FUNCTIONAL F1RST

"Why are we trying to decrease inflammation? Inflammation, the last I checked, was an amazing thing, it's a good thing!"

We speak with physiotherapist, Dr. Bahram Jam [D.Sc.PT, M.PHTY, B.Sc.PT, FCAMT], about the evidence behind the use of ice post soft tissue injury. Bahram also discusses the effects of ice, heat, and anti-inflammatories on the body's healing process.

To read Bahram's article on Ice and for references to studies visit:

Questioning the use of ICE Given Inflammation is a Perfectly Healthy Response Following Acute Musculoskeletal Injuries

Learn more about us here.

00:28 Can you introduce yourself?

01:03 Patients often ask if they should use ice or heat for an injury. How do you answer that?

02:10 Do you think that peoples preference (ice vs. heat) has an influence on their pain?

03:35 Can you explain how the inflammatory process works and how ice would influence that?

06:49 Is there any research that ice may have a negative effect after acute injury?

08:28 What are your thoughts on ice baths and whole body cryotherapy as a recovery tool?

10:41 What do you think is the best way to reduce swelling?

11:42 What are your thoughts on Rice vs Price vs Police post injury?

13:21 What would you suggest to help with recovery for people with mobility restrictions eg. Non-weight bearing or in a cast?

14:11 A common use of ice is post-surgery. What are your thoughts on ice machines post-op?

15:54 What about the use of heat post injury?

16:50 What are your thoughts on the use of anti-inflammatories post injury?

20:42 What about the use of topical anti-inflammatories?

21:31 Where can people find out more about you?

You asked, they answered!

Three top pain scientists - Prof Lorimer Moseley, Dr. Tasha Stanton, Dr. David Butler - answer your burning questions about pain science. This episode is live from the Pain Revolution event in Australia.

Thank you to all who contributed questions and special thanks to the online communities who collaborated with us to make this podcast possible: Trust Me I'm a Physiotherapist, PhysioTutors, Rethinking Physiotherapy, GetPT1st, InfoPhysiotherapy and Exploring Pain Science. Check them out on Instagram, Facebook, and Twitter.

Learn more about us here.

00:30 What is pain?

01:24 What do you tell a patient who answers you "So it's just in my head?"

02:07 How can we change people's general knowledge (before they become "patients") about pain and pain management?

03:09 What metaphors and analogies do you use with your patients?

04:38 How much is it possible to deliver in a 20-minute clinical education setting? What would you focus on?

05:37 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?

06:22 What is one piece of advice you would give to someone suffering from persistent pain?

07:11 Those of us in the profession like to dig deep in the science and research, but what the overall public is interested in is far more practical - what can we do? Data alone hasn't convinced many, how can we better explain what's going on in a simple, understandable way?

09:24 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?

10:43 What are the biggest barriers in making physio and pain management move forward?

11:56 How do you see the role of manual therapy in both acute and persistent pain - assuming an ethical and accurate explanation (as opposed to a PSB model approach)

13:35 What is the most effective way to implement a pain science approach in chronic regional pain syndrome (CRPS), and how should medications be used during implementation?

16:44 What can you tell us about pain thresholds? Could a pain threshold be more about coping/ pain tolerance or is there an actual inter-individual difference on a neurological level, such as our perception, or even a nociceptor level?

18:45 Does the health industry need to change the way it understands and treats pain? if yes - what are your suggestions?

21:18 With the biopsychosocial model, there is often a focus on the psychosocial factors, where does the bio fit into all of this? Where does it come into play or are they thought of very separately?

23:09 How do you explain pain to an uneducated patient who thinks treatment is a quick fix? My challenge is breaking down the information simply enough for such patients to understand.

24:48 What changes do you think healthcare professionals need to institute in the treatment of acute pain, in order to help prevent transition to chronic pain states?

26:29 What is your go-to one liner to explain Central sensitization to your chronic pain patient? How do you explain this on day one without loosing the patient?

29:37 Please explain fibromyalgia.

31:10 How does stress and emotion contribute to pain manifestation at different sites?

34:14 Mindfulness, how can it be used to work with people’s pain management/ perception?

