Physio

After a patient has undergone ACL surgery, rehabilitation is bread and butter in many physiotherapy/sports medicine clinics. Many BJSM podcast listeners will be expert in this role. If you are less expert and wondering if there is an ‘optimum’ way to guide the patient back to sport, Dr Andy Franklyn-Miller provides some food for thought. 

He discusses some novel ways of assessing a patient’s progress after ACL reconstruction, advocates for the use of video in the clinic, and shares the dynamic tests he uses before allowing a player to return to sport. He shares exercises that both test, and help rehabilitate athletes in this setting.
 
Dr Franklyn-Miller is a sports physician at the Sports Surgery Clinic in Dublin, Ireland. He has published widely in sports medicine and his book, Clinical Sports Anatomy (2011), co-authored with Eanna Falvey and Peter Brukner, is an international best-seller. You can follow him on Twitter @AFranklynMiller and his blog provides great resources (www.drAndyFranklyMiller.com) including a further series of podcasts.
 
See also:
His previous podcasts on BJSM relating to running injuries (http://bit.ly/1bqMh8C) and groin pain (http://bit.ly/1fo2TAW).

Consensus criteria for defining ‘successful outcome’ after ACL injury and reconstruction: a Delaware-Oslo ACL cohort investigation: http://bjsm.bmj.com/content/early/2013/07/23/bjsports-2013-092299.full

Lower extremity performance following ACL rehabilitation in the KANON-trial: impact of reconstruction and predictive value at 2 and 5 years: http://bjsm.bmj.com/content/47/15/980.full
 

Andy Franklyn-Miller - Tuning up rehabilitation after ACL reconstruction

Dr Alex Kountouris is the physiotherapist or the Australian men’s cricket team, a position he has held for 8 years. He has just completed his PhD on the relationship between quadratus lumborum and lumbar stress fractures. 

In this podcast he discusses strategies for the prevention and treatment of lumbar spine injuries in cricket. The interesting questions posed to him come from our twitter followers, so hear his responses to your questions!

See also:

Biomechanics of lumbar spine injury in young Australian fast bowlers: http://bjsm.bmj.com/content/44/Suppl_1/i4.3.abstract

MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players: http://bjsm.bmj.com/content/41/11/836.full

A stress fracture of the lumbar spine in a professional rugby player: http://bjsm.bmj.com/content/41/5/337.full

Injuries in West Indies cricket 2003–2004: http://bjsm.bmj.com/content/40/2/119.full

@PeterBrukner discusses today’s major headline: 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/

Book Review: Clinical anatomy of the lumbar spine and sacrum: http://blogs.bmj.com/bjsm/2008/10/16/book-review-clinical-anatomy-of-the-lumbar-spine-and-sacrum/



Lower back injuries in cricket players, with Alex Kountouris

Welcome to the Sports Medcast, brought to you in association with the American Medical Society for Sports Medicine.

In this episode, AMSSM members discuss the recently published 'Overuse Injuries and Burnout in Youth Sports: A Position Statement from the AMSSM' with statement authors Dr John DiFiori, Dr Joel S Brenner and Dr Neeru Jayanthi.

Read the statement: http://goo.gl/lczEHo

Please feel free to contact us at thesportsmedcast@gmail.com regarding this or any other Sports Medcast.

AMSSM Sports Medcast: Overuse injuries and burnout

Professor Philippe Neyret from Lyon, France, is a renowned sports orthopaedic surgeon. Following from his talk at the Isokinetic Football Medicine Conference in Milan, BJSM editor Karim Khan reached him via mobile phone. 

Prof Neyret discusses patellar dislocation in the setting of football and explains that certain anatomic variations (including trochlea dysplasia) make the condition more likely to occur. For players who have suffered patellar dislocation, next steps are not straightforward. Professor Neyret explains which players he would recommend have surgery.  

