Physio Edge podcast

ACL injuries can be career ending, or they can be an opportunity to sort out movement efficiency, motor control and and technical skills, coming back from the rehabilitation process with more power, speed and efficiency than they had before they injured their ACL.

In this podcast, Enda King from the Sports Surgery Clinic in Dublin currently completing his PhD in 3D biomechanical analysis after ACL reconstruction, with the aim to assist in RTP decision making and identifying fully rehabilitated athletes, and David Pope discuss ACL injuries, and the most important factors in pre-operative management and post-operative exercise programming to get your patients back to sport with improved sporting performance.

Going deep on the details involved in ACL Rehabilitation, including:

  • 01:20 Enda King and SSC, and working with ACL athletes PhD in 3D biomechanical analysis after ACL reconstruction, aim to assist in RTP decision making and what a fully rehabilitated athlete looks like

  • What does a fully rehabilitated athlete look like?

  • Incorporating performance goals into the rehab process

  • Can athletes achieve better performance post ACL rehab than they were pre-injury

  • Types of ACL grafts

  • Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery

  • Preoperative education

  • Restoring knee extension, balancing pain and improved range of movement, empowering your patient

  • Guidelines for pain, swelling when restoring range of movement

  • Restoring quadriceps activation, normalising gait patterns

  • Clinical Edge

  • Clinical Edge’s free webinar program

  • Preoperative length of time

  • Post-op - initial management

  • To use or not use co-contraction exercises of quads and hamstrings

  • Should you use squatting style exercises Week 1 post op

  • Activating quadriceps - internal quadriceps cues or external exercise focus

  • How much pain should a patient experience during or after an exercise

  • Week 2 post-op

  • When can heavy gym training commence

  • Changing movement patterns throughout the kinetic chain

  • Advice for patients in the early stages of rehab

  • Frequency of exercise

  • Week 2 onwards - exercises incorporating balance and proprioception

  • Open vs closed chain exercises

  • Advice for patients in weeks 2–6

  • Nutrition and dietary advice for patients

  • Gym based rehabilitation

  • Choosing and modifying exercises for middle stages of the rehabilitation process

  • Various types of squatting movement, and progressing the types of squats

  • Goblet squats

  • Retraining ideal squat patterns

  • Progressing squats, deadlifts and lunges

  • Front squats

  • Front squats and trap bar deadlifts vs back squats during rehabilitation

  • When can an athlete start cycling

  • Disadvantages of using cycling as the main part of a rehabilitation program

  • Hamstring rehabilitation after semitendinosis/gracilis graft

  • Strength and power development

  • Strength testing - mid thigh pull, leg press

  • Should we use open chain strength tests

  • When to perform strength tests

  • Strength vs power and rate of force development

  • Running - incorporating into the program. When can your patient start running?

  • Preparation for running

  • Running drills

  • Ideal movement patterns in running

  • Enda King and SSC, and working with ACL athletes

Podcast timeline

  • 3:35 What does a fully rehabilitated athlete look like?

  • 5:40 Incorporating performance goals into the rehab process

  • 6:50 Can athletes achieve better performance post ACL rehab than they were pre-injury

  • 8:20 Types of ACL grafts

  • 11:10 Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery - an opportunity to prepare your patients knee, ROM, strength and educate them on the rehabilitation process

  • 14:20 Preoperative education

  • 14:40 Restoring knee extension, balancing pain and improved range of movement, empowering your patient with

  • 15:40 Guidelines for pain, swelling when restoring range of movement

  • 16:15 Restoring quadriceps activation, normalising gait patterns

  • 17:10 Clinical Edge

  • 18:45 Clinical Edge’s free webinar program

  • 19:30 Preoperative length of time

  • 20:35 Post-op - initial management

  • 23:20 To use or not use co-contraction exercises of quads and hamstrings

  • 24:50 Should you use squatting style exercises Week 1 post op

  • 25:25 Activating quadriceps - internal quadriceps cues or external exercise focus