36:32 I want to hear their answer on a question asked by Mick Thacker: If pain is a perception, then how does the neuro-physiology involved go on to be become a higher centre cognitive function?

40:13 Children who fall over in the playground experience a broad range of responses from their parents ranging from a "toughen up" type of indifference right through to overt and excessive concern. How might these paren

"Some of the biggest manufacturers in Canada and the US often claim to make custom product when they’re actually using stock item shells and creating orthotics that are not actually unique to the patients feet."

We speak with Aaron Tran, pedorthist and founder of Orthogenic Laboratories, about custom foot orthotics - what they are, what conditions they help treat, how they're made, and how to tell if they are truly custom.

To find out more visit http://orthogeniclab.com

Learn more about us here.

00:25 Can we start by having you introduce yourself?

01:06 Can you give us an overview of what Orthogenic Lab does?

01:42 What are the differences between the types of foot specialists?

03:28 What are orthotics and why are they important?

04:35 What types of conditions can orthotics help with?

05:22 Can orthotics help conditions that are not foot related, such as low back pain?

06:25 Are orthotics a temporary or long term solution?

08:12 Do you recommend that if someone has orthotics they use them all of the time?

09:43 What are the components of an orthotic? What are the purposes of the different layers?

10:16 What are the common materials used in orthotics?

10:57 Can you tell us the purpose of the different parts of orthotics?

12:21 Is there a difference between hard and soft orhtoics?

15:00 Do orthotics make your feet lazy?

16:03 What are the different methods of casting orthotics? How accurate are they?

18:50 What is the difference between a weight bearing vs. non weight bearing casting?

20:02 Once someone is casted, what is the process of making the orthotics?

22:46 What type of process do you use at Orthogenic Lab?

24:35 Do you think technology will keep changing your profession?

25:33 Do insurance companies cover the cost of orthotics made using a 3D scanner?

26:44 What is the difference between custom and off the shelf orthotics?

28:26 There have been a few articles about off the shelf orthotics being advertised as custom made. What are your thoughts on that?

30:50 Is there a cost difference between off the shelf vs. custom?

31:28 What should patients look for when purchasing orthotics?

33:01 Are there any regulations for selling orthotics?

34:40 What healthcare providers can prescribe orthotics?

35:55 How can healthcare providers who don’t prescribe orthotics screen a patient to see if they may be appropriate for them?

37:16 Are there any online resources for healthcare providers to learn more about different conditions orthotics may help?

38:10 Where can people find out more about you?

“If there’s no bio (in biopsychosocial), why are there physios?...For a long time we said every body has a brain, meaning don’t forget there’s a brain attached, but we have to also go backwards and remember that the brain has a body”

We speak with physiotherapist Adriaan Louw (PT, PhD, CSMT) about pain neuroscience education, including layman's explanations and metaphors to help patients better understand their pain. Adriaan discusses the science behind pain education and current research in this area. He also addresses the biosychosocial model, and the importance of including the bio in a pain science approach. 

For more information visit www.ispinstitute.com

Learn more about us here.

00:24 Can you introduce yourself?

00:42 What was your PhD in?

01:21 How did you get involved with pain neuroscience education?

02:18 Can you define Pain Neuroscience Education?

03:14 Can you give us a 5 minute layman’s explanation to describe pain?

06:47 What metaphors do you use to help patients understand their pain?

07:43 How does neuroscience education actually work to change someone’s pain?

09:24 What is the latest evidence to support this as a treatment intervention? How strong is this evidence?

11:04 What are some common pitfalls when explaining pain neuroscience to patients?

12:24 How do you change your explanations to suit the patient in front of you?

14:10 How do you explain the difference between acute and chronic pain?

16:10 How do psychosocial and lifestyle factors influence pain?

17:26 How do you like to address Pain Neuroscience Education when working with patients who are highly invested in the belief that structural pathology/biomechanical flaws are the source of their pain?

20:44 If a patient is seeing other health professionals who have been given other explanations about their pain, how do educate them without undermining the other HCP’s?

23:20 Depending on where you practice, there is very limited time during a treatment session. Do you have any strategies for therapists to incorporate pain neuroscience in that kind of setting?

