Physio Edge podcast (general)

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

How do you answer your patient when they ask why they still have back or neck pain more than 12 months after an injury? Shouldn't their body have healed by now? Why does their knee pain get worse every time they do their exercises, put tape on it, go for a walk or just climb the stairs?

What is going on? Why do they still have pain? How are you going to explain it, and how can you help them?

In this podcast with Dr Tim Mitchell and Dr Darren Beales, you'll discover:

  • 4 types of pain, and how they change your assessment and treatment
  • Why some patients become sensitised following an injury
  • Questions you need to ask in your subjective
  • How to identify red flags
  • Is night pain and disturbed sleep a red flag?
  • When your patient is sensitised to pain, can you differentiate between central and peripheral sensitisation?
  • Important aspects to include in your objective assessment
  • Assessing movement and function
  • How hyperalgesia and allodynia affect your treatment
  • Why it can backfire if you tell your patient they have central sensitisation and pain is in their brain
  • How to challenge a patient's beliefs about their pain, like they "just need a massage" or their "pelvis is out" so that it won't backfire and make their faulty belief even stronger
  • When should your patients return to work or have adjusted duties?
  • How to use the Musculoskeletal clinical translation framework and apply it in your clinical practice

Download and subscribe to the Physio Edge podcast now to improve your treatment of musculoskeletal pain and sports injuries

Resources associated with this episode:

Other Episodes of Interest:


Have you had patients that developed groin pain after getting a bit carried away with situps or abdominal exercises in the gym? Or have your patients developed lower abdominal pain after running or training that is causing them pain into hip extension?

In this podcast with Andrew Wallis, Sports Physiotherapist with the St Kilda AFL team, we explore how you can treat patients that were a little too exuberant with their abdominal training or running, including:

  • The Doha Agreement on groin pain terminology
  • Inguinal related groin pain
  • Anatomy of the abdominal region and groin
  • Rectus abdominus tendon overload
  • Whether pelvic tilt contributes to abdominal overload
  • How you can identify the cause of pain in this suprapubic region
  • How to objectively assess patients, and key tests to perform
  • How you can treat patients with an acute overload history
  • Progressive abdominal loading, including exercises you can use
  • How to progress running, interval training and hill running
  • Adding in cutting, agility training and kicking
  • How to help set your patient's expectations about recovery timeframes and progress

Andrew Wallis is also presenting a webinar on how to treat athletes with the most common type of groin pain - adductor-related groin pain. It'll be held on Wednesday 25th October, so grab your spot on this webinar now!

Resources associated with this episode:

Other Episodes of Interest:


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

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

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

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

Other episodes of interest:


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

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

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

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

Other episodes of interest:


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: