Sport Physical Therapy

PE028 Groin Screening, Injury and Rehabilitation with Dr Kristian Thorborg
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
Case Study of Adductor tear rehabilitation
Dr Kristian Thorborg
Dr Kristian Thorborg on Twitter
HAGOS
Studies that Dr Kristian Thorborg has completed or been involved in
PE #025 Groin Assessment with Dr Kristian Thorborg
PE #016 Preventing hamstring injuries with Dr Kristian Thorborg
Review the Physio Edge podcast in iTunes
Download the Physio Edge podcast from iTunes
Clinical Edge
20% off your first month’s membership to Clinical Edge with the code PHYSIOEDGE
Kristian Thorborg’s editorial on BJSM
Kristian Thorborg’s PhD Thesis
Review the Physio Edge podcast in iTunes
Download the Physio Edge podcast from iTunes
Clinical Edge
20% off your first month’s membership to Clinical Edge with the code PHYSIOEDGE
Tags: groin, groin pain, groin assessment, kristian thorborg, dr kristian thorborg, HAGOS, strength testing, adductors, inguinal, hip flexor, hip joint, acetabular labrum, hip strength, function assessment, pubic symphysis, sports hernias, physio edge, physiotherapist, physio, edge, clinical edge, podcast, online education



PE #028 Groin Injury Screening and Rehabilitation With Dr Kristian Thorborg

Did you listen to Ray Moynihan’s podcast on ‘’Overdiagnosis in sports medicine”? That’s a ‘gold’ podcast (>5000 listens) and Peter O’Sullivan now extends those ideas into the realm of sports physiotherapy. 

“We can massively create health problems” warns Prof O’Sullivan speaking about the way clinicians may explain pathology to patients. If not explained appropriately, MRI and other imaging can have a negative effect on a patient’s perception of injury. 

Pete refers to this free paper in RADIOLOGY: McCullough et al. Lumbar MR imaging and reporting epidemiology: do epidemiologic data in reports affect clinical management? Radiology. 2012 Mar;262(3):941-6. doi: 10.1148/radiol.11110618. 

If you missed Ray Moynihan’s podcast, here’s the link: http://bit.ly/1oA45UC

See also:

Listen to Prof O'Sullivan discussing low back pain: http://goo.gl/WgseGQ

It's time for change with the management of non-specific chronic low back pain: http://bjsm.bmj.com/content/46/4/224.full

Successful antibiotic treatment in a subset of people with chronic low back pain:  http://blogs.bmj.com/bjsm/2013/05/08/peterbrukner-discusses-todays-major-headline-successful-antibiotic-treatment-in-a-subset-of-people-with-chronic-low-back-pain/

Professor Peter O’Sullivan (Curtin) walks you through two cases of low back pain: https://soundcloud.com/bmjpodcasts/professor-peter-osullivan-curtin-walks-you-through-two-cases-of-low-back-pain

‘Overdiagnosis’ in sports medicine? FAI for example? The great Ray Moynihan (‘Selling sickness’: https://soundcloud.com/bmjpodcasts/overdiagnosis-in-sports-medicine-fai-for-example-the-great-ray-moynihan-selling-sickness

‘Overdiagnosis’ / ‘overtreating’– relevant in sportsphysio/medicine? Professor Peter O’Sullivan

This is a podcast by Dr Robert-Jan de Vos, sports physician in the Erasmus Medical Centre in the Netherlands, with Guustaaf Reurink, who is a registrar in Sports medicine in the Netherlands and is currently finishing his thesis on diagnosis and treatment of acute hamstring injuries. Recently, he published a paper in the New England Journal of Medicine about the role of Platelet-rich Plasma (PRP) treatment for acute hamstring injuries (http://www.nejm.org/doi/full/10.1056/NEJMc1402340). 

We start with discussing this interesting study, which did not show a benefit of PRP injections in acute hamstring injuries. Dr Reurink expresses the methods and results of this study and possible explanations for these findings are debated.

