JOSPT Insights (JOSPT)

Is primary cam morphology a plain and simple bump on the hip—nothing to worry about? Or is it much more of a burden?

Dr Paul Dijkstra, Consultant Sport & Exercise Medicine Physician and Director of Medical Education at the Aspetar Orthopaedic & Sports Medicine Hospital in Doha, Qatar, walks through his approach to diagnosing and managing hip pain in youth athletes.

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RESOURCES

Primary cam morphology concept analysis: https://pubmed.ncbi.nlm.nih.gov/34281962/

physioFIRST pilot study: https://pubmed.ncbi.nlm.nih.gov/29607766/

Physiotherapist-led treatment for hip-related pain: https://pubmed.ncbi.nlm.nih.gov/31732651/

Unravelling the relationship between cam morphology and hip osteoarthritis: https://pubmed.ncbi.nlm.nih.gov/30175856/

Zurich consensus recommendations for classifying hip-related pain: https://pubmed.ncbi.nlm.nih.gov/31959678/

More on the YAHiR collaborative work: https://www.ndorms.ox.ac.uk/events/Oxford-Hip-2022

Dr Cara Baxter takes Dan and Chelsea through the keys to designing top-quality rehabilitation programs for ski and snow athletes.

Dr Baxter describes the wide variety of competitive events, the demands they place on the athlete, plus the common acute and chronic injuries that plague particular snow sport disciplines.

We discuss the travel and schedule demands of the sport, the cognitive demands, the harsh and changing environment, and how you and the athlete can make an informed decision about when is the right time to return to snow.

Dr Amy Arundale, physical therapist and biomechanist with the Brooklyn Nets, gives you the low down on why you want to add clinical practice guidelines to your reading list. Guest host Dr Karen Litzy of Karen Litzy Physical Therapy and the Healthy Wealthy & Smart podcast asks the questions, diving into the knee and anterior cruciate ligament injury prevention guideline that Dr Arundale led, published in JOSPT in 2018, and exploring why Dr Arundale is a strong advocate for educating, collaborating, and consistently following up with athletes.

Quadriceps are Queen. Knee and ACL rehabilitation leader Professor Lynn Snyder-Mackler is a vocal advocate for quality rehabilitation. What should you include in an ACL rehabilitation program? How should you measure quadriceps strength? Which return-to-sport tests should you choose? In today’s episode, we disentangle fact from fiction.

Assessing how people move and helping them to reach their goals for moving is your bread and butter as a clinician.

Today we're learning from 2 leaders in sports biomechanics: Drs Elanna Arhos and Stephanie Di Stasi from the Ohio State University.

We discuss how to make sense of a biomechanics research article, how to translate what you read to clinical practice, and the minimum biomechanics set-up for your clinic.

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RESOURCES

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

In part 1 of this JOSPT Insights x JOSPT Cases collaboration, clinicians Dr Cody Mansfield, Dr Laura Cutler, and Dr Jake Bleacher review their approach to supporting a patient with chronic low back pain.

First, they review the history, clinical assessment, and the interventions performed over the first 2 treatment sessions.

Next, the clinical team reviews how they decided when to leave the biomechanical world and when to focus on graded motor imagery and laterality training.

Dr Chris Hughes, Editor-in-Chief for JOSPT Cases, introduces the journal. He explains why case reports are important in musculoskeletal health and rehabilitation.

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RESOURCES

Check out the case report article that is the main subject of today's discussion plus its supplemental material: https://www.jospt.org/doi/full/10.2519/josptcases.2021.9875

Dr Lorimer Moseley on the role of the brain in chronic pain (snake story): https://www.youtube.com/watch?v=bj9CUGzw6fs&t=26s

Dr Peter O’Sullivan and “Jack” sharing how Jack regained his life: https://www.youtube.com/watch?v=j4gmtpdwmrs&t=214s

Understanding pain in less than 5 minutes, and what to do about it: https://www.youtube.com/watch?v=C_3phB93rvI

Back pain: separating fact and fiction with Dr Peter O'Sullivan: https://www.youtube.com/watch?v=dlSQLUE4brQ

The Recognise App from the NOI group: https://www.noigroup.com/product/recogniseapp/

Today’s sports corner is all about managing high-level basketball athletes. Dr Maggie Bryant, Director of Rehabilitation for the LA Clippers, explains the physical demands of basketball, common injuries, and important things to consider when planning rehabilitation with basketball athletes.

From the acceleration and deceleration demands, physical playing space restrictions, challenging anthropometrics of these athletes, and the variation in position demands—your rehabilitation plans for basketball athletes will require careful thought. Maggie’s hot tip: don’t forget about the foot and ankle!

Kids are resilient, but that doesn't mean they don't struggle with pain. Sometimes it can feel daunting to know how best to support a child in pain, and their family, as everyone navigates school, sport and other environments.

Physiotherapist, researcher and educator at University of Technology Sydney, Dr Joshua Pate, is on a mission to help kids and clinicians work better together when it comes to understanding and managing musculoskeletal pain. Today he shares the latest on pain neuroscience, and tips for honing your listening and communicating skills.

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RESOURCES

More on assessing children's understanding of pain: https://pubmed.ncbi.nlm.nih.gov/32960825/ (Concept of Pain Inventory) and what paediatric pain experts think https://pubmed.ncbi.nlm.nih.gov/29342976/

More on the pGALS (paediatric Gait Arms Legs and Spine) quick musculoskeletal assessment tool: https://pubmed.ncbi.nlm.nih.gov/24219838/

https://www.zoeandzakspainhacks.com is the free online portal for kids, clinicians, parents and teachers. You'll find the books at: https://www.noigroup.com/product/zoe-and-zaks-pain-hacks/

More from Josh on his website: https://joshuawpate.com/

What are the sport demands of professional kiteboarding? F1 racing? How would you best support a cliff diver who is returning from injury?

Dr Amy Arundale joins Dan and Chelsea to share her experiences working with elite extreme athletes at the Red Bull Athlete Performance Center, Austria.

Amy explains what a typical day looks like, how she approaches tailoring rehabilitation to the demands of training and competition, and how to authentically connect with an athlete who plays a sport you aren’t familiar with. Spoiler alert: humility and YouTube go a long way.

When working with a patient who has femoroacetabular impingement syndrome (FAI), knowing how and when to work with an orthopaedic surgeon can feel daunting. Dr. Travis Maak puts your mind at ease today as he chats with Dan and Chelsea to share the surgeon's perspective. Dr Maak is a strong proponent of multidisciplinary practice—he’s a big fan of physical therapists and surgeons working together. In today’s episode, he covers when to refer a patient to a surgeon, what happens when hip treatments aren’t going to plan, different surgical techniques and how they can influence rehabilitation.

Musculoskeletal disorders are the number one contributor to the number of years lived with disability, and osteoarthritis—which affects over 300 million people across the world—is one of the top contributors to global disability. Chances are, you have treated a patient with knee pain this week. So how did you approach that clinical session? Patients might ask for your advice when they are making a decision about knee surgery—what do you tell them? Professor Ewa Roos, international leader in exercise-based osteoarthritis care, joins JOSPT Insights to answer these questions and share her thoughts.

How long will it take for my whiplash symptoms to improve? In this episode, Dr Michele Sterling helps answer that important question. She shares the basics of whiplash: diagnosis and mechanisms, key factors to consider when determining prognosis, and planning treatment. Learn more about assessing pain-related disability and hyperarousal symptoms, as well as the benefits of a proactive approach to treatment. More info on using WhipPredict: https://recover.centre.uq.edu.au/whiplash-associated-disorders-clinician-resources#0 https://www.jospt.org/doi/10.2519/jospt.2016.6918

Frozen shoulder is an enigma characterized by uncertainty, pain, stiffness and disability. It is difficult for patients and clinicians to know how best to manage the symptoms and what is the likely prognosis. In today’s episode, Part 2 of a 2-part series, Prof Jeremy Lewis gives us the low-down on the best evidence for treating frozen shoulder. Manual therapy, injections, exercise therapy: what, when, and how much? Tune in for the answers you’re looking for. Framework for assessing and managing frozen shoulder: https://pubmed.ncbi.nlm.nih.gov/25107826/ Effectiveness of non-surgical interventions: https://pubmed.ncbi.nlm.nih.gov/31233183/ UK FROST trial: https://pubmed.ncbi.nlm.nih.gov/33010843/ Prof Lewis’ new book "The Shoulder: Theory & Practice" is available from Handspring Publishing: https://www.handspringpublishing.com/product/the-shoulder-theory-and-practice/

Stack height, drop, rocker soles, cushioning and more. Join Dr Nathan Brown and Dr Matt Klein—runners and physical therapists—for the low-down on the latest in running shoe construction and technology: what really works and how to help runners choose the best shoe for them. More on the effects of motion-control shoes: https://www.jospt.org/doi/10.2519/jospt.2021.9710. More on monitoring training load in runners: https://www.jospt.org/doi/10.2519/jospt.2020.9533. Visit www.doctorsofrunning.com to connect with Nathan and Matt.

