Time for some detective work - can you diagnose the cause of this man’s shoulder pain? Listen out for the clues in this interesting case study.

When your shoulder pain patient has bilateral shoulder pain after starting a gym program, difficulty lifting their arms overhead due to weakness, significant bilateral scapular winging and muscle atrophy, what are your potential diagnoses?

Find out in this case study with Jo Gibson (Clinical Physiotherapy Specialist), and discover:

- When patients have uncommon shoulder pain presentations, what potential diagnoses can you keep in mind? 
- How does it impact your diagnosis if your patient has difficulty smiling, whistling and drinking through a straw?
- What’s this patients’ diagnosis?
- What tests can be performed to confirm the diagnosis?
- Which muscles are commonly affected?
- How much muscle weakness commonly occurs?
- What is the long term prognosis for this condition?
- What treatment is supported by the evidence? 
- Are braces helpful?
- Which medical specialists are important to include in diagnosis & management?

Accurately assess, diagnose & treat stiff shoulders, including frozen shoulder, with this free videos series from Jo Gibson (Clinical Physiotherapy Specialist) at clinicaledge.co/shoulder

115. Shoulder pain & weakness - diagnosis and detective work. Physio Edge Shoulder success podcast..

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

How can you thoroughly assess your neck pain patients, and use the information from your assessment to guide your treatment? What treatments are effective in helping patients overcome their neck pain? 

In the first podcast with Specialist Musculoskeletal Physiotherapist, researcher and Emeritus Prof. Gwen Jull [121. Neck pain assessment, clinical reasoning & rehab. Physio Edge podcast with Prof Gwendolen Jull][PE121], we discussed questions to ask during your subjective history that help guide your neck pain assessment and clinical reasoning. 

In this followup podcast, discover how to accurately assess and effectively treat neck pain with Emeritus Prof. Gwen Jull.

130. Neck pain objective assessment & treatment part 2 with Prof. Gwendolen Jull

When you’re treating patients that feel like their scapulae are asymmetrical, a rib is “out of place”, or they feel neck or thoracic stiffness without any restriction in movement, they may expect you to perform treatment that is unlikely to help, like joint mobilisation, manipulation or massage. 

How can you use the latest pain science in your treatment to help patients overcome the experience of asymmetry, stiffness or something being out of place? 

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

134. How to help patients that feel asymmetrical, stiff or something’s “out of place”. Physio Edge..

Patients with anterior knee pain may have pain with activities that load the patellofemoral joint (PFJ), such as squatting, going up or down stairs, and running. When is it important to offload patients PFJ during your rehab, to help settle their symptoms? How can you design a rehab program to improve your patients' knee pain?

Find out in this podcast with Tom Goom (Running Physio) as you discover how to effectively offload and treat patellofemoral joint pain, exercises to include in rehab, and activities and exercises to reduce during your initial phases of treatment.

141. How to reduce patellofemoral pain & load. Physio Edge Track record..

Zoe Russell discusses ankle sprain assessment and treatment, and how to return your patients to sport. You’ll discover how to help your ankle sprain patients fully recover as quickly as possible, and avoid long term issues, such as chronic ankle instability, osteoarthritis or other lower limb injuries. 

Zoe is a Specialist Sports Physiotherapist (FACP), APA Titled Musculoskeletal and Sports Physio, as well as a Clinical Edge Senior Educator and Presenter, and in this Physio Edge podcast hosted by David Pope, we discuss the latest evidence and practical strategies for ankle sprains.

148. How to assess ankle sprains & start rehab with Zoe Russell

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..

Posterior shoulder instability can occur after a fall onto an outstretched arm, or diving and hitting the ground with your arm (like diving to score a try in rugby), injuring the posterior labrum and/or the glenohumeral joint. Unlike anterior shoulder instability, patients with posterior shoulder instability may not have a feeling of instability, but may just experience pain, fatigue and weakness. 

How can you identify posterior shoulder instability in your shoulder pain patients? What does your rehab for posterior shoulder instability need to include?


Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

153. Posterior shoulder instability assessment, surgery & rehab with Jo Gibson

Stingers or burners are a burning or stinging pain, often with some paraesthesia and occasionally weakness, often occurring in impact sports such as rugby or American football. 

When your patients present with neck and arm symptoms, how can you differentiate a stinger or burner from a C/sp fracture, discogenic symptoms or nerve root compression, which all require very different treatment?

How should you manage patients with one-off or repeated stingers or burners?

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

155. Stingers, burners & shoulder instability in sport with Jo Gibson

When a patient presents with a potential frozen shoulder, what other differential diagnoses must be considered?

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio), exploring the case study of a patient diagnosed with “frozen shoulder” with symptoms that don’t quite match a typical frozen shoulder. What’s the diagnosis of this patient’s stiff shoulder?

