Lower limb tendinopathies with Dr Peter Malliaras Tendinopathies are a hot topic, and there are lots of new developments in research and treatment. Dr Peter Malliaras, a Physiotherapist with a PhD studying tendinopathy, has a special interest in the treatment of tendinopathy, and treats elite basketball and volleyball, EPL football, rugby, and cricket players, the […]

PE #023 Lower limb tendinopathies with Dr Peter Malliaras

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 ACL injuries result in significant time away from sport and distress for patients. The variety of management options, from surgical intervention to non-surgical management and rehabilitation protocols, often makes us uncertain when educating and helping patients choose the most appropriate care for their needs and goals. Recently, a new non-operative ACL injury management pathway called the “Cross bracing protocol” has been pioneered and developed by Dr Tom Cross and Tom’s father (the late Orthopaedic surgeon) Dr Merv Cross. This protocol offers a promising alternative for patients with ACL injuries who are suitable for non-surgical intervention, where the ACL injury may heal or repair itself. Not all patients with an ACL injury are suitable for the Cross bracing protocol or non-surgical management, so how can you identify whether your patient is suitable, and which treatment options are best for each patient? In this insightful podcast episode, we discuss the complex challenge of ACL injury management and Cross bracing with Clare Walsh (Specialist Sports & Exercise Physiotherapist, FACP). Clare treats a lot of patients with ACL injuries with prehabilitation, post-op rehabilitation, or non-surgical management including Cross bracing. Clare works alongside Dr Tom Cross and other Sports Medicine Doctors, Orthopaedic surgeons (including the late Dr Merv Cross) and leading Sports Physiotherapists at Stadium Sports Physiotherapy and The Stadium Clinic. Clare teaches on the Cross bracing course conducted in Australia for Physiotherapists and health professionals, and is a Senior Educator & Presenter here at Clinical Edge. In this podcast we explore:  Cross bracing  What it is and how it developed. What research has been performed to date, and what it shows about the chances of ACL healing with the Cross bracing protocol. Assessment tests & specific imaging that are used to assess patient suitability. Why patients might opt for Cross bracing rather than surgery. Who isn’t suitable for Cross bracing. Potential negative outcomes of Cross bracing. Which patients are more likely to be suitable and successful with Cross bracing - eg. injury type, age, level of sport, goals, psychosocial factors. Medical factors that impact suitability. Psychosocial factors that impact whether a patient can undergo the protocol. Which leg (right or left) is better suited to bracing and why. Which type of braces are commonly used. How soon the protocol needs to commence after injury to be successful. Which concomitant injuries can still heal in a brace and which need surgery e.g. meniscus injuries, bucket handle tears of the meniscus, MCL tears. How long patients remain in a brace. Exercises and activities that can and should be performed throughout Cross bracing. How patients can move or walk around throughout the Cross bracing period. How Cross bracing has changed and evolved. Whether the ACL is at increased risk of re-rupture following the protocol. Essential medical management during the protocol. Whether therapists can put a patient in a brace, or manage the protocol independently. What to you do if you think a patient may be suitable for Cross bracing. How to refer patients for Cross bracing Followup imaging at the end of the protocol. Functional assessment tests used at the end of the protocol. Return to training (RTT) and return to play (RTP) following the protocol.   Which patients require surgery instead of conservative management. Early surgery vs delayed surgery. Spontaneous ACL healing - what the research says. How to use patient-centred decision-making to guide patients into the most suitable recovery pathway - surgery, bracing or non-surgical management. Case studies and comparisons of patients that underwent either Cross bracing or ACL reconstruction.  This podcast is packed full of great information on this emerging ACL injury treatment. You’ll finish this podcast with a deeper understanding of ACL injury management and Cross bracing plus practical knowledge, solutions and insights you can apply into your practice.        Links  Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership Free Achilles tendinopathy video series with Tom Goom David Pope at Clinical Edge  Download and subscribe to the podcast on iTunes Download the podcast in Overcast Listen to the podcast on Spotify Clare Walsh on Twitter David Pope on Twitter David Pope & why I started Clinical Edge  Review the podcast on iTunes Infographics by Clinical Edge 

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

   How can you treat patients who experience knee pain and swelling during and after running? If you suspect their symptoms are caused by a meniscal injury, how can you rehab and return these patients to running without surgery? In this Physio Edge: Running repairs podcast with Tom Goom, you’ll explore meniscal injuries in runners, recent research on runners with meniscal tears, and how to provide effective non-surgical management. You’ll discover:  Initial steps for managing pain and swelling in affected runners. Techniques to restore and maintain range of movement. Strategies for rebuilding strength in key muscle groups. Approaches to improve impact control and tolerance, preparing runners for a gradual return to their sport. When to manage these patients non-surgically, and when to refer for a surgical opinion.  Tom explores the physical aspects of recovery, along with the impact of general health, weight management, and gait retraining on knee health. With a realistic timeline for recovery and a focus on individualised treatment plans, this podcast is a must-listen for therapists who treat runners. 