Dr Reurink also performed a number of studies on the value of clinical tests and Magnetic Resonance Imaging (MRI) in acute hamstring injuries. Previously, he already showed that most MRIs are still abnormal when the athlete already returned to gameplay (http://bjsm.bmj.com/content/early/2013/11/19/bjsports-2013-092450.abstract?eaf). 

We close by discussing the role of MRI and standardised clinical tests as a predictor of time to return to play and re-injury.

Diagnosing and treating acute hamstring injuries

Dr Christian Barton discusses the loading programs and clinical implementation with Dr Michael Rathleff


Dr Michael Rathleff discussing loading programs for plantar fasciopathy

Dr David Opar joins us for this BJSM podcast. David is a lecturer at the Australian Catholic University in Melbourne and one of the emerging voices in the field of hamstring strain injuries, having done work on the possible mechanism of injury as well as prospective studies aimed at better understanding eccentric strength as a risk factor for these injuries. 

His work also investigates the Nordic Hamstring Device, developed by the Queensland University of Technology Hamstring Group, looking into the potential of this device in prevention, treatment and rehabilitation of hamstring injuries. 

Nicol van Dyk, a physiotherapist in the Rehabilitation Department at Aspetar Sports Medicine & Orthopaedic Hospital in Qatar, leads the discussion around nordic hamstring exercises, the role of eccentric strength in hamstring strain injuries and the seeing the big picture in prevention and rehabilitation.

With hamstring strain injuries continuing to receive much attention in the literature and mainstream media, David Opar elucidates some significant features of this common injury.

Eccentric hamstring exercises – they work in practice but not in theory?

All clinicians aim to classify muscle injury classifications to guide treatment and predict return – it’s a hot topic. The British Athletics Muscle Injury Classification is one helpful classification system and Dr Noel Pollock explains to Dr Markus Laupheimer (BJSM) how and why the Classification developed, as well as why the (older) Munich classification was not ideal. Listen for tips on how this classification adds something special and is of practical value for treating your athletes with muscle injuries.

Timeline:
01:01m – Why a new muscle injury classification?

03:50m – Limitations of the Munich consensus
Open access Munich Paper: http://bjsm.bmj.com/content/47/6/342.full.pdf+html

05:18m – British Athletics classification explained
Open access British athletics paper: http://bjsm.bmj.com/content/48/18/1347.full

09:15m – Clinical application, follow up papers

12:00m – Discussion: MRI or not?
http://bjsm.bmj.com/content/49/24/1579.full

14:05m – Future Development of muscle injury classification

Links:
British athletics muscle injury classification: a new grading system
http://bjsm.bmj.com/content/48/18/1347.long (Open Access)

Time to return to full training is delayed and recurrence rate is higher in intratendinous (‘c’) acute hamstring injury in elite track and field athletes: clinical application of the British Athletics Muscle Injury Classification
http://bmj.co/1lWvDdy

Previous podcast:
The Munich muscle classification: Using it for more accurate diagnosis and treatment
https://soundcloud.com/bmjpodcasts/the-munich-muscle-classification-using-it-for-more-accurate-diagnosis-and-treatment?in=bmjpodcasts/sets/bjsm-1

Range of BJSM podcast: http://bjsm.bmj.com/site/podcasts/

You can readily access BJSM podcasts via our Mobile App (BJSM). Latest sports medicine updates are posted via Twitter (@BJSM_BMJ) 


Managing muscle injuries better: Tips from Dr Noel Pollock (British Athletics)

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

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely.

Relevant links: 
Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes:  https://soundcloud.com/bmjpodcasts/high-fat-for-health

Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus

Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach:
https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1

If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook -  we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

Professor Peter Brukner on food as medicine. No industry funding.

Phil Glasgow is the head of sports medicine at the Sports Institute, Northern Ireland. A vastly experienced physiotherapist, he has worked at 3 Olympic Games, and has just returned from Rio. In this podcast, we discuss a case history of a football player with hip pain, from assessment to RTP. We look at the sensitivity vs. specificity of various tests, how to explain the symptoms to patients, and any co-existing pathologies there may be in the athlete. Finally, the discussion moves to treatment, the role of manual therapy, and exercises the patients can do to increase strength in the tissue.

