitable for non-surgical intervention, where the ACL injury may heal or repair itself.

Not all patients with an ACL injury are suitable for the Cross bracing protocol or non-surgical management, so how can you identify whether your patient is suitable, and which treatment options are best for each patient?

In this insightful podcast episode, we discuss the complex challenge of ACL injury management and Cross bracing with Clare Walsh (Specialist Sports & Exercise Physiotherapist, FACP).

Clare treats a lot of patients with ACL injuries with prehabilitation, post-op rehabilitation, or non-surgical management including Cross bracing. Clare works alongside Dr Tom Cross and other Sports Medicine Doctors, Orthopaedic surgeons (including the late Dr Merv Cross) and leading Sports Physiotherapists at Stadium Sports Physiotherapy and The Stadium Clinic.

Clare teaches on the Cross bracing course conducted in Australia for Physiotherapists and health professionals, and is a Senior Educator & Presenter here at Clinical Edge.

In this podcast we explore:

• Cross bracing
  • What it is and how it developed.
  • What research has been performed to date, and what it shows about the chances of ACL healing with the Cross bracing protocol.
  • Assessment tests & specific imaging that are used to assess patient suitability.
  • Why patients might opt for Cross bracing rather than surgery.
  • Who isn’t suitable for Cross bracing.
  • Potential negative outcomes of Cross bracing.
  • Which patients are more likely to be suitable and successful with Cross bracing - eg. injury type, age, level of sport, goals, psychosocial factors.
  • Medical factors that impact suitability.
  • Psychosocial factors that impact whether a patient can undergo the protocol.
  • Which leg (right or left) is better suited to bracing and why.
  • Which type of braces are commonly used.
  • How soon the protocol needs to commence after injury to be successful.
  • Which concomitant injuries can still heal in a brace and which need surgery e.g. meniscus injuries, bucket handle tears of the meniscus, MCL tears.
  • How long patients remain in a brace.
  • Exercises and activities that can and should be performed throughout Cross bracing.
  • How patients can move or walk around throughout the Cross bracing period.
  • How Cross bracing has changed and evolved.
  • Whether the ACL is at increased risk of re-rupture following the protocol.
  • Essential medical management during the protocol.
  • Whether therapists can put a patient in a brace, or manage the protocol independently.
  • What to you do if you think a patient may be suitable for Cross bracing.
  • How to refer patients for Cross bracing
  • Followup imaging at the end of the protocol.
  • Functional assessment tests used at the end of the protocol.
  • Return to training (RTT) and return to play (RTP) following the protocol.
• Which patients require surgery instead of conservative management.
• Early surgery vs delayed surgery.
• Spontaneous ACL healing - what the research says.
• How to use patient-centred decision-making to guide patients into the most suitable recovery pathway - surgery, bracing or non-surgical management.
• Case studies and comparisons of patients that underwent either Cross bracing or ACL reconstruction.

This podcast is packed full of great information on this emerging ACL injury treatment. You’ll finish this podcast with a deeper understanding of ACL injury management and Cross bracing plus practical knowledge, solutions and insights you can apply into your practice.

Links

• Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership
• Free Achilles tendinopathy video series with Tom Goom
• David Pope at Clinical Edge
• Download and subscribe to the podcast on iTunes
• Download the podcast in Overcast
• Listen to the podcast on Spotify
• Clare Walsh on Twitter
• David Pope on Twitter
• David Pope & why I started Clinical Edge
• Review the podcast on iTunes
• Infographics by Clinical Edge

Chapters:

• 6:26 - ACL injury treatment options 
• 9:08 - Early vs late surgery 
• 11:38 - Current research 
• 15:40 - Cross-bracing protocol development 
• 15:40 - Who's suitable for Cross bracing? 23:38
• 30:24 - Potential negative outcomes 
• 41:10 - Return to sport 
• 44:24 - Re ruptures 
• 52:12 - Non operative management

How can you treat patients who experience knee pain and swelling during and after running? If you suspect their symptoms are caused by a meniscal injury, how can you rehab and return these patients to running without surgery?