See also:

Injuries of the sporting knee: http://bjsm.bmj.com/content/34/6/467.1.full

Patient Information Sheet: Patellar Instabilities (dislocation or subluxation of the kneecap): http://blogs.bmj.com/bjsm/2008/10/16/patient-information-sheet-patellar-instability-dislocation-or-subluxation-of-the-kneecap/

Patellar dislocation in football, with Professor Philippe Neyret, France

Hip dysplasia is a commonly missed cause of hip and groin pain. In this podcast, which is part 2 in the 3 part series with Tom Goom (Running Physio), you’ll discover three types of hip dysplasia that will cause different symptoms and need different treatment (based on Wilkins et al. 2017), how to identify each type, and common exercises and a treatment approach that may be stirring up your patients hip and groin pain.

156. 3 types of hip dysplasia and how to identify them with Tom Goom

Professor Lorimer Moseley holds the Inaugural Chair in Physiotherapy at the University of South Australia as well as being a Professor of Neurosciences. He completed his PhD in 2002 and has both learned and shared wisdom at the Universities of Queensland, Sydney and Oxford before settling in Adelaide. He leads the Body in Mind Research Group and coauthored the best-selling ‘Explain Pain’.

In this podcast he answers questions from Ebonie Rio, Department of Physiotherapy, Monash University, covering the important difference between pain and nociception, and sharing thoughts on how pain science can help clinicians working in sports medicine. 

You’ll hear him share the best, and worst, ways to explain pain to patients. He predicts how low back pain management will look in 100 years’ time. As always with Lorimer Moseley. expect thoughtful reflections shared with big dob of humour and humility. 

See also:

TEDx talk ‘Why things hurt’: http://www.youtube.com/watch?v=gwd-wLdIHjs

Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment http://goo.gl/zaNX8s

Are children who play a sport or a musical instrument better at motor imagery than children who do not? http://goo.gl/Xv9Qum

Exercise is medicine, for the body and the brain: http://bjsm.bmj.com/content/48/12/943.full

Chronic traumatic encephalopathy in sport: a systematic review: http://bjsm.bmj.com/content/48/2/84.full

Professor Lorimer Moseley on the brain and mind in chronic pain

Managing the athlete with hip stiffness detected at a physical exam or in a PPE is one of the hottest topics of 2014. Some would argue that nothing needs to be done given that the patient is asymptomatic but on the other hand many orthopaedic papers argue for ‘preventive’ osteotomy. Is this ‘overdiagnosis’ and ‘overtreatment’? Mike Reiman is a highly respected clinician-academic and he has integrated the literature on this topic with his clinical expertise. A ‘must’ podcast for physiotherapists, ATCs and doctors who take care of active people. 

See also: 

Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis: bit.ly/1inIRfW 

Physical examination tests for hip dysfunction and injury: bit.ly/1lHRoVP

Jo Kemp, Kay Crossley, Ewa Roos, What fooled us in the knee may trip us up in the hip: lessons from arthroscopy: bit.ly/1pifElu

Julianne Ryan, Neasa DeBurca, Karen McCreesh, Risk factors for groin/hip injuries in field-based sports: a systematic review: bit.ly/1sq5ip2

Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes: http://bjsm.bmj.com/content/48/14/1102.full

Jon Patricios - Hip injuries in sport, in association with SASMA: https://soundcloud.com/bmjpodcasts/hip-injuries-in-sport-in-association-with-sasma

Managing the PAINFUL hip and groin in sport – a focus on conservative Rx – Prof Mike Reiman (Part 2): https://soundcloud.com/bmjpodcasts/managing-the-painful-hip-and-groin-in-sport-a-focus-on-conservative-rx-mike-reiman-part-2

Duke University’s Assoc Prof Mike Reiman on managing the stiff hip in sport – is it FAI? (Part 1)

This podcast logically follows (Part 1) below but it stands alone as well. Painful hip and groin pain requires a careful history looking for aggravating factors and risk factors, as well as targeted physical examination including but not limited to the hip and groin. Duke University’s Associate Prof Mike Reiman shares specific tips for both assessing, and rehabilitating, the patient with hip and groin pain. 

