Stress fractures and bone stress injuries in running patients need to be identified early, to allow recovery before the injury worsens and requires extensive time away from running. When should you suspect a stress fracture or a bone stress injury (BSI) in your running patients? Find out in the podcast with Tom Goom (Running Physio), and explore:

- How to identify stress fractures & BSI’s in your patients.
- Which patients are at greater risk of developing BSI or stress fractures?
- Features in your patient history, including past & medical history, onset & aggravating factors that increase your suspicion of a stress fracture.
- Which BSI’s are “high risk”?
- Common training errors that lead to a stress fracture.
- What tests can be performed in your objective assessment to help diagnose stress fractures?
- How to differentiate tendon pain from bone stress injuries
- Will bruising or swelling appear with bone stress fractures?
- How palpation can help your diagnosis
- Why common assessment tests are often painfree in bone stress injuries.
- When imaging is important.
- Which imaging modalities to request when you suspect a stress fracture or BSI.

Improve your identification and assessment of stress fractures and bone stress injuries now with this podcast.

119. Suspect a stress fracture? Physio Edge Track record: Running repairs podcast with Tom Goom

How can you accurately assess neck pain patients and choose the most effective treatment to help resolve their pain and prevent recurrence? Find out in part 1 of this two part podcast series with Emeritus Professor Gwendolen Jull, and explore:

- How to accurately assess patients movements, muscular control, strength, posture, and palpate the cervical spine to identify the source of neck symptoms and contributing factors.

- Which questions and assessment tests will help you choose treatment that resolves symptoms, fully rehabilitates patients and helps to prevents future episodes of neck pain?

- How to use clinical reasoning to target your rehab, and decide if your treatment should include neck strengthening, manual therapy, sensory motor control, postural or work position changes?

Download this podcast now to improve your assessment and treatment of neck pain.

The next podcast with Prof Gwen Jull, available soon, will build on the knowledge you gain from part 1, and provide you with additional neck pain treatment strategies.

121. Neck pain assessment, clinical reasoning & rehab. Physio Edge podcast with Prof Gwendolen Jull

Why do some rotator cuff (RC) repair patients progress really slowly post-operatively and experience high levels of pain and sleep disturbance for long periods? 

Find out in this case study and exploration of the latest evidence in this podcast with Jo Gibson (Shoulder Rehabilitation Specialist) as she reveals:  

Quick or slow recovery?

- Which patients are likely to improve quickly, and which patients are likely to take longer to improve.
- How soon after arthroscopic RC repair your patients will experience significant improvements in pain.
- When patients sleep is likely to improve.

Objective assessment tests

- How to identify post-op nerve injury, red flags and infection.
- Objective tests you can safely perform without overstressing the rotator cuff.
- How to identify patients developing post-op frozen shoulder.

Expectations, education & reassurance 

- How to help set patient expectations for recovery before and after surgery.
- Questions to ask patients after surgery that will help guide your treatment.
- How to reassure patients that are experiencing pain.
- How to explain post-op recovery to patients that are unhappy with their progress, even when their recovery is on track.

Treatment & resources

- Activities your patients may be performing that slow their post-op recovery.
- Positions and postures you can show patients to improve their pain in the day, and sleep at night. 
- Resources to give your post-op patients.

Learn more: https://www.clinicaledge.co/podcast/physio-edge-podcast/132

132. Rotator cuff repairs: How to treat slowly recovering patients. Physio Edge Shoulder Success..

Exercise is a vital component in our rehabilitation of patients with musculoskeletal pain and injuries. 

How can you, as a Physiotherapist, Physical therapist or health professional, choose exercises for your patients that improve their pain, strength, control, confidence and the ability to reach their goals, without stirring up their pain?

Find out in this podcast with David Pope (APA Titled Sports & Musculoskeletal Physio) and David Toomey (NZ Titled Musculoskeletal Physio & PhD Candidate) from the Clinical Edge education & presentation team.