25:44 It seems that the pendulum has swung heavily in favor of addressing the psychosocial aspects of chronic pain. How important is the bio aspect in chronic pain?

28:44 How do you explain why you are doing manual therapy to a patient?

31:26 Are there any specific words that you feel should never be used when educating someone about their pain?

32:53 What treatment approaches do you find work best for patients with allodynia and/or strong central sensitization?

33:50 How important do you think movement and exercise is in treatment?

34:25 What research questions are you hoping that get answered in the future?

37:21 Where can people find out more about you or your work?

In this episode, physiotherapist Darryl Yardley (FCAMPT, B.Kin (Hons), M.Sc.(PT), M.Cl.Sc.(Manip), Chair Private Practice Division – Canadian Physiotherapy Association, Founder - Mentorship Bootcamp) answers questions from students and new grads. Topics include job hunting and applying for jobs, contract negotiations, salary, building a caseload, and mentorship for both private and public sectors. 

To find our more visit http://cpaprivatepractice.ca

Learn more about us here.

00:37 Can you introduce yourself and your background?

02:38 Today we are getting your answers to some student and new grad questions that were collected from physiotherapy schools across Canada.

02:50 The first question is: What is the best way to build a caseload when first starting out?

06:01 Do you have any suggestions on how new grad can market themselves when they don’t have much experience?

08:00 One of the biggest questions that was asked is: What is the difference between an independent contractor and an employee.

12:08 As an independent contractor, when should you incorporate?

13:35 How do you make sure your billing number is being used appropriately?

16:35 How do you know if there is someone else using your billing number if it is public information?

18:55 For physios starting out, is it better to learn through experience or take a lot of courses?

23:42 Do you have any tips for physios starting in a clinic where there are already established PTA’s?

26:02 For those working in publically funded settings, how do you maintain quality care given restraints?

29:25 It seems like every hospital job wants 1-2 years of experience in the field. Seeing as new grads have limited experience through placements, how can they possibly demonstrate that they have the skills and experience to be employable?

32:24 If a hospital or clinic does not offer mentorship, how do you suggest that students or new grads seek out that external mentorship on their own?

36:08 In a hospital setting, how can new grads get full time employment?

39:04 How difficult is it to transition from hospital to private practice and vice versa?

41:10 There seems to be a perception that private clinics lead to a bigger income compared to hospitals? Does this hold true in the long run (5-10 years) with benefits and pension factored in?

44:05 Where should new grads start when looking for a job?

47:11 Do you recommend applying for jobs even if you don’t have the required experience?

48:53 What is negotiable in a contract?

49:52 Are there any questions you feel new grads should ask in an interview?

53:27 What starting salary should a new grad expect?

55:55 How often should you renegotiate your contract?

58:24 Are there any ethical issues/business red flags that new grads should be aware of when job hunting or starting out at a new clinic?

1:02:56 How long should you practice before opening your own clinic?

1:07:15 What are some benefits of being a CPA member?

1:09:33 Where can people find out more about you?

"Degenerative change is not something we really want to put cortisone in and around if we can avoid it, because the pathology in that situation is not inflammation...On top of that you've added a drug that can be degenerative to tissue that already is degenerative, and for that reason again I'm reluctant to use cortisone in most situations."

In this podcast, Dr. Douglas Stoddard (MD, Sports Medicine Physician and Founder of RegenerVate) gives an overview of therapeutic medical injections, including: Cortisone, Prolotherapy, Viscosupplementation, Platelet-rich plasma (PRP), and Stem cells.

These injections are used to treat a variety of musculoskeletal injuries and are considered if conservative treatment fails. Controversy still exists around regenerative and non-regenerative injections. Conflicting research shows either favourable or unfavourable results depending on the type of injection. Whether medical injections will be standard in musculoskeletal medicine remains to be seen.

Learn more about us here.

00:28 Can we start by having you introduce yourself?

00:44 So what are the different types of injections used in sports medicine?

02:01 What are the differences between the injections? How do you determine which one to use?

03:33 What are the physiological mechanisms of how these injections work?

04:30 Can you explain the procedure of these types of injections?

06:27 Are all the injections done using ultrasound guidance or just the PRP and stem cell?