See also:

Jo Kemp, Kay Crossley, Ewa Roos. What fooled us in the knee may trip us up in the hip: lessons from arthroscopy: bit.ly/1pifElu 

Per Holmich, Kristian Thorborg, Pedersen Nyvold. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain?: bit.ly/1ic7PPu

UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons: http://bjsm.bmj.com/content/43/13/1036.full

Risk factors for groin/hip injuries in field-based sports: a systematic review: http://bjsm.bmj.com/content/48/14/1089.full

The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition: http://bjsm.bmj.com/content/44/11/799.full

Hip flexibility and strength measures: reliability and association with athletic groin pain: http://bjsm.bmj.com/content/43/10/739.abstract

Jon Patricios - Hip injuries in sport, in association with SASMA: https://soundcloud.com/bmjpodcasts/hip-injuries-in-sport-in-association-with-sasma

Duke University’s Assoc Prof Mike Reiman on managing the stiff hip in sport – is it FAI? (Part 1): https://soundcloud.com/bmjpodcasts/duke-universitys-assoc-prof-mike-reiman-on-managing-the-stiff-hip-in-sport-is-it-fai-part-1

Managing the PAINFUL hip and groin in sport – a focus on conservative Rx – Prof Mike Reiman (Part 2)

How can you identify the reason your patient has groin pain and the structures that may be causing it? Groin pain is one of the most common issues in a lot of sports, particularly the football codes, and in episode 25 of the Physio Edge podcast, David Pope talks to Dr Kristian Thorborg about assessment of the groin.

Some of the topics we discuss on this podcast include:
Types of groin injuries
Identifying and diagnosing groin pain and injury
Groin vs hip pain
Tests you can perform to identify the irritated or painful structures
The relevance of diagnostic imaging, and when to refer for this
Hip and Groin Outcome Score (HAGOS)
Using the HAGOS in your clinic
Adductor related groin pain
Hip flexor related groin pain
Abdominal related groin pain
The hip joint
Pubic symphysis
Sports Hernias
Testing hip strength
Assessment of function
And much more!

PE #025 Groin Assessment With Dr Kristian Thorborg

The advanced stages of ACL rehabilitation are enjoyable to progress your patients through, and at the same time challenging to find the right exercises, and optimise the rate of progression through to return to training (RTT) and return to play (RTP). In this episode, Enda King from the Sports Surgery Clinic Dublin and David Pope discuss these later stages of rehabilitating your patients following an ACL Reconstruction.

We discussed the prehabilitation and early stage ACL Rehab in the Physio Edge podcast episode 32, and episode 34 Enda and I cover in detail:

• Return to straight line running and change of direction

• Advanced Exercise Programming

• What exercises to choose

• Proprioception and motor control training

• Strength and power programming

• Periodisation

• Sports specific conditioning

• Plyometrics – readiness, what to use and timing of these in the training schedule

• Multi-directional performance

• Strength testing – what Enda uses, indicators of strength

• Decisions on return to training

• Return to contact

• Decision making on Return to play

• Bridging the gap between the gym and the field

• Advice for Physios rehabilitating athletes recovering from an ACL reconstruction

• When to discharge an ACL athlete

• And much more




PE034 Advanced ACL Rehab With Enda King

Chris McNicholl brings the experience of the Olympic Games and two Commonwealth Games to his sports taping courses for UK Physios in Sport. In this podcast we dig below the surface. Does taping really prevent injuries and if so, how? We cover lower limb, upper limb, joints & muscles. Football and rugby. But we keep the issue of Kinesio-tape for a separate podcast. 

You’ll hear Chris refer to the following papers: 

Tricia J. Hubbard, et al. Effect of Ankle Taping on Mechanical Laxity in Chronic Ankle Instability Foot & Ankle International/Vol. 31, No. 6/June 2010

Heather Miller et al. Role of External Prophylactic Support in Restricting Accessory Ankle Motion after Exercise Foot Ankle Int 2012 33: 862

Karl Stoffel et al. Effect of Ankle Taping on Knee and Ankle. Joint Biomechanics in Sporting Tasks. MEDICINE & SCIENCE IN SPORTS & EXERCISE 2010

Eamonn Delahut et al. Altered Neuromuscular Control and Ankle Joint Kinematics During Walking in Subjects With Functional Instability of the Ankle Joint. The American Journal of Sports Medicine, Vol. 34, No. 12 2006

Effective ankle taping: Mechanisms, myths and more….(Part 1)

Drs. M.P. (Rien) Heijboer, orthopedic surgeon, works at the Dept at Orthopedic at the Erasamus Medical Centre in Rotterdam. 