145. How to choose exercises that improve patients pain with David Toomey

Patients with knee osteoarthritis (OA) often believe their knee is “bone on bone”, exercises will wear out their knee more and they just need a knee replacement. This narrative can make it difficult to motivate your patients to perform knee rehab exercises that have the potential to improve their pain, function and quality of life. 

How can you shift the narrative, educate your patients with knee OA so they “buy in” and perform an effective knee rehab program, and get better results with your treatment?

In this podcast with Dr JP Caneiro you’ll discover:

- How to start your patient on a rehab program when they have fear avoidance, and don’t want to exercise.
- How to help patients have a positive response to your treatment, experiencing better movement, function or pain with exercise and movement.
- How to encourage your patient to share their narrative and perspective, so you can start addressing this with your treatment.
- How to accurately describe OA to your patients and provide a positive narrative. 
- How to help patients recognise load and lifestyle factors that are influencing their pain and movement.
- How to modify patients’ unhelpful behaviours and integrate new movement strategies into daily activities.
- How to manage flareups and provide patients with self-management strategies.

Enjoy this podcast with Dr JP Caneiro and hosted by David Pope and Clinical Edge now to improve your treatment of knee OA.

146. Knee osteoarthritis (OA) rehab. Shifting patient beliefs & narratives with Dr JP Caneiro

Marathon runners often come to us with pain, but also they need to build up their mileage in preparation for one of the most challenging events in endurance sport. They're trying to do more when their body may be telling them they need to be doing less. 

How do we manage their symptoms, and guide them up to the marathon itself?

Find out in this podcast with Tom Goom (Running Physio).

150. Top tips for treating marathon runners. Physio Edge Track record: Running repairs podcast..

An Interview with David Butler

Physio Edge Podcast #1 -
Fascinating insights into pain, painful experiences, and neurodynamics from one of the world’s leading neuroscience and pain experts. Learn why we (and our patients) experience pain, the latest research in pain and pain management. Learn how to talk to your patients to reduce their pain experience, when pain is more from joints or the periphery, and how to use neural glides.

Brought to you by Physio Edge and you podcast host, David Pope

This show is supported and sponsored by Clinical Edge – providers of fantastic online and face-to-face education for Physiotherapists.

PE #001 Physio Edge Podcast 001 - David Butler Painful paradigms and sensitive systems

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

Physio Edge #032 How To Rehabilite ACL Injuries With Enda King

Patients regularly present for Physiotherapy with lateral hip pain. This is often aggravated by walking or standing, sidesleeping, performing hip stretches, and sitting, amongst other activities, and lateral hip pain can often mimic lumbar spine pathology. In this podcast, Alison and I discuss symptoms, assessment and treatment of an extremely common cause of lateral hip pain – Glute Med Tendinopathy (GMT), a condition which is often misdiagnosed as Trochanteric Bursitis.

Some of the aspects we explore in this podcast are:

Subjective clues that someone may have a Glute Med Tendinopathy
“Trochanteric Bursitis”
Differentiating Glute Med Tendinopathy from pain of Lumbar origin
Assessment of the hip
Tests to confirm or rule out a Glute Med Tendinopathy
Causes of a Glute Med Tendinopathy
Advice for patients
Treatment of Glute Med Tendinopathy
Deep hip muscle activation
Essential elements for an effective treatment program
much more
I also want to take this moment to wish you and your family a very Happy New Year.

PE #009 Lateral Hip Pain With Dr Alison Grimaldi

Treatment of the cervical spine often involves some degree of manual therapy or manipulation, and VBI testing is generally encouraged or required prior to this. In this episode of the Physio Edge podcast, Roger Kerry, a Physiotherapist, Lecturer and Researcher from Nottingham University and David Pope discuss Cervical Arterial Dysfunction (CAD), the accuracy and limitations of VBI testing, and a lot of other good stuff, including:

