Physio Edge podcast (general)

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

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

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

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

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

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

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

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


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

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

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

You will explore:

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

Complex presentations

  • How can you make a diagnosis and tailor your rehab when a patient has multiple areas of pain and positive tests eg ARGP plus Psoas related groin pain or Inguinal related groin pain?
  • How your treatment program may evolve as your patient progresses through their rehab

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

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

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

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

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

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

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

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

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Shoulder pain can involve the rotator cuff, scapula, cervical spine, thorax, and other structures in this area. Recent research has also explored the role of patient beliefs and expectations on the outcomes of Physiotherapy for shoulder pain. Which factors are important in your shoulder pain patients? Can we identify the contributing factors to your patients shoulder pain? What information will you get from orthopaedic special tests during a shoulder examination? How can you improve your treatment results with your patient education?

In this episode of the Physio Edge podcast, Dr Chris Littlewood and David Pope discuss shoulder pain, including:

  • Classification of shoulder pathology
  • How to identify painful vs stiff vs unstable shoulder pain vs cervical spine referred pain
  • Questions to ask in your subjective assessment
  • Does subacromial impingement exist, and how does a diagnosis of subacromial impingement effect outcomes
  • Patient expectations of treatment outcomes
  • How to perform an objective assessment
  • What information special tests provide
  • Is scapular dyskinesis pathological or normal movement variation
  • Are painful or non-painful exercises most helipful in chronic shoulder pain
  • What role does imaging have in shoulder pain

This podcast adds to Physio Edge podcast 47 - Rotator cuff tendinopathy with Dr Chris Littlewood .

Webinar - "Exercise for rotator cuff tendinopathy: Does it work as we think it should, and can we do better? with Dr Chris Littlewood

Download the handout from this podcast

Cervical spine assessment & treatment online course

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David Pope on Twitter

Clinical Edge on Facebook

Dr Chris Littlewood at Keele University

Dr Chris Littlewood on Twitter

Dr Chris Littlewood on ResearchGate

Experiencing increasing calf pain with running can be an incredibly frustrating experience for your running patients, especially when it is severely limiting or stopping them from being able to run. You can have a lot of success in helping your runners overcome running related calf pain, and in episode 66 of the Physio Edge podcast, we give you practical strategies and exercises you can use in your treatment.

Tom Goom and David Pope helped you explain the causes of calf pain to your running patients, differential diagnosis and red flags, and what you need to assess in episode 64 and episode 65, and in Episode 66 you will explore:

  • How to strengthen the calf complex
  • Strengthening for local ankle and foot muscles
  • Benefits and how to incorporate strengthening for the kinetic chain
  • Incorporating neural mobility into your treatment
  • Adjusting and progressing training loads
  • The role of gait retraining in the treatment of calf pain

If you would love to get better results with calf pain in runners, the podcast handout contains the key takehome 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

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Direct download: Physio_Edge_066_How_to_treat_calf_pain_in_runners_with_Tom_Goom.mp3
Category:general -- posted at: 3:22pm AEST

When your patients present with calf pain, do you have a clear understanding of the likely causes and potential differential diagnosis? Do they have any red flags that require urgent medical attention? What other issues besides a calf tear could be causing their calf pain?

It's time to brush off those diagnostic skills, to understand the types of calf pain you can treat, and which patients you need to refer on immediately.

In this podcast with Tom Goom and David Pope, we are going to break it down for you, so you are confident in assessing and diagnosing the different types of calf pain. You will understand:

  • How to identify calf muscle pathology or tears
  • When symptoms are due to neural irritation or pathology
  • Different types of vascular pathology, including popliteal artery entrapment
  • Red flags such as deep vein thrombosis (DVT)
  • What information imaging can provide

You can download a free handout containing a summary of the podcast info on differential diagnosis, which you can download here.