  • 26:30 How much pain should a patient experience during or after an exercise

  • 27:30 Week 2 post-op

  • 28:30 When can heavy gym training commence

  • 29:30 Changing movement patterns throughout the kinetic chain

  • 31:00 Advice for patients in the early stages of rehab

  • 32:10 Frequency of exercise

  • 32:55 Week 2 onwards - exercises incorporating balance and proprioception

  • 34:10 Open vs closed chain exercises

  • 35:40 Advice for patients in weeks 2–6

  • 37:15 Nutrition and dietary advice for patients

  • 37:45 Gym based rehabilitation

  • 38:50 Choosing and modifying exercises for middle stages of the rehabilitation process

  • 41:00 Various types of squatting movement, and progressing the types of squats

  • 41:45 Goblet squats

  • 42:30 Retraining ideal squat patterns

  • 43:25 Progressing squats, deadlifts and lunges

  • 44:00 Front squats

  • 46:00 Front squats and trap bar deadlifts vs back squats during rehabilitation

  • 47:25 When can an athlete start cycling

  • 48:00 Disadvantages of using cycling as the main part of a rehabilitation program

  • 48:30 Hamstring rehabilitation after semitendinosis/gracilis graft

  • 49:45 Strength and power development

  • 51:00 Strength testing - mid thigh pull, leg press

  • 53:15 Should we use open chain strength tests

  • 54:20 When to perform strength tests

  • 55:00 Strength vs power and rate of force development

  • 55:50 Running - incorporating into the program. When can your patient start running?

  • 57:30 Preparation for running

  • 58:35 Running drills

  • 1:00:30 Ideal movement patterns in running

Links:

Direct download: PE_032_How_to_rehabilite_ACL_injuries_with_Enda_King.mp3
Category:general -- posted at: 4:40pm AEST

030. CrossFit injuries with Antony Lo

CrossFit is a very popular form of improving strength and fitness, and CrossFit athletes have a variety of common injuries. Training errors and the athlete’s biomechanics often contribute to these injuries, and identifying incorrect biomechanics and other contributing elements in their training is often the key to helping your patients recover from injury, train pain free and importantly for your patients, ultimately get stronger and fitter.

In episode 30 of the Physio Edge podcast, David Pope discusses CrossFit injuries, training, biomechanics and injury recovery with Antony Lo. Antony is a Musculoskeletal Physiotherapist with a number of clinics within CrossFit gyms across Sydney, and a large proportion of his patient population are CrossFit athletes.

In this podcast Antony and David explore:

  • The most common injuries in CrossFit
  • Factors that contribute to injuries in the Shoulders, Neck, Back, Knees, and lower limb
  • Specific exercises performed in CrossFit
  • Squats
  • Pullups/Chinups
  • Pushups
  • Overhead exercises
  • Double unders
  • Overhead squats
  • Snatch
  • Running
  • Ideal biomechanics for each of these movement
  • Common movement errors and ways to assess each movement
  • Rest from training vs continue training
  • Manual therapy on cross fit athletes
  • Modifying training loads
  • Rhabdomyolisis
  • Urinary continence while training
  • Advice for Physios treating CrossFit athletes

Links of Interest

 
 
Direct download: PE030_Cross_Fit_Injuries_with_Antony_Lo.mp3
Category:general -- posted at: 9:48am AEST

Shoulder pain patients often have poor scapula control. Is their shoulder pain caused by poor scapula control, or is their scapula dysfunction caused by shoulder pain?  

When your patients present with shoulder pain, should your focus be on scapula control, glenohumeral control, or treatment of the neck and thorax?

In this podcast, David Pope talks to Ann Cools, a Physiotherapist and Head of Education for Rehabilitation Sciences and Physiotherapy at Ghent University in Belgium, and is also the founding member and president (2010–2012) of EUSSER - European Society of Shoulder and Elbow Rehabilitation. We discuss in detail assessment of the scapula, the role of the scapula in shoulder pain and how to retrain unruly scapulae.