Cervical Arterial Dysfunction (CAD), and VBI
Why is it important for clinicians to know about CAD
The limitations of VBI testing
Clues within the history to alert you to the possibility of CAD
Symptoms of CAD
2 types/causes of dizziness and differentiation
The 5 Ds and 3 N’s – what are the limitations of this approach
Signs & Symptoms of Cerebral and retinal ischaemia
Aetiology
Upper cervical instability
As clinicians, where should CAD and VBI testing lead our assessment, treatment and investigations?
When can we conservatively treat someone with these symptoms
Monitoring – during and post rx
Contraindications to Rx

PE #013 Cervical Spine Artery And VBI Testing With Roger Kerry

Join hosts David Pope and The Hip Physio - Mehmet Gem as they dive deep into the myths and misconceptions surrounding hip and groin pain. This podcast explores common myths about glutes and hip flexors, effective rehab exercises, and how to accurately assess and treat various hip conditions.     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

165. Busting hip pain myths with Mehmet Gem

168. How to explain shoulder pain to patients. Physio Edge Shoulder Success podcast with Jo Gibson

168. How to explain shoulder pain to patients with Jo Gibson

Static stretching has long been used to improve flexibility, but research shows its effects are often short-lived. So how can you help patients achieve lasting improvements?

In this episode, Tom Goom (Running Physio) explores exercises you can provide to patients to increase muscle fascicle length, improve flexibility, and reduce injury risk.

You’ll discover:
- Why static stretching alone may not create long-term flexibility gains
-  Exercises to improve muscle length and function
- Key training parameters for effective flexibility training
-  Strategies to maintain flexibility improvements over time

If you’re a physiotherapist or health professional looking for research-backed flexibility strategies, this episode is packed with practical insights!

169. Beyond stretching: How to create lasting flexibility with Tom Goom

170. Brazilian Jiu Jitsu (BJJ) injuries with Dr Lachlan Giles

18. Manual therapy for low back pain part 1 with Simon Olivotto

171. Achilles tendon ruptures: Rehab & recovery with Prof. Peter Malliaras

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.

172. Shoulder pain assessment & clinical reasoning with Jo Gibson

20. PPIVMs with Simon Olivotto

Anterior hip pain is often blamed on the hip flexors, but in runners, that’s rarely the diagnosis. So how can you identify the real cause and guide patients to a safe, effective recovery?

In this episode, Tom Goom (Running Physio) explores the function of the hip flexors in running, key differentials for anterior hip or groin pain, and practical rehab strategies you can use right away.

173. Hip flexor pain in runners: Diagnosis, myths, and rehab with Tom Goom

Have any of your shoulder patients improved and then plateaued, unable to regain their full range of movement, or get rid of their painful arc?

Sometimes it’s not the cuff, capsule, nerves or neck—it’s the acromioclavicular joint (ACJ) holding things back.

In this episode, Jo Gibson sheds light on this often-overlooked contributor to persistent shoulder pain.

From real patient case studies to the latest research and simple clinic-ready symptom modification tests, Jo shares practical strategies you can use immediately.

Learn how to identify ACJ involvement, and use targeted rehab exercises, symptom modification and treatment strategies to help patients break through their plateau and regain their confidence and range.


174. ACJ - The hidden culprit behind stubborn shoulder pain? with Jo Gibson

Lateral elbow pain (lateral epicondylalgia/tennis elbow) affects , and can respond fantastically to Physiotherapy treatment, or in other patients with a similar presentation, not at all.

Dr Leanne Bisset is a Physiotherapist, Physiotherapy lecturer and researcher at [Griffith University][GU] in Queensland, Australia that has extensively researched and published on lateral elbow pain, and spends the majority of her clinical time treating the upper limb and lateral elbow.

This is a two part podcast, and in Part 1, episode 44 of the Physio Edge podcast, David Pope and Dr Leanne Bisset discuss:

Why is Lateral Epicondylalgia (LE) difficult to treat?
What tissue pathology exists in LE
Pain pattern for LE
Patient reports that will help your diagnosis of LE
Important aspects to communicate with your patients regarding their LE
Objective tests that you can perform
Patient advice
Should you rest your patients or provide exercises?
How is tendinopathy in the Upper Limb different to the Lower Limb?
Commencing treatment
How to incorporate manual therapy into your treatment
Exercises you can start your treatment with
Should you include isometric exercises for lateral elbow pain
How often should your patients perform their exercises
Exercise into pain, or avoid pain?