Over the past decade, the way clinicians and researchers understand patellofemoral pain—what causes it and how to manage it—has evolved from a focus on the biomechanics of joint alignment and posture to embracing a more rounded biopsychosocial model of musculoskeletal pain. Tune in as Professors Bill Vicenzino and Michael Rathleff share the results of the recent consensus they led to establish the clinical and research priorities on pain features and psychological factors in people with patellofemoral pain. Access the consensus at: https://www.jospt.org/doi/10.2519/jospt.2022.10647

We couldn't interview 2 experts in running and running shoes without talking about the shoe that's taking the running world by storm: the Nike Vaporfly. Dr Nathan Brown and Dr Matt Klein walk you through the technology that's in the Vaporfly, and explain what makes this shoe different to most other running shoes on the market today. Visit www.doctorsofrunning.com to connect with Nathan and Matt.

Neuromuscular electrical stimulation (NMES) hasn't quite had the coverage it deserves, especially when one considers the strength of evidence supporting NMES as a musculoskeletal rehabilitation intervention

Today, Drs Elanna Arhos (Northwestern University) and Naoaki Ito (University of Wisconsin - Madison) are re-visiting how NMES is applied in sports clinical practice. Get the low-down on why you need NMES in your sports rehabilitation toolkit, and how to figure out dose and intensity.

In part 2 we discuss how to support patients to get the most out of NMES, and which equipment is best for your clinic.

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RESOURCES

Who's afraid of electrical stimulation? Let's revisit the application of NMES at the knee: https://www.jospt.org/doi/10.2519/jospt.2023.12028

There's plenty of work going into how AI can make health care better - including in recording consultation notes, or making early cancer diagnoses, or opening up low cost ways of doing musculoskeletal imaging.

The technology and applications of AI in healthcare changes just about every week. Today, we're exploring generative AI as a help, not a hindrance to musculoskeletal rehabilitation practice.

Physiotherapists Rebecca Fechner (Queensland Paediatric Persistent Pain Service), Dr Josh Pate (University of Technology Sydney) and Professor Mick Thacker (Royal College of Surgeons Ireland) talk about ways to use chatbots and generative AI to generate ideas and solve clinical problems.

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RESOURCES

The Prompt Engineering Guide is a deep dive into how to craft effective prompts for generative AI: https://www.promptingguide.ai/

More on the science of active inference: https://pubmed.ncbi.nlm.nih.gov/25563935/

How do you start a clinical consultation, and what do you do with the information that comes from the patient’s story? Jo Belton and Professor Pete O’Sullivan are tireless advocates for patient-centered care in the truest sense of the phrase. They share their insights on building authentic connections with patients—how to be a human to a human.

Dr Christian Barton joins Drs Dan Chapman and Chelsea Cooman to dive into the patellofemoral pain CPG published in JOSPT in April 2019. In the first episode of this 2-part series, we hit the highlights of this extensive CPG, including the true definition of patellofemoral pain syndrome, as well as the 4 categories of impairments the CPG lays out to allow for a simplified diagnosis. Dr Barton makes the case for looking beyond the research—widening the clinical lens for better diagnosis and better musculoskeletal care. The patellofemoral pain CPG is freely available on JOSPT's website at the following link: https://doi.org/10.2519/jospt.2019.0302

Sports podiatrists and researchers Dr Katrine Kryger and Dr Athol Thomson raise the profile of footwear for improving athletes’ health and performance. Today’s episode jumps into the impact of footwear in sport—how the right footwear can help athletes avoid injury, what athletes should look for when selecting footwear, and the long overdue investment in footwear specifically for women athletes.

Frozen shoulder is an enigma characterized by uncertainty, pain, stiffness and disability. It is difficult for patients and clinicians to know how best to manage the symptoms, and what is the likely prognosis. In today’s episode, you’ll hear ideas from Professor Jeremy Lewis about how you might approach assessing a painful and stiff shoulder, and how you might talk with patients to make a decision together about the best way forward.

Find Part 2 of the chat with Jeremy—all about treating frozen shoulder—here: https://podcasts.apple.com/us/podcast/ep-68-frozen-shoulder-and-how-to-treat-it-with-prof/id1522929437?i=1000550291168 or https://open.spotify.com/episode/2mDypUMV2BNEypGe52wsIs.

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RESOURCES

Framework for assessing and managing frozen shoulder: https://pubmed.ncbi.nlm.nih.gov/25107826/

Effectiveness of non-surgical interventions: https://pubmed.ncbi.nlm.nih.gov/31233183/

UK FROST trial: https://pubmed.ncbi.nlm.nih.gov/33010843/

Prof Lewis’ book, The Shoulder: Theory & Practice, is available from https://www.handspringpublishing.com/product/the-shoulder-theory-and-practice/

It is sometimes difficult to know what the best approach is for preventing and treating shoulder injuries in athletes. Enter, the 2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport—a paper that delivers a flexible, principle-based approach that you can implement with any athlete in any sport. Today, the two clinician researchers who led the consensus—Ariane Schwank and Paul Blazey—bring you the key messages. Download the consensus statement for free: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952

Dr Todd Davenport joins Drs Chelsea Cooman and Dan Chapman to share the headlines from the fresh, updated clinical practice guideline (CPG) for lateral ankle sprains and chronic ankle instability. We discuss the advantages of prophylactic bracing, how ankle dorsiflexion influences mechanics, the importance of neurodynamic control, and why ice is no longer #1. Download the CPG here: https://www.jospt.org/doi/10.2519/jospt.2021.0302

Do you work with young people with ACL injury? Well, you're in the right place! Today, Drs Chris Kuenze and Adam Weaver walk through the story behind creating a comprehensive normative dataset for knee function and strength outcomes. You'll learn how the project got started, and how you can use the information to help make even more informed clinical decisions.

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RESOURCES

Find the paper "Age-, Sex-, and Graft-specific Reference Values From 783 Adolescent Patients At 5-7 months After ACL Reconstruction: IKDC, PEDI-IKDC, KOOS, ACL-RSI, Single-leg Hop, and Thigh Strength" on the JOSPT website: https://www.jospt.org/doi/abs/10.2519/jospt.2023.11389

To access the normative database: https://dataverse.lib.virginia.edu/dataset.xhtml?persistentId=doi:10.18130/V3/JNPHUB

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

Returning to work after work-related injury often throws up some curveballs. Beyond the usual health care practitioners, there are multiple stakeholders who are invested in the person's care. Outside pressures, and factors specific to the person's situation and work requirements also demand careful attention. That’s where the clinical practice guideline can help you know what to pay attention to, to support participation in work after injury or illness. Access the CPG here: https://www.jospt.org/doi/10.2519/jospt.2021.0303

When helping someone to manage their femoroacetabular impingement syndrome, knowing how and when to refer to a surgeon can feel like an uncertain decision.

In today's episode, Dr Travis Maak shares the orthopaedic surgeon's perspective on hip pain in athletes. Dr Maak is a strong advocate for multidisciplinary practice—he’s a big fan of physical therapists and surgeons working together.

We cover when to refer to an orthopaedic surgeon, what to do when hip treatments aren’t going to plan, and how different surgical techniques have implications for the decisions clinicians make about rehabilitation.

Dr Casey Humbyrd—orthopaedic surgeon and Chief of foot & ankle orthopedics at the University of Pennsylvania—shares her expertise and insights on treating ankle sprains that are not responding to non-surgical treatment.