Other topics covered in this podcast include:

  • Research by Ann Cools
  • What we currently know from the research about the role, movement and control of
  • the scapula
  • Scapula dyskinesis - what is it
  • Static vs dynamic assessment of the scapula
  • Altering muscle balance and timing with specific exercises
  • How altering scapula mechanics effects muscle balance around the shoulder
  • Important parts of the subjective history
  • Scapula vs glenohumeral joint
  • How subjective will guide your objective assessment and treatment
  • Red flags around the shoulder, nerve pathology and frozen shoulder
  • Frozen shoulder imaging
  • Nerve injuries - symptoms, objective examination and treatment
  • Assessment of the scapula, Type 1 scapula dyskinesis
  • Differentiating contributors to Type 1 scapula dyskinesis (anteriorly rotated scapula)
  • Testing GHJ IR
  • Clinical Edge and online education on the shoulder
  • Stretching and shoulder joint mobilisation
  • Palpation, stretching and manual therapy for pec minor
  • Type 2 scapula dysfunction
  • Handheld dynamometry - serratus
  • Handheld dynamometry - middle and lower traps
  • Pain when strength testing
  • Type 3 scapula dysfunction
  • Dynamic assessment of the scapula
  • To retract and depress the scapula or not?
  • Shoulder Symptom Modification Procedure (SSMP) by Jeremy Lewis
  • Special tests around the shoulder
  • Laxity tests for the GH joint
  • Posterior GHJ laxity
  • Anterior GHJ laxity
  • Explanations of scapula dysfunction to your patients

Links of Interest

Direct download: PE_031_Scapula_Assessment_in_Shoulder_Pain_with_Ann_Cools.mp3
Category:general -- posted at: 12:12pm AEST

On Episode 29 of the Physio Edge podcast, David Pope is joined by the Australian Socceroos Physio Kurt Lisle, a Specialist Sports Physiotherapist to discuss assessment and management of Acute knee injuries.

On this podcast, David and Kurt discuss:

  • Acute Ligament Injuries - Initial management
  • When to refer for Orthopaedic consult
  • Bracing/not bracing
  • Adolescent knee injuries - when to refer for XR to check for an avulsion injury
  • Swelling during and after treatment
  • ACL injury - when to trial conservative management and when to refer for surgery
  • Timeframes for surgery following ACL injury
  • Different types of ACL grafts - pros and cons
  • LARS
  • Hamstring vs ITB tendon vs Patella tendon
  • Open chain X’s eg leg extensions to restore quads and patellar tendon load capacity?
  • Important aspects of post op rehab
  • Return to training/change of direction criteria
  • RTP criteria
  • PLC
  • Details of PLC injuries
  • Mechanism
  • Structures normally injured
  • Symptoms
  • Testing for PLC injuries
  • Conservative vs surgical
  • Rehab guidelines
  • RTP timeframes

Links of Interest

Direct download: PE_029_Acute_Knee_Injuries_with_Kurt_Lisle.mp3
Category:general -- posted at: 3:32pm AEST

David Pope and Dr Kristian Thorborg (Physiotherapist, PhD) discuss screening and rehabilitation of groin injuries.

Find out in this podcast:

  • Which tests to use when screening for potential groin injuries
  • Prevention tactics
  • Acute groin injuries - initial management and exercise progressions
  • Rehabilitation of adductor related groin pain
  • Rehabilitation of hip flexor related groin pain
  • Rehabilitation of long standing groin pain
  • Conservative management of hip related groin pain and FAI
  • Pubic symphysis
  • Management of acute compared to long standing groin pain
  • Role of manual therapy in the treatment of groin pain
  • Stretching
  • Adductor tendinopathy
  • Load management for groin pain and much more!

