Dr Feigenbaum is a medical doctor, strength and conditioning coach, strong dude, wicked golfer and motocross expert.  He co-runs Barbell Medicine catering to both health care professionals and clients.

We talk:

technique and injury risk (duh)

the ideas behind the "orthopaedic cost" of lifting

the role of excess body weight on health and Osteoarthritis

the need for specificity of training

when we can forego specificity and be very general in our training

and the importance of healthy debate and clinical reasoning

This is another episode where we will definitely have a Part Two!

Dr Pak has a PhD in minimal effective dose training in powerlifters.  So, guess what we talked about?

Dr Pak is a powerlifting coach, scientist and science communicator in the world of strength and conditioning.

His PhD specifically focused on the minimum that a power lifter could do to increase their strength.  

We talked about:

- adults >50 and their powerlifting safety and performance gains

- minimal and optimal approaches to improving strength and hypertrophy

- when, how and whether technique matters for injury and performance (as usual)

Have a look at his research here

We have Erik Meira (The Science PT) talking ACL injury, the importance or not of strength, whether valgus is a true risk factor for injury or a sign of something else and who technique matters for primary or secondary injury prevention.

Please go to Erik's website not just for his links to what he offers but excellent blogs and resources that really explain complicated topics in clinically applicable ways.

Erik's website is here

We talk what role Motivational Interviewing plays in working with patients.  We talk about how to do it and of course how not to do it.

Have a listen

More about Guillaume:

Graduated from Bordeaux (France) in 2005, Guillaume began his career as a physiotherapist working full-time for a professional football club in France. Since 2007, he has been practicing in private practice, specializing in the treatment of musculoskeletal conditions. He has developed a coordinated practice with general practitioners to provide patients with his expertise in musculoskeletal rehabilitation. He now focuses exclusively on shoulder pathologies.

Guillaume holds an MSc in Physiotherapy and Education from the University of Brighton (UK). During this Master's program, he explored and synthesized literature on the prescription of home therapeutic exercises, shared decision-making and reflective practice which was the subject of his final dissertation.

As a trainer, he teaches Motivational Interviewing, Reflective Clinical Practice, and his course titled "Motivating Patients to Do Their Home Exercises." He also hosts the French podcast "Evidence Based Physio Podcast." Lastly, Guillaume is the co-founder and co-manager of l'Agence EBP, a continuing education organization for healthcare professionals that offers training based on the latest scientific evidence.

Jo Nijs, PT, MT, PhD,^[1] is a Belgian professor of physiotherapy at the Vrije Universiteit Brussel and physiotherapist/manual therapist at the University Hospital Brussels.  He has published more than 200 peer reviewed journals and has been strong proponent of some of our favourite topics on this podcast.

We talk about:

- classifying pain based on mechanisms (nociceptive, neuropathic, nociplastic)

- what nociplastic pain is

- the utility of understanding nociplastic pain 

- how lifestyle interventions (sleep, stress, diet) can influence pain

- how we can tailor those interventions to individuals in pain

- how traditional "motor control" exercises can be reframed and help with pain

Dr Nijs can be found at Pain In Motion

Relevant Papers

LIfestyle and Pain

Another paper on a lifestyle management approach to pain

Cognition Targeted Motor Control Exercises RCT 

Sleep and Pain

Nociplastic Pain

Another paper on Nociplastic Pain and CS

Welcome to the Movement Optimism Podcast

The critical thinkers resource for fitness, pain, injuries and health.

In this brief podcast we touch on what Movement Optimism is and what you can expect from the podcast.  In general, we will have three different types of podcasts :

1. Greg with a Guest Expert in their field.
2. A guest expert tells Greg why he is wrong (a gentle debate to really understand a topic)
3. A deeper dive into the research behind previous podcasts or special topics of interest.

Enjoy!

Dr Stu Phillips, Tier 1 Canada Research Chair in Skeletal Muscle Health, shares his expertise on the importance of strength, power and muscle hypertrophy for healthy aging.

As is often the case Stu discusses how simple exercise programming can achieve the physical attributes that help us all age well.  