Download the podcast here

Subscribe free to the Physio Edge podcast in iTunes

Download the podcast from Stitcher

Download and listen to the podcast on Soundcloud

Links of Interest

Dr Leanne Bisset

Dr Leanne Bisset on ResearchGate

Dr Leanne Bisset on Twitter

Download the free podcast handout

Review the podcast in iTunes

Get your free trial of Clinical Edge online education

PE044 LE With Leanne Bisset Levelled

How can you treat your patient’s lateral elbow pain (lateral epicondylalgia (LE)/tennis elbow)? How and when should you progress your patient’s exercise program? Is pain during their exercise program ok?
In this episode, which is Part 2 of Lateral Elbow pain with Dr Leanne Bisset, we explore in detail how you can differentially diagnose LE from other causes of lateral elbow pain, and treat it successfully.
Discover:
	•	Diagnosis and differential diagnosis of LE
	•	How to get the best outcomes for your patients when treating LE
	•	Do isometrics work?
	•	How can you commence strengthening?
	•	Should your patient experience any pain during their exercise program?
	•	When and how can you incorporate Mobilisation with Movement into your treatment program?
	•	How to perform MWM’s for LE
	•	How to progress your treatment
	•	Identifying and treating radial nerve involvement
	•	Incorporating strengthening for the upper limb
	•	High level athletes and weightlifters with lateral elbow pain - is this likely to be LE or another condition?
	•	Identifying nerve root irritation with pain over the lateral elbow
	•	Taping methods to deload the lateral elbow when there is nerve involvement
	•	Clinical reasoning of your treatment
	•	Predictors of poor treatment prognosis
	•	When to order imaging
	•	Evidence for and against other treatment strategies including the Cyriax approach, massage, laser, ESWT, corticosteroids and PRP
	•	Validated screening tools for LE, including the PRTEE
In this episode, Leanne answers a lot of your questions on LE, asked via Twitter and the Clinical Edge newsletter.
Dr Leanne Bisset is a Physiotherapist, Physiotherapy lecturer and researcher at Griffith University in Queensland, Australia who has extensively researched and published on lateral elbow pain, and spends a large proportion of her clinical time treating the upper limb and lateral elbow.

This is a two part podcast, followup up Lateral Elbow Pain Part 1, episode 44 of the Physio Edge podcast, David Pope and Dr Leanne Bisset.

