Physio

Sport Physical Therapy

Dr Kieran O’Sullivan, PT, PhD, was one of the first podcast guests to crack 9,000 listens! From the University of Limerick, Ireland, he has vast clinical experience and he completed a PhD on the role of sitting in back pain. In this 18-minute podcast he reviews his 2015 podcast in the first 3 minutes and then rattles off at least 7 practical tips. 

Kieran was a guest of PhysioFirst (UK) when BJSM interviewed him in April 2015. The 2017 PhysioFirst conference is on April 1-2 (2017!) in Nottingham (UK) and guest speakers include Professor Paul Hodges, Dr Tania Pizzari and Dr Igor Tak. 

Timeline: 
1.00 m Back pain is neither explained by what patients and clinicians see on scans nor just by load

2.00 m When treating, you need to assess the various factors that could be playing a role, such as load, posture, stress, and address the right one. 

4.00 m Should we try to prevent all back pain? Listen to Dr O’Sullivan challenge the belief that it’s important to never have back pain. He likens back pain to conditions like sadness, constipation – not great but not a major problem as long as it doesn’t persist. Athletes need to load their bodies and adapt rather than avoid load and become vulnerable (See Gabbett papers and podcast, below). Don’t pass on fear (of back pain coming on or persisting) to athletes. 

5.00 m Screen for red flags of course, if the clinical picture warrants it – but most long-term back pain is NOT due to something listed as a red flag. 

6.00 m Reassurance – being empathetic without inducing fear. 

7.00 m Think through. What precipitated the pain? Too much load, too much stress, bad posture, movement patterns? If unknown, have patient create a pain diary. Look for trends. Examine all the dimensions of the biopsychosocial model. 

9:00 m Don’t just make the diagnosis but be practical. Patient sad? Don’t just say ‘You are sad, your back pain will go away’. Provide specific treatment for the specific threat. 

10:00 m Empower the patient to choose the exercises he or she wants and what he or she will do! Exercise has benefits across systems. 

11:00 m Don’t give up. Here Kieran walks us through a challenging real life case. A simple tissue diagnosis would not have helped this person at the centre of the case 

12:00 m Explain! Explain the pain! (HT to Professor Lorimer Moseley and Dr David Butler).  

13:00 m The period at 4-6 weeks of pain can be difficult – patient has not adapted to the contemporary model and may still be on waiting list for imaging. 

14:00 m What is the evidence for this approach? How does the evidence compare, with, for example Hamstring injuries? 

Links to previous podcast: 
2015 – Dr O’Sullivan on “Effective treatments for back pain: Kieran O'Sullivan’s practical tips within a guiding framework” http://ow.ly/4nepGu

BJSM paper: 
O'Sullivan K, O'Sullivan P. The ineffectiveness of paracetamol for spinal pain provides opportunities to better manage low back pain. Br J Sports Med. 2016 Feb;50(4):197-8. http://ow.ly/4neqbS (Members Only/subscribers)

Manual Therapy paper: 
Hurley J, …., O'Sullivan K. Effect of education on non-specific neck and low back pain: A meta-analysis of randomized controlled trials. Man Ther. 2016 Mar 10. pii: S1356-689X(16)00017-5. doi: 10.1016/j.math.2016.02.009. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/27026111


Dr Kieran O’Sullivan on managing back pain: 7 habits of highly effective clinicians. Part 2, 2016

Professor Damian Griffin talks about the Warwick Agreement, an international consensus on the management of femoroacetabular impingement syndrome. This podcast brings you right up to date on the most current thinking about hip impingement or FAI.

0.38 Aim of the consensus
1.36 Consensus methodology
2.26 What is FAI syndrome? Symptoms, clinical signs, and imaging findings.
3.40 How should FAI syndrome be diagnosed?
6.26 What is the appropriate treatment for FAI syndrome?
8.26 What is the prognosis of FAI syndrome?
10.23 How should someone with an asymptomatic hip, with cam or pincer morphology, be managed?
11.53 What research is now needed?
14.15 How is this new definition of FAI syndrome going to influence clinical care?