The 2nd World Conference of Sports Physiotherapy will be held in Belfast, 2017- details can be found here: http://bit.ly/2dP2HjH

Timeline
0.40 - Hip pain: a case history and when is it reported to the physio?
3.08 - Ruling things out in the hip is easy: how do we rule things in?
7.30 - Things to consider when treating the hip
10.30 - Prescribing exercise for the patient - how do we go about it?
13.00 - How to increase the load in the injured athlete
18.26 - Bridging exercises for the hip
22.50 - Building a model for the pain and tips from the top

Phil Glasgow talks all things around the hip and treatment

A world leader in sportsphysiotherapy, Associate Professor Dr Kristian Thorborg is from Copenhagen University. He is renowned for his studies and clinical workshops related to patients with hip, groin, hamstring and knee related injuries.

Here he outlines:

- the paradigm shift for the use of exercise to treat conditions such as tendinopathy and hamstring strains. He addresses questions such as ‘What is the ideal type of exercise?’ and ‘Does the body know if the exercise is concentric or eccentric?’

- cheap technology that can be used to help patients measure the load they are using and to check compliance

- the challenge of treating patients in season

- the concept of progression and the different stage of rehab that is preparation for ‘return to play’

- prevention – it needs monitoring of the players – waiting until they show up with pain is too late

Sports physiotherapist Dr Kristian Thorborg drills down on optimal loading. Heavy and Slow!

You want the big names on BJSM podcasts and Twitter asked for Dr Graeme Close. Fresh from the UK undergraduate student conference, Graeme shares pearl after pearl on this top podcast. What do you do in a first consultation? How does nutrition in team sport vary from individual sport? What’s the key to a successful pre-game routine? How should nutrition change when an athlete is injured? Supplements? Coffee? Sleep? Take home tips – all in this 16 minute gem. 

Graeme has a great CV for his role in top sport. He is (i) a former professional rugby league player (clips here https://youtu.be/1mHljSGlQwA) (ii) a sports science PhD and now faculty at Liverpool John Moores University (iii) rumored to be the only person in the UK accredited with the official bodies for sports science (BASES), sports nutrition (SENr) and strength & conditioning (UKSCA). We call that the ‘triple crown’.

Kudos to medical student Tej Pandya for organizing the conference and for a great debut as a podcast host. BJSM’s podcasts have been hosted by 23 different interviewers and there are podcasts in 5 languages. Feel free to submit a podcast for our consideration. (info.bjsm@bmj.com)

Nutrition pearls for sport performance: Professor Graeme Close provides 27 practical tips

In part 1 of two podcasts, Dr Ben Kibler, international shoulder authority, shares top tips on examination and diagnosis of the tennis player.  (Part 2 will focus on baseball pitchers)

Dr Ben Kibler, orthopaedic surgeon and medical director of Lexington Clinic in Kentucky is a world expert on management of shoulder injuries with a particular focus on the role of the scapula (scapular dyskinesis).  He has held regular ‘scapular summit’ meetings of experts in his hometown of Lexington, Kentucky, USA. The most recent summary of that meeting can be read here: http://bjsm.bmj.com/content/47/14/877 

In this podcast, we discuss:

•	Briefly how Dr Kibler, a surgeon, learned about biomechanics
•	Examination of the tennis player’s shoulder including how to perform a biomechanical analysis
•	Simple tests to recognize abnormal asymmetry in the tennis player
•	Diagnosis of injury in tennis players; search for culprit (the real cause) – don’t just incriminate the victim
•	The rise in the double-handed backhand in tennis and how it has increased the incidence of ulnar wrist injuries 
•	Role of communication within the multidisciplinary team: how much should the physician know about the biomechanics?
•	Two tests commonly used to assess shoulder function – the Scapular Assistance Test (SAT) and the Scapular Retraction Test (SRT).