Download your free podcast handout at clinicaledge.co


Physio Edge 045 Treatment Of Lateral Elbow Pain Part 2 With Dr Leanne Bisset

Proximal hamstring tendinopathy (PHT) occurs in athletes, runners, weightlifters, and other athletes, as well as more sedentary patients, causing pain at the hamstring origin and limiting your patients ability to sit, run and continue to be active.
There are a number of structures that can contribute to pain in this area, and in this podcast, Tom Goom and David Pope discuss how to clearly identify PHT and differentiate it from lumbar spine referred pain, hip pain, sciatic nerve pain and other conditions.
Tom recently released an article in JOSPT on Proximal Hamstring Tendinopathy: clinical aspects of assessment and management with Peter Malliaras, Mike Reiman and Craig Purdam. We explore this article, and the research around PHT, and cover in detail:
	•	Subjective clues to guide you towards diagnosis
	•	Aggravating factors and 24 hour pain patterns
	•	Differential diagnosis
	•	Lumbar spine pain
	•	How the lumbar spine could contribute to development of PHT
	•	Hip pain
	•	SIJ pain
	•	Sciatic nerve pain
	•	Development of PHT
	•	Central sensitisation
	•	Diagnostic tests for PHT
	•	Hamstring tests
	•	Other assessment tests
	•	Functional tests
	•	The value of palpation
	•	Tests for involvement of the rest of the kinetic chain
	•	Running assessment/gait analysis
	•	Testing load tolerance
	•	Biopsychosocial aspects of tendon recovery
	•	Other advice for patients
	•	Whether stretching is helpful
	•	When your patient can return to running
	•	Cross training
	•	Does manual therapy have a role in the treatment of PHT?
	•	Starting treatment (Stage 1)
	•	When and how to progress rehabilitation (Stage 2)
	•	Further rehabilitation progressions (Stage 3)
	•	Advanced exercise progressions for high load sports
	•	Exercises you can incorporate during the various stages
	•	How long recovery will take
Links
	•	Free webinar with Tom Goom
	•	Download the free handout summary of this podcast
	•	Tom’s website - Running Physio
	•	Tom on Twitter
	•	Running Repairs courses with Tom
	•	Article in JOSPT on Proximal Hamstring Tendinopathy: clinical aspects of assessment and management
	•	JOSPT
	•	Peter Malliaras
	•	Mike Reiman
	•	Craig Purdam
	•	VISA-H
	•	Become a Clinical Edge member to access Tom’s webinar and other great online education
Tags: running, hamstring, tendinopathy, tom goom, podcast, proximal, peter malliaras, craig purdam, mike reiman, treatment, assessment


Physio Edge 046 Proximal Hamstring Tendinopathy With Tom Goom

Physio Edge 047 Rotator Cuff Tendinopathy With Dr Chris Littlewood

Acute and chronic groin pain is common in sports, however diagnosis can be challenging. A thorough understanding of pathology around the hip and groin and when pathology relates to symptoms, knowledge of potential red flags, along with patterns and symptoms associated with each diagnosis is vital in guiding your treatment of hip and groin pain.

In the first of two podcasts on hip and groin pain with Physiotherapist and Extended Scope Practitioner Benoy Mathew, we explore:

How you can use the patient history to help your diagnosis and treatment
Important questions you NEED to ask all of your hip and groin pain patients
Sources of hip and groin pain - intra and extra-articular
How you can identify referred pain from the lumbar spine and SIJ
How you can identify important red flags around the hip and groin
When you should refer your patients for further investigations, medical assessment and surgical opinion
How you can identify osteoarthritis in younger patients
Differentiating hip impingement, labral pathology and hip dysplasia
When to request X-ray or MRI
Identifying and understanding iliopsoas pain and pathology
This is a vital podcast for anyone that treats hip and groin pain, and is highly recommended listening before Hip & groin pain part 2 - Assessment & Treatment with Benoy Mathew coming soon.

As mentioned in this episode Benoy is presenting a webinar with Clinical Edge. The webinar will discuss:
• Rehabilitation of adductor and iliopsoas related groin pain
• Practical tips
• Common presentations
• Osteitis pubis, sports hernia, hip impingement
• Rehabilitation from initial stages to plyometrics

Enrol on this free webinar at clinicaledge.co

Physio Edge Podcast

Physio Edge 053 Hip and groin pain part 1 - diagnosis, pathology and red flags with Benoy Mathew

Shoulder pain can involve the rotator cuff, scapula, cervical spine, thorax, and other structures in this area. Recent research has also explored the role of patient beliefs and expectations on the outcomes of Physiotherapy for shoulder pain. Which factors are important in your shoulder pain patients? Can we identify the contributing factors to your patients shoulder pain? What information will you get from orthopaedic special tests during a shoulder examination? How can you improve your treatment results with your patient education? In this episode of the Physio Edge podcast,&nbsp;Dr Chris Littlewood&nbsp;and&nbsp;David Pope&nbsp;discuss shoulder pain, including:  Classification of shoulder pathology How to identify painful vs stiff vs unstable shoulder pain vs cervical spine referred pain Questions to ask in your subjective assessment Does subacromial impingement exist, and how does a diagnosis of subacromial impingement effect outcomes Patient expectations of treatment outcomes How to perform an objective assessment What information special tests provide Is scapular dyskinesis pathological or normal movement variation Are painful or non-painful exercises most helipful in chronic shoulder pain What role does imaging have in shoulder pain  This podcast adds to&nbsp;Physio Edge podcast 47 - Rotator cuff tendinopathy with Dr Chris Littlewood&nbsp;. Links of interest Webinar - "Exercise for rotator cuff tendinopathy: Does it work as we think it should, and can we do better? with Dr Chris Littlewood  Download the handout from this podcast  Cervical spine assessment &amp; treatment online course Get your free trial Clinical Edge membership David Pope on Twitter Clinical Edge on Facebook Dr Chris Littlewood at Keele University Dr Chris Littlewood on Twitter Dr Chris Littlewood on ResearchGate