@DamianGriffin #WarwickAgreement

Damian Griffin is the Professor of Trauma and Orthopaedic Surgery at the University of Warwick. He trained in Cambridge, Oxford and the United States, and worked as a Consultant in Oxford before taking up the Foundation Chair in Warwick and helping to establish Warwick Medical School.

Damian’s passion is the diagnosis and treatment of hip and groin pain in young adults. His clinical practice and research focus on joint-preserving surgery for early arthritis, hip arthroscopy, the management of femoroacetabular impingement and sport injuries of the hip. He runs the largest national referral service for young and active people with hip pain in the UK, based at the University Hospital of Coventry and Warwickshire NHS Trust, and for private patients and elite athletes in London and Coventry (www.hiparthroscopyclinic.co.uk).

Damian leads a research team based at the University of Warwick, with a portfolio of hip research. In particular he is the chief investigator for the FASHioN trial, a large, multicenter randomised controlled trial of treatments for people with FAI syndrome, comparing surgery with physiotherapy-led rehabilitation:www.nets.nihr.ac.uk/projects/hta/1310302

You can follow Damian on Twitter @DamianGriffin and @WarwickOrtho or reach him on damian.griffin@warwick.ac.uk



The Warwick Agreement on the management of femoroacetabular impingement syndrome with Damian Griffin

Professor Peter O’Sullivan is among the top 3 most popular physiotherapy voices on podcasts and here he focuses on myths and harmful beliefs about back pain. He takes a swing at clinicians who rely excessively on imaging findings to attempt to explain the source of pain. He shares the story of a clinician who told a patient his spine was ‘shredded’. 

Prof O’Sullivan emphasizes the importance of history taking, finding factors that can sensitize neural tissue and gives an overview of treatment. He will be the keynote Refshauge Lecturer at Sports Medicine Australia’s 2016 Conference (#SMAConf16, @SMA_Events). 

Timeline: 
0.35 m - A sneak preview of the Refshaughe lecture plan – back pain is a big problem and those in sport can learn from what is known in back pain in the general population

2.17 m - Patients respond well to a combination of explanation, being shown ways they can get back to the things they love to do, and appropriate progressive exercises

4.21 m - A case where a patient could have been treated with early investigation, aggressive medical intervention, potentially surgery. An alternative approach to management

6.48 m - How junior clinicians can approach the patient who presents with a bag of images or a medical note that may not reflect current best practice for managing back pain

9.45 m - The biology of how neural tissue can be sensitized by lack of sleep, stress. Fascinating neuroimmunology

10.55 m - You do treat the back don’t you? It’s not just explaining pain, counseling?  

12.30 m - Parallels with work of other physiotherapists such as Prof Jill Cook (@ProfJillCook) and Dr Alison Grimaldi (@alisongrimaldi) who advocate for progressive loading as a stimulus for healing. “Backs love movement”

13.55 m - A 30-second summary!  

Related podcasts: 
Please consider downloading the mobile app “BJSM’ from iStore or GooglePlay. There are over 250 to choose from and the 10 most recent are very easy to get via the app. 

1. Professor Peter O’Sullivan (@PeteOSullivanPT) on Tiger Woods’ back and ‘core strength’
http://ow.ly/uNgj304udUI

2. Dr Kieran O’Sullivan (@KieranOSull) on how top clinicians approach back pain
http://ow.ly/18Ru304ue96



Prof Peter O’Sullivan’s sneak peek of Refshauge Lecture on Back Pain: Sports Medicine Australia 2016

Dr Clare Ardern is a sports physiotherapy researcher at Linkoping University in Sweden. She carries Australia’s prestigious NHMRC’s top scholarship for clinician researchers – the 4-year Fellowship Award.  You may know of her publications that highlight the relatively low return to play rates after ACL reconstruction. In this podcast, she addresses return to play more broadly. From 12-15th October this year she will be a keynote speaker at Sports Medicine Australia’s conference. You can follow that via BJSM Twitter #SMAConf16 and Facebook.