Dr Humbyrd reviews ankle anatomy and her rationale for recommending surgery, how she performs a Broström repair, and explains how she works in close partnership with physical therapists and patients to achieve quality rehabilitation and return to sport outcomes.

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

In today's part 2 of an NMES masterclass from Dr Elanna Arhos (Northwestern University) and Dr Naoaki Ito (University of Wisconsin - Madison), we're getting into the nitty gritty of how to support patients to get the most out of a very beneficial intervention. Drs Arhos and Ito, and their team have tested a mix of common stimulators available on the market today, and are here to share the results with us. Let them help you make an informed decision about your next equipment purchase for your clinic.

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RESOURCES

Who's afraid of electrical stimulation? Let's revisit the application of NMES at the knee: https://www.jospt.org/doi/10.2519/jospt.2023.12028

The ground feels like it's forever shifting for clinicians who work with runners—whether you work with high performance athletes, or the person who likes to run for physical and mental health a few times a week—in this intersection between technology, marketing, biomechanics and health. It can be hard to know where the research is at, and how to tease out what is marketing hype from the truth. Today, Dr Nathan Brown and Dr Matt Klein, who specialise in running injuries and performance, cut through the confusing information, to help you help the runners you work with. Managing stress fractures in runners: https://www.jospt.org/doi/10.2519/jospt.2021.9982 Gait re-training for preventing injury and improving performance: https://www.jospt.org/doi/abs/10.2519/jospt.2022.10585 Visit www.doctorsofrunning.com to connect with Nathan and Matt.

How many times have you reached for the explanation that pain hurts when the brain concludes that the body’s tissues need protecting from an external threat? Specialist clinician and pain educator Laura Rathbone wants to challenge the nociception view of pain and invite clinicians to cultivate a philosophy of pain. For more, check out these links: NoiJam blog: https://bit.ly/35RFH02 Philosophers Chatting with Clinicians podcast: https://spoti.fi/3quCL31 The Words Matter Podcast: http://www.wordsmatter-education.com/blog Why pain experience is not a controlled hallucination of the body: http://philsci-archive.pitt.edu/18770/

How do you approach managing low back pain with children and adolescents? Do you have a different approach than when working with adults?

Diving into the 2022 JOSPT clinical commentary, “What Works When Treating Children and Adolescents with Low Back Pain?”, Dan and Chelsea chat with author Dr Tiê Yamato. They review the physical, psychological, pharmacological, interdisciplinary and family-centered, and communication interventions that are most effective for treating and managing low back pain in this important population.

Read Dr Yamato's article here: https://www.jospt.org/doi/10.2519/jospt.2022.10768

Sports physiotherapist, PhD and strength & conditioning coach, Dr Matt Whalan, breaks down the demands of the beautiful game by position. Did you realize how much coaching philosophy can alter the physical and mental demands on players?

Dr Whalan explains which injuries you can expect to see, and the best (free!) resources for preventing these injuries. You’ll also hear tips for building trust relationships with coaches and players, educating athletes, and how using empowering language when athletes are returning to sport can make all the difference.

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RESOURCES

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Football Australia Perform+ program: https://www.footballaustralia.com.au/performance

Fit To Play: https://fittoplay.org/

FIFA 11+ program: https://www.yrsa.ca/wp-content/uploads/2019/11/pdf/Fifa11/11plus_workbook_e.pdf

Do niggles matter infographic: https://adamvirgile.com/2020/01/09/do-niggles-matter-increased-injury-risk-following-physical-complaints-in-football-soccer/

”My hip hurts when I sit, sleep, and walk up stairs—what is the problem?” Dr Alison Grimaldi joins Dr Chelsea Cooman and Dr Dan Chapman to take a deep dive into gluteal tendinopathy: how to accurately diagnose lateral hip pain, typical symptoms to watch out for, and the best objective tests and measures. Dr Grimaldi shares her gluteal tendon loading progression, and expert tips on rehabilitation including patient education, gait cues, and posture adjustments.

Nick Kane, the head physio at Essendon Football Club in Australia, brings our attention back to Australian Rules Football. Like in all Sports Corner episodes, he reviews the demands of the sport, the common injuries, and key things to keep in mind when designing and progressing rehabilitation programs with Australian football athletes.

In today’s episode, we take a deep dive into the hard preseason work that goes into preventing injuries, as Nick shares the specific primary and secondary strategies his team uses to keep athletes healthy and performing at their best.

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RESOURCES

For more on the Sports MAP Network: https://sportsmap.com.au/

Normative isometric plantarflexion strength values: https://www.sciencedirect.com/science/article/pii/S1466853X23000469?via%3Dihub

More on the relationship between fascicle length and hamstring strength: https://bjsm.bmj.com/content/50/24/1524

JOSPT Insights episode 138 with Melissa Haberfield: https://open.spotify.com/episode/0qizZvG0ESHDfvWhOxq1Nd?si=c052ab2987e141f8 or https://podcasts.apple.com/us/podcast/ep-138-sports-corner-footy-the-game-they-play-in/id1522929437?i=1000619109573

JOSPT Insights episode 124 with Dr Seth O'Neill: https://open.spotify.com/episode/4n4wkxGK1hwBykR1MZyzJm?si=be616b82cc9542d6 or https://podcasts.apple.com/us/podcast/ep-124-caring-for-the-calf-with-dr-seth-oneill/id1522929437?i=1000604944985

Postmenopausal women can build some serious bone AND stay safe with the right instruction and the right load.

What’s the right load? Dr Belinda Beck can answer that, and in today's episode, she takes us through the results of the LIFTMOR trial. With the right instruction and supervision, postmenopausal women can be lifting 85% of their 1 repetition maximum safely, and make a substantial change in their bone density, strength, and quality of life while doing it.

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RESOURCES

For more on the LIFTMOR trial: https://pubmed.ncbi.nlm.nih.gov/30861219/

Dr Erik Meira joins Drs Dan Chapman and Chelsea Cooman to discuss ACL rehabilitation at every stage: acute, strengthening, plyometric, and returning to sport. Dr Meira breaks down the typical timelines and priorities, shares his favorite interventions, and outlines progression criteria for each stage of rehabilitation.

Musculoskeletal rehabilitation clinicians are well versed in the physical and mental benefits of regular physical activity. Unfortunately there is limited evidence to guide clinicians on how to best support return to sport and physical activity after childbirth. That's where today's guest comes in.

Dr Jenna Schulz (physiotherapist and postdoctoral researcher from Western University, Canada) specializes in pelvic health and sport, women’s health, and improving longevity in sport for females across the lifespan. Today, Jenna shares how she approaches supporting physical and mental readiness for sport postpartum, and when to refer to your colleagues in the multidisciplinary health care team.

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RESOURCES

Systematic review of exercise interventions for physical activity and cardiorespiratory fitness: https://www.jospt.org/doi/10.2519/jospt.2024.12666

Scoping review of guidelines for returning to physical activity and sport postpartum: https://pubmed.ncbi.nlm.nih.gov/37898507/

Relative Energy Deficiency in Sport (REDs) and the lactating athlete: https://pubmed.ncbi.nlm.nih.gov/37752008/

What you can do to help prevent neck pain? What are the best exercise approaches?

PhD candidate, Florian Teichert, and Professor Daniel Belavy, from The University of Applied Sciences in Bochum, Germany, discuss which exercises and why they might work. We use their recent systematic review published in JOSPT as a launching point for the discussion.

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RESOURCES

To read the full systematic review: https://www.jospt.org/doi/10.2519/jospt.2023.12063

Blog and infographic: https://www.jospt.org/do/10.2519/jospt.blog.20231011/full/

Today is hamstring strain care from start to finish! Prof Heiderscheit joins Chelsea and Dan to share the headlines from the 2022 JOSPT Clinical Practice Guideline (CPG) for managing hamstring strains in athletes. This CPG includes evidence-based recommendations for accurately diagnosing, treating, and preventing hamstring strains.

