Physio Edge podcast

When your female patient has shoulder pain, how can you identify if the cause is musculoskeletal, or related to women’s health issues? Find out in this podcast with Jo Gibson (Clinical Physiotherapy Specialist). You’ll explore two separate case studies of female shoulder pain patients with different diagnoses, that’ll help you discover:

  • Which female reproductive issues can cause shoulder pain?
  • How can you differentiate musculoskeletal and non-musculoskeletal causes of shoulder pain?
  • Is pain at different stages of the menstrual cycle really just “hormones”?
  • What questions can you ask your patients to help guide your diagnosis?
  • What is the typical history of patients with shoulder pain related to women’s health?
  • If patients wake with acute shoulder pain, what are the potential musculoskeletal and non-musculoskeletal diagnoses?

For free video series covering assessment & diagnosis of acute shoulder pain and stiff shoulders head over to clinicaledge.co/shoulder


Are eccentric exercises useful in subacromial shoulder pain rehab? When shoulder pain rehab has stalled, and patients aren’t improving, will eccentric exercises help? Are eccentric exercises the missing component in successful rehab programs for recalcitrant shoulder pain?

Find out in this discussion with Jo Gibson (Clinical Physiotherapy Specialist). Also discover:

  • Should eccentric exercises be included in shoulder rehab programs?
  • What does the research reveal about eccentric shoulder exercises?
  • How can the research be applied and adapted clinically with shoulder pain patients?
  • If eccentric exercises are helpful, which exercises should patients use?
  • When and how often should eccentric exercises be performed?
  • Are eccentric exercises helpful in acute shoulder pain?
  • How long does shoulder pain normally take to recover from?
  • How can gym programs be adapted to allow shoulder pain to recover while patients continue training or exercising?
  • How many exercises should be included in shoulder pain rehab programs?

Get free access to the stiff shoulder & acute shoulder pain assessment & diagnosis video series with Jo Gibson at clinicaledge.co/shoulder


An unusual cause of shoulder pain - what's the diagnosis? Solve this patient case study with Jo Gibson (Clinical Physiotherapy Specialist) and discover musculoskeletal and non-musculoskeletal causes of shoulder pain that are important to keep in mind when features don't fit.

Get free access to the free webinar series on how to assess & diagnose shoulder pain and stiff shoulders with Jo Gibson at clinicaledge.co/shoulder


When is shoulder pain from the C/sp? When a patient presents with shoulder pain and stiffness, how can C/Sp referral be identified? If a patient has full neck range of movement, and neck movements don’t reproduce shoulder pain, can their pain still be from the C/sp?

Recent research shows that including treatment of the C/sp can improve results in up to ⅓ of shoulder pain patients. In this video with Jo Gibson (Clinical Physiotherapy Specialist) discover how to identify, assess and treat patients with cervical referral, including:

  • What history and pain features will patients with cervical referred shoulder pain report?
  • What assessment tests can be performed to diagnose or rule out the C/Sp involvement in shoulder pain?
  • What information does palpation and repeated movements in the objective assessment provide?
  • What does the research reveal about cervical referred shoulder pain?
  • What biopsychosocial factors may be involved in cervical referred shoulder pain?
  • How can manual therapy to the C/Sp improve shoulder range of movement?
  • What education can be provided to patients with cervical spine referral?
  • What exercises and exercise variations may be used to improve cervical referred shoulder pain?
  • Are upper muscle fibres of trapezius “overactive” or are these muscles actually weak?
  • What exercises can be used for upper traps in C/sp referred shoulder pain?
  • What manual therapy can be used for C/sp referred shoulder pain?
  • Does the thorax get “stiff”, and what exercises help improve thoracic range of movement?

Get your access to free videos with Jo Gibson on acute shoulder pain & stiff shoulder assessment & diagnosis at clinicaledge.co/shoulder.

 

Articles associated with this episode:


When your patient has neck and arm pain, or low back and leg pain from neural tissue pain disorders (NTPD) such as peripheral nerve sensitisation (PNS), how will you treat them? Pain associated with PNS can occasionally be mild and non-irritable, but more often than not, it’s severe, highly irritable, and easy to stir up.

How can you provide treatment that settles their pain, without stirring them up? What advice, education, manual therapy and exercise will you provide to help improve symptoms and speed up recovery? What are the keys to success with PNS patients?