He has extensive experience with sports-related injuries and has worked for more than 30 years as medical adviser of football club Feijenoord in Rotterdam. He is a member of the medical staff of the Dutch National Soccer Team and visited the world soccer championships in Brasil in 2014, which he describes as a "life-time experience"! 

He is president of the Dutch Orthopedic Society (NOV). 

He has a great interest in sports-related injuries and today Rien discusses his lifetime experience of managing difficult stress fractures in sport.

Further reading:

Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review.
http://bjsm.bmj.com/content/49/6/370.long
Mallee WH, Weel H, van Dijk CN, van Tulder MW, Kerkhoffs GM, Lin CW.
Br J Sports Med. 2015 Mar;49(6):370-376. doi: 10.1136/bjsports-2013-093246. Epub 2014 Aug 19. Review.

Ultrasonography of fractures in sports medicine.
http://bjsm.bmj.com/content/49/3/152.long
Hoffman DF, Adams E, Bianchi S.
Br J Sports Med. 2015 Feb;49(3):152-60. doi: 10.1136/bjsports-2014-094217. Epub 2014 Dec 24.

Fifth metatarsal fractures among male professional footballers: a potential career-ending disease.
http://bjsm.bmj.com/content/47/12/754.long
Ekstrand J, van Dijk CN.
Br J Sports Med. 2013 Aug;47(12):754-8. doi: 10.1136/bjsports-2012-092096. Epub 2013 Apr 9.


Management of difficult stress fractures in sport

K-tape is ubiquitous in top sport. Does it boost performance or prevent injury? In this 2nd podcast about tape, two-time Commonwealth Games and Olympic Games physiotherapist Chris McNicholl shares his clinical wisdom and his scrutiny of the literature. 

See below for list of papers that Chris mentions and here’s the link to his other podcast – on regular taping. http://bit.ly/1bUnP5U

Don’t forget to check out the UK Physios Taping courses here: http://www.physiosinsport.org/courses.html

Schiffer T, J Sport Rehabil. 2015 Feb;24(1):47-50. Kinesio taping and jump performance in elite female track and field athletes and jump performance in elite female track and field athletes.

Nunes GS, Effect of kinesio taping on jumping and balance in athletes: a crossover randomized controlled trial. J Strength Cond Res. 2013 Nov;27(11):3183-9. 

Poon KY, Kinesiology tape does not facilitate muscle performance: A deceptive controlled trial.Man Ther. 2015 Feb;20(1):130-3. http://www.ncbi.nlm.nih.gov/pubmed/?term=j+strength+cond+res++tape+volleyball+soccer

Parreira P C, Kinesio Taping to generate skin convolutions is not better than sham taping for people with chronic non-speciﬁc low back pain: a randomised trial., J Physiother. 2014 Jun;60(2):90-6. http://www.ncbi.nlm.nih.gov/pubmed/24952836

Kachanathu SJ Comparison between Kinesio Taping and a Traditional Physical Therapy Program in Treatment of Nonspecific Low Back Pain. J Phys Ther Sci. 2014 Aug;26(8):1185-8. http://www.ncbi.nlm.nih.gov/pubmed/25202177

Shaheen AF, Rigid and Elastic taping changes scapular kinematics and pain in subjects with shoulder impingement syndrome; an experimental study. J Electromyogr Kinesiol. 2015 Feb;25(1):84-92 http://www.ncbi.nlm.nih.gov/pubmed/25138646

Link to a BJSM paper on K-tape: 

Br J Sports Med doi:10.1136/bjsports-2014-094151 Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. http://bjsm.bmj.com/content/early/2015/01/16/bjsports-2014-094151.abstract

Is K-taping effective sports taping? Part 2 with UK Physios In Sport’s Chris McNicholl

Dr Carolyn Broderick, MBBS, FACSP, PhD is staff specialist in Sport and Exercise Medicine at the Children’s Hospital at Westmead, Australia. Dr Carolyn is Team Physician for the Australian Federation Cup Tennis Team. 

She was Medical Director of the Australian Team for the Youth Olympic Games in 2014 and Team Physician for the Australian Team at the Sydney 2000 and London 2012 Olympic Games. She is a member of the Australian Olympic Committee Medical Commission and Deputy Medical Director for the Australian Olympic Team in Rio 2016. Her research is on injury surveillance in youth sport and physical activity in children with chronic disease. 