The fast recap is:

- something is better than nothing

• strength train 2x/week, 2-4 sets, 5-20 repetitions with an effort of 8/10.  
• progress this over time
• train power but moving a much lighter faster!
• eat a little bit of protein within 24 hours of your workout.
• easy peasy
  
  
  

One of the hardest discussions to have with people in pain is shifting our focus from trying to "fix" pain to living well with pain.  Because, if we are very honest there are a huge number of people who might always have pain.  Sometimes the goal for healthy rehab is to shift from eliminating pain to living well with pain.  This is a fundamental of Acceptance and Commitment Therapy (ACT).

Dr Bronnie Lennox Thompson is an expert in this area and she takes us through the importance of this approach and how you can have this difficult conversation with your patients.

Bronnie's webiste is here

Dr Bret Contreras (The "Glute Guy") sits down with Greg to discuss some of our favourite topics.  We dive into Bret being one of the original movement optimists with his wildly controversial article "To crunch or not to crunch" in 2011.  Bret took a well thought out position on spinal flexion that was fairly revolutionary at the time.

We get Bret's views on whether and when technique is important for injury, performance and life long lifting.

Bret also discusses his involvement in the Plotkin et al 2023 study that really challenged some of Bret's thoughts on using EMG to select exercise.

Links to Bret

bretcontreras.com

Some Relevant Papers

To Crunch or not to Crunch Paper

Plotkin et al (2023) Hip thrust and back squat training elicit similar gluteus muscle hypertrophy and transfer similarly to the deadlift

The Collings paper on assessing muscle tension to choose exercise

Music  - Late night train by Vans in Japan

Greg and Alex delved into a wide-ranging discussion about the science of endurance and fitness, with a focus on injury prevention and treatment. They explored the effectiveness of strength training in injury prevention, the inconsistencies in the research, and the debatably importance of stretching in the prevention of injury. 

Alex shared his personal experiences with a hamstring injury and his approach to running injury prevention and some of the limitations of our current research base.

As usual, we also talked about the role of technique in injury risk reduction.  Greg did get confused and brought up technique and performance so that was nice accidental discussion point.

Alex's Outside Magazine Profile 

Alex's website

Rachel Hannah talks about her own experience as a runner dealing with Relative Energy Deficiency (REDs) and her recovery from bone stress injuries (BSIs).  And Greg (Rachel's former Physiotherapist)  talks about his professional failings as a therapist helping Rachel with her first Bone Stress Injury.

If you want help with all things diet, healthy weight and REDs then you can work with Rachel here:

https://rachel-hannah-registered-dietitian.ca1.cliniko.com/bookings

Or See Rachel on IG here: https://www.instagram.com/rachelhannahrd/

Once again we are lucky to have another leader in our physio and rehab space.  Dr Ebonie Rio PhD, researcher (>100 peer reviewed publication), big thinker and practicing sports physiotherapist (with the Victorian Institute of Sport and The National Ballet).

Ebonie discusses her dual role as a researcher and as a practicing clinician.  She shares her insights on:

• manual therapy
• the role of heavy resistance training in tendinopathy
• the importance of a diagnosis for both rehab and in research
• when we need to be specific
• when we need to back off and sometimes listen to pain
• my pain in the butt

This podcast was excellent and there is no way we won't have her on again.  She has too much knowledge that eveyone needs to know.

Dr Stephanie Mundt (PT, PhD Candidate) is on talking about bone stress injuries and optimizing the health of athletes to keep them performing and living well.

We talk about:

- can you run with pain when you have a bone stress injury

- why bone stress injuries occur

- high risk versus low risk stress fractures

- how to build bone and manage injury risk

Dr Neil Meigh is a physiotherapist and associate professor at Bond University (Gold Coast Australia).

Neil conducted a pragmatic exercise intervention in insufficiently active older adults.  The intervention was a hard style kettlebell program in those aged 60-80.  These people were not life long athletes but many of them thrived in his program.  They got the type of results and improvements in fitness where an independent observer could be skeptical.  

We talk details of the program and the resiliency seen in this population while performing high intensity exercise.