Physio Edge 067 Shoulder special tests and the rotator cuff with Dr Chris Littlewood

Femoroacetabular impingement (FAI) may contribute to hip and groin pain, buttock pain, pelvic or low back pain and referred pain into the thigh. Is conservative management effective in patients with FAI, or is surgery required? If we can treat FAI conservatively, what is the best treatment, and how can you tailor your treatment to your individual patients? In episode 74 of the Physio Edge podcast with&nbsp;Dr Joanne Kemp&nbsp;you will discover:  What is FAI, and how can you identify it? Common clinical presentations Key subjective questions to ask Types of FAI morphology and how they are identified Is FAI just a normal finding? How you can perform an objective assessment in patients with FAI Differential diagnosis Components you need to include in your conservative treatment for FAI Which objective markers to use when treating FAI How to address common impairments in your rehabilitation, including strength, functional tasks, cardiovascular training and range of movement When to refer for a surgical opinion Outcomes of surgical treatment Future risk of developing OA in presence of FAI  Sports Injuries virtual conference presentation As mentioned in this episode Joanne will be part of the Sports Injury virtual conference. Her pre conference presentation will discuss FAI and the diagnostic process in more detail. Her subsequent conference presentation will be available on 9-10 December 2017, with access for up to 12 months following the conference, and will discuss: • Conservative management of FAI • Specific exercise progressions you can use • Return to sport for athletes Enrol on the 2017 Sports Injuries virtual conference by CLICKING HERE  Download this podcast and subscribe on iTunes Links associated with this episode:  Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino Enrol on the 2017 Sports Injuries virtual conference Twitter - @JoannaLKemp Joanna Kemp - Research gate David Pope on Twitter Clinical Edge on Facebook Have a free trial Clinical Edge membership LaTrobe Sports and Exercise Medicine Research Blog Twitter - @LaTrobeSEM GLA:D Australia Lake Health Group  Articles associated with this episode: Griffin et al. 2016. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Articola et al. 2014. A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players. A Prospective Study With Minimum 2-Year Follow-up. Other episodes of interest:   Physio Edge 054 - Hip and groin pain part 2 with Benoy Matthew  Physio Edge 053 - Hip and groin pain part 1 with Benoy Matthew  Physio Edge 009 - Lateral hip pain with Dr Alison Grimaldi  Physio Edge 004 - Hip injuries and labral tears with Nicole Hamilton

Physio Edge 074 Hip pain and femoroacetabular impingement (FAI) with Dr Joanne Kemp