Tom Goom and I are really excited to share three free evidence-based Achilles tendinopathy rehabilitation videos - to help you master the treatment of achilles tendinopathy. These will be out soon, so join us for these free masterclasses


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Research associated with this episode

One of the most popular blogposts of all time on Tom Goom's website is on how to manage calf tears in runners. Is this because it is a really common problem, or because Tom wrote such a great blogpost? It's a bit hard to tell, and most likely it's a bit of both, but it begs the question "Why is calf pain one of the issues so many runners face? "

In episode 64 of the Physio Edge podcast, David Pope and Tom Goom discuss the latest research around calf pain in runners and what is actually going on. We want to give you all the tools you need to assess runners that present with calf pain, so we have included this in the episode as well.

We also created a free handout with the info and assessment tests from this podcast, which you can download here.

If you would like to up your game on calf pain, here are some of the highlights from the podcast:

  • What is responsible for calf pain in runners?
  • What are the common symptoms?
  • What will imaging show (or not show)?
  • What happened to chronic exertional compartment syndrome (CECS)? Does it still exist?
  • What is biomechanical overload syndrome, and how is it different to CECS?
  • Who are the most likely culprits to experience calf pain?
  • How can you assess runners with calf pain?
  • What tests should you perform?
  • How can you perform a calf capacity test?

Tom Goom and I are releasing free Achilles running rehab videos - a series of three evidence-based videos to get you great results with achilles tendinopathy. These will be out soon, so join us to master Achilles treatment

Links of Interest

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Research associated with this episode

Posterior hip pain can have a number of causes, with referral from the lumbar spine, SIJ and hip, along with local structures such as the hip joint, gluteals, glute tendons, proximal hamstring tendons. How can you identify the structures involved in your patient's posterior hip pain? What tests can you perform in your objective assessment to assist your treatment? What is the best way to treat the glutes if they are the involved in your patient's pain?

In episode 63 of the Physio Edge podcast, Benoy Mathew and David Pope explore how you can improve your diagnosis and results with posterior hip pain.

You will discover:

  • What are some of the common causes of posterior hip pain?

  • Gluteal tendinopathy (GT)

    • What area of symptoms will patients with GT report?
    • What are the pattern of symptoms for GT?
    • What tests can we perform to make GT more or less likely
    • How can we treat GT?
  • Deep gluteal syndrome (DGS)

    • What is deep gluteal syndrome?
    • What muscles can be involved in DGS?
    • How can we differentiate it from Gluteal tendinopathy?
    • What tests can you perform to confirm or exclude DGS?
    • How does the treatment for DGS differ to GT?

Benoy is presenting a free webinar with Clinical Edge on "How to assess & diagnose posterior hip and gluteal pain, that complements this podcast, and takes you through the common sources of hip pain, how to identify hip and lumbar spine red flags, and demonstrates exactly how you can perform an assessment to test and differentially diagnose the structures involved in your patients pain.

CLICK HERE to enrol on this free webinar with Benoy Mathew

Ben also presented a webinar with Clinical Edge on how to rehabilitate adductor and psoas related groin pain. The webinar helps you discover:

  • Rehabilitation of adductor and psoas related groin pain
  • Practical tips
  • Common presentations
  • Osteitis pubis, sports hernia, hip impingement
  • Rehabilitation from initial stages to plyometrics

CLICK HERE to watch the webinar "Rehab of adductor and iliopsoas related groin pain" with Benoy Mathew with a free trial Clinical Edge membership

Links of Interest


Articles related to this episode:

  1. Franklyn-Miller et al (2009)- The Gluteal Triangle: a clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes , BJSM. Open Access Link
  2. Grimaldi & Fearon (2015)- Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Management, JOSPT. Open Access Link
  3. Hernando et al (2016)- Evaluation and management of ischio-femoral impingement: a pathophysiologc, radiolgic and therapeutic approach to a complex diagnosis, Skeletal Radiol
  4. Martin et al (2016)- Deep Gluteal Syndrome, JHPS, Open Access Link
  5. Martin et al (2016)- Ishiofemoral Impingement and Hamstrings Syndrome, Distal Causes of Deep Gluteal Syndrome. Where do we go next? Clin Sports Med. Open Access Link
  6. Michel et al (2013)- Piriformis muscle syndrome: Diagnostic criteria and treatment of a mono centricseries of 250 patients, Annals of Physical and Rehabilitation Medicine
  7. The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist
  8. Physical Examination of the Hip by Dr. Hal D. Martin