She was interviewed by Dr Christian Barton, who is a well-published physiotherapist PhD as well. He serves as BJSM Deputy Editor and the Editor responsible for Social Media (small job! easy!).

Timeline:
1:00m - Where did the Return To Play Consensus come from?

2:00m - Defining Return to Play; what does it mean in different settings

3:00m - The difference in RTP for o/c acute – removal from play?

4: 10 - Decision making – how should the return to play decision be made?

3:30m - Return to Play is a continuum that requires meticulous planning

4:00m - When can the athlete return to a pre-injury (or better) level of performance?

4:30m - What is the evidence for return to play decisions? Spoiler alert! – It’s limited. 

5:20m - Taking the emphasis of the ‘one day’ that players focus on to be back at sport. The concept of a continuum (from when you first see the athlete). 

6:45 - Return to play and returning to perform at the previous level. Are there important differences? What can clinicians do to help players get back to that level?

8:30m - Does ‘Return to Play’ end? It’s very different for different athletes. 

10:10m - Should athletes have ACL reconstruction after ACL injury? What does the research show? 

11:40 - Clare’s perspective on the return to play data after ACL reconstruction in the non-elite players. 

12:15 - An example of a player in the English Premier League who was ACL deficient.

Dr Clare Ardern (Sweden) shares the latest on Return to Play – World Congress Consensus Statement

In this podcast, Steffan Griffin of the BJSM speaks to Dr Andrew Murray – SEM consultant & adventurer (amongst other things!), who is currently undertaking a PhD looking into ‘Golf and Health’. We talk about how the Golf and Health project was born, and some of the notable findings from his recently published scoping review. This is a must-listen for any SEM professional/student, not only due to some of the clinical pearls, but due to the fact that this is a shining light of what other sports could also be doing!

Contents
1.00: Andrew tells us about the Golf and Health project

2.30: What are the main findings from the scoping review?

5.30: Deeper dive into the potential benefits

6.45: What about mental health?

7.30: Could spectators also be reaping some of the health rewards associated with playing?

9.45: What lessons are there for other sports?

Links
Scoping Review http://bjsm.bmj.com/content/early/2016/09/26/bjsports-2016-096625.full

Infographic http://bjsm.bmj.com/content/early/2016/09/20/bjsports-2016-096866.full.pdf+html

Golf and Health website http://www.golfandhealth.org/ 

Golf and Health twitter https://twitter.com/GolfAndHealth 

Golf and Health facebook https://www.facebook.com/GolfAndHealth/?fref=ts

Dr Andrew Murray on golf and its effects on health

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy. How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with&nbsp;Dr Peter Malliaras&nbsp;in episode 68 of the Physio Edge podcast. We also explore:  Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas? How will you identify tendinopathy or other structures that may be contributing to your patients symptoms? Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement How can you measure your patients load tolerance? What categories of tendinopathy patients can you use to help differentiate your treatment? How can you rehabilitate patients with tendinopathy? What role does biomechanics have? What advice can you provide to your patients about load management, symptoms and flareups? When is it ok for your patients to continue or return to running? What strength tests should your patients be able to complete before returning to running? If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration? When are isometrics useful in your treatment? When can you start isotonic and plyometric exercises? How can you incorporate tendon neuroplastic training (TNT)?  Links associated with this episode   Download your podcast handout Dr Peter Malliaras on Twitter Tendinopathy rehab blog with Dr Peter Malliaras Get your free trial Clinical Edge membership David Pope on Twitter Clinical Edge on Facebook  Other episodes of interest:   PE 046 - Proximal hamstring tendinopathy with Tom Goom  PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O’Neil  PE 023 – Lower limb tendinopathies with Dr Pete Malliaras  Articles associated with this episode:    Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia   Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy   Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.   Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.