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RESOURCES

Hamstring strain injury in athletes CPG: https://www.jospt.org/doi/10.2519/jospt.2022.0301

Hamstring injury: what is it? What should I do about it? When can I get back to my sport? Patient information: https://www.jospt.org/doi/10.2519/jospt.2022.0502

Infographic: criteria-based progression for hamstring injury rehabilitation: https://www.jospt.org/doi/10.2519/jospt.2022.9001

Pain-free vs. pain-threshold rehabilitation: https://www.jospt.org/doi/10.2519/jospt.2020.8895

Dr Saurab Sharma knows first hand the challenges and opportunities of working across different cultures and in different resource settings. From his work as a physical therapist in Nepal, to his research at University of Otago, and his current work at Neuroscience Research Australia, Saurab is committed to improving the lives of people living with chronic pain. Tune in as Saurab shares his ideas for improving how clinicians and people living with pain can talk about and understand pain.

Tactical athletes work and cope with injury in complex and often changing environments. In today’s episode, Dr John J Fraser shares his expertise and advice on working with tactical athletes, such as military, fire, and police. He explains the most common injuries, what makes a tactical athlete different than other athletes, how musculoskeletal rehabilitation clinicians can best communicate their allyship, and the #1 thing to remember when working with tactical athletes.

“Concussion is a clinical diagnosis only.” As a concussion physical therapy specialist and someone with lived experience of concussion, Dr Jessica Schwartz provides sage advice about assessing concussion (orthopaedic, neurological, vestibular system, exercise tolerance) and progressing rehabilitation after concussion. She also shares her top tips for structuring your concussion assessment to help you prioritize rehabilitation.

Does the thought of dermatomes and myotomes, nerve trunks and nerve roots fill you with confidence or fill you with fear? Physiotherapist and neuroscientist, Dr Annina Schmid (Nuffield Department of Clinical Neurosciences, Oxford University), shares a checklist of what you need to know, and what you need to do, to nail your neurological assessment next time you're in the clinic.

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RESOURCES

Does your neurological examination for suspected peripheral neuropathies measure up? Do a check-up here: https://doi.org/10.2519/jospt.2022.11281

Why you cannot trust the dermatomes: https://www.youtube.com/watch?v=BZYtAR4zUpg&t=283s

More from Dr Schmid's Neuromusculoskeletal Health and Science Laboratory: https://www.ndcn.ox.ac.uk/research/neuromusculoskeletal-health-and-science-lab

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

Dr Dustin Jones, from StrongerLife, talks about the important impact that preventing falls can have on an older adult's wellbeing.

He explains how to assess falls risk and physical performance, and recommends his top measures and resources.

Dr Jones addresses why it’s important to focus, not only on preventing falls, but on helping older people prepare for falls too, and reviews some drills he uses with his clients.

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RESOURCES

STEADI: https://www.cdc.gov/steadi/index.html

Ability Lab: https://www.sralab.org/additional-resources

Stronger Life: https://www.strongerlifehq.com/

In this episode, we throw ourselves into the world of team handball with Dr Martin Asker (Sophiahemmet University, Sweden).

If your exposure to handball is every 4 years at the Olympic Games, we've got you covered with a review of the game and the demands of the sport.

Martin's shoulder expertise shines as he covers the common injuries and key things to keep in mind while treating these tricky, well-rounded athletes.

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RESOURCES

Handball Medicine & Science website: https://www.handballmedicine.com/

Bern consensus on managing shoulder injuries in athletes: https://www.jospt.org/doi/10.2519/jospt.2022.10952

There's plenty to think about when you're trying to diagnose and then manage shoulder instability. Sometimes simply teasing out exactly what is going on can frustrate clinicians and patients alike. Today we hear from Dr Amee Seitz, who has spent her clinical and research career trying to improve how clinicians and patients manage musculoskeletal shoulder disorders for best recovery and performance.

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RESOURCES

2022 Bern consensus on shoulder injury prevention, rehabilitation and return to sport: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952

3 findings that are key to diagnosing multidirectional instability: https://www.jospt.org/doi/10.2519/jospt.2020.0602

Derby Shoulder Instability Rehabilitation Programme: https://derbyshoulderunit.co.uk/download/derby-shoulder-instability-rehabilitation-programme/

Dr Stephanie Mathieson (Institute for Musculoskeletal Health, University of Sydney) is sounding the alarm and tackling the super-wicked problem of opioid prescription. She covers the opioid epidemic, why communication within the multidisciplinary team is critical to helping patients manage pain, and how musculoskeletal clinicians can be part of the solution to overuse of medicines. Dr Mathieson's work is nested in the WISER Healthcare collaboration, a leading multidisciplinary research collaboration focused on reducing overdiagnosis and overtreatment in health care.

Did you know that calf injuries are one of the most common soft tissue injuries in team sports? How comfortable do you feel assessing and managing calf pain, especially designing and progressing a program to help someone get back to their sport?

Today, Dr Seth O'Neill from the University of Leicester, joins us to blend the latest science in calf injury with high-level clinical reasoning. You'll get something out of today's chat whether you're beginning in your clinical career or whether you're looking for suggestions for advanced clinical practice.

Join Kate Mahony—sports physical therapist and Head of Performance Health at the New South Wales Institute of Sport—for a post-Olympics wrap-up of the achievements and advocacy of women athletes, clinicians and coaches in sport. Kate shares her tips for supporting women athletes to help them perform at their best and her advice for clinicians who aspire to work in elite sport.

Myofascial pain syndrome is common - affecting somewhere around 1 in every 5 people. Yet there is plenty of debate about what causes myofascial pain syndrome, how to diagnose it, and even whether myofascial pain syndrome is a primary condition.

Today, Professor Chad Cook (Duke University) discusses whether it is even possible to differentiate myofascial pain syndrome from other pain conditions, and the implications for you, the clinician.

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RESOURCES

Myofascial pain syndromes - controversies and suggestions for improving diagnosis and treatment: https://www.jospt.org/doi/10.2519/jospt.2025.13072

International Association for the Study of Pain - Myofascial pain fact sheet 14: https://www.iasp-pain.org/wp-content/uploads/2022/10/14.-Myofascial-Pain-Fact-Sheet-Revised-2017.pdf

Today brings a refresher on best practice in managing non-traumatic shoulder pain.

Professor Karen McCreesh (University of Limerick) guides the listener to the best available clinical practice guidelines and runs the ruler over different approaches to exercise therapy.

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RESOURCES

Diagnosing, managing and supporting return to work for people with rotator cuff disorders (practice guideline): https://www.jospt.org/doi/10.2519/jospt.2022.11306

Efficacy of exercise therapy - systematic review: https://www.jospt.org/doi/10.2519/jospt.2024.12453

GRASP trial: https://pubmed.ncbi.nlm.nih.gov/34382931/

JOSPT Insights episode 173 (shared decision making): https://podcasts.apple.com/ca/podcast/ep-173-shared-decision-making-what-it-is-and-what-it/id1522929437?i=1000651049481 or https://open.spotify.com/episode/6CCh5FRTGAsz54bdpWbYGB?si=c40b2c227eb94a12

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The American Academy of Sports Physical Therapy and JOSPT are co-hosting the second Virtual Sports PT Conference on Saturday 2 November. You'll hear from world-leading clinician-scientists including Drs Terri Chmielewski, Lori Michener, Karin Silbernagel, Liz Wellsandt and Rich Willy. Register now to take advantage of the opportunity for up to 13 continuing education contact hours.

Registration and information: https://tinyurl.com/3xkcrtu2

The YAHiR (Young Athletes' Hip Research) Collaborative takes over the JOSPT Insights podcast today with a deep dive into best practice for imaging the painful hip.

What is the best approach to imaging for young people with hip pain? When do you reach for radiographs? What are the pros and cons of MRI for hip pain? And how do you interpret and act on the information you gather from the scan?

Never fear, Dr Vasco Mascarenhas—radiologist and Assistant Professor at Católica Medical School, Portugal—is here to explain all you need to know to confidently use imaging for hip pain in clinical practice.

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RESOURCES

More on the methods of imaging for hip preservation: https://pubmed.ncbi.nlm.nih.gov/31163499/

Overview of the state of play for imaging in suspected femoroacetabular impingement syndrome: https://pubmed.ncbi.nlm.nih.gov/32845416/

If you consult a clinical practice guideline for any musculoskeletal condition, you'll probably see advice and education included as part of the recommendations for helping someone manage their musculoskeletal pain.