You’ll also discover whether an X-ray or imaging is required when a patient presents with a stiff or frozen shoulder.

157. Case study: Frozen shoulder or misdiagnosis? with Jo Gibson

How can you successfully treat hip pain and instability associated with your patients’ hip dysplasia? 

Find out the eight critical steps to excellent results with hip dysplasia in this podcast, which is part 3 in this three-part podcast series with Tom Goom (Running Physio).

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs

158. Hip dysplasia treatment. Physio Edge Track record: Running repairs podcast with Tom Goom

Rotator cuff tear arthropathy (RCTA) is a pattern of glenohumeral joint degenerative changes following rotator cuff tears, causing shoulder pain and stiffness. Subscapularis tears can also be involved in RCTA, or a significant cause of shoulder pain and disability.

How can you identify RCTA and subscap tears in your shoulder pain patients? How can they be treated, and do these patients respond well to non-surgical management?

Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio).

159. Rotator cuff tear arthropathy & subscapularis tears with Jo Gibson

Join David Pope (APA Titled Musculoskeletal and Sports & Exercise Physio) and Zoe Russell (Specialist Sports Physiotherapist, FACP; APA Titled Musculoskeletal Physio) in the Physio Edge podcast as they explore how to assess, treat, and manage patients suffering from ACL injuries or suspected ACL injuries.

You'll discover how to assess a patient with a suspected ACL injury, and criteria you can use to identify whether a patient may be suited to non-surgical management or is likely to require surgery. You'll also understand when immediate or delayed surgery is the best option, and how to guide patients through the decision-making process and different phases of rehab. Listen in to provide your ACL injury patients with the best treatment options.

160. ACL injuries with Zoe Russell

Join David Pope (APA Titled Musculoskeletal and Sports &amp; Exercise Physio) and Zoe Russell (Specialist Sports Physiotherapist, FACP; APA Titled Musculoskeletal Physio) in the Physio Edge podcast as they explore how to assess, treat, and manage patients suffering from ACL injuries or suspected ACL injuries. You'll discover how to assess a patient with a suspected ACL injury, and criteria you can use to identify whether a patient may be suited to non-surgical management or is likely to require surgery. You'll also understand when immediate or delayed surgery is the best option, and how to guide patients through the decision-making process and different phases of rehab. Listen in to provide your ACL injury patients with the best treatment options.&nbsp;    Free Achilles tendinopathy video series with Tom Goom available now  Links

Jo Gibson (Upper Limb Rehabilitation Specialist Physio) discusses the keys to successfully treat persistent anterior shoulder pain in two tennis players who had not recovered despite previous extensive rehab.
In this podcast Jo explores what to include in your rehab of sportspeople who place large demands on their shoulders, elements commonly overlooked in shoulder rehab and how to address patients’ psychosocial factors, fears and beliefs to successfully treat persistent shoulder pain.

161. Overcoming persistent shoulder pain in tennis players with Jo Gibson

How can you treat patients who experience knee pain and swelling during and after running? If you suspect their symptoms are caused by a meniscal injury, how can you rehab and return these patients to running without surgery?

In this Physio Edge: Running repairs podcast with Tom Goom, you’ll explore meniscal injuries in runners, recent research on runners with meniscal tears, and how to provide effective non-surgical management. You’ll discover:

- Initial steps for managing pain and swelling in affected runners.
- Techniques to restore and maintain range of movement.
- Strategies for rebuilding strength in key muscle groups.
- Approaches to improve impact control and tolerance, preparing runners for a gradual return to their sport.
- When to manage these patients non-surgically, and when to refer for a surgical opinion.


Tom explores the physical aspects of recovery, along with the impact of general health, weight management, and gait retraining on knee health. With a realistic timeline for recovery and a focus on individualised treatment plans, this podcast is a must-listen for therapists who treat runners.

162. Three top tips for treating runners with a meniscal injury with Tom Goom

ACL injuries result in significant time away from sport and distress for patients. The variety of management options, from surgical intervention to non-surgical management and rehabilitation protocols, often makes us uncertain when educating and helping patients choose the most appropriate care for their needs and goals.

Recently, a pioneering non-operative ACL injury management pathway called the “Cross bracing protocol” has been pioneered and developed by Dr Tom Cross and Tom’s father (the late Orthopaedic surgeon) Dr Merv Cross. This protocol offers a promising alternative for patients with ACL injuries who are suitable for non-surgical intervention, where the ACL injury may heal or repair itself.

Not all patients with an ACL injury are suitable for the Cross bracing protocol or non-surgical management, so how can you identify whether your patient is suitable, and which treatment options are best for each patient?

In this insightful podcast episode, we discuss the complex challenge of ACL injury management and Cross bracing with Clare Walsh (Specialist Sports & Exercise Physiotherapist, FACP).

