The anterior talofibular ligament (ATFL) and the Achilles tendon captures much of our ankle attention. As JOSPT Insights listeners know, there's plenty more to the ankle than the ATFL.

Today, Liz Bayley shares her approach to diagnosing, managing and ideally, preventing ankle pain in active people. Liz covers diagnosing the problem, where imaging fits, and how to support return to function, including high-level sport.

Liz is a former professional dancer, who now works as a dance-specialist physiotherapist. Her clinic is in London's West End, in close proximity to the freelance professional and student dancers she works with, at Trinity Laban Conservatoire of Music and Dance, and on 'Matilda The Musical' in Covent Garden.

------------------------------

RESOURCES

Lateral ankle ligament sprains clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2021.0302

Updated model of chronic ankle instability: https://pubmed.ncbi.nlm.nih.gov/31162943/

Predictors of chronic ankle instability: https://pubmed.ncbi.nlm.nih.gov/26912285/

Intrinsic foot muscle training systematic review: https://pubmed.ncbi.nlm.nih.gov/35724360/

Neuromuscular electrical stimulation for foot intrinsic muscles: https://pubmed.ncbi.nlm.nih.gov/35142810/

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.

------------------------------

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

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.

------------------------------

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

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

------------------------------

RESOURCES

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

Clinicians appreciate the value of a trustworthy clinical practice guideline for helping guide decisions in practice.

Professor François Desmeules (University of Montréal) led an international team of shoulder experts who synthesised the latest evidence on diagnosing and non-surgically managing rotator cuff tendinopathy. Today he shares the headlines of the CPG and explains how the guideline group made sense of all the evidence to come up with recommendations for assessment, diagnosis, treatment and prognosis, including return to sport.

------------------------------

RESOURCES

Rotator cuff tendinopathy diagnosis, non-surgical medical care and rehabilitation CPG: https://www.jospt.org/doi/10.2519/jospt.2025.13182

How do you approach assessing pain when you're working with athletes? What tools do you find most helpful?

Today, sports physiotherapist and researcher, Ciarán Purcell (University of Limerick, Ireland) describes the project he is leading to gather consensus from athletes and sports medicine & rehabilitation clinicians about how best to assess athletes' pain. Listen to the end to learn about how you can get involved in the consensus!

------------------------------

RESOURCES

IOC consensus on managing pain in elite athletes: https://pubmed.ncbi.nlm.nih.gov/28827314/

Framework for assessing upper and lower limb pain in athletes: https://www.jospt.org/doi/10.2519/jospt.2024.12807

Scoping review of tools for assessing pain in athletes: https://pubmed.ncbi.nlm.nih.gov/36759138/

To get in touch with Ciarán about the consensus project, email [email protected]

The latest update to the midportion Achilles tendinopathy Clinical Practice Guideline is hot off the presses!

Dr Ruth Chimenti is a co-author of the updated clinical practice guideline, “Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024”, and joins JOSPT Insights to share the key updates relevant for your practice.

Dr Chimenti highlights the most important changes from the last CPG update in 2018, including specifics on the best way to exercise, how to approach patient education, and which modalities to consider.

------------------------------

RESOURCES

Updated Achilles CPG: https://www.jospt.org/doi/10.2519/jospt.2024.0302 (no paywall)

ICON 2020: International Scientific Tendinopathy Symposium consensus on psychological outcome measures: https://www.jospt.org/doi/10.2519/jospt.2022.11005

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

Did you know that only about 10% of the participants in sports medicine and sports physical therapy research are women?

When people are under-represented in research, it might mean that clinicians and researchers miss key concerns of women and girls when working with them to achieve the best outcomes of treatment.

Melissa Haberfield - physiotherapist and PhD candidate at the La Trobe Sports and Exercise Medicine Research Centre in Melbourne, Australia - shares the results of her work with women who have experienced serious knee injury, about what they wanted to know about managing knee health.

------------------------------

RESOURCES

Systematic review of self-reported activity and knee-related outcomes after ACL injury (sex and gender differences): https://pubmed.ncbi.nlm.nih.gov/36889918/

Sex/gender equity in sport and exercise medicine/physical therapy publishing: https://pubmed.ncbi.nlm.nih.gov/36631242/

What do women (with serious knee injury) want to know about knee health (article): https://www.jospt.org/doi/10.2519/jospt.2025.12869

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? Today's guest 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.

------------------------------

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/

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.

------------------------------

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