Physio Edge podcast

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:

Ankle syndesmosis injuries following forced ankle dorsiflexion and lateral rotation of the foot require very specific management and rehabilitation to achieve great treatment outcomes. If you approach management of ankle syndesmosis injuries in the same manner as a lateral ankle ligament injury it will likely result in long term pain and dysfunction for your patients.

In the previous episode of the Physio Edge podcast - How to assess ankle syndesmosis injuriesChris Morgan and David Pope explored how to assess and diagnose ankle syndesmosis injuries (ASI).

In this new Physio Edge podcast - "How to treat ankle syndesmosis injuries with Chris Morgan (Arsenal 1st Team Physiotherapist in the English Premier League), you will discover how to manage different grades of ASI, including:

Grade 1 syndesmosis injury management

  • Initial injury management
  • How long should you immobilise a Grade 1 injury for?
  • What weight bearing should be allowed in the initial stages?
  • Taping techniques that can be utilised during return to running, training and play
    • Rehab - initial exercises and progressions
  • How much pain is acceptable during return to training?
  • Return to sport timeframes & how you and your athlete can decide when RTP is appropriate
  • When can contact be initiated?

Grade 2 syndesmosis injuries

  • Grade 2 injury management and immobilisation
  • Which players are likely to require arthroscopy to confirm instability, and subsequent stabilisation surgery?
  • Why rehabilitation of stable grade 2 injuries is different from grade 1 injuries
  • Which movements you need to restrict
  • How to maintain lower limb musculature and minimise muscle atrophy should be performed
  • Additional general conditioning your patient should perform during the early phase of rehab
  • How to incorporate an Alter G treadmill into rehab
  • Occlusion training for lower limb conditioning
  • How to modify rehab if you do not have access to an Alter G
  • Timeframes and criteria to assess when your patient can remove their immobilisation boot
  • Tests to perform at each stage of rehab
  • When and how should dorsiflexion range be improved?
  • Timeframes and criteria to meet prior to return to running
  • Exercise progressions and variations
  • Return to play markers and tests you can use
  • What to do when a player still reports a ‘nipping’ at the front of the ankle after 6 weeks and is having difficultly achieving full dorsiflexion

Unstable injuries - Grades 2b, 3 and 4

  • Management of unstable injuries
  • Post-surgical immobilisation and management
  • Common return to play timeframes

Click here to download your podcast handout

To accurately grade your patients ASI and prescribe the most appropriate rehab I strongly recommend listening to Physio Edge podcast episode 80 – How to assess ankle syndesmosis injuries with Chris Morgan prior to this podcast

CLICK HERE to register for the free webinar - Medial knee injuries with Chris Morgan

Medial knee injuries often occur in snow sports, or other sports when landing or being tackled. Different areas of the medial knee can be injured, including the deep, superficial, proximal or distal fibres of the MCL and medial knee. Depending on the injured structures, patients will either cope with a more aggressive treatment approach and early return to sport, or require a more conservative approach. How can you know the rehab approach your individual patient requires?

In this free webinar with Chris Morgan (1st Team Physiotherapist with Arsenal FC), you will explore:

  • Applied anatomy of the medial knee
  • Mechanism of injury, presentation and diagnosis of medial knee injuries
  • How you can differentiate between deep, superficial, proximal, distal and Grade 1, 2 and 3 clinical injuries
  • How imaging findings correlate with your clinical findings
  • MRI grading (radiological versus clinical)
  • How you can perform an objective assessment
  • How function, pain and instability impact your treatment
  • Accelerated vs more conservative treatment - how can you choose the ideal approach for your patient?
  • Are PRP injections appropriate?
  • Rehabilitation principles you can use with your medial knee injury patients
  • Ligament loading
  • Which bracing and weight bearing regime should you utilise?
  • What should you do when your patient has joint laxity?
  • Is pain during rehab acceptable?
  • Should you overload OR "under load to overcome"?

You can CLICK HERE to access this free webinar

Articles associated with this episode:

Other episodes of interest:

Direct download: Physio_Edge_081_How_to_treat_ankle_syndesmosis_injuries_with_Chris_Morgan.mp3
Category:general -- posted at: 12:15pm AEST

Ankle syndesmosis injuries, also known as a high ankle sprain, commonly occur during high impact tackles or collisions that involve forced lateral rotation of the foot in ankle dorsiflexion. Syndesmosis injuries can be missed in the early stages as the degree of pain and swelling may not reflect the severity of the injury. Early diagnosis of syndesmosis injuries is key in preventing persistent pain, disability and limited ability to return to play or activity.