In Physio Edge podcast 104Dr Toby Hall and I discussed PNS, common symptoms, causes, questions to ask, and how to assess and diagnose PNS in your patients. In this followup podcast, the second in our two-part series, Dr Toby Hall and I take you through the next phase - how to treat PNS. You’ll discover:

  • The 7 keys to success with PNS
  • How to successfully treat PNS in the neck and upper limb, AND the low back and lower limb.
  • What education and advice should you provide to your patient about activities to avoid or reduce, and which activities should they increase?
  • What are the most effective exercises for patients with PNS?
  • Should exercise be painful or painless?
  • When is neural mobilisation an effective treatment?
  • When should you avoid using neural mobilisation as a treatment?
  • Is manual therapy effective in PNS?
  • Which manual therapy techniques can you use to improve symptoms and range of movement (ROM) immediately?
  • How to perform effective manual therapy techniques that reduce pain without stirring up your patients.
  • How can you combine neural mobilisation with manual therapy?
  • If you use manual therapy to improve symptoms, what home exercises should patients perform after each treatment session?
Direct download: 107._Treatment_of_peripheral_nerve_sensitisation_with_Dr_Toby_Hall.mp3
Category:general -- posted at: 2:05pm AEDT

Explore cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, & strength tests for athletes with Simon Olivotto, Dave Toomey, Paula Peralta & Nick Kendrick.
In this Clinical Edge member Q&A, the Clinical Edge Senior Physio Education & Presentation team discussed:


Cervical radiculopathy patients with an irritable presentation

  • Do imaging findings such as modic changes, alter our management
  • How can you approach treatment of cervical radiculopathy?
  • Are medications indicated?
  • Red flags you need to rule out
  • Are sliders and gliders a useful treatment?

 

Sensitivity to cold or ice

  • How can you use tests to identify sensitivity to cold or ice to guide your treatment?
  • Does ice sensitivity indicate central sensitisation?
  • How does this impact management?
  • If your whiplash patients have sensitivity to cold or ice, how does this impact treatment & prognosis?
  • Which research articles cover this topic?

 

Calf & achilles strengthening

  • When is it best to perform calf raises into dorsiflexion (DF)?
  • When should you avoid strengthening the calf into end of range (EOR) DF?
  • What ankle issues may lead you to avoid strengthening or stretching into EOR DF?

 

Hip joint pain and the acetabular labrum

  • Can we identify when the labrum is responsible for hip or groin pain?
  • What tests are important to perform in patients with hip or groin pain?
  • If deep structures such as the hip joint are painful or injured, does this mean more superficial structures such as the acetabular labrum are also pain generators?

 

Strength assessment & screening of athletes

  • What strength screening tests can you perform in athletes with large demands such as motorcross?
  • Which areas do you need to assess?
  • What are simple and more complex ways to assess strength in different regions of the body?
  • What are important considerations when designing a S&C program for a motocross athlete?
  • Making sense of pain

 

How can you make sense of pain? How can you describe pain to your patients in a way that makes sense, and doesn’t tell them “it’s all in your head”? Find out how to improve your confidence with acute and persistent pain in the upcoming “Making sense of pain” module.

Warning: Contains swearing

 

 

Articles associated with this episode:

 


When you assess your patients shoulder movements, and notice a winging scapula, altered resting position or timing of scapula movement, do you need to treat it? Can we diagnose “Scapular dyskinesis”, and does it matter? How can you simplify your scapular assessment?

In this podcast, Jo Gibson (Clinical Physiotherapy Specialist) explores common beliefs and myths around the scapula, including:

  1. Abnormal scapular kinematics cause pain
  2. We can predict patients that are going to get shoulder pain
  3. Upper traps should be retrained to decrease their activation
  4. Scapular-based interventions are superior to rotator cuff based treatment
  5. There are reliable and valid ways to assess scapular movement

Alongside this mythbusting, you’ll explore:

  • Is there any point assessing the scapula?
  • Is scapular asymmetry normal or abnormal?
  • Is scapular dyskinesis a normal response to exercise or loading?
  • How accurate are we at identifying scapular dyskinesis compared to findings in laboratory studies of scapula movement?
  • What scapular findings will you commonly observe in patients with massive rotator cuff tears, nerve injuries & stiffness?
  • How does rotator cuff fatigue impact scapular movement?
  • How does fear avoidance and worry about particular movements impact muscle activity and movement?
  • When is increased upper traps activity helpful and beneficial?
  • Should we try to decrease upper traps activity in patients with C/Sp driven shoulder pain?
  • Can we preferentially target the scapular or rotator cuff with our exercises?
  • Do improvements in shoulder pain correlate with changes or “improvements” in scapular movement?
  • How do scapular assessment test (SAT) results impact your treatment and exercise prescription?
  • If the SAT improves pain, does that mean we should perform scapular based exercises?
  • Can we use scapular dyskinesia classification to stratify patients or guide our treatment?
  • Is there any reliability in scapular assessment?
  • Does the SAT simply identify those that have a favourable natural history ie are going to get better on their own regardless?
  • Do scapular treatments increase the subacromial space, and does this matter?
  • Is winging post-surgery (posterior stabilisation + labral repair) a product of surgery or does this need to be addressed?
  • How does incorporating the kinetic chain into rehab impact patient movement strategies, scapular and rotator cuff recruitment?
  • Are scapulothoracic bursae relevant to shoulder pain?
  • How can you address patient beliefs and fear avoidance around their shoulder pain?