06:57 With stem cells, are there different types of stem cell procedures?

07:35 What are the criteria for someone to be eligible for these treatments?

09:04 So for healthcare practitioners who treat that level 1, at what point would you say that they should refer a patient on to discuss injections?

10:16 How long do the results of the injections normally last?

11:15 For someone who does get an injection, do they need to then continue with those level 1 interventions, like physiotherapy, after the injection?

12:19 Are there are specific protocols that therapists should be following for patients post injection?

12:54 What are the risks of the injections?

16:01 Are there any patients who you would not give an injection to, for example someone with a lot of comorbidities?

17:55 What are you noticing clinically with your outcomes of these injections?

19:15 How do you determine whether an injection is successful? Is that largely based off of the patients’ report of pain levels and function?

20:38 What is your opinion on the use of corticosteroids in sports medicine?

23:05 For a patient wanting a repeat cortisone injection, would you direct them more towards the regenerative injections?

24:04 With any of these injections do you do imaging before to find out the condition of the tissue?

26:04 I know there’s a bit of skepticism around PRP and stem cell injections because they’re still consider new and there’s not a ton of research on them and they haven't been proven in clinical trials. So what are your thoughts on this?

29:37 Are there any regulations around the field of regenerative injections?

32:19 Where do you see the future of these types of injections going?

33:45 What is the training like to be able to provide these services?

34:37 Where can people find out more about you?

"What I’ve learned is that when a muscle becomes wasted, its not just because of a lack of impulses from the nerve into the muscle, its not just a lack of activity, it’s being told by a trophic factor produced by the nerve to get wasted"

We speak with physiotherapist Michael Shacklock (DipPhysio, MAppSC, FACP, NDS Instructor and founding director) about neurodynamics, nerve dysfunction, the anatomy and physiology of the nervous system, diagnosis and treatment of peripheral nerve disorders, and patient education.

Check out the summary video we did with Michael on Why Do Nerves Become Hypersensitive?

To find out more about Michael, visit his website, Twitter, Facebook and Instagram.

Learn more about us here.

Shownotes:

Reliability of clinical tests to evaluate nerve function and mechanosensitivity of the upper limb peripheral nervous system

Neural Mobilization: Treating Nerve-Related Musculoskeletal Conditions

Ectopic sensory discharges and paresthesiae in patients with disorders of peripheral nerves, dorsal roots and dorsal columns.

00:29 Can we have you introduce yourself?

02:05 Can you explain what neurodynamics are?

03:22 Are there any terms that are important to understand when discussing neurodynamics?

04:12 Can you provide a layman’s explanation of the function of nerves and how structure relates to its function?

05:17 What are the mechanical properties of nerves?

06:54 How much mechanical load can a nerve tolerate?

07:35 How do nerves become injured or sensitive? What is the physiological response in the nerve?

08:41 How about with ischemic injuries?

09:52 How does the nervous system respond to movement and why is movement effective?

12:13 Clinically can you determine elongation values?

13:14 Can you describe the difference between a sensitive nerve and a damaged nerve?

14:37 Do neurodynamic tests and medical tests if there’s a nerve condition look at the same thing?

15:37 What medical tests or subjective history may point to a nerve issue?

16:17 What constitutes a positive neurodynamic test?

18:40 Can neurodynamic tests selectively load or bias a specific nerve or nerve root?

19:45 What exactly is occurring in the body when you perform a sensitizing movement?

21:45 Can you explain what double crush syndrome is?

23:38 What has been the evolution in the treatment of nerve issues?

26:53 How important is treating the mechanical interface?

28:22 How long does it take a sensitive nerve to return to normal?

29:36 Can you discuss chemical irritation a bit more?

30:46 What are some common misconceptions surrounding nerves and nerve pain?

There are some common explanations that you hear when clinicians explain nerves, and we’d like your opinion on them:

32:34 - a nerve is like a telephone wire.

33:07 - Your nerve is stuck?

35:46 - When you’re doing neurodynamic exercises you’re stretching nerves

36:37 Can you give an example of how you would explain a nerve issue?