In Physio Edge podcast episode 80, English Premier League Physiotherapist Chris Morgan, and David Pope explore how to assess and diagnose ankle syndesmosis injuries (ASI), including:

  • Questions you need to ask when your patient has had an ankle injury
  • What is an ASI?
  • What symptoms will your patient report following ASI?
  • Ligaments and structures that are often involved in an ASI
  • What is a "peeling injury", and how does this influence the structures that are injured?
  • Common mechanism of injury
  • How to assess, diagnose, classify and grade ASI
  • How to differentiate between stable and unstable ASI
  • Which tests can you perform to accurately diagnose ASI?
  • Differential diagnosis
  • Which injuries are likely to require surgical intervention, and which injuries may be managed conservatively?
  • When imaging is useful
  • What type of imaging to perform
  • Identifying underlying chondral lesions
  • Early management strategies

CLICK HERE to download your podcast handout

Upcoming podcast - How to treat ankle syndesmosis injuries with Chris Morgan

A subsequent podcast with Chris Morgan will discuss in detail how to treat ankle syndesmosis injuries . Download this podcast now to improve your assessment and diagnosis of ankle syndesmosis injuries.

Free webinar - Medial knee injuries with Chris Morgan

Chris Morgan's Physiotherapy roles in English Premier League with Liverpool and Crystal Palace have provided him with a lot of experience treating acute injuries, including the ankle and knee. To help you take advantage of this experience, Chris is presenting a Clinical Edge webinar on medial knee injuries. In his webinar Chris will discuss:

• Presentation of medial knee injuries
• How imaging findings correlate with clinical findings
• How to progress your rehabilitation and return players to performance
• Incorporating change of direction and trunk control into rehabilitation

You can CLICK HERE to access this free webinar

Articles associated with this episode:

Morgan et al. 2014. Conservative management of syndesmosis injuries in elite football

Sikka RS, Fetzer GB, Sugarman E, Wright RW, Fritts H, Boyd JL, Fischer DA. Correlating MRI findings with disability in syndesmotic sprains of NFL players. Foot & ankle international. 2012 May;33(5):371-8.

Sman AD, Hiller CE, Rae K, Linklater J, Black DA, Nicholson LL, Burns J, Refshauge KM. Diagnostic accuracy of clinical tests for ankle syndesmosis injury. Br J Sports Med. 2015 Mar 1;49(5):323-9.

Other episodes of interest:

PE 017 - Injury reduction with Dr Peter Brukner

PE 027 - Sports injury management with Dr Nathan Gibbs

Following ACL injury, patients can have a smooth recovery with full return to sport and activity, or end up with ongoing knee symptoms and limited ability to perform the activities they love. How can you help your ACL injured patients have a great outcome?

In Physio Edge podcast episode 079, Dr Lee Herrington and David Pope explore how to make your ACL injury rehab successful, and provide you with a comprehensive guide to rehabilitate ACL injuries. You will understand how to take your patients from initial injury to return to sport, and develop the knowledge to help inform your patients decide with your patient whether surgical repair or conservative management is their best option.

You will discover:

  • Do ACL injuries require surgical management?
  • Which factors commonly affect whether people with ACL-deficient knees require surgery?
  • Common diagnostic errors in ACL injury patients
  • What are the key elements you need to include in your rehab of ACL injuries?
  • Conservative vs surgical management
  • Should your rehab focus on movement control, strength or skills?
  • How you should objectively assess your patients rehab progress?
  • What valid measurement tools can you use when assessing patient progress?
  • Are open-chain exercises safe, and should they be used in your rehab?
  • Most effective types of movement control and skill training
  • How to know when your patient should progress their exercises?
  • Which strength measures are important?
  • Which strength training exercises can you include?
  • When can running be commenced?
  • Running progressions you can use
  • What pain measures should you monitor throughout rehab?
  • Is pain during rehab ok?
  • How to return your patient to training and sport
  • What maintenance exercises should your patient continue after completing their rehab?

Related online courses

Advanced ACL rehab with Andrew Ryan

Other episodes of interest:


Click here to download the podcast handout

Articles associated with this episode:

Direct download: Physio_Edge_079_How_to_rehabilitate_ACL_injuries_with_Dr_Lee_Herrington.mp3
Category:general -- posted at: 6:29pm AEST

How can you incorporate high performance elements into your sports injury rehab, to help your injured players and athletes become strong, fit, powerful and fast? How can you rehab a player to perform at a high level when they return to sport following injury?

In Physio Edge podcast episode 78, David Joyce shares how you can improve the performance aspects of your rehabilitation. You will discover some of the key elements when managing high performance athletes and sporting teams. If you work with injured athletes at an elite, recreational or junior level, or would like to work with a sports team, you will love this podcast.