Physio Edge 068 Lower limb tendinopathy loading, running and rehab with Dr Peter Malliaras

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&nbsp;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&nbsp;podcast handout contains the key take-home messages for you. You can&nbsp;download it here. To complement this podcast and improve your treatment of runners,&nbsp;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 Links of Interest    Free Achilles tendinopathy rehabilitation in runners videos with Tom Goom - a series of three evidence-based videos to get you great results with achilles tendinopathy    Download and subscribe to the podcast on iTunes   Download your free podcast handout on treatment of calf pain in runners Tom Goom on Twitter Let David Pope know what you liked about this podcast on Twitter  Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Get your free trial Clinical Edge membership Tom Goom's website &amp; courses Tom on Facebook Live  Related posts   Physio Edge 065 - Differential diagnosis of calf pain in runners with Tom Goom  Physio Edge 064 What is causing calf pain in runners and how can you assess it with Tom Goom  Physio Edge 062 How to treat plantar fasciopathy in runners with Tom Goom  Infographic - How to treat plantar fasciopathy in runners with Tom Goom  Physio Edge 061 How to assess &amp; diagnose plantar fasciopathy in runners with Tom Goom  Infographic - How to assess &amp; diagnose plantar fasciopathy in runners with Tom Goom  Physio Edge 060 Plantar fasciopathy in runners with Tom Goom  Infographic - Plantar fasciopathy in runners with Tom Goom  Infographic - Plantar fasciopathy imaging &amp; education with Tom Goom  Research associated with this episode   Esculier et al. 2015. A consensus definition and rating scale for minimalist shoes. Fuller et al. 2017. Six week transition to minimalist shoes improves running economy and time-trial performance. Kong et al. 2009. Running in new and worn shoes: a comparison of three types of cushioning footwear.  Mallisoux et al. 2015. Influence of heel to toe drop of standard cushioned running shoes on injury risk in leisure time runners: a randomised controlled trial with 6 month follow up. Nigg et al. 2015. Running shoe and running injuries: myth busting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Salzier et al. 2016. Injuries observed in a prospective transition from traditional to minimalist footwear: correlation of high impact transient forces and lower injury severity.

Physio Edge 076 Footwear advice for running injuries with Tom Goom

What are the keys to good running form? Is there a magical number for step rate? Should we all be changing the way we run?
 
This week Tom Goom joins us to chat about gait retraining and its role in helping injured runners. Known to many in the SEM community as the ‘Running Physio’, Tom is a physiotherapist with over 15 years of experience who specialises in running injuries. He shares his knowledge with clinicians and runners around the world through his website Running-physio.com and very popular Running Repairs Course.
  
In this 20-minute episode, Tom discusses the rationale for gait retraining, who needs it, how to assess the injured runner and his comprehensive gait retraining management plan.

Stepping up to better running form with the Running Physio – Tom Goom. Episode #408

At the 6 th International Patellofemoral Pain Research Retreat held in Milwaukee in October 2019, Erin Macri pulled four clinician-scientists (Dr. Simon Lack, Dr. David M. Bazett-Jones, Dr. Gretchen Salsich,
Dr. Christian Barton) into the ring, with a goal of teasing out key concepts and providing guidance on how to incorporate dynamic knee valgus into the evaluation and treatment of individuals with
patellofemoral pain. Should dynamic knee valgus always be treated? Find out in this episode.

Dynamic knee valgus and patellofemoral pain – what gives? Episode #411

Dr. Andrea Mosler is a specialist sports physiotherapist and research fellow at La Trobe University, Melbourne. In this podcast, Liam West poses the questions that see Dr. Mosler explain how you should approach the prevention and management of hip and groin pain in athletes. She describes findings from her PhD and gives you the listener some clinical pearls to add to your “hip and groin” treatment toolbox!