How well do the recommendations in clinical practice guidelines about what topics advice and education should cover align with the main concerns of people with back pain?

Dr Giovanni Ferreira (University of Sydney) joins JOSPT Insights to explain.

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RESOURCES

Concerns of people with acute back pain: https://www.jospt.org/doi/10.2519/jospt.2024.12571

AI chatbots answering questions about low back pain: https://pubmed.ncbi.nlm.nih.gov/39299722/

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The American Academy of Sports Physical Therapy and JOSPT are co-hosting the second Virtual Sports PT Conference on Saturday 2 November. You'll hear from world-leading clinician-scientists including Drs Terri Chmielewski, Lori Michener, Karin Silbernagel, Liz Wellsandt and Rich Willy. Register now to take advantage of the opportunity for up to 13 continuing education contact hours.

Registration and information: https://tinyurl.com/3xkcrtu2

What are the pros and cons of using AI chatbots in musculoskeletal rehabilitation? What are chatbot applications in education, clinical practice, and research?

How does the chatbot advice compare to the recommendations of trusted clinical practice guidelines? Dr Giacomo Rossettini shares the results of 2 new papers from his research team to answer these questions.

This episode is about the best ways clinicians can think about using AI chatbots to advance their clinical practice, while avoiding the pitfalls.

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RESOURCES

Pros and cons of AI chatbots in musculoskeletal rehabilitation practice: https://www.jospt.org/doi/10.2519/jospt.2023.12000

ChatGPT vs. CPGs for managing lumbosacral radicular pain: https://www.jospt.org/doi/10.2519/jospt.2024.12151

Join JOSPT Insights hosts Drs Chelsea Cooman, Dan Chapman and Clare Ardern as they revisit their favorite episodes from a jam-packed 2021, from treating ACL injuries and shoulder pain to designing quality rehabilitation for patients with meniscus repair and building authentic connections with patients. Share your favorite episodes on social media using #JOSPTInsights.

Welcome to a chat with a physical therapist who is using their orthopaedic and sports skills outside the typical practice environment. Dr Patricia Weber shares her experience as a senior physical therapist in the shock trauma setting–a world that blends orthopedic, neurologic and multi-trauma in a challenging emotional and psychological environment.

Dr Weber is a senior physical therapist at the University of Maryland Medical Center. She primarily treats within the R. Adams Cowley Shock Trauma center in downtown Baltimore.

Protecting the health of our best and brightest stars of the future holds a special place in Dr Jackie Whittaker's heart. How do you ensure youth athletes stay healthy and happy in sport, and what do you do if it goes pear-shaped? Dr Whittaker shares her tips, honed from years of clinical practice and field-leading research, on planning and managing return to sport after serious knee injury. Find the International Olympic Committee's paediatric ACL consensus statement at: https://pubmed.ncbi.nlm.nih.gov/29478021/

Clinical physiotherapy specialist, Jo Gibson, is making assessing and diagnosing shoulder problems simple. What are the keys to communicating well with athletes, and the tests you need in your clinical arsenal to best support injured athletes?

Part 2 of our chat with Jo (find it here: https://podcasts.apple.com/us/podcast/ep-99-solving-stubborn-shoulders-part-2-with-jo-gibson/id1522929437?i=1000578394772) was all about supporting the athlete to return to sport: key considerations and best tests.

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RESOURCES

The Athletic Shoulder (ASH) test: https://pubmed.ncbi.nlm.nih.gov/30057775/

Upper-extremity performance tests: https://pubmed.ncbi.nlm.nih.gov/33874850/

How much do you know about the social and economic factors that influence health? Did you know that the social determinants of health are central drivers of health inequities? Orthopaedic physical therapy leader Professor Chad Cook helps unmask the characteristics and factors that play a key role in how people access and experience health care. We look at what the social determinants of health are and why clinicians should care about them, then do a quick wrap-up of research on social determinants of musculoskeletal health.

Are you spending your time reading worthwhile research articles? How can you tell if you should be integrating the findings into your practice? In this episode, Dr Chelsea Cooman and Dr Dan Chapman talk with Prof Steven Kamper about how to evaluate articles and how best to use the Physiotherapy Evidence Database (PEDro). They also quiz Dr Kamper, in a lightning round, on research concepts that he covers in his Evidence in Practice series in JOSPT. Finally, Dr Kamper tackles the question, "Is evidence-based practice simply cookbook medicine?"

Dr Marcie Harris-Hayes joins Drs Dan Chapman and Chelsea Cooman to share her extensive knowledge of hip-related groin pain. We dive into 3 of her papers to get to the bottom of 3 important questions: What counts as hip-related groin pain? Can physical therapy help? Which treatment interventions are most effective for improving function?

The complex world of clinical practice in musculoskeletal rehabilitation brings many challenges. Some you might feel prepared for, while others...not so much.

Musculoskeletal physiotherapist and shoulder specialist, Jared Powell, is here to reassure us that no-one expects you to have all the answers, encourage us all to think carefully and critically when evaluating information, and to embrace a work-related niche that resonates with your passions and strengths.

Jared shares ideas on how to succeed as a compassionate and effective musculoskeletal rehabilitation specialist.

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RESOURCES

"Dear newly graduated physical therapst" article: https://www.jospt.org/doi/10.2519/jospt.2024.12676

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The American Academy of Sports Physical Therapy and JOSPT are co-hosting the second Virtual Sports PT Conference on Saturday 2 November. You'll hear from world-leading clinician-scientists including Drs Terri Chmielewski, Lori Michener, Karin Silbernagel, Liz Wellsandt and Rich Willy. Register now to take advantage of the opportunity for up to 13 continuing education contact hours.

Registration and information: https://tinyurl.com/3xkcrtu2

Have you ever found yourself feeling uncertain or confused when choosing a patient-reported outcome measure (PROM)?

Today we're talking about the hallmarks of a PROM for people with patellofemoral pain. Physical therapist, educator and researcher, Professor Lisa Hoglund, fills in the gaps to help us find the promise in PROMs.

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RESOURCES

Construct validity, reliability, responsiveness and interpretability of PROMs for patellofemoral pain: https://www.jospt.org/doi/10.2519/jospt.2023.11730

Content validity and feasibility of PROMs for patellofemoral pain: https://www.jospt.org/doi/10.2519/jospt.2022.11317

Find out more about the KOOS (including the Excel scoring sheet): http://www.koos.nu/index.html

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The American Academy of Sports Physical Therapy and JOSPT are joining forces to bring you the Virtual Sports PT Conference on Friday the 3rd and Saturday the 4th of November, 2023. Visit the link below to see the full conference programme and to secure your ticket. If you purchase your ticket before the end of August, you can take advantage of a $50 discount.

https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427

How do you approach evaluating psychological health factors when working with people in pain? Do you have an established process for screening? How about an approach to managing the psychological aspects of injury and health?

Athletes say they would like psychological support, while many musculoskeletal rehabilitation clinicians feel ill-equipped to provide appropriate support. What to do?!

Fortunately, Dr Kate Jochimsen (ATC, PhD; Massachusetts General Hospital) is leading a research program geared towards developing and evaluating mind-body interventions for chronic hip pain, and she addresses some of the clinical challenges in today's episode.