Neil's paper is here

Dr Gerard McMahon is a sports scientist out of Ulster University with a special interest in how we can train tendons for both performance and rehab.

We talk:

Partial range vs full range squats for vertical jump

Partial range vs long range training to build tendon mechanical properties (e.g stiffness)

Is there a sweetspot for tendon loading (e.g 4.5-6% strain) and why it may be greater than this range.

Why knowing the actual tendon strain may not be required to prescribe exercises to increase tendon stiffness and strength

Dr McMahon's Ulster University Profile

Clifton is a Canadian Power Lifter and Chiropractor.  I worked with a Clifton a few years ago to help him with his concussion symptoms, low back and hip pain.  Working with health care professionals is often interesting.  You will feel the pressure to "fix them" but when you get to listening to them you often realize that they have the answers and the knowledge.  They just need help and sometimes coaching.  I think (IIRC) I was once told that I can't comment on low back pain and lifting until I "fix" elite level powerlifters.  Besides this being an absolutely silly and anti-science statement I guess by this standard I can never talk about low back pain again.  Because it's true.  I don't "fix" anyone.  No one does. We work with people where they are and problem solve solutions together.  Working with people is often about coaching, reassurance and being there for that person.

Clifton shares his experience with pain, his recovery, how he helps his own patients and his fundamentals of rehab.

Kate Jochimsen, PhD, ATC is a Researcher at the Center for Health Outcomes and Interdisciplinary Research (CHOIR) at Massachusetts General Hospital and a Member of the Faculty in the Department of Psychiatry at Harvard Medical School. Her work “bridges the gap” between sports medicine and psychology by developing interventions to improve patient's pain-related cognitions (‘how they think’) and emotions (‘how they feel’) to improve their health behaviors and increase physical activity. She is passionate about advancing psychologically informed practice and teaching clinicians how to communicate about mental health and intervene when appropriate. Her work has been funded by agencies such as the National Institutes of Health and the American College of Sports Medicine.

The big questions we try to answer:

1. When you have hip pain why does it hurt?

2.  What is the mechanism behind psychological factors influencing pain?

3.  How do we address these psychological factors?

4.  What is cognitive restructuring and how can you do it to help pain?

Dr Johan Lahti PhD is a strength and conditioning coach and an expert in the prevention and training on hamstrings.

Johan is a great thinker related to all aspects of strength and conditioning but has a special interest in mitigating the risk of hamstring strains.

• In this episode we talk about:
  
  potential risk factors for hamstring strains
• how to best train the hamstrings for performance and injury risk
• using EMG to assess hamstring exercises
• and the role of technique in injuries

Some relevant references

Johan's injury prevention study

Training hamstrings

Sprinting and hamstrings

Physios have been lambasted awhile for not understanding the basics of strength and conditioning principles.

I reject this idea.  There two areas we explore in this podcast.

1. The idea that strength and conditioning basics are relevant for rehabilitation

2. Whether physios actually know these basics.

I make an attempt at trying to understand the arguments againsts physios and try to provide a competing view.

Here is how the AI summarized it (not really accurate but I don't want to piss off the robots):

Recovery Mechanisms in Rehabilitation Programs

Greg discussed the importance of understanding what facilitates recovery in rehabilitation programs, emphasizing that it's not always about building strength. He argued against the judgment of programs based on arbitrary ideas of what needs to change, as the actual mechanism of recovery can vary. He also addressed the concept of tolerance, suggesting that improving a person's ability to tolerate loads can lead to recovery, even without necessarily building strength. Greg rejected the idea that physiotherapists don't understand the basics of strength and conditioning, stating that they do and that the judgement often comes from bias. He also highlighted the need for more research to better understand what mediates recovery.

Strength Training Program Design Debate
Greg discussed the flexibility and options in designing a strength and conditioning program. He highlighted that the basics are simple and the key is to progressively overload the muscles. Greg also addressed the debate around whether to push to failure during exercises and suggested checking in to see how close one is to their failure zone. He further stated that there's no need to obsess over specific exercises, as the principle of progressive overload applies to them all. Greg concluded by stating that he'd like the debate to shift towards understanding when specific attributes are important and how to achieve them, with a focus on patient-centered care.