In this Physio Edge: Running repairs podcast with Tom Goom, you’ll explore meniscal injuries in runners, recent research on runners with meniscal tears, and how to provide effective non-surgical management. You’ll discover:

• Initial steps for managing pain and swelling in affected runners.
• Techniques to restore and maintain range of movement.
• Strategies for rebuilding strength in key muscle groups.
• Approaches to improve impact control and tolerance, preparing runners for a gradual return to their sport.
• When to manage these patients non-surgically, and when to refer for a surgical opinion.

Tom explores the physical aspects of recovery, along with the impact of general health, weight management, and gait retraining on knee health. With a realistic timeline for recovery and a focus on individualised treatment plans, this podcast is a must-listen for therapists who treat runners.

🔗 Free Webinar Alert! Don't miss out on our free webinars for therapists on shin pain and Achilles tendinopathy in runners. Check the link in the description for more information.

Free running injury assessment & treatment video series available now

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs.

Links associated with this episode:

• Free Achilles tendinopathy videos
• Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Tom live on Facebook & ask your shoulder related questions every Friday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Tom Goom on Twitter
• Tom Goom’s website
• David Pope - Twitter
• David Pope & why I started Clinical Edge
• Review the podcast on iTunes
• Infographics by Clinical Edge

Chapters:

• 03:36 - Recent research
• 05:17 - Management
• 09:26 - Restore ROM
• 10:42 - Rebuild muscle strength
• 12:07 - Return to sport
• 17:03 - Surgical & non-surgical management

Rotator cuff tear arthropathy (RCTA) is a pattern of glenohumeral joint degenerative changes following rotator cuff tears, causing shoulder pain and stiffness. Subscapularis tears can also be involved in RCTA, or a significant cause of shoulder pain and disability.

How can you identify RCTA and subscap tears in your shoulder pain patients? How can they be treated, and do these patients respond well to non-surgical management?

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

Click here for the free webinar with Jo Gibson “Rotator cuff revealed! Rehab & reasoning”.

The handout for this podcast consists of a transcript and research articles referenced in this podcast.

Free video series “Frozen shoulder assessment & treatment” with Jo Gibson

Improve your frozen shoulder assessment and treatment now with Jo Gibson’s free video series at clinicaledge.co/shoulder

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Free trial Clinical Edge membership

Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial

Links associated with this episode:

• Free webinar - Rotator cuff revealed: Rehab & reasoning with Jo Gibson
• Get your access to the free video series “Frozen shoulder assessment & treatment” with Jo Gibson
• Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Jo Gibson on Twitter
• Let David know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the articles associated with this podcast
• Conaire EÓ, Delaney R, Lädermann A, Schwank A, Struyf F. Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review. International Journal of Environmental Research and Public Health. 2023 Mar 23;20(7):5242.
• Fahy K, Galvin R, Lewis J, Mc Creesh K. Exercise as effective as surgery in improving quality of life, disability, and pain for large to massive rotator cuff tears: A systematic review & meta-analysis. Musculoskeletal Science and Practice. 2022 Jun 10:102597.

Chapters:

• 03:25 - What is cuff arthropathy?
• 05:35 - Contributing factors
• 07:33 - Patient history
• 08:37 - Subscapularis tendon tears
• 12:29 - Common mechanisms of injury
• 13:46 - Assessment tests
• 16:51 - Rotator cuff related shoulder pain

How can you successfully treat hip pain and instability associated with your patients’ hip dysplasia? Find out the eight critical steps to excellent results with hip dysplasia in this podcast, which is part 3 in this three-part podcast series with Tom Goom (Running Physio).

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs

Free video series: Achilles Tendinopathy from start to finish line! with Tom Goom

In this free Masterclass "Achilles tendinopathy: Assessment & rehab from start to finish line" presented by Tom Goom and hosted by Clinical Edge, you’ll discover:

• 3 common conditions that cause Achilles pain.
• How to assess patients with Achilles pain to get a clear diagnosis, and know where to start treatment.
• Rehab exercises that will help your patients overcome their Achilles pain.
• How to successfully return your patients to running or sport, and achieve their goals, without stirring up their pain.