Clare treats a lot of patients with ACL injuries with prehabilitation, post-op rehabilitation, or non-surgical management including Cross bracing. Clare works alongside Dr Tom Cross and other Sports Medicine Doctors, Orthopaedic surgeons (including the late Dr Merv Cross) and leading Sports Physiotherapists at Stadium Sports Physiotherapy and The Stadium Clinic.

Clare teaches on the Cross bracing course conducted in Australia for Physiotherapists and health professionals, and is a Senior Educator & Presenter here at Clinical Edge.

This podcast is packed full of great information on this emerging ACL injury treatment. You’ll finish this podcast with a deeper understanding of ACL injury management and Cross bracing plus practical knowledge, solutions and insights you can apply into your practice.

163. ACL treatment options and cross-bracing with Clare Walsh

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

How can you reduce the chance of sporting injury? What are the most useful recovery aids from games and training? When are injections helpful in injury recovery?

In episode 17 of the Physio Edge podcast, Dr Peter Brukner, fresh from working with Liverpool Football Club in the EPL, co-author of Clinical Sports Medicine with Dr Karim Khan, and author of many other publications discusses with David Pope the management of sporting teams, injury reduction, prevention, recovery and a multitude of other topics, including:

ACL Injury Prevention
Hamstring Injury Prevention
Strength training vs Specific strengthening
Player load management
Recovery from tendinopathy
The role of injections, including PRP, Cortisone and Orthokine
Player screening
Player game recovery
and more. Enjoy this episode, hosted by David Pope, and brought to you by the podcast sponsor, Clinical Edge, with their fantastic face to face and online education. Get 20% off your first months Clinical Edge membership with the code “PHYSIOEDGE”.

Happy Christmas and New Year to you and your family too for 2012!

PE #017 Injury Reduction With Dr Peter Brukner

Shoulder pain – what are the causes, and how can you treat it? Are your special tests around the shoulder really isolating and identifying pathology? How can the rotator cuff still function with small and large tears?

In Episode 21 of the Physio Edge podcast, Jeremy Lewis and David Pope discuss these questions and more including:

What is the value of special tests around the shoulder?
What diagnosis can you provide your patients for their shoulder pain
How can you identify if you need to focus your treatment on the scapula, glenohumeral joint, cervical spine or thorax?
How can you identify a rotator cuff tendinopathy?
What is the Rotator Cable, and how is it important in rotator cuff tears?
Is the acromion really the cause of “impingement” or subacromial pain?
If a patient has a biceps tendinopathy and a rotator cuff tendinopathy, which should be treated first?
What contributes to biceps tendinopathy?
Theraband – valuable?
When imaging of the shoulder is valuable, and when it is a waste of time
Frozen shoulder – what treatments work well
And much more.

PE #021 Shoulder Pain With Dr Jeremy Lewis

Dr Kieran O’Sullivan is back on the Physio Edge podcast after talking previously about hamstring injuries, this time discussing his other big area of interest and expertise – chronic low back pain (CLBP). In this episode, Kieran and David Pope discuss

Recent research on chronic low back pain
Central vs peripheral contributions to CLBP
Sitting postures and behaviours, and the relationship of this to pain
Is there an ideal sitting posture, and does changing sitting behaviour change CLBP?
Manual therapy in CLBP
Lumbar kyhposis/lordosis
Physical and psychological interventions for CLBP
The effect of exercise on CLBP
Movement patterns and retraining in chronic pain states
The challenges of talking to patients about chronic pain states
Enjoy this episode, brought to you by the podcast sponsor, Clinical Edge, and their fantastic face to face and online education. Get 20% off your first months Clinical Edge membership with the code “PHYSIOEDGE”.

PE #022 Chronic Low Back Pain With Dr Kieran O'Sullivan

PE040 Shoulder simplified with Adam Meakins
How complex does your shoulder assessment need to be? How can you can simplify your shoulder assessment and treatment?
Find out in episode 40 of the Physio Edge podcast with Adam Meakins, where Adam and I discuss:
	•	Common mistakes Physio’s make in assessment and treatment of the shoulder
	•	Adam’s classification of shoulder pain
	•	Subjective clues to guide your objective and treatment
	•	How to identify weak and painful shoulders
	•	Red flags with shoulder pain
	•	Frozen shoulders
	•	Objective assessment
	•	Subacromial impingement
	•	GIRD (Glenohumeral Internal Rotation Deficit)
	•	The use of US in shoulder pain
	•	Surgical treatment for shoulder pain
	•	Treatment for weak and painful shoulders
	•	Loading the rotator cuff for pain relief and strength
	•	Gym junkie shoulder pain and how to adapt their weight training programs