Greg speaks with Jeff Beran of Evolution PT and Jeff's partner Frank Tardi.  They run a successful private practice with exercise, health and optimal training as the foundation of their intervention.  They teach a popular course on energy systems training to improve outcomes entitled "Practical Programming: A
Clinician's Guide to Maximizing Physical Potential

They share their thoughts on both exercise prescription and manual therapy AND offer mentorships to those looking to learn more about their model.

Their Bios are here

Dr Stefi Cohen holds multiple (25) world records in powerlifting, is an accomplished Physical Therapist, Strength Coach,author and pro boxer.  She has done it all and shares the wisdom she has gained in all these areas.

Stefi talks about her views on:

• overcoming her own low back pain
• her book (Back in Motion) to help others with low back pain
• her powerlifting and athletic career
• her views on movement technique and injury risk
• her approach to helping others improve performance, stay healthy and get out of pain.

Some Relevant Links

The Revived Method

Minimal Effective Dose Training 

Dr Lori Michener (Professor of Biomechanics and Physical therapist) is a super expert on shoulder biomechanics and rehabilitation.

Today we talked about:

- the role of biomechanics in pain and injury

- whether you need to be concerned with scapular movement/control

- changes in her clinical opinion

- shoulder "impingement" debates



and so much more.

More about Dr Michener

The central theme of Michener’s funded research is to define optimal treatment pathways for patients with musculoskeletal shoulder disorders by focusing on characterizing mechanisms, defining classification and management approaches and determining optimal outcomes of care. Specifically, her main research aims are: 1) to elucidate the biomechanical and neurophysiological mechanisms related to the presence of pain and poor recovery, in order to 2) develop classification and management strategies to optimize functional outcomes and simultaneously 3) determine the optimal set of patient outcome measures that comprehensively capture activity limitations and participation restrictions to judge treatment outcomes. She is director of the Clinical Biomechanics and Orthopedic Outcomes Research Laboratory, and directs the development, collection and analysis of patient-rated outcomes and process of care in the USC Physical Therapy clinics, and serves as a resource for clinical research.

We had Colin on today to primarily talk about the pragmatic aspects of rehabbing an Achilles tendon in the sporting population.

Part of Colin's PhD thesis was looking at this specific topic.  In my opinion, a lot of the researched tendon loading programs aren't pragmatic, are boring, are hard to stick to and just don't seem like they would contribute to performance.  Colin's program is NOT like that.

His simple, progressive, performance based and pragmatic tendon and lower extremity program should be used as your "recipe" for care.

Have a look at his paper here that outlines the full rehab program.

More about Dr Colin Griffin

Colin is a strength and conditioning coach at the UPMC Sports Surgery Clinic with a role that includes the rehabilitation of lower-limb injuries and the delivery running performance services.

He completed a degree in Strength and Conditioning with Setanta College in 2015 and completed Masters Degree in Coaching and Exercise Science in University College Dublin in 2016. He is an IAAF Level 4 certified endurance coach, coach eduaction tutor with Athletics Ireland and an accredited professional member of the Sport Ireland Institute in High Performance Sport Strength and Conditioning.

He has over 15 years experience in high performance sport having represented Ireland at the 2008 and 2012 Olympic Games in the 50km walk as well as a number of top 12 perofrmances at world and european level. He has also coached other Irish athletes to Olympic level.

In 2011 he founded The Altitude Centre Ireland and pioneered the development of Irelands first residential altitude training centre at the University of Limerick.

His main areas of interest include the rehabilitation of tendinopathies and muscle overload injuries, biomechanics, physiology and athletic development.

Colin is undertaking a PhD on the biomechanics of muscle-tendon interaction at the achilles during exercise, working under JB Morin at the University of Côte d’Azur and in collaboration with SSC Sports Medicine.

Today we take a bit of a detour and talk a little bit about the business side of Physical Therapy.  We don't do justice to our speakers knowledge but I hope that if this a topic you need to know more about I've introduced you to the right person.  Karen Litzy is an excellent physical therapist out of New York City, owner of a concierge physical therapy business, host of the very popular podcast "Healthy, Wealthy and Smart" and she is the creator the Strictly Business Blueprint.