What are the challenges of being a team physician for tennis players who travel the world continually? Does an athlete management system help to monitor work load and injuries?

Musculoskeletal conditions in children and adolescents managed in Australian primary care. Henschke N, Harrison C, McKay D, Broderick C, Latimer J, Britt H, Maher CG. BMC Musculoskelet Disord. 2014 May 20;15:164. 
doi: 10.1186/1471-2474-15-164. 
http://www.biomedcentral.com/1471-2474/15/164 

Children, sport and the Olympics: Observations from the Games of the XXX Olympiad in London. Broderick C. J Paediatr Child Health. 2013 Sep;49(9):701-3.
doi:10.1111/jpc.12217. http://onlinelibrary.wiley.com/doi/10.1111/jpc.12217/abstract

The International Olympic Committee Consensus statement on age determination in high-level young athletes.
Engebretsen L, Steffen K, Bahr R, et al. Br J Sports Med. 2010 Jun;44(7):476-84. 
doi: 10.1136/bjsm.2010.073122. http://bjsm.bmj.com/content/44/7/476.extract 
 
Reducing the risk of injury in young footballers.
Broderick C, McKay D. BMJ. 2009 Mar 18;338:b1050. 
doi: 10.1136/bmj.b1050.
http://www.bmj.com/content/338/bmj.b1050 


Travelling with teams? Practical tips for team clinicians; includes Athlete Management System

Plantar Fasciopathy (Plantar heel pain) can be a stubborn condition to treat, or you can learn to love treating it like Dr Michael Rathleff, incorporate the right loading program and activity modification and get some great results.
In episode 38 of the Physio Edge podcast, I talk to Dr Michael Rathleff, author of the RCT “High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up: HL strength training and plantar fasciitis”. We discuss:
	•	Common mistakes in the treatment of plantar fasciopathy (PF)
	•	How we can improve our treatment of PF
	•	Why call it plantar fasciopathy instead of plantar fasciitis?
	•	Research on PF
	•	Loading programs for PF
	•	Patient advice
	•	Activity modification
	•	Running load modification
	•	Short and long term results from loading the plantar fascia
	•	Considerations when treating PF
	•	Who is not suitable for a loading program
	•	Who respond the best to this program, and who responds the least
	•	How to modify the loading program
	•	Development of PF
	•	Running technique
	•	Treatment or strengthening of other areas
	•	Stretching
	•	Orthotics
	•	Cortisone
	•	Plantar fascia tears
Download my five top tips from this podcast with Dr Michael Rathleff.
Links of interest
	•	Dr Michael Rathleff on ResearchGate
	•	Dr Michael Rathleff on Twitter
	•	“High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up: HL strength training and plantar fasciitis”
	•	Clinical Edge Online Education
	•	Virtual conferences with Physio Edge and Clinical Edge
	•	Physioedge on Facebook
	•	David on Twitter


PE038 Plantar fasciopathy loading programs with Michael Rathleff

Do you want to get your athletes with an acute hamstring injury back to play as quickly as possible, without the risk of a recurrence? Should you include lengthening exercises, trunk stabilisation, Nordic curls or PRP injections? Are you searching for a comprehensive, evidence-based update? 

This 10-minute podcast will answer all your questions. BOOM!  

Eminent sports physician Johannes Tol asks the hard questions. Sports physician Haiko Pas provides answers based on his recent systematic review & meta-analysis on hamstring rehab programs and PRP injections. 

Time codes: Optimal treatment for a quick return to play (2.30 min), re-injury reduction (3.50min) and the added value of PRP injections (6.20min). The podcast finishes with three evidence based take home messages for the clinician dealing with acute hamstring injuries (8.20 min).