Tendinopathy patients may present for treatment with an ultrasound or MRI report in hand, unsure how you can help them, or how they can possibly recover when they have so much tendon pathology. To add insult to injury, they may even have a partial tendon tear on their imaging report thrown into the mix. How do imaging results impact your treatment and your patient's recovery? Are the imaging findings relevant to their pain? In this Physio Edge podcast with Dr Sean Docking (Physiotherapist, PhD), you will explore what information imaging actually provides in your tendinopathy patients, how to explain imaging to your patients, and whether partial tendon tears identified on imaging will effect your treatment. You will also discover:  Who develops tendon pathology If patients have tendon pathology on imaging, is this responsible for their symptoms, or will it cause future tendon pain Asymptomatic tendon pathology in sports people How tendon pathology can actually be linked to better performance Can we prevent tendon pathology The advantages and disadvantages of different imaging types, including MRI Ultrasound Ultrasound tissue characterisation (UTC) Why a thickened tendon may actually be helpful in recovery How can we actually diagnose tendinopathy When is imaging useful Differential diagnosis of Achilles pain, including  Achilles tendinopathy Paratenonitis Plantaris associated tendinopathy   Partial tendon tears, the accuracy of identification, and how they impact your treatment  Sports injuries virtual conference As mentioned in this episode Sean presented at the&nbsp;2017 Sports Injuries virtual conference. His main conference presentation on tendinopathy and imaging discusses:  The research around the use for imaging A framework for when and when not to use imaging How to explain imaging findings to patients  You can get immediate access to his presentation, and presentations from 13 of the leaders in sports injuries by&nbsp;CLICKING HERE  Download this podcast and subscribe on iTunes &nbsp; Links associated with this episode:  Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino Enrol on the 2017 Sports Injuries virtual conference Twitter - @SIDocking Sean Docking - La Trobe University website Sean Docking - Research gate David Pope on Twitter Clinical Edge on Facebook Have a free trial Clinical Edge membership  Articles associated with this episode: Alfredson. 2011. Midportion achilles tendinosis and the plantaris tendon Brown et al. 2011. The COL5A1 gene, ultra-marathon running performance and range of motion  Docking et al. 2016. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC).  Docking et al. 2015. Tendinopathy: Is imaging telling us the entire story? Lieberthal et al. 2014. Asymptomatic achilles tendinopathy in male distance runners McAuliffe et al. 2016. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis Simpson et al. 2016. At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis Other episodes of interest: PE 068 - Lower limb tendinopathy loading, running and rehab with Dr Pete Malliaris  PE 042 - Treatment of Plantaris and achilles tedninopathy with Seth O’Neil  PE041 - Plantaris involvement in achilles tendinopathy with Dr Christoph Spang

Physio Edge 075 Tendinopathy, imaging and diagnosis with Dr Sean Docking

Manual therapy (MT) comes in all shapes and sizes - mobilisation, manipulation, mobilisation with movement, soft tissue massage, instrument assisted massage, muscle energy techniques, pointy elbows pressed into flesh and more. Patients (often) love it, and it's a popular treatment modality with therapists. Debate rages, and myths and misconceptions surround MT. Could the time we spend performing MT be better spent elsewhere? How does MT work? Is it worth using if treatment effects are short lived? Is it just used as revenue raising by therapists, while creating reliance on passive therapies?

Is MT evidence-based? Is it worth including in our treatment? Which patients may benefit from MT, and which patients you should steer away from MT?

In this podcast, clinical researcher, physical therapist and Professor at Duke University, Dr Chad Cook, we discuss the evidence around MT, myths and misconceptions, how MT works, and using your clinical reasoning to decide when and how to utilise MT.

You'll discover:
- What are the arguments against manual therapy?
- Do the arguments against MT have merit?
- Does MT break up scar tissue or adhesions, correct alignment of joints, or put them back into place?
- Do we have evidence that MT creates reliance on passive therapies?
- Evidence for and against MT
- How to use clinical reasoning with MT
- How MT works - potential mechanisms
- What MT is NOT doing
- How to explain MT to your patients
- Clinical reasoning
- Identifying pain adaptive and non pain adaptive patients
- How MT can help identify patients with a better or worse prognosis
- How many sessions of MT should patients receive?
- How to select MT techniques
- Does MT cause harm and patient reliance?
- How to identify patient treatment expectations
- How to help change patient expectations

Physio Edge 093 Manual therapy - evidence, effects and expectations with Prof Chad Cook

Patients with thoracic outlet syndrome (TOS) may have undiagnosed pain and symptoms into their shoulder, arm, hand, scapula, head, face, upper back, axilla, chest and anterior clavicle.