Links

Karen's Website

Antony Lo (aka The Physio Detective) is an elite physiotherapist with a special interest in the pelvic floor and the female athlete.  Antony is an amazing clinical educator and provides a lot of insight into how our profession can keep moving forward.

We discuss:

his evolution from the kinesiopathological model to movement optimism

the role of movement technique in injury risk reduction (he hates this question)

when we need to be clinically specific in our interventions (specific examples related to the pelvic floor are discussed)

his views on behaviour and opinion change.

Future Teaser! - we are going to have Antony on again to dive deep into behaviour change.

Relevant Links

More about Antony's courses here

Antony's clinic page here

Antony's popular The Female Athlete LITE course

And The Female Athlete Full course

Global Pelvic Health Course

Diastasis Done Differently course

Greg's Links (Blogs, courses, Recovery Strategies Workbook blah, blah, blah)

Website

We had Dr Peter Malliaris on this week talking tendons.  Its great to hear different researcher clinicians provide their different takes on the same topic.  Dr Malliaris is a full time professor at Monash University with a keen interest in Tendinopathy.  He teaches the popular online course Tendinopathy rehab.

We talk about:

The role of injections in tendinopathy (hint: not much)

The limitations of the literature and research surrounding exercise and tendinopathy

The role of load management in tendinopathy and why we don’t have a lot of research on it despite it probably being the most important thing we can manage

The role of heavy loading, strength changes and tendinopathy recovery

Strength testing and tendinopathy rehab

Another very practical and pragmatic podcast.  Dr Falk Mersmann is a leader in how tendons adapt to load and I would say an accidental leader in the minumum effective dose to get tendons to adapt.

Some topics we covered:

• Why having a good balance between tendon stiffness and muscle strength is important for tendinopathy prevention and treatment
• How personalized tendon loading can address this potential risk factor
• Specifics of tendon loading to achieve tendon positive tendon adaptations (e.g increasing stiffness).
• Why plyometrics don’t seem to influence tendon strength
• Why only doing the goal activity (e.g running) may not be enough for a healthy tendon
• Why stretching can’t decrease tendon stiffness
• Limitations of shear wave elastography versus measuring mechanical stiffness

Some relevant papers (all open access)

1.  Addressing tendon - muscle imbalances 

2. Comparing different loading volumes and frequencies to achieve tendon adaptations

3. A functional high load program to prevent/treat tendon related pain in athletes

Dr Bas van Hooren discussing running injury prevention, running technique and running economy.

Dr van Hooren is a true expert in running biomechanics.  Blending critical thinking, a strong academic background of excellent publications and personal success in elite running Bas brings huge insights into this field.

I said it numerous times in the podcast but Bas' PhD in this field should really be used as an exemplar for all PhD students.  His work goes beyond the biomechanics of running and also tests his ideas with clinical relevant intervention studies.

You can see his papers here with many of them being open access 

Bas's papers on Pubmed

You can also read more about Bas on Twitter (@basvanhooren) and his website (basvanhooren.com)

Dr Malfliet was on today discussing her PhD thesis paper which deserves a lot of attention. We discussed her RCT entitlted "Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial" where we focused on the importance of nudging into pain (Time Contingent Exercise), reframing motor control exercises as movements that you get comfortable and confident in moving and how to progress these exercises with a graded exposure/activity approach.

We also talked about the role of losing weight (specifically adipose tissue) and its potential role in managing persistent pain.  Weight loss is a difficult topic to broach with patients and providers and we touched on these issues.  We didn't spend too much time on this contentious topic and its certainly worth exploring more in detail

Our Guest - Anneleen Malfliet

Anneleen Malfliet is an assistant professor and postdoctoral researcher at the Vrije Universiteit Brussel. She is also a member of the Pain in Motion international research group. Her research and clinical interest goes out to chronic pain with a special interest in chronic spinal pain, pain rehabilitation, central sensitization, nutrition and diet. More info at our Pain in Motion website: www.paininmotion.be