Links: 

Pas H, Reurink G, Tol JL, Weir A, Winters M, Moen M. Br J Sports Med 2015 (BJSM issue 18)
Efficacy of rehabilitation (lengthening) exercises, platelet rich plasma injections and other conservative interventions in acute hamstring injuries: An updated systematic review and meta-analysis. http://bjsm.bmj.com/content/early/2015/07/21/bjsports-2015-094879.abstract

Brukner P. 
Hamstring injuries: prevention and treatment—an update.
Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094427. doi: 10.1136/bjsports-2014-094427. [Epub ahead of print]
http://bjsm.bmj.com/content/early/2015/06/23/bjsports-2014-094427.long

Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, Whiteley R, Chalabi H.
Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. 
Br J Sports Med. 2015 Jul;49(14):943-50. doi: 10.1136/bjsports-2015-094603.
http://bjsm.bmj.com/content/49/14/943.long

Bahr R, Thorborg K, Ekstrand J.
Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey.
Br J Sports Med. 2015 May 20. pii: bjsports-2015-094826. doi: 10.1136/bjsports-2015-094826. [online first and issue 22]
http://bjsm.bmj.com/content/early/2015/05/20/bjsports-2015-094826.long

Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JA, Bierma-Zeinstra SM, Maas M, Tol JL; Dutch HIT-study Investigators.
Rationale, secondary outcome scores and 1-year follow-up of a randomised trial of platelet-rich plasma injections in acute hamstring muscle injury: the Dutch Hamstring Injection Therapy study.
Br J Sports Med. 2015 May 4. pii: bjsports-2014-094250. doi: 10.1136/bjsports-2014-094250. [Epub ahead of print]
http://bjsm.bmj.com/content/early/2015/05/03/bjsports-2014-094250.long


Hamstring injuries: A 10-min evidence based update on optimal treatment (H Pas and H Tol)

Dr. Joanne Kemp, research fellow at ACRISP (Australian Centre for Research into Injury in Sport and its Prevention) Federation University Australia, discusses Femoral Acetabular Impingement (FAI) and the overall health of the hip joint.  Dr. Kemp completed her PhD at the University of Queensland in 2013. She remains very much involved in clinical physio practice as an APA sports physiotherapist and director of Bodysystem®. (@JoanneLKemp)

An emerging voice in sports medicine, she explores some of the difficult questions regarding hip pathology. Do we know when surgery is appropriate for FAI, or when to opt for conservative treatment?  Which outcomes should guide our clinical decision to treat patients with hip pathology? What are the long term implications for joint health after sports-related hip injury? 

Links to 3 of Dr Kemp’s papers here: 

Hip arthroscopy for intra-articular pathology: a systematic review of outcomes with and without femoral osteoplasty - http://bjsm.bmj.com/content/46/9/632.abstract

Hip chondropathy at arthroscopy: prevalence and relationship to labral pathology, femoroacetabular impingement and patient-reported outcomes - http://bjsm.bmj.com/content/48/14/1102.abstract

What fooled us in the knee may trip us up in the hip: lessons from arthroscopy - http://bjsm.bmj.com/content/48/16/1200.extract

Follow @JoanneLKemp on Twitter

What makes a happy hip? Understanding FAI, arthroscopy and treatment outcomes

Mo Farah has great running technique. You see it, you know it. But what are the elements of Mo Farah’s running style? Can we assess running patients and guide them to improve their technique? Might gait education prove more effective than medication to treat symptoms? 

Andy Cornelius has the answers. He’s a Graduate Sport Rehabilitator and head running coach who works in private clinics, premiership football and with high profile clubs and athletes. Posing the questions is Stephen Aspinall, Chairman of the British Association of Sports Rehabilitators and Trainers (BASRaT - http://www.basrat.org) and Lecturer in Sport Rehabilitation at the University of Salford, England.

Timeline
1:20m - What are the key elements of running assessment?

2:45m - What you can learn by watching the runner from behind (frontal plane) and the side (sagittal plane) on the track and on the treadmill.

4:08m - The runner with injuries related to overstriding. What is overstriding? What can the clinician advise?

6:00m - Assessing cadence and helping the athlete to make a change of between 5-10% in cadence.

7:00m - Role of hip extension, angle of trunk lean.

7:40m - Treatment of the runner who over-strides. Exercises for rehabilitation: split stride, triple extension position, mat sliding exercise, TRX device, verbal queues.

10:20m - Stride width: consider this in conditions like ITB friction syndrome, medial tibial stress syndrome (overloading one side). 

12:00m - Risk of knee pain with widening stride.

12:20m - Detailed exercise progression to adjust stride width.

