physio

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

Who are the biggest names in the back pain world? Correct – Peter O’Sullivan is one of them. 

He's provocative, clinically-relevant, and vastly experienced. He’s desperate to help patients, that’s obvious! But not everyone has to agree. Listen to his take on management of both chronic, and acute, back pains – does it make sense to you? 

Peter O’Sullivan is Professor of Musculoskeletal Physiotherapy at Curtin University, Perth, (http://goo.gl/Dk6beV)and a Specialist Musculoskeletal Physiotherapist who consults at bodylogicphysiotherapy.com. 

------

See also:

It’s time for change with the management of non-specific chronic low back pain (2012) http://bit.ly/1nY6YxK

Professor O’Sullivan discusses the risk of clinicians ‘overservicing’ or ‘overdiagnosing’ various conditions in another BJSM podcast: http://goo.gl/7HYDiX

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/

‘Overdiagnosis’ / ‘overtreating’– relevant in sportsphysio/medicine? Professor Peter O’Sullivan: https://soundcloud.com/bmjpodcasts/overdiagnosis-overtreating-relevant-in-sportsphysiomedicine-peter-osullivan

Professor Peter O’Sullivan (Curtin) walks you through two cases of low back pain

PE035 - Know Pain with Mike Stewart Part 1
Persistent pain can be a challenge, but also enjoyable to treat. In this episode of the Physio Edge podcast, Mike Stewart and I focus on specific examples and case studies of patients with complex or persistent pain, how you may approach persistent pain patients, explain their pain, use metaphors and explanations so they understand it, and help guide them through the recovery process. 
Mike and I get into the details on:
	•	Why Physios need a deep understanding of pain science
	•	How does the “bio” part come into bio-pscyho-social
	•	How can we identify if the patient needs pain education, further investigations, a biological approach eg specific exercise
	•	How can you incorporate pain science into the treatment of patients with acute pain
	•	Mike’s top tips when working with persistent pain
	•	Specific case studies of patients with persistent and complex back pain, and how Mike has worked with these patients, including their presentation, beliefs, Mike’s language used in their session, activity modification and results achieved with these patients
	•	How to develop our teaching skills to achieve the best results with our patients
Links of Interest
Mike Stewart
Know Pain
Courses with Mike Stewart
Mike Stewart on Twitter
Virtual conferences with Physio Edge and Clinical Edge
Clinical Edge discounts for Undergraduate Physio students available by emailing verification of your student status to info at clinicaledge.com.au
Clinical Edge online education
Free video on Metatarsal head padding with Nick Torrance
Free video on soft metatarsal domes for acute metatarsalgia
Free video on firmer metatarsal domes for metatarsalgia
Facebook
David on Twitter
Tags: Pain, persistent pain, chronic pain, complex pain, know pain, mike stewart, physiotherapy, physio, podcast, physio edge, clinical edge, courses, virtual conference, conference, understanding, biopsychosocial, communication


PE #035 Know Pain With Mike Stewart

As evidence based practitioners, is manual therapy for the Cervical spine evidence based? Should we just be using exercise, or is manual therapy appropriate for the C/sp?

A Cochrane review in 2015 by Anita Gross and colleagues found "No high-quality evidence was found, so uncertainty about the effectiveness of mobilisation or manipulation for neck pain remains." So where does that leave us? With no evidence for mobilisation or other manual therapy?

In this weeks 5 Minute Physio tip, find out how you can be evidence based in your treatment of the Cervical spine

5 Minute Physio Tip - Manual Therapy For The Cervical Spine - Is There Any Evidence?

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

Physio Edge 047 Rotator Cuff Tendinopathy With Dr Chris Littlewood

 Per Holmich, head of the Arthroscopic Centre at Amager University Hospital, has been working for many years on overuse problems especially hamstring, groin and hip problems focusing on exercise treatment and hip arthroscopy.

In this podcast he talks to Karim Khan about groin injuries, what to watch out for in diagnosis, and how to treat.

PE #035 Know Pain With Mike Stewart

physioedge

Related tracks