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RESOURCES

Psychologically-informed practice when managing sports injuries: https://pubmed.ncbi.nlm.nih.gov/37647239/

More on the prevalence of hip morphology in athletes: https://www.jospt.org/doi/10.2519/jospt.2021.9622

Physiotherapist-led treatment for hip-related pain: https://pubmed.ncbi.nlm.nih.gov/31732651/

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Find out more about the Pain Science in Practice courses delivered by Prof Lorimer Mosley: https://tinyurl.com/25kzcfmh

Direct links for each of the North American Pain Science in Practice courses:

Vancouver, Canada (27-28 September, 2024): https://clinicalsportsmedicine.com/lorimer-moseley

San Francisco, USA (5-6 October, 2024): https://www.noigroup.com/event/pain-science-in-practice-moseley-san-francisco/

New York City, USA (12-13 October, 2024): https://www.noigroup.com/event/pain-science-in-practice-moseley-nyc/

Dr Luciana de Michelis Mendonça realized very early on in her physical therapy career that something wasn't quite right in the sports physical therapy arena; very few of her women colleagues progressed through the ranks of general training to the specialist field of sports, and even fewer worked at the top level of sports, especially with elite or professional teams. She was determined to drive change. Register for the 4th World Congress of Sports Physical Therapy (early bird closes May 1): https://www.conferencemanager.dk/wcspt2022 Gender bias in sports physical therapy: https://www.jospt.org/do/10.2519/jospt.blog.20210825/full/

Dr Mitchell Selhorst continues his chat about spondylosis/spondylolysis/spondylolisthesis in adolescent athletes. After reviewing the who, why, and what in part 1, today’s episode is full of clinical pearls about rehabilitation and return to sport.

Dr Selhorst presents a 3-stage approach to rehabilitation, and shares how he thinks differently when planning rehabilitation for an acute vs. a chronic injury. Another big take-home message: how important it is to consider the psychological aspect of these injuries for youth athletes.

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RESOURCES

More on rehabilitation for spondylolysis in youth athletes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134351/

Micheli Functional Scale: https://pubmed.ncbi.nm.nih.gov/22382433/

Muscle strength is a core focus of many sports injury rehabilitation programmes, and often a prominent discharge criterion. Today's guest has an important message about the uninjured limb in ACL rehabilitation: "beware the moving target of strength".

Olivia Barbosa is a sports physiotherapist with over a decade of experience in soccer and rugby. She currently works at the Aspetar Orthopaedic & Sports Medicine Hospital where she contributes to the concussion and the ACL clinical teams, and does research focused on muscle activation and strength recovery in ACL rehabilitation.

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RESOURCES

More on changes in quadriceps and hamstrings muscle strength over rehabilitation: https://www.jospt.org/doi/10.2519/jospt.2023.11961

Aspetar ACL rehabilitation clinical practice guideline: https://www.aspetar.com/en/professionals/aspetar-clinical-guidelines/recommendations-on-rehabilitation-after-aclr

Professor Nicola Phillips is here to guide us through how to best load the upper extremity after injury. She shares her expertise on how rehabilitation professionals can change the way we prescribe functional exercise to maximize the benefits of how patients learn. She also provides insight into considerations for both short- and long-term programming for an upper limb rehabilitation plan. For more, check out: http://dx.doi.org/10.1136/bjsports-2014-094443

Musculoskeletal rehabilitation practitioners spend years honing our clinical skills—how much time do we spend thinking about and practicing skills like listening, working in teams, and making decisions?

Today, Dr Nicol van Dyk - physiotherapist and Assistant Professor at University College Dublin - is here to make the case for real skills as keys to expert musculoskeletal rehabilitation practice.

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RESOURCES

To find out more and register for the YAHiR-JOSPT Young athlete’s Hip Webinar Series: https://semrc.blogs.latrobe.edu.au/events/yahir/

Essential skills for Physiotherapists led by David Clancy: https://www.us.elsevierhealth.com/essential-skills-for-physiotherapists-9780443111280.html

Seth Godin blog on real skills: https://itsyourturnblog.com/lets-stop-calling-them-soft-skills-9cc27ec09ecb and TED talk https://ideas.ted.com/soft-skills-and-real-skills/

Harvard Business Review - In praise of the incomplete leader: https://hbr.org/2007/02/in-praise-of-the-incomplete-leader

More on listening as a clinical skill: https://pubmed.ncbi.nlm.nih.gov/30279218/

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NICOL'S TOP BOOK RECOMMENDATIONS

How to win friends and influence people (Dale Carnegie): https://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034

Leaders eat last (Simon Sinek): https://simonsinek.com/books/leaders-eat-last/

Dare to lead (Brene Brown): https://brenebrown.com/book/dare-to-lead/

The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You (John C Maxwell): https://www.amazon.com/21-Irrefutable-Laws-Leadership-Anniversary/dp/0785288376

Amazing discussion about vulnerability from Adam Grant with Brene Brown: https://www.youtube.com/watch?v=uXVhDSBiZCI

Today's episode takes the spirit of our popular SPORTS CORNER series, and flips it to learning about playing a leading role in the world of sports medicine and rehabilitation.

Dr Ciara Burgi has worked across collegiate, professional men's, and professional women's sport, and has a ton of wisdom to share.

From building rapport with athletes and patients, to valuing your work in the present without looking too far ahead to what might (or might not) come next, and doing what you can with the resources at your disposal, are among the topics Dr Burgi covers.

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RESOURCES

The American Academy of Sports Physical Therapy and JOSPT are co-hosting the second Virtual Sports PT Conference on Saturday 2 November. You'll hear from world-leading clinician-scientists including Drs Terri Chmielewski, Lori Michener, Karin Silbernagel, Liz Wellsandt and Rich Willy. Register now to take advantage of the extended early-bird price and the opportunity for up to 13 continuing education contact hours.

Registration and information: https://tinyurl.com/3xkcrtu2

A surfer walks into your clinic with neck pain…What do you do next? And why?

Dr Lynn McKinnis expertly walks through when and how to apply the Canadian C-Spine Rule when a patient presents with neck pain, types of vertebral artery injuries, and tips for diagnosing and treating acute neck trauma.

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RESOURCES

Learn more about the specific case here: https://www.jospt.org/doi/full/10.2519/jospt.2016.0416

Canadian C-Spine Rule: https://med-fom-clone-pt.sites.olt.ubc.ca/files/2014/01/C-spine-Rule-FAQs.pdf

NEXUS Criteria for detecting clinically-important cervical spine injury following blunt trauma: https://www.nejm.org/doi/full/10.1056/NEJM200007133430203

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

You don't have to go far to find a media story warning people off the high impacts of running, especially on concrete, and claiming that running is no good for your knees.

Maybe you've had someone in the clinic who worries that running will wear their joints out? My guest today has dedicated his career to helping runners stay healthy and running for life, and is adamant that running is a great physical activity choice, even for people with osteoarthritis and joint replacement.

Dr Jean François Esculier is a physiotherapist based in Kelowna, Canada. He leads the Research & Development team at The Running Clinic, and teaches at The University of British Columbia; his clinical practice is at MoveMed Physiotherapy.

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RESOURCES

Survey about perceptions on running and knee health: https://pubmed.ncbi.nlm.nih.gov/36199830/

Education resource on running and joint health, in 7 languages: http://hdl.handle.net/2429/82767

Evaluation of the education resource: https://www.jospt.org/doi/10.2519/josptopen.2024.0149

Free webinar (account required) about the influence of running on cartilage: https://therunningclinic.com/tv/?VideoId=185711&SelectedCategory=185731

Running with osteoarthritis case report: https://pubmed.ncbi.nlm.nih.gov/38725598/

Sports Corner is a brand-new series from JOSPT Insights! Dan and Chelsea talk with experts in a specific sport, and ask them to share their knowledge on how to deliver best care for athletes. Dr Tim Stone is a physical therapist who specializes in treating lacrosse players, and is an athlete himself. He details the demands of lacrosse by position and shares tips on how to handle “lax back”.

Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy.

In part 2 of this series, Dr de Vos covers the multitude of options for treatment, outside of exercise therapy. Should you and the patient consider corticosteroid injections, PRP injections, heel lifts, shockwave, NSAIDs, or surgery? And when? What are the important clinical considerations when patients choose these options? Part 2 has it all!

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RESOURCES

Terminating corticosteroid injection in tendinopathy? https://www.jospt.org/doi/10.2519/jospt.2023.11875/

Dutch multidisciplinary guideline on Achilles tendinopathy: (https://pubmed.ncbi.nlm.nih.gov/34187784/

Platelet-rich plasma injection for chronic Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/20068208/

Time to put down the scalpel when treating tendinopathy? https://pubmed.ncbi.nlm.nih.gov/31653777/

Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/

Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/

Clinical tool for identifying spondyloarthropathy: http://tinyurl.com/3my87hma

More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/

Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/

Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/

Achilles Pain, Stiffness, and Muscle Power Deficits - 2024 updated clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2024.0302

Hip arthroscopy is a common surgical procedure in athletes and active people, and it's not surprising that this clinical population is focused on returning to sport. Today, Dr Matthew King, physiotherapist and Senior Lecturer from La Trobe University's Discipline of Physiotherapy in Melbourne, Australia, discussed return to sport outcomes after hip arthroscopy.