Articles associated with this episode:

Direct download: 105._Scapular_dyskinesis_-_Does_it_really_matter_with_Jo_Gibson.mp3
Category:general -- posted at: 4:25pm AEDT

When your patient has leg, shoulder or arm pain, how can you identify if their pain is due to neural tissue compression, sensitisation or irritation? How can you differentiate whether pain is from neural tissue or local structures like nearby joints, tendons or muscles? What questions and objective tests will help you diagnose a neural tissue pain disorder (NTPD)?

In this podcast with Dr Toby Hall (Specialist Musculoskeletal Physiotherapist, FACP, PhD), you’ll discover:

  • Three types of neural tissue pain disorders, and how to identify each one
  • What is Peripheral nerve sensitisation (PNS)?
  • What clues in your subjective examination will help you identify PNS?
  • Why do nerves become inflamed or irritated?
  • How to identify & differentiate radiculopathy and radicular pain in patients with radiating limb pain.
  • Do all patients with NTPD have obvious neuro symptoms such as pins and needles, numbness or weakness?
  • Quick screening tests you can use in your assessment to identify PNS.
  • How to identify if your patients shoulder and arm pain is from neural tissue or from local shoulder structures.
  • How to diagnose a NTPD in patients with hip or leg pain.
  • How to perform passive neurodynamic tests such as the straight leg raise (SLR), upper limb neurodynamic test (ULNT), slump test and femoral nerve slump test.
  • What information does a positive or negative neurodynamic test provide?
  • Can we identify the location of a nerve lesion or irritation with our passive neurodynamic tests or palpation?
  • Initial PNS treatment options
  • Is exercise helpful or harmful in patients with PNS?
  • How can you palpate over neural tissue, and what information does this provide?
  • Do opioids provide pain relief, or prolong recovery in patients with NTPD?

This podcast is the first part in a two part series on neural tissue pain disorders with Dr Toby Hall. Part 1 (this podcast) guides you through the types of NTPD, and how to assess and diagnose NTPD. Part 2 (available soon) will take you through how to treat PNS.

I highly recommend listening to this episode (part 1) prior to part 2, to have a thorough understanding of when and how to treat PNS.


A young male patient woke with an acute onset of constant, shooting shoulder pain, is painful into abduction, reluctant to lift his arm, and feels like he’s losing shoulder strength. He has no recent history of injury. 

Can you diagnose this unusual cause of shoulder pain, based on this patient's symptoms and physical tests? What are your differential diagnoses and red flags to keep in mind with this patient? 

In this podcast, Jo Gibson puts your knowledge of shoulder pain and diagnostic skills to the test, and explores how you can treat patients with this diagnosis.

Articles associated with this episode:

Get access to free videos with Jo Gibson on diagnosis of shoulder pain at clinicaledge.co/shoulder

Direct download: 103._An_unusual_cause_of_shoulder_pain_with_Jo_Gibson.mp3
Category:general -- posted at: 1:24pm AEDT

Do you include stretches in your treatment of shoulder pain? Have you ever identified a glenohumeral internal rotation deficit (GIRD) and used the "Sleeper stretch" to help improve internal rotation? Do stretches have any value for shoulder pain, or are there better treatment options?

In this podcast, Jo Gibson (Clinical Physiotherapy Specialist) discusses how to differentiate true capsular stiffness from muscle stiffness, what information GIRD provides, and whether sleeper stretches for shoulder pain are a useful treatment.

Jo explores the current research and clinical implications on your treatment, including:

  • What is the driver of decreased range of movement (ROM)?
  • If we get immediate changes in ROM with a sleeper stretch, does that mean we should use this as a treatment?
  • Is stretching an effective, efficient and evidence-based treatment?
  • Can we use strengthening movements to improve range and cuff recruitment?
  • What exercises can you use with patients with GIRD to improve ROM and cuff recruitment?
  • Humeral retroversion and how torsional load from throwing sports at a young age impact your ROM assessment.
  • If you have a patient with GIRD, what does this tell you?
  • In patients with true capsular stiffness, does stretching in combination with damp heat have a role?
  • Does eccentric strengthening have a role in improving GIRD in patients with true capsular stiffness or fibrosis?
  • How can you use GIRD to monitor your athletes fatigue and recovery?

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