This episode follows on from Episode 25 of the Physio Edge podcast on Groin Assessment with Dr Kristian Thororg. I hope you enjoy Kristian sharing his experience, research and knowledge of the evidence with us on the treatment of groin pain.

Links of Interest

Direct download: PE_028_Groin_Injury_Rehabilitation_with_Dr_Kristian_Thorborg.mp3
Category:general -- posted at: 4:23pm AEST

In this week's podcast,  Dr Nathan Gibbs and I discuss managing sports injuries in a team setting. Dr Nathan Gibbs has worked with many professional sports teams, including the Sydney Swans for 15 years, 10 years with South Sydney Rugby League Football club and is one of the owners of South Sydney Sports Medicine, and in episode 27 of the Physio Edge podcast, we discuss:

  • Ideal working relationships between Physiotherapists and Sports Physicians
  • The role of a Sports Physician
  • Hamstring injury - common factors involved, imaging and return to play
  • Injections - cortisone, PRP
  • Use of PRP in ligament injury, with chondroplasty and OA

Links of Interest

Direct download: PE_027_Sports_Injury_Management_with_Dr_Nathan_Gibbs.mp3
Category:general -- posted at: 2:16pm AEST

Gymnastics places some fairly unique demands on fairly young bodies. In episode 26 of the Physio Edge podcast, I discuss these demands with Kingsley Gibson, a Sports Titled Physiotherapist that has worked with Australian Diving, Synchronised Swimming, Shooting and Hockey teams at a number of Commonwealth and Olympic games, and works with elite gymnasts on a daily basis. For his services to gymnastics, in 2000 the Commonwealth awarded Kingsley with a Sports Services Medal. So Kingsley has a lot of experience to draw on, and we got into detail on a number of topics.

In this podcast we discuss:

  • Common injury patterns in the various gymnastic disciplines

  • Important factors to consider when returning gymnasts to training and competition

  • Factors that can influence your gymnasts treatment outcome

  • Communication with parents and coaches

  • How to best implement load management strategies

  • Various motor control patterns in gymnasts that contribute to injuries

  • Screening gymnasts

  • Designing specific upper limb rehab programs

  • Lower limb and lumbar spine rehab programs

  • Management of acute vs chronic injuries

  • Stress reactions in the Lumbar spine

  • Apophyseal injuries – hip flexors, hamstrings, calcaneus (Sever’s) and Osgood-Schlatter’s

  • Management of apophyseal injuries compared to tendinopathy

  • Motor control/“stability” patterns in gymnasts

  • When to order imaging

  • Growth plate injury management – particularly in the wrist

  • The effect of other factors such as training surfaces and equipment on injury

Links of Interest

 
 
Direct download: PE026_Gymnastics_Injuries_with_Kingsley_Gibson.mp3
Category:general -- posted at: 1:34pm AEST

025. Groin assessment with Dr Kristian Thorborg

How can you identify the reason your patient has groin pain and the structures that may be causing it?

Groin pain is one of the most common issues in a lot of sports, particularly the football codes, and in episode 25 of the Physio Edge podcast, David Pope talks to Dr Kristian Thorborg about assessment of the groin.

Some of the topics we discuss on this podcast include:

  • Types of groin injuries
  • Identifying and diagnosing groin pain and injury
  • Groin vs hip pain
  • Tests you can perform to identify the irritated or painful structures
  • The relevance of diagnostic imaging, and when to refer for this
  • Hip and Groin Outcome Score (HAGOS)
  • Using the HAGOS in your clinic
  • Adductor related groin pain
  • Hip flexor related groin pain
  • Abdominal related groin pain
  • The hip joint
  • Pubic symphysis
  • Sports Hernias
  • Testing hip strength
  • Assessment of function and much more!

Links of interest

 
 
 
Direct download: PE_025_Groin_Assessment_with_Dr_Kristian_Thorborg.mp3
Category:general -- posted at: 9:25pm AEST

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