Dr King led a team that synthesised and analysed return to sport outcomes after hip arthroscopy from 45 studies and over 5000 participants. The team's focus was on sex and gender differences, and how the return to sport outcomes change with increasing time after surgery.

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RESOURCES

Are women less likely to return to sport compared to men following hip arthroscopy? A systematic review with meta-analysis: https://www.jospt.org/doi/10.2519/jospt.2025.12813

Dr Sarah Haag brings her engaging brand of practical tips and her down-to-earth demeanor as she demystifies how to assess and treat the pelvic floor, whatever the clinical setting. No longer fear the pelvic floor—instead, head into the clinic this week confident in your skills.

Melissa Haberfield, very patiently, takes Chelsea and Dan through all things Australian Rules Football. From the field, scoring, and rules, to the punching, kicking, and tackling required to play—it’s a crash course in the game of footy.

Melissa breaks down the demands of the sport, the common injuries, and key things for clinicians to keep in mind when working with Australian football athletes.

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RESOURCES

More on the Prep2Play injury prevention program, including player, coach and clinician resources: https://www.play.afl/coach/resources/prep-to-play/

Intro to footy video: https://www.youtube.com/watch?v=u_SqfNNfhmM&authuser=0

Tayla Harris and the landmark AFLW photo: https://www.abc.net.au/news/2019-03-21/tayla-harris-aflw-photo-could-be-landmark-moment-in-australia/10921892

Delivering quality musculoskeletal rehabilitation practice is a balancing act of art and science. Dr Jason Beneciuk, physical therapist and clinical research scientist at Brooks Rehabilitation and University of Florida, understands the challenges—and he’s here to offer practical solutions. Find the article "What does best practice care for musculoskeletal pain look like?" (Lin et al 2020) here: https://bit.ly/3kMtFxM

Does the thought of managing elbow pain leave you reaching for your orthopaedics textbook? Maybe you've got lateral elbow tendinopathy sorted, but how confident do you feel about managing elbow fractures and dislocations?

Today, Val Jones, Clinical Lead Physiotherapist at the Sheffield Shoulder and Elbow Unit at the Sheffield Teaching Hospital Foundation Trust, shares practical advice to help you feel confident about managing elbow pain.

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RESOURCES

CT versus MRI for assessing osteochonritis dissecans of the capitellum: https://pubmed.ncbi.nlm.nih.gov/36342019/

Shoulder arm return to sport test battery: https://pubmed.ncbi.nlm.nih.gov/31203142/

Lateral elbow pain clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2022.0302

2022 Bern shoulder consensus: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952

JOSPT Insights episode 136 (lateral elbow pain with Drs Lucado and Day): https://podcasts.apple.com/us/podcast/ep-136-lateral-elbow-pain-2022-clinical-practice-guideline/id1522929437?i=1000617533681

JOSPT Insights episode 103 (baseball pitching biomechanics with Wake Forest Pitching Lab): https://podcasts.apple.com/us/podcast/ep-103-baseball-pitching-biomechanics-with-the-wake/id1522929437?i=1000581372250

In Part 2 of our 2-episode interview, Dr Merv Travers walks through his experience of musculoskeletal trauma (and Lego), and the questions to ask patients about their beliefs and experiences of chronic pain. Dr Travers implores clinicians to adopt an anti-fragile mindset—placing exercise and movement at the top of the priority list for people with chronic pain.

How would you approach diagnosing concussion for an athlete with underlying balance problems? Or for an athlete who is blind? The usual concussion tests simply may not be appropriate. Dr Osman Ahmed is a physical therapist on a mission to improve how athletes receive and experience care after concussion. Tune in to hear all about the work of the Concussion in Para Sport Group. Download the position statement of the Concussion in Para Sport (CIPS) Group: https://pubmed.ncbi.nlm.nih.gov/33837003/ Find out more about the CIPS Group’s work: https://www.parafootball.com/our-projects/concussion-in-para-sport

“If we’ve learned anything from all these different studies, it’s that different meniscus tears behave differently, require different treatment, and ultimately have a different prognosis.” Dr James Dreese is an orthopedic surgeon at MedStar Health in Baltimore, MD, who joined Chelsea and Dan to share his thoughts on how different meniscus tears in different locations in the meniscus might influence the choices you make in rehabilitation.

Sports Corner is back for 2024! Today, we revisit ice hockey, and focus on acute injuries—preventing and managing them.

Dr Joe Robinson is the head physical therapist for the National Hockey League’s Boston Bruins. He skates into Sports Corner to explain the physical demands of hockey, the typical acute injuries he sees and how to prevent them, and runs through how the medical team responds during emergency scenarios.

In part 2 of this JOSPT Insights x JOSPT Cases collaboration, clinicians Dr Cody Mansfield and Dr Laura Cutler, with Dr Jake Bleacher continue discussing how they used graded motor imagery to help a patient with low back pain.

Treatment sessions 3 and 4 include breakthroughs, progressions, graded movement exposure, and mindfulness training.

We discuss who finds pain neuroscience most helpful, and Dr Chris Hughes explains why this case was a perfect match for JOSPT Cases.

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RESOURCES

Check out the case report article that is the main subject of today's discussion plus its supplemental material: https://www.jospt.org/doi/full/10.2519/josptcases.2021.9875

Understanding pain in less than 5 minutes, and what to do about it: https://www.youtube.com/watch?v=C_3phB93rvI

Back pain: separating fact and fiction with Dr Peter O'Sullivan: https://www.youtube.com/watch?v=dlSQLUE4brQ

The Recognise App from the NOI group: https://www.noigroup.com/product/recogniseapp/

Find the Why I Hurt Flashcards and heaps of helpful information about pain neuroscience education here: https://whyyouhurt.com/WYH-why.html

Find out more about Headspace, and download the app for free: https://www.headspace.com/

Find "Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation" here: https://www.jospt.org/doi/10.2519/jospt.2018.0610

The NOI Group's website has plenty of courses and resources for clinicians on managing pain: https://www.noigroup.com/

Don't forget, JOSPT has a terrific series called Pain Science in Practice, which is all about helping you understand and link basic pain science to the clinic and quality musculoskeletal rehabilitation care. Find part 1 in the series (6 editorials, and more on the way!) here: https://www.jospt.org/doi/10.2519/jospt.2022.10995

Have you pivoted to telerehabilitation during the coronavirus pandemic? Are you wondering what the digital future of musculoskeletal rehabilitation is? Professor Kim Bennell leads a multidisciplinary team designing, implementing, and studying telehealth for musculoskeletal rehabilitation. Join her for a run-down of the key issues to consider when you’re planning and delivering telerehabilitation and an overview of what the research says about its effectiveness.

Health care practice is slowly transitioning from a paternalistic way of delivering care (doing to the patient) to a shared decision-making model (doing with the patient). Health systems, clinical professions and individual clinicians are at different points along the transition.

As a process, shared decision-making provides a scaffold for the patient's values, preferences and circumstances to receive primacy when discussing options, benefits and risks. As a mindset, shared decision-making is a standard of excellence in clinical practice - it ensures your are focused supporting the patient to authentically engage in decisions about their health.

Today, Diane Slater, physiotherapist and educator from Aalborg University, Denmark is helping you self-diagnose your shared decision-making practice. Diane shares tips for staying up-to-date with the best information to support quality shared decision-making, which she has honed through her work as a coach and mentor to musculoskeletal health practitioners.

When 2 in every 3 people with a musculoskeletal condition also have at least one other underlying health condition, it’s time for rehabilitation clinicians to up our game in understanding complex health needs. Thankfully, Professor Søren Skou is here to help. Who is best placed to help patients manage their complex health needs? And is exercise—the veritable polypill—always the answer? Link to the START trial: https://pubmed.ncbi.nlm.nih.gov/33591346/

In Part 1 of this 2-part podcast, Dr Dan Lorenz joins Drs Dan Chapman and Chelsea Cooman to dig into what quality rehab looks like in the late stages after an ACL reconstruction. Dr Lorenz covers the importance of loading, including where to start, how to load for the demands of the sport, and how it can look different at 4 vs 8 months. He shares his criteria for returning to run, prerunning drills, when and how to progress into plyometrics, and a peek into what he thinks the early stages should look like to prepare for later success.

