Sport Physical Therapy

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..

Apophyseal injury in children and adolescents are common and usually respond to simple unloading interventions. But what is the underlying pathology and why do some children succumb and others not? And why do some apophyses become painful and others fail completely with a complete avulsion? Despite these questions it is an area that is under-researched and few people have a specific interest in this area. 

Listen to the insights of Dr Matthieu Sailly, who is a French sports physician who has expertise and research interest in injuries in young athlete. He was the head of the Aspire Academy medical centre where he worked extensively with highly trained adolescent athletes and developed experience on growth related injuries and long term development strategies for immature athletes in various sports.

See also:

Physeal injuries in children’s and youth sports: reasons for concern?: http://bjsm.bmj.com/content/40/9/749.full

Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis: http://bjsm.bmj.com/content/41/11/827.full

“Goalkeeper’s hip”: acute haematogenous osteomyelitis secondary to apophyseal fractures: http://bjsm.bmj.com/content/40/9/808.full

Matthieu Sailly - Apophyseal injury in children and adolescents

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

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

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.

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

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