JOSPT Insights

The RESTORE trial, published in 2023, put cognitive functional therapy (CFT) on the map as an effective approach for managing chronic, disabling low back pain. Since then, there has been more research supporting CFT, including a large network meta-analysis published in JOSPT in early 2026. In today's episode, we explore the results of the CONFeTTI trial, which tested the CFT+ intervention - combined care delivered by a physiotherapist and a psychologist in an interdisciplinary pain clinic.

Dr Henrik Bjarke Vægter led the CONFeTTI trial. He is an experienced physiotherapist and head of the interdisciplinary Pain Centre at Odense University Hospital in Denmark. Dr Bjarke Vægter is Professor of Physiotherapy and Pain Treatment at the University of Southern Denmark's Department of Clinical Research.

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RESOURCES

CONFeTTI trial

Tailored exercise therapy with or without psychological interventions: systematic review with network meta-analysis

How many patients describe receiving what sounds like inadequate care for osteoarthritis before they reached your clinic? Osteoarthritis is one of the most common chronic musculoskeletal conditions. When there are many trustworthy, international clinical guidelines that clearly outline what best-practice osteoarthritis care should entail, why are so many patients missing out on high-value care?

Today's guest, Dr Jodi Young, discusses her team's analysis of data from nearly 25,000 patients who received osteoarthritis care in the United States, and what these data say about osteoarthritis care. Dr Young is the Director of Research for the Doctor of Science in Physical Therapy program at Bellin College in Green Bay, Wisconsin. She is also a fellow of the American Academy of Orthopaedic Manual Physical Therapists.

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RESOURCES

Real-world use of exercise and manual therapy for managing knee osteoarthritis: https://www.jospt.org/doi/10.2519/josptopen.2026.0221

Opioid prescribing to active duty US military personnel: https://pubmed.ncbi.nlm.nih.gov/37507224/

Opioid vs. non-opioid medications for people with chronic back pain or hip or knee OA (SPACE Trial): https://pubmed.ncbi.nlm.nih.gov/29509867/

Opioid use patterns among active duty service members and civilians: https://pubmed.ncbi.nlm.nih.gov/29514335/

JOSPT Insights episode 257 - Reflecting on contemporary manual therapy: https://pod.link/1522929437/episode/NzM4ZjYwY2EtMzNhYi00OTI5LWE5OTAtZmUwY2ZkM2QxMDA0

There's plenty of debate in the musculoskeletal rehabilitation community about how to clearly communicate with patients about a diagnosis. Clinicians are trying to balance being clear about what the likely cause of the symptoms is without inducing unnecessary worry. How much should you—or even can you—accurately describe the pathology and anatomy of the problem? On the flip side, others have strongly argued that pathoanatomic labels do more harm than good.

Today, experienced musculoskeletal physiotherapist and researcher (Laval University, Canada), Marc Perron makes the case that clinicians should not hide the pathology and anatomy—it's how you talk with patients about their diagnosis that matters most.

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RESOURCES

Physical therapists diagnosing musculoskeletal conditions: don't hide what matters - just say it the right way: https://www.jospt.org/doi/10.2519/jospt.2026.14197

Psychological factors like a person's thoughts, beliefs and emotions can exert a strong influence on rehabilitation outcomes for people with chronic musculoskeletal conditions. When a person has pain, they might feel scared to move or convinced that moving in a certain way will damage their body. Today's discussion focuses on how a person's thoughts about shoulder pain can change over an 8-week exercise-based rehabilitation program, and the implications for how musculoskeletal rehabilitation clinicians approach discussions about fear and moving with the patients you work with. Dr Courtney Mears and Dr Matthew Heindel discuss their recent JOSPT publication (linked below).

Dr Mears is a physical therapist at the University of Southern California, and a researcher in the Clinical Biomechanics Orthopedic and Sports Outcomes Research Lab. Her research focuses on understanding the relationship between psychosocial factors, shoulder pain, and functional outcomes.

Dr Heindel is a physical therapist, and a postdoctoral associate at Duke University’s School of Medicine, where he studies the neuroimmune mechanisms of chronic musculoskeletal pain. Dr Heindel completed his PhD on the mechanics of pain and muscle dysfunction in rotator cuff tendinopathy in 2025 at the Clinical Biomechanics Orthopedic and Sports Outcomes Research Lab at the University of Southern California.