With a number of potential sources of pain in these areas, TOS patients commonly have a delayed or incorrect diagnosis, followed by unnecessary and unsuccessful surgery. Further complicating matters, imaging and nerve conduction studies are often clear or inconclusive. Studies show that on average, patients with TOS have an average of 5 years of symptoms and see 6 doctors before receiving an accurate diagnosis.

What tests and questionnaires will help guide your diagnosis and intervention? When are patients suitable for Physiotherapy and conservative management? When should you refer on for a surgical opinion?

In this podcast with Jo Gibson (Clinical Physiotherapy Specialist), you will discover:

- What is Thoracic outlet syndrome (TOS)?
- Commonly reported symptoms of TOS
- Three different types of TOS
- The most common type of TOS with around 80% of all TOS patients
- Why imaging and investigations are often clear, and don’t match up with symptoms
- 3 key causes of TOS
- The relationship between TOS and hypermobility syndrome
- Criteria for diagnosis in the latest TOS diagnostic consensus statement
- Differential diagnosis (DDx) - Cervical NR compression, and peripheral nerve entrapment
- Common subjective findings that guide you towards a diagnosis of TOS
- A questionnaire you can use to assist cervicobrachial diagnosis
- What information is gained from imaging, including MRI and MR Neurography & nerve conduction studies
- What are the limitations of imaging?
- What is the difference between small nerve fibre and large nerve fibres, and how this impacts diagnosis
- QST - Quantitative sensory testing - Pin prick (Neurotip) and Thermal testing - warm and cold
- Simple QST test using a coin
- Objective testing
*What tests do you need to perform in patients with suspected TOS?
*What is the elevated stress test (EST)?
*What information does an upper limb tension test (ULTT) provide?
*Does a negative ULTT test exclude TOS?
- How are nerve blocks used?
- What is the best way to perform a nerve block?
- How effective are nerve blocks in assisting diagnosis?
- Who should we refer on for early medical or surgical management?
- When should you get an early surgical opinion?
- Which patients are likely to benefit from conservative management?

Physio Edge 096 Thoracic outlet syndrome with Jo Gibson

When your patient has leg, shoulder or arm pain, how can you identify if their pain is due to neural tissue compression, sensitisation or irritation? How can you differentiate whether pain is from neural tissue or local structures like nearby joints, tendons or muscles? What questions and objective tests will help you diagnose a neural tissue pain disorder (NTPD)?

In this podcast with Dr Toby Hall (Specialist Musculoskeletal Physiotherapist, FACP, PhD), you’ll discover:

- Three types of neural tissue pain disorders, and how to identify each one
- What is Peripheral nerve sensitisation (PNS)?
- What clues in your subjective examination will help you identify PNS?
- Why do nerves become inflamed or irritated?
- How to identify & differentiate radiculopathy and radicular pain in patients with radiating limb pain.
- Do all patients with NTPD have obvious neuro symptoms such as pins and needles, numbness or weakness?
- Quick screening tests you can use in your assessment to identify PNS.
- How to identify if your patients shoulder and arm pain is from neural tissue or from local shoulder structures.
- How to diagnose a NTPD in patients with hip or leg pain.
- How to perform passive neurodynamic tests such as the straight leg raise (SLR), upper limb neurodynamic test (ULNT), slump test and femoral nerve slump test.
- What information does a positive or negative neurodynamic test provide?
- Can we identify the location of a nerve lesion or irritation with our passive neurodynamic tests or palpation?
- Initial PNS treatment options
- Is exercise helpful or harmful in patients with PNS?
- How can you palpate over neural tissue, and what information does this provide?
- Do opioids provide pain relief, or prolong recovery in patients with NTPD?

This podcast is the first part in a two part series on neural tissue pain disorders with Dr Toby Hall. Part 1 (this podcast) guides you through the types of NTPD, and how to assess and diagnose NTPD. Part 2 (available soon) will take you through how to treat PNS.

I highly recommend listening to this episode (part 1) prior to part 2, to have a thorough understanding of when and how to treat PNS.

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