What actually works? Hip and Groin masterclass with Dr. Andrea Mosler. Episode #437

Are injury recurrences due to a return to sport prior to adequate biological healing? Can we accurately measure stages healing with imaging or blood tests? Professor Erik Witvrouw discusses the importance of respecting biological healing in sports musculoskeletal injuries with BJSM’s Liam West.

Are we allowing injured athletes enough rest? Biological healing with Erik Witvrouw. Episode #439

There has been a huge shift in golfers over the last 10 to 15 years with many more golfers at the top of the game such as Tiger Woods, Rory Mcllroy and Brooks Koepka focusing on Strength and Conditioning (S&C) to improve performance.
COVID-19 has stopped many sporting events and has provided some a unique opportunity to focus on S&C. Bryson DeChambeau took full advantage of this putting on large amounts of muscle and is the latest golfer to demonstrate the benefits of S&C in golf performance. In this podcast Dan Coughlan explains to Will Wynter Bee the shift in S&C in golf and how the different S&C programmes used by tour players can improve performance while minimising injury risk. He also discusses the S&C set up on the European tour.
Additional information.
https://bjsm.bmj.com/content/bjsports/53/1/13.full.pdf?casa_token=SP73J6k2B4AAAAAA:EmiTi99T9da2ALJWIbVB350UmxsyeNLtkCz43HLNyVAGaDqzP9F1bJZC6_ReinWhYHzI8TLCTvA

https://shapeamerica.tandfonline.com/doi/abs/10.1080/02640414.2018.1559972#.Xw8soZNKhTY

https://sportperfsci.com/strength-and-conditioning-in-golf-probability-of-performance-impact/

Dan’s Twitter and Instagram accounts

https://twitter.com/etpi?lang=en

https://www.instagram.com/etpi_performanceunit/

Strength and Conditioning in Golf – How did Bryson get so big? Dan Coughlan discusses. Episode #440

Dr. Harvi Hart is a postdoctoral researcher at Western University in London, Ontario, funded by the Canadian Institutes of Health Research. Dr. Hart’s research focuses on identifying risk factors for knee osteoarthritis, both non-traumatic and post-traumatic osteoarthritis. Through better understanding these risk factors, Dr. Hart aims to develop new treatment approaches for managing knee OA. In this episode, Dr. Erin Macri asks Dr. Hart about her most recent studies looking at cadence and its possible role in joint loading and knee osteoarthritis. 
 
Twitter:
@HarviHart
@Erin_Macri
 
Resources and references
Hart HF, Birmingham TB, Primeau CA, et al. Associations between cadence and knee loading in patients with knee osteoarthritis. Arthritis Care Res (Hoboken) 2020. Published online first doi:10.1002/acr.24400
Hart HF, Gross KD, Crossley KM, et al. Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2019. Published online first doi: 10.1002/acr.23864
Lenhart RL, Thelen DG, Wille CM, Chumanov ES, Heiderscheit BC. Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc 2014; 46: 557-564. 
Willy RW, Meardon SA, Schmidt A, Blaylock NR, Hadding SA, Willson JD. Changes in tibiofemoral contact forces during running in response to in-field gait retraining. J Sports Sci 2016; 34: 1602-1611.
Bramah C, Preece SJ, Gill N, Herrington L. A 10% increase in step rate improves running kinematics and clinical outcomes in runners with patellofemoral pain at 4 weeks and 3 months. Am J Sports Med 2019 7:3406-3413.

Cadence: Steps to manage joint load in knee OA? An interview with Dr. Harvi Hart. Episode #447

As a three-time Major winner and the current European Ryder Cup team captain, Padraig Harrington is uniquely placed to consider the cultural changes in golf with respect to medicine and performance.

During this two-part conversation with Dr Sean Carmody and Padraig's longtime fitness coach, Dr Liam Hennessey, Padraig provides an insight into his experiences of injury, what he believes contributes to injury, and how a willingness to innovate has helped him to continue playing at the highest level over so many years.

Strength and Conditioning in Golf – How did Bryson get so big? Dan Coughlan discusses. Episode #440

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