Physio Edge podcast

Your patient presents with shoulder pain, and straight away you need to identify:

Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely?

  • Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely?
  • Is the pain actually coming from the shoulder?
  • Could it be the cervical spine?
  • Is there a tear that needs urgent referral?
  • Should you order imaging? Refer to a surgeon? Or confidently continue with rehab?

In this podcast, Jo Gibson (Upper Limb Rehabilitation Specialist Physio) guides you through a simple, evidence-informed clinical reasoning framework to help you confidently assess and treat patients with shoulder pain.

Drawing on decades of clinical experience and the latest research, Jo breaks down four essential questions you need to ask in every shoulder assessment—helping you identify red flags, tailor your treatment plan, and avoid common diagnostic pitfalls.

In this episode, you’ll discover:

  • How to distinguish shoulder pain from cervical spine referral
  • Key subjective clues that guide your diagnosis and treatment decisions
  • Whether it’s “torn”—and how to know if a surgical referral is appropriate
  • Clinical signs that help differentiate frozen shoulder from other causes of stiffness
  • Why pain irritability matters—and how it impacts your rehab approach
  • When to use (and when to avoid) imaging
  • How to identify instability and assess the likelihood of recurrence
  • What assessment tests to perform in your objective examination
  • The real value—and limitations—of special tests like the Hawkins-Kennedy, drop arm, Hornblower’s, and more.
  • How to modify testing to better isolate rotator cuff contributions
  • Why symptom modification tests are useful—and what they tell you
  • How to help your patient overcome fear, regain confidence, and move again
  • What research says about exercise prescription, and how many exercises you should give patients

Listen in to strengthen your clinical reasoning and give your shoulder assessments a clear structure that helps you feel more confident—and gets better outcomes for your patients.

Chapters:

  • 00:00 - Intro
  • 03:12 - Subjective clues that guide diagnosis
  • 04:33 - What to call shoulder pain? RCRSP or SAP?
  • 06:04 - 4 key questions to ask
  • 06:29 - Cervical spine driven shoulder pain
  • 10:03 - Is it torn and does it matter?
  • 11:29 - Traumatic dislocations
  • 12:37 - Special tests in the "Is it torn" group
  • 15:56 - Is it stiff?
  • 17:36 - Is it irritable?
  • 20:38 - Can I change it?
  • 23:05 - Summary

Click on an image below to access these free resources from Jo Gibson and Clinical Edge

The handout for this podcast consists of a transcript associated with this podcast.

Shoulder: Steps to Success online course with Jo Gibson

Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Free trial Clinical Edge membership

Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial

Links associated with this episode:

Chapters:

  • 00:00:00 - Intro
  • 00:03:12 - Subjective clues that guide diagnosis
  • 00:04:33 - What to call shoulder pain? RCRSP or SAP?
  • 00:06:04 - 4 key questions to ask
  • 00:06:29 - Cervical spine driven shoulder pain
  • 00:10:03 - Is it torn and does it matter?
  • 00:11:29 - Traumatic dislocations
  • 00:12:37 - Special tests in the "Is it torn" group
  • 00:15:56 - Is it stiff?
  • 00:17:36 - Is it irritable?
  • 00:20:38 - Can I change it?
  • 00:23:05 - Summary
Direct download: 172.mp3
Category:general -- posted at: 11:53pm AEST

Your patient is running, playing sport, or jumping or lunging forward - an activity with fast eccentric or concentric activity in dorsiflexion,and suddenly they feel like they’ve been kicked in the back of the leg.

They might hear a snap and have difficulty weightbearing, walking and pushing off.

What’s your likely diagnosis?

You picked it - an Achilles tendon (AT) rupture.

AT ruptures are a devastating injury that can drastically impact a patient’s ability to walk, run, or return to sport.

Despite their frequency, there’s a lot of uncertainty among clinicians, patients, and even surgeons around how to best assess, treat, and rehabilitate Achilles tendon ruptures.

Patients are often fearful of doing the wrong thing and re-rupturing the tendon.

Therapists often follow a non-surgical protocol of putting people in a boot, but are unsure how to progress, how fast to progress and what to do during and after they’re in the boot.

An even bigger problem than AT re-rupture is the very common issue of an elongated tendon where patients have long-term difficulty with calf weakness and inefficiency, walking long distances, hopping, jumping, and returning to sport.

In this podcast, David Pope (APA Titled Musculoskeletal and Sports & Exercise Physiotherapist) is joined by Prof. Peter Malliaras (Specialist Physiotherapist FACP, clinician and researcher with a PhD in tendinopathy) to explore the latest evidence, clinical insights, and rehab strategies for Achilles tendon ruptures.

Peter draws on his extensive clinical experience, recent research, and the development of a specialist Achilles rupture service at OrthoSport Victoria to help guide your decision-making and treatment approach.

In this podcast, you’ll discover:

  • The mechanism of injury and clinical presentation of Achilles tendon ruptures.
  • Key diagnostic tests and how to avoid missed or delayed diagnoses.
  • Common pitfalls that lead to tendon elongation—and how to prevent them.
  • When to recommend surgical vs non-surgical management.
  • A new, innovative approach to strengthening the Achilles tendon while the patient is in the boot.
  • How to safely begin loading the Achilles in the early phase of rehab.
  • Strategies to protect against tendon elongation during and after boot use.
  • Whether we should be stretching or trying to improve dorsiflexion.
  • Objective strength criteria to guide progression through rehab stages.
  • Return-to-walking and return-to-sport timeframes—and how to individualise them.
  • What to do when patients present late or have already developed elongation.
  • Complications to watch for post-injury or post-surgery.
  • How to help patients navigate the psychological and motivational challenges of recovery.

Listen to this episode to gain clarity on Achilles tendon rupture assessment and rehab, and develop a structured, evidence-based approach you can apply immediately in your clinical practice.

Timeline

00:06:23 Problems Physios and patients face with AT ruptures?

00:09:29 Subjective - How to identify a likely AT

00:12:03 Who gets an AT rupture?

00:18:45 Why do AT's rupture?

00:20:06 Misdiagnosis

00:24:14 Surgical or non-surgical management?

00:30:25 Elongation - Improve dorsiflexion or make the AT stiffer?

00:36:53 Safe loading in the boot & progressions

00:42:49 When to start exercising in the boot

00:46:08 Elongation - why is it a problem?

00:54:00 Bent or straight knee calf exercises?

00:59:55 RTP - How long does it take?

01:03:32 Surgical vs non-surgical timeframes

01:04:25 Assessment and diagnosis of AT ruptures

01:08:40 Initial management of an AT rupture

01:11:26 Education - What to tell patients

01:12:54 Imaging

01:14:57 Delayed presentation - How to manage

01:16:10 Red flags & complications

01:19:10 Walking - How to guide patients as they come out of the boot

01:21:27 Exercise progressions after the boot

01:23:48 Key takehome messages

   

Get free access to the "Tricky tendons" infographic series

Unlock the secrets of successful tendinopathy assessment and treatment with this free infographic series for therapists.

Links associated with this episode:

Research associated with this podcast

Direct download: 171.mp3
Category:general -- posted at: 5:05pm AEST

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