Remember to keep an eye out for Part 2 – management of the overhead throwing athlete. You can meet with Dr Kibler in person at the AMSSM annual conference. May 9-13, 2017, San Diego. It’s a prime spot on the sports medicine calendar. https://www.amssm.org/Content/pdf%20files/BROCHURES/2017_Annual_Meeting.pdf

Dr Ben Kibler:  Clinical assessment of the tennis player with a focus on the shoulder

Jo Gibson is a Clinical Physiotherapy Specialist at the Liverpool Upper Limb Unit based at the Royal Liverpool Hospital, UK. She lectures both nationally and internationally about rehabilitation of the shoulder. Her research interests are shoulder instability and motor learning. Jo is currently Squad Physiotherapist for the Great Britain Endurance riding Team.

How to rehabilitate the athlete after shoulder surgery. Top physio Jo Gibson on shoulder and mind

A respected global voice within Sports Physiotherapy, Phil Glasgow returns to the BJSM podcast to share his thoughts and expertise on loading for injury prevention and treatment. Phil has worked at numerous major international sporting events and was the Chief Physiotherapy Officer for Team GB at the Rio 2016 Olympics. As Former Head of Sports Medicine at Sports Institute, Northern Ireland, he has amassed extensive experience in high performance sport working with elite athletes from a wide range of sports learning their best loading patterns amongst the way.

BJSM’s Liam West poses the questions that see Phil take you through the fundamental principles of loading, when to start loading after injury, different loading patterns based on tissue type and loading pattern variations during rehabilitation.

Want to hear more on loading? Check out these two conferences below that Phil and other great speakers will be discussing loading patterns more in depth;

-	Second World Congress of Sports Physical Therapy in Belfast, Northern Ireland on 6th-7th October 2017 (http://www.opload2017.com)
-	New Zealand Sports Physiotherapy Conference in Auckland, 14th-15th October 2017 (http://bit.ly/2vudQmN). 

Some further reading:

PRICE needs updating, should we call the POLICE? - http://bjsm.bmj.com/content/46/4/220

Optimal loading: key variables and mechanisms - http://bjsm.bmj.com/content/49/5/278

Optimising load to optimise outcomes - http://bjsm.bmj.com/content/51/13/985

A view from New Zealand and an invitation to Sports Physiotherapy New Zealand’s Symposium (14–15 October 2017) - http://bjsm.bmj.com/content/51/5/413 

Training – injury prevention paradox. Should athletes be training smarter AND harder bjsm.bmj.com/content/early/2016…sports-2015-095788

Related Podcasts:
Dream Team of training load management: How training influences injury and performance - http://bit.ly/29gPxxg 

Putting load management evidence into practice: Sometimes you can’t! Dr Darren Burgess - http://bit.ly/2el00rR

What is Optimal Loading? How do we achieve it? Top Sports physio Dr Phil Glasgow reveals all

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

Babette Pluim (BJSM’s deputy editor) talks to Ben Kibler (medical director of the Lexington Clinic Sports Medicine Center, Lexington, Kentucky) about his varied and prolific career in tennis and baseball sports medicine. Dr Kibler discusses his research on the shoulder and also the tennis serve, the importance of considering biomechanics in injury prevention and recovery, and the role of surgery.

0.43 Founding the society for tennis medicine and science

2.34 The increasing focus on the shoulder in sports medicine research

3.45 Dr Kibler interest in the scapula

6.09 The tennis serve as a weapon

9.03 The importance of biomechanics in sports medicine

11.14 The Kibler rehabilitation programme

13.46 The role of surgery

15.02 Basics of the throwing motion conference

16.28 Do we need guidelines on how many serves young tennis players should hit?

19.11 The importance of the rotation of the shoulder and position of the scapula in preventing injury

See also:
Basics of the throwing motion conference

The shoulder in sport, with Ben Kibler

Critical thinker, curious, eclectic and genuinely interested in knowledge in every field, mostly in science and writing. Sports physio as first profession, involved in bringing high quality clinical and sport science education with Novavia Project in Italy, Switzerland and Slovenia.

Sport Physical Therapy

SalviatiSPT