CLICK HERE to register for your free access to this three-part video series with Tom Goom

CLICK HERE for your access to three free videos with Tom Goom

Links associated with this episode:

• Free Achilles tendinopathy videos
• Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom
• Physio Edge podcast 154 - Part 1 of 3 - Hip dysplasia key signs & symptoms with Tom Goom
• Physio Edge podcast 156 - Part 2 of 3 - 3 Types of hip dysplasia and How0 to identify them
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Tom live on Facebook & ask your shoulder related questions every Friday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Tom Goom on Twitter
• Tom Goom’s website
• David Pope - Twitter
• David Pope & why I started Clinical Edge
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the article associated with this podcast
• Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. The Journal of arthroplasty. 2017 Sep 1;32(9):S20-7.

Chapters: 

• 05:36 - Step 1: Assessment
• 07:10 - Step 2: Investigations
• 08:35 - Step 3: Patient education
• 10:07 - Step 4: Settling symptoms
• 16:25 - Step 5: Strength
• 18:15 - Step 6: Control and proprioception
• 20:08 - Step 7: Co-existing pathology
• 21:09 - Step 8: General health
• 22:32 - Key points

Hip dysplasia is a commonly missed cause of hip and groin pain. In this podcast, which is part 2 in the 3 part series with Tom Goom (Running Physio), you’ll discover three types of hip dysplasia that will cause different symptoms and need different treatment (based on Wilkins et al. 2017), how to identify each type, and common exercises and a treatment approach that may be stirring up your patients hip and groin pain.

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs

Tricky tendons - Your free video guide to tendinopathy treatment with Tom Goom.

Discover a new, effective approach to treatment of tricky tendinopathy presentations, and lesser known tendinopathies with this free video series presented by Tom Goom (Running Physio) and hosted by Clinical Edge.

Tom will reveal the secrets to successfully treat tendon pain, and get your patients back to running and sport quickly and easily, without stirring up their pain.

Get your free access to this video series now.

CLICK HERE for your access to three free videos with Tom Goom

CLICK HERE for your access to three free videos with Tom Goom

Improve your running injury assessment & treatment now with the Running Repairs Online course with Tom Goom

Links associated with this episode:

• Free Achilles tendinopathy videos
• Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom
• Physio Edge podcast 154 - Part 1 of 3 - Hip dysplasia key signs & symptoms with Tom Goom
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Tom live on Facebook & ask your shoulder related questions every Friday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Tom Goom on Twitter
• Tom Goom’s website
• David Pope - Twitter
• David Pope & why I started Clinical Edge
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the article associated with this podcast
• Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. The Journal of arthroplasty. 2017 Sep 1;32(9):S20-7. 

Chapters:

• 03:12 - Signs & symptoms
• 06:05 - Assessment
• 08:05 - 3 types of hip dysplasia
• 08:28 - Anterior instability
• 09:58 - Posterior instability
• 11:42 - Lateral/global instability
• 13:29 - Key takeaways

Stingers or burners are a burning or stinging pain, often with some paraesthesia and occasionally weakness, often occurring in impact sports such as rugby or American football.

When your patients present with neck and arm symptoms, how can you differentiate a stinger or burner from a C/sp fracture, discogenic symptoms or nerve root compression, which all require very different treatment?

How should you manage patients with one-off or repeated stingers or burners?

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

The handout for this podcast consists of a transcript and articles referenced in the podcast.

Free video series “Frozen shoulder assessment & treatment” with Jo Gibson

Improve your frozen shoulder assessment and treatment now with Jo Gibson’s free video series at clinicaledge.co/shoulder

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Free trial Clinical Edge membership

Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial

Links associated with this episode:

• Get your access to the free video series “Frozen shoulder assessment & treatment” with Jo Gibson
• Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Jo Gibson on Twitter
• Let David know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the article associated with this podcast

• Bowles DR, Canseco JA, Alexander TD, Schroeder GD, Hecht AC, Vaccaro AR. The prevalence and management of stingers in college and professional collision athletes. Current reviews in musculoskeletal medicine. 2020 Dec;13:651-62.