In this podcast, David Joyce and David Pope discuss:

  • How to help athletes move from being a junior player to performing at an elite level
  • How to help players build tolerance and resilience to cope with high level sport
  • How to create "elite level people", not just "elite level players"
  • What makes a player likely to succeed?
  • Schedules and weekly programs you can use to prepare junior players
  • What load should a junior player perform during preseason relative to a senior player?
  • When players need to be exposed to higher loads
  • How to schedule training and running to prevent bony and soft tissue injuries
  • How many running sessions per week should players perform?
  • "Earning the right" to run at full speed
  • How to structure strength sessions do players perform
  • Incorporating plyometrics
  • What load measures are actually important
  • Important screening questions to ask your players
  • How to return injured players to high level sport
  • How many weeks of full training do ACL injured players require before return to play
  • Key tests to perform for your players
  • Tips when objectively testing athletes

CLICK HERE to download your podcast handout

Get your access to Sports Injury Assessment and Treatment FREE videos

Other episodes of interest:

Direct download: Physio_Edge_078_High_performance_athlete_management_with_David_Joyce.mp3
Category:general -- posted at: 4:10pm AEST

The long head of biceps tendon and superior labrum can get a hard time in throwing athletes and patients that fall on their arm or shoulder. This can result in long head of biceps tendon pathology or SLAP tears, and cause ongoing shoulder pain.

A lot of our shoulder tests are non-specific, and are unable to identify particular structures that are irritated or painful in the shoulder. In the case of the long head of biceps (LHB) tendon and slap tears, there are a few useful tests that in combination with a good history can help you identify when the structures are involved in your patient's shoulder pain.

In episode 77 of the Physio Edge podcast, Jo Gibson, Shoulder Specialist Physio and David Pope discuss anterior shoulder pain, LHB pathology and SLAP tears. You will discover:

  • Anatomy of the long head of biceps tendon and superior labrum
  • Why the anatomy is important, and may be different to what you learnt at university around the biceps tendon and bicipital groove
  • The clinical presentation and relevant history of patients with SLAP lesions and LHB tendon pathology
  • Which patients are more likely to get SLAP tears following trauma
  • Special tests that may help you identify LHB pathology and SLAP tears
  • What information imaging gives us
  • When to request imaging for your shoulder pain patients
  • Different groups of patients that develop LHB pathology
  • Rehabilitation of LHB tendon pathology and SLAP tears
  • When to specifically target the LHB tendon, and when to target the surrounding structures for best results
  • Other areas to consider in your rehab beyond the shoulder
  • How the kinetic chain can impact shoulder pain
  • How someone's hop distance can influence their shoulder pain
  • How to start treatment of someone with an irritable LHB tendon
  • Important education components to include in your treatment
  • Time frames - How long do these injuries take to recover?
  • Which patients are suitable for surgical management?
  • Different types of surgery for LHB tendon pathology
  • Which SLAP tear patients should have conservative treatment?
  • How suprascapular nerve involvement can present following traumatic shoulder injury, and how to identify patients with suprascapular nerve compression

Articles associated with this episode:

Exercise videos

Other episodes of interest:

There are a lot of myths around footwear, and your patients with running injuries will often blame an "incorrect shoe" choice for their injury, or believe that getting the "right shoe" will help resolve an injury. Are running shoes the cause of, and solution to running injuries?

What advice should you give your patients when they ask that inevitable question "Do you think I need to get new shoes?", closely followed by "What shoe do you think I should run in?"

In Physio Edge podcast episode 76 with Tom Goom, you will also discover:

  • What footwear should your runners and injured runners wear?
  • Footwear questions you need to ask your running injury patients
  • Does footwear change gait patterns?
  • Can footwear contribute to injury?
  • What footwear may contribute to or help in your treatment of Achilles tendinopathy
  • What is heel-toe drop and how is this important?
  • Does footwear affect ground reaction forces, and how does this relate to bone stress injuries and plantar fasciopathy?
  • Is minimalist or barefoot running helpful or harmful?
  • Can runners safely transition to barefoot or minimalist running?
  • Is footwear the key to resolving running injuries?
  • Shoe prescription
  • Recommendations when buying new shoes
  • Footwear considerations for specific pathologies
  • When should runners change their shoes?

If you would love to get better results with running injuries, the podcast handout contains the key take-home 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

Related posts

Research associated with this episode

Direct download: Physio_Edge_076_Footwear_advice_for_running_injuries_with_Tom_Goom.mp3
Category:general -- posted at: 8:13pm AEST