37:24 When hearing the word swollen, do some patients think that they have a big inflammatory resp

Sanjeev Bhatia (CEO and co-founder of Clinic Space) returns as guest host to interview Charlotte Anderson (PhD(c), MScPT). Charlotte is a physiotherapist and owner of Alpha Health Services, a multi-disciplinary rehab clinic she started over 4 years ago. In this podcast, they explore the challenges of starting, managing and growing a private practice.

You can follow Sanjeev on Instagram @thesanjeevbhatia or find him on LinkedIn.

To find out more information about Charlotte visit https://www.alphahealthservices.ca

Learn more about us here.

This Business Series is in partnership with the CPA Private Practice Division. Check out http://cpaprivatepractice.ca for more great business content and stay tuned for the next instalments of the business series.

"The real key with the Mulligan Concept and its effectiveness is that you know you're in the right place, doing the right technique, in the right direction, with the right grade while you're doing it, by symptom abolition."

We speak with physiotherapist Jack Miller [BSc(PT), DipMT(NZ), MClSc, DPT, FCAMPT] about the Mulligan Concept, including common terminology, techniques used, and current research. Jack also discusses the structure of the Mulligan Concept courses that he teaches.

To find out more about Jack Miller and the Mulligan Concept visit www.mulliganconcept.ca

Learn more about us here.

00:24 Can you introduce yourself?

00:52 How did you get involved with the Mulligan Concept?

01:41 Can you explain what the Mulligan Concept is?

03:18 Can you explain the terminology used with the Mulligan Concept?

04:06 What body areas can this concept be used on?

05:16 What are the basic principles of the Mulligan technique?

07:15 How do you determine what technique to perform?

08:41 How do the techniques change when the condition is acute vs. chronic?

09:34 How do patients maintain any improvements that they get during treatment, are there specific Mulligan exercises they are given?

10:25 Is there any equipment needed?

10:42 What research has been done on the Mulligan Concept?

11:44 Why do you think the Mulligan techniques are effective?

13:33 When would you use a Mulligan technique vs. a passive manual therapy technique such as a joint mobilization?

14:35 What is your opinion on the relevance of manual therapy to patient outcomes?

15:46 What do you teach at your courses?

16:51 Where can people find out more about you?

“You can give someone all the tactics, all the strategies. You can even give them the processes, the training material, get team buy in. But if you can’t execute, and you can’t deliver, then you’ve dropped the ball. So what I’ve learned is execution is everything.”

We speak with Sanjeev Bhatia (CEO and Co-founder of Clinic Space) about how to efficiently run and automate your practice and how the patient experience is the common thread that ties it all together. 

You can follow Sanjeev on Instagram @thesanjeevbhatia and LinkedIn 

This Business Series is in partnership with the CPA Private Practice Division. Check out CPA Private Practice Division for more great business content and stay tuned for the next instalments of the business series.

Learn more about us here.

00:42 Can you introduce yourself?

03:25 How do you define clinic operations?

04:41 Why is it important to have your operations in place?

05:51 How do you systematize different parts of the clinic? Can all parts of a clinic work in this way?

12:05 Employee training would be important to make sure things run smoothly and to get a great patient experience. How do you make sure that is executed from an organizational level?

16:54 Part of patient experience is the treatment they receive. With big clinics, how do you reduce inconsistency between providers?

20:23 In your opinion, what separates a bad clinic from a good clinic, or a good clinic from a great clinic?

22:13 What are some top mistakes you see business owners make?

23:22 Why is it important for the clinic owner to understand about all of the clinic operations?

25:11 How does a therapist wanting to branch out into owning a business transition to that business owner role?

26:25 What are the most important things that you believe you need to have in place when starting a clinic?

28:12 Do you think smaller companies will have a harder time attracting new business with all of the larger companies that are expanding?

30:05 What role do you think technology will play in the future?

31:58 From a business perspective, where do you see the future of the therapy professions going?

33:43 With all of the advances in technology, how can current clinic owners keep up with all of these changes?

35:06 Many business rely on patients having benefits and insurance coverage for treatment. Do you see any trends towards declining insurance coverage?

37:18 What challenges do you see for the rehab profession as a whole?

38:46 Where can people find out more about you?