14:30m - How to couple pelvic stability with hip mobility – the need to balance stability and mobility.

15:15m - Mo Farah as an example - what he does right.

16:00m - Exercise progressions to address limitations around the hip and pelvis. Strive for Mo Farah’s stride! 

17:00m - When to introduce bounding, hopping drills.

17:40m - Learn more at running workshops organised by BASRaT, including at the BASRaT Annual Symposium - Manchester City’s Etihad Stadium, November 20, 2015. http://www.basrat.org/


Links
Paul Hodges on the balance between mobility and stability – http://ow.ly/S4UKE

The Telegraph on Mo Farah in 2013 - http://ow.ly/S4UQh

Andy Franklyn Miller et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med. 2014 Mar;48(6):415-6. (OPEN ACCESS) (@AndyFranklynMiller)
http://www.ncbi.nlm.nih.gov/pubmed/22983122

Andy Franklyn Miller’s related podcast - biomechanics and running injuries  - http://ow.ly/S4VBF (@AndyFranklynMiller)

Christopher Napier’s Systematic Review gait retraining - http://ow.ly/S4V29 (ONLINE FIRST, live October 1st 2015)

BASRaT Annual Conference – Friday November 20th, Manchester - http://www.basrat.org/

Please feel free to suggest links via @BJSM_BMJ or email karim.khan@ubc.ca

Keeping runners running: the secrets of running assessment - advice and exercise progressions

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

Do you treat patients with neck pain? Do you have neck pain? Stop reading and start listening to the podcast. Professor Gwen Jull is one of the most lauded health professionals in the world right now and she shares pearls every minute of this podcast. 

Here's the link to the second part of the podcast: https://soundcloud.com/bmjpodcasts/managing-cervicogenic-headache-and-other-pearls-professor-gwen-jull-second-of-two-podcasts?in=bmjpodcasts/sets/bjsm-1

Timeline
0:00m - How do you approach the patient aged in the prime of life who complains of neck pain and bad cervical posture?

2:00m - “Big development in physiotherapy is the assessment /examination which then forms the basis of our treatment” - movement and also how the movement is performed. Facet joint tests, muscle coordination. 

3:10m - Detailed specific assessment of posture in the patient with neck pain. Have the patient adopt the work positions. Aim to correct the posture to see if pain changes.  

5:10m - How to distinguish the superficial and deep neck extensors

8:30m - 3 trajectories in whiplash patients; folks who get better fairly rapidly (50%), those who suffer persistent mild pain (> 2years, 30%), and ‘the major worry’ of those who have persistent moderate to high levels of pain for many months and sometimes going on for years. What predicts these trajectories? “The last group is a real stumbling block for all professions”.

11:00m - Predictors of the poor outcomes. 

12:00m - See the link to the Jull and Sterling booklet for patients - ow.ly/Soyma. 

13:00m - Treatment of a patient with uncomplicated whiplash - “Hurry slowly”. 

14:00m - Contribution of post-traumatic stress disorder 

14:30m - Management of the complicated case of whiplash. Multiprofessional approach. Multimodal care. Instruments to assess severity and to look for particular elements. 

16:20m - Providing overall management of the patient. Avoiding the medical merry-go-round

17:00m - Exercise is important (this will appeal to you Adam!)! 

17:30m - “My emphasis is on treating multimodally”

18:00m - Manual therapy in the context of multimodal programme

19:00m - Explaining imaging findings to the patient

19:33m - Trigger points and dry needling? 

Remember the 2nd part of this conversation (about Headache and more) will be available on the BJSM podcast site on 2nd October, 2015. 

Links:
Grieve’s Modern Manual Physiotherapy (4th edition): Book review here http://ow.ly/Sj4cn Gwen Jill is the lead author of this physiotherapy bible

Related podcast: Professor Michele Sterling: ‘Managing Whiplash’ (2013).  Very practical management of Whiplash that held up over the 2 years.  http://ow.ly/Sj4Jz

Is the neck pain related to concussion? A related paper in BJSM: Schneider KJ, et al. Br J Sports Med. 2014 Sep;48(17):1294-8. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial.
http://bjsm.bmj.com/content/48/17/1294.abstract

Physio

soozy Q