• Sobue S, Kawasaki T, Hasegawa Y, Shiota Y, Ota C, Yoneda T, Tahara S, Maki N, Matsuura T, Sekiguchi M, Itoigawa Y. Tackler’s head position relative to the ball carrier is highly correlated with head and neck injuries in rugby. British journal of sports medicine. 2018 Mar 1;52(6):353-8.

• Swiatek PR, Nandurkar TS, Maroon JC, Cantu RC, Feuer H, Bailes JE, Hsu WK. Return to play guidelines after cervical spine injuries in American football athletes: a literature-based review. Spine. 2021 Jul 1;46(13):886-92.

Chapters:

• 03:56 - What are stingers or burners?
• 08:13 - 3 key mechanisms 
• 14:36 - Signs & symptoms
• 15:36 - Management guidelines
• 18:46 - Shoulder instability treatment

Hip dysplasia is a commonly missed cause of hip and groin pain, catching, clicking, locking or popping, resulting from lack of coverage of the femoral head by the acetabulum.

How can you identify hip dysplasia in your hip or groin pain patients, and avoid misdiagnosing it as iliopsoas or adductor related groin pain? What signs and symptoms will your patients reveal in their subjective history that’ll help you identify this condition?

Find out the key signs and symptoms of hip dysplasia in this podcast with Tom Goom (Running Physio).

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs

Tricky tendons - Your free video guide to tendinopathy treatment with Tom Goom.

Discover a new, effective approach to treatment of tricky tendinopathy presentations, and lesser known tendinopathies with this free video series presented by Tom Goom (Running Physio) and hosted by Clinical Edge.

Tom will reveal the secrets to successfully treat tendon pain, and get your patients back to running and sport quickly and easily, without stirring up their pain.

Get your free access to this video series now.

CLICK HERE for your access to three free videos with Tom Goom

CLICK HERE for your access to three free videos with Tom Goom

Improve your running injury assessment & treatment now with the Running Repairs Online course with Tom Goom

Links associated with this episode:

• Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom
• Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
• Join Tom live on Facebook & ask your shoulder related questions every Friday
• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Tom Goom on Twitter
• Tom Goom’s website
• David Pope - Twitter
• David Pope & why I started Clinical Edge
• Review the podcast on iTunes
• Infographics by Clinical Edge

Articles associated with this episode:

• CLICK HERE to download the article associated with this podcast
• Jacobsen JS, Søballe K, Thorborg K, Bolvig L, Storgaard Jakobsen S, Hölmich P, Mechlenburg I. Patient-reported outcome and muscle–tendon pain after periacetabular osteotomy are related: 1-year follow-up in 82 patients with hip dysplasia. Acta orthopaedica. 2019 Jan 2;90(1):40-5.
• Nunley RM, Prather H, Hunt D, Schoenecker PL, Clohisy JC. Clinical presentation of symptomatic acetabular dysplasia in skeletally mature patients. JBJS. 2011 May 4;93(Supplement_2):17-21.
• O'Brien MJ, Jacobsen JS, Semciw AI, Mechlenburg I, Tønning LU, Stewart CJ, Heerey J, Kemp JL. Physical impairments in Adults with Developmental Dysplasia of the Hip (DDH) undergoing Periacetabular osteotomy (PAO): A Systematic Review and Meta-Analysis. International Journal of Sports Physical Therapy. 2022 Oct 1;17(6):988-1001.
• Reiman MP, Décary S, Mathew B, Reiman CK. Accuracy of clinical and imaging tests for the diagnosis of hip dysplasia and instability: a systematic review. journal of orthopaedic & sports physical therapy. 2019 Feb;49(2):87-97.

Chapters:

• 03:43 - Who develops hip dysplasia?
• 06:35 - Objective tests
• 09:11 - Hip dysplasia vs gluteal tendinopathy
• 10:45 - Hip dysplasia vs femoral neck stress structure 
• 14:13 - Key takeaways