Links of Interest
Download your free handout on The Shoulder Simplified
Follow Adam Meakins on Twitter
Adam’s website
Adam’s Shoulder courses
Adam’s presentation on “When is a GIRD not a GIRD”
Shoulder Pain Virtual Conference
Follow David on Twitter
Access practical Online Courses for Physiotherapists with a Free Membership Trial of Clinical Edge
Download your free handout on the Shoulder Simplified


Physio Edge 040 Shoulder Simplified With Adam Meakins

Shoulder pain and injury in overhead athletes is very common and has a high recurrence rate. In this podcast with Jo Gibson we discuss sporting shoulder injuries and rehabilitation, including:

The role of the Rotator Cuff
Train strength or efficiency in the Rotator Cuff?
Rotator Cuff muscle balance
When is (and when isn’t) surgery necessary for Rotator Cuff or SLAP tears
Assessment of shoulder stiffness
Bursal involvement
Imaging of the shoulder
How you can help improve Rotator Cuff activation
What role does manual therapy have in shoulder treatment?
The importance of the postero-superior cuff
What stretches can you perform for the postero-superior Rotator Cuff
Treating pain in loaded and overhead activities
Exercises you can use in shoulder treatment with your athletes
Incorporating the kinetic chain in shoulder rehabilitation
Managing shoulder load
Central sensitisation
Treating throwing athletes
The role of the thoracic spine in shoulder pain
Communication tips with your shoulder pain patients

Download the podcast from iTunes

Review the Physio Edge podcast in iTunes

Download the podcast from Stitcher

Download and listen to the podcast on Soundcloud

Links of Interest

Jo Gibson

Download the free podcast handout

Subscribe free to the podcast in iTunes

Jo Gibson’s courses

David Pope

Clinical Edge

Get your free trial of Clinical Edge online education

Jo Gibson’s video - Gym ball rollout

Jo Gibson’s video - Wall squat

Jo Gibson’s video - Step up with V

Physio Matters Podcast with Jo Gibson

Skills for Communicating with Patients Book

Key communication skills and how to acquire them - Article in BMJ by Peter Maguire, Carolyn Pitceathly

EUSSER

Physio Edge 043 Sporting Shoulder 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

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

Achilles tendinopathy treatment - what is the latest research, and how can it help your treatment? What is the best way to treat Achilles tendinopathy (AT)? 

Over the years our treatment of tendinopathy has evolved significantly. You may remember rubbing tendons with ultrasound or our thumbs in years gone past, and stretching the painful area or muscle-tendon complex. If you did, you may also remember the number of people that didn't really improve or develop the load tolerance to return to activity with this approach, supported by research demonstrating the lack of effectiveness of this approach. 

We progressed to the golden era of loading, initially using eccentric training. Additional research emerged on the benefits of heavy slow resistance in tendinopathy treatment, closely followed by the importance of load management demonstrated in research on soft tissue injuries. In 2015 and 2016 Rio et al. released promising preliminary research utilising isometric holds in patellar tendinopathy patients, and we have extrapolated and used isometric holds with many different types of tendinopathy. 

In Physio Edge podcast episode 82 with Dr Seth O'Neill, you will discover:  
Are isometric holds effective with Achilles tendinopathy patients? 
What is the most effective treatment for AT? 
What does the latest research on the treatment of AT reveal? 
Is relief of pain with isometric holds necessary to make a diagnosis of tendinopathy? 
What assessment tests can you perform to diagnose AT? 
How can you assess patient calf strength? 
How can you differentially diagnose other conditions including Plantaris involvement, insertional AT, talocrural impingement or neural irritation? 
How can you explain AT to your patients? 
What exercises can you include in your treatment? 
Exercise progressions you can use When are eccentrics a useful addition to a treatment program? 
When can patients start, continue or progress a walking or running program? How can you incorporate the biopsychosocial model into your treatment? 
Is dorsiflexion range of movement important? 
Is stretching an effective treatment for tendinopathy? 
Are ice, massage or ESWT useful? 
When is imaging useful? 
How can you treat insertional Achilles tendinopathy?   

Download this podcast now to improve your results with Achilles tendinopathy 

Dr Seth O'Neill completed a MSc in Musculoskeletal Physiotherapy, followed by a PhD focused on Achilles tendon disorders. Seth is a lecturer in Physiotherapy at the Universities of Leicester and Coventry, and has a Physio private practice in Nottingham, UK.  

Articles associated with this episode:   
Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine. 2015 Jul;43(7):1704-11.   

O’Neill S, Radia J, Bird K, Rathleff MS, Bandholm T, Jorgensen M, Thorborg K. Acute sensory and motor response to 45-s heavy isometric holds for the plantar flexors in patients with Achilles tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy. 2018:1-9.   

Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015 May 15:bjsports-2014.

Physio Edge 082 Achilles tendinopathy treatment - the latest research with Dr Seth O'Neill

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

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