JOSPT Pain Science in Practice is a new series that aims to decode the basic science of pain and how it applies to your clinical practice. Dr Morten Høgh—physiotherapist, educator and researcher—leads the series, and today he explains how #JOSPTPainScienceInPractice will help you help the patients you work with. We're co-developing #JOSPTPainScienceInPractice with you! Let us know what you want to read about. Follow the discussion on social media (Twitter: @JOSPT, @MH_DK, #JOSPTPainScienceInPractice). You can read the first article in the series here: https://www.jospt.org/doi/10.2519/jospt.2022.10992.

Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy.

In part 2 of this series, Dr de Vos covers the multitude of options for treatment, outside of exercise therapy. Should you and the patient consider corticosteroid injections, PRP injections, heel lifts, shockwave, NSAIDs, or surgery? And when? What are the important clinical considerations when patients choose these options? Part 2 has it all!

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RESOURCES

Terminating corticosteroid injection in tendinopathy? https://www.jospt.org/doi/10.2519/jospt.2023.11875/

Dutch multidisciplinary guideline on Achilles tendinopathy: (https://pubmed.ncbi.nlm.nih.gov/34187784/

Platelet-rich plasma injection for chronic Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/20068208/

Time to put down the scalpel when treating tendinopathy? https://pubmed.ncbi.nlm.nih.gov/31653777/

Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/

Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/

Clinical tool for identifying spondyloarthropathy: http://tinyurl.com/3my87hma

More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/

Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/

Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/

Dr Jeremy Graber joins us to help answer the question: how often should patients with total knee arthroplasty come to rehabilitation? To answer this and more, we dive into the 2023 JOSPT article, “Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study.”

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RESOURCES

Dr Graber and his colleagues led a expert consensus process to establish recommendations for how often and for how long you might consider scheduing rehabilitation visits. The group also discussed discharge planning, how to implement telerehabilitation, and monitoring the patient's progress to guide clinical decisions

Check out the JOSPT article: https://www.jospt.org/doi/10.2519/jospt.2023.11840

For more on predicting outcomes after total knee replacement: https://www.medrxiv.org/content/10.1101/2023.10.23.23297404v1 (preprint)

Why do we hurt, and why does pain persist for some people? Today, Dr Tasha Stanton—clinical pain neuroscientist and physiotherapist from the University of South Australia—is exploring ways to hijack the complex processes going on in our body for good. All in the name of managing pain better. ------------------- DR STANTON'S RESOURCE RECOMMENDATIONS NOI Group: https://www.noigroup.com/ Pain Chats: https://painchats.com/ HealthSkills Blog (Dr Bronnie Lennox Thompson): https://healthskills.wordpress.com/

We're premiering a new series focused on JOSPT Cases—a teaching tool to help develop your clinical reasoning and highlight how to apply evidence in your practice. Today, Dr Kimiko Yamada explains an orthopedic case from JOSPT Cases. She outlines how JOSPT Cases works, how you can subscribe, and how you can submit your own cases to be highlighted in future editions.

To visit JOSPT Cases you can follow the link here: https://www.jospt.org/loi/jospt-cases

The YAHiR (Young Athletes Hip Research) Collaborative take over the JOSPT Insights podcast today with the second part of our explainer on hip dysplasia. Drs Inger Mechlenburg and Julie Jacobsen cover the key elements of an effective treatment program, when hip preserving surgery is an option, and how to balance loading, exercise and information to help people with hip dysplasia to stay active and healthy throughout life.

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RESOURCES

Learn more about how the YAHiR collaborative is partnering to promote and protect athletes' hip health through high-quality research: https://www.ndorms.ox.ac.uk/research/yahir

You can register to access full recordings of the Young Athlete's Hip Symposium, and the Oxford-Aspetar-La Trobe Young Athlete's Hip Webinar Series (11 webinars): https://www.ndorms.ox.ac.uk/events/Oxford-Hip-2022

The next Young Athlete's Hip Symposium is on 25-27 September, 2024 at Worcester College, Oxford University

Andrew Mitchell (RB Leipzig) knows a thing or two about supporting athletes to return to play after injury, especially in professional football/soccer.

Today, Andrew explains his return to performance pathway, which is a criteria-based approach to help you and the athlete keep focused on the athlete's return to performance goal.

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RESOURCES

Andrew's return to performance pathway: https://www.jospt.org/doi/10.2519/josptopen.2024.1240

Clinical pearls for supporting return to performance: https://www.jospt.org/doi/10.2519/josptcases.2021.0103

Control-chaos continuum for progressing rehabilitation: https://pubmed.ncbi.nlm.nih.gov/30737202/

On-field rehabilitation progression (part 1): https://www.jospt.org/doi/10.2519/jospt.2019.8954

On-field rehabilitation progression (part 2): https://www.jospt.org/doi/10.2519/jospt.2019.8952

Most people who pursue a career in health care do so because they want to help people. Depending on where you work, patients might find it easier or harder to access high-value musculoskeletal care, and you might run into barriers to providing the care you would like to provide.

Dr Roy Film is a physical therapist, educator and current President of APTA Maryland. In today's episode, Roy explains his work trying to make it easier for people to choose high-value musculoskeletal rehabilitation.

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RESOURCES

Racial disparities in outpatient PT use: https://www.jospt.org/doi/10.2519/jospt.2024.12641

There's a range of different interventions at your disposal when managing spine pain.

Today we're focusing on spinal manipulative therapy, and asking questions like: does it matter how you apply a manipulation to get the best outcomes for the patient?

Answering the questions is Dr Casper Nim from the University of Southern Denmark. Casper is an Associate Professor, chiropractor, and senior researcher at the Spine Centre of Southern Denmark.

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RESOURCES

Does it matter how you apply spinal manipulative therapy? Network meta-analysis: https://www.jospt.org/doi/10.2519/jospt.2025.12707

Does targeting a specific vertebral level make a difference? Systematic review: https://www.jospt.org/doi/10.2519/jospt.2023.11962

Effect on clinical outcomes when targeting spinal manipulative therapy. Randomised controlled trial: https://pubmed.ncbi.nlm.nih.gov/32884045/

Preference randomised trials: https://www.jospt.org/doi/10.2519/josptmethods.2025.0129

JOSPT Methods journal website: https://www.jospt.org/toc/jospt-methods/current

Dr Claire Minshull joins Drs Dan Chapman and Chelsea Cooman to unpack rate of force development (RFD): what it is, what it isn’t, and how to measure it. We take a deep dive into how fatigue affects RFD, differences between the sexes, potential implications for injury, and the best ways to incorporate RFD training into your rehabilitation plans.

Does the thought of managing elbow pain leave you reaching for your orthopaedics textbook? Maybe you've got lateral elbow tendinopathy sorted, but how confident do you feel about managing elbow fractures and dislocations?

Today, Val Jones, Clinical Lead Physiotherapist at the Sheffield Shoulder and Elbow Unit at the Sheffield Teaching Hospital Foundation Trust, shares practical advice to help you feel confident about managing elbow pain.

For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

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RESOURCES

CT versus MRI for assessing osteochonritis dissecans of the capitellum: https://pubmed.ncbi.nlm.nih.gov/36342019/

Shoulder arm return to sport test battery: https://pubmed.ncbi.nlm.nih.gov/31203142/

Lateral elbow pain clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2022.0302

2022 Bern shoulder consensus: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952

JOSPT Insights episode 136 (lateral elbow pain with Drs Lucado and Day): https://podcasts.apple.com/us/podcast/ep-136-lateral-elbow-pain-2022-clinical-practice-guideline/id1522929437?i=1000617533681

JOSPT Insights episode 103 (baseball pitching biomechanics with Wake Forest Pitching Lab): https://podcasts.apple.com/us/podcast/ep-103-baseball-pitching-biomechanics-with-the-wake/id1522929437?i=1000581372250