162. Three top tips for treating runners with a meniscal injury. Physio Edge Track record: Running repairs podcast with Tom Goom

    Jo Gibson (Upper Limb Rehabilitation Specialist Physio) discusses the keys to successfully treat persistent anterior shoulder pain in two tennis players who had not recovered despite previous extensive rehab. In this podcast Jo explores what to include in your rehab of sportspeople who place large demands on their shoulders, elements commonly overlooked in shoulder rehab and how to address patients’ psychosocial factors, fears and beliefs to successfully treat persistent shoulder pain. Click here for the free webinar with Jo Gibson “Rotator cuff revealed! Rehab & reasoning”.  The handout for this podcast consists of a transcript and research articles referenced in this podcast.       Free video series “Frozen shoulder assessment & treatment” with Jo Gibson Improve your frozen shoulder assessment and treatment now with Jo Gibson’s free video series at clinicaledge.co/shoulder  Shoulder: Steps to Success online course with Jo Gibson Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess  Free trial Clinical Edge membership Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial Links associated with this episode:  Free webinar - Rotator cuff revealed: Rehab & reasoning with Jo Gibson Get your access to the free video series “Frozen shoulder assessment & treatment” with Jo Gibson Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday  Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Jo Gibson on Twitter Let David know what you liked about this podcast on Twitter  Review the podcast on iTunes Infographics by Clinical Edge  Articles associated with this episode:   CLICK HERE to download the articles associated with this podcast Lluch-Girbés E, Requejo-Salinas N, Fernández-Matías R, Revert E, Mejías MV, Camargo PR, Jaggi A, Sciascia A, Horsley I, Pontillo M, Gibson J. Kinetic chain revisited: Consensus expert opinion on terminology, clinical reasoning, examination and treatment in people with shoulder pain. Journal of shoulder and elbow surgery. 2023 Feb 15.t McMullen J, Uhl TL. A kinetic chain approach for shoulder rehabilitation. Journal of athletic training. 2000 Jul;35(3):329.t Ellenbecker TS, Aoki R. Step by step guide to understanding the kinetic chain concept in the overhead athlete. Current reviews in musculoskeletal medicine. 2020 Apr;13:155-63.t      Podcast chapters:    02:30 - Case studies: 2 tennis players 03:14 - Kinetic chain definition  04:18 - When to consider the kinetic chain  07:07 - Screening tests  10:17 - Objective measures     

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

    Join David Pope (APA Titled Musculoskeletal and Sports & Exercise Physio) and Zoe Russell (Specialist Sports Physiotherapist, FACP; APA Titled Musculoskeletal Physio) in the Physio Edge podcast as they explore how to assess, treat, and manage patients suffering from ACL injuries or suspected ACL injuries. You'll discover how to assess a patient with a suspected ACL injury, and criteria you can use to identify whether a patient may be suited to non-surgical management or is likely to require surgery. You'll also understand when immediate or delayed surgery is the best option, and how to guide patients through the decision-making process and different phases of rehab. Listen in to provide your ACL injury patients with the best treatment options.      Free Achilles tendinopathy video series with Tom Goom available now  Links  Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership Free Achilles tendinopathy video series with Tom Goom David Pope at Clinical Edge  Download and subscribe to the podcast on iTunes Download the podcast in Overcast Listen to the podcast on Spotify Zoe Russell on Twitter David Pope on Twitter David Pope & why I started Clinical Edge  Review the podcast on iTunes Infographics by Clinical Edge     

160. ACL injuries with Zoe Russell

 Rotator cuff tear arthropathy (RCTA) is a pattern of glenohumeral joint degenerative changes following rotator cuff tears, causing shoulder pain and stiffness. Subscapularis tears can also be involved in RCTA, or a significant cause of shoulder pain and disability. How can you identify RCTA and subscap tears in your shoulder pain patients? How can they be treated, and do these patients respond well to non-surgical management? Find out in this podcast with Jo Gibson (Upper Limb Rehabilitation Specialist Physio). The handout for this podcast consists of a transcript and research articles referenced in this podcast.         Free trial Clinical Edge membership Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial Links associated with this episode:  Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday  Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Jo Gibson on Twitter Let David know what you liked about this podcast on Twitter  Review the podcast on iTunes Infographics by Clinical Edge  Articles associated with this episode:   Download the handout above to receive the following articles   Conaire EÓ, Delaney R, Lädermann A, Schwank A, Struyf F. Massive Irreparable Rotator Cuff Tears: Which Patients Will Benefit from Physiotherapy Exercise Programs? A Narrative Review. International Journal of Environmental Research and Public Health. 2023 Mar 23;20(7):5242.   Fahy K, Galvin R, Lewis J, Mc Creesh K. Exercise as effective as surgery in improving quality of life, disability, and pain for large to massive rotator cuff tears: A systematic review & meta-analysis. Musculoskeletal Science and Practice. 2022 Jun 10:102597.   Chapters:  03:25 - What is cuff arthropathy? 05:35 - Contributing factors 07:33 - Patient history 08:37 - Subscapularis tendon tears 12:29 - Common mechanisms of injury 13:46 - Assessment tests 16:51 - Rotator cuff related shoulder pain   

PE #023 Lower limb tendinopathies with Dr Peter Malliaras

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