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RESOURCES

Changes in pain-related fear: https://www.jospt.org/doi/10.2519/jospt.2026.13563

OSPRO yellow flag assessment tool: https://www.jospt.org/doi/10.2519/jospt.2016.6487

Does hip crepitus make a difference to the health of the joint? Does crepitus indicate damage, harm or progression of osteoarthritis? How should clinicians explain hip crepitus and its implications to patients? Today's guest addresses those questions and more in a deep dive on hip crepitus. Dr Danilo De Oliveira Silva (La Trobe University) discusses his JOSPT article, Self-Reported Hip Crepitus Is Prevalent in Football Players With Hip/Groin Pain, but Is It Associated With Early Hip Osteoarthritis Structural Features? A Longitudinal Study, with Dan and Marquis.

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RESOURCES

Self-reported hip crepitus - longitudinal study: https://www.jospt.org/doi/10.2519/jospt.2025.13474

Beliefs and attitudes about hip crepitus: https://pubmed.ncbi.nlm.nih.gov/41056730/

Hip morphology and hip injuries have been receiving increasing attention, which is a good thing given their prevalence and impact on athletes' health and performance. Today's guests combine the hip and groin field, with the attention that female athletes deserve to their health and performance.

Dr Pim van Klij, who works with Dutch football/soccer powerhouse, Ajax, and Pirette Claes, who is starting her career in sports medicine, discuss the PROFE study. We focus on the work they have been leading to quantify the relationship between groin symptoms, and pubic symphysis radiological findings and skeletal maturity.

Dr van Klij is sports medicine physician and Assistant Professor at Amsterdam University Medical Centre, Department of Orthopaedic Surgery and Sports Medicine. Pirette Claes is a medical intern at Leiden University Medical Centre, and an early-career researcher.

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RESOURCES

Prevalence of symphyseal radiographic findings and relationship to groin symptoms (PROFE study): https://www.jospt.org/doi/10.2519/jospt.2026.13580

JOSPT focused issue on hip and groin research (July 2026): https://www.jospt.org/toc/jospt/56/7

Tendinopathy will show up regularly in the clinic for many JOSPT Insights listeners. In a person-centred care model, it's important to understand the person with tendinopathy, where they're coming from and what they're experiencing.

Today's guest has been studying patients' experience of different types of lower limb tendinopathies. The results might surprise you, in just how complex and variable people's experiences are.

Max Hopes is an osteopath and researcher (University of Technology Sydney) studying lower limb tendinopathy. Today Max shares some of the early results of his PhD work, and we explore what it means for musculoskeletal practice.

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RESOURCES

Lived experiences of people with tendinopathy: https://www.jospt.org/doi/10.2519/jospt.2026.13666

In last week's episode, Dermot Simpson and Simon Wallace explained the hamstring and rectus femoris rehabilitation pathways that they and their colleagues at the Aspetar Orthopaedic & Sports Medicine Hospital have developed to guide daily practice.

In using the rehabilitation pathways, Dermot and Simon, and the team have discovered some clinical pearls that help them help the athletes they're working with. Today, Dermot and Simon are sharing those clinical tips. These are the things that you can do in practice tomorrow to give you and the athlete the best chance of rehabilitation success.

Dermot Simpson and Simon Wallace are sports physiotherapists working at the Aspetar Hospital in Doha, Qatar. Between them, they have more than 2 decades of experience in elite sport, especially in rugby and football/soccer.

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RESOURCES

Aspetar Hamstring Injury Rehabilitation Pathway: https://www.jospt.org/doi/10.2519/josptopen.2026.0213

Aspetar Rectus Femoris Injury Rehabilitation Pathway: https://www.jospt.org/doi/10.2519/josptopen.2026.0212

Longer muscle length resistance training (systematic review): https://pubmed.ncbi.nlm.nih.gov/41646176/

Nordic hamstring exercise vs. lengthened state eccentric training: https://pubmed.ncbi.nlm.nih.gov/38857522/

If you work with athletes who play any of the football codes, or any field-based sport that involves high-speed running or kicking, you'll surely have hamstring and rectus femoris injuries at the front of your mind. Even if you're not in field-based sports, today's first episode in a 2-part series is a terrific opportunity to review your approach to managing thigh muscle injuries. We're taking a deep dive into best practice in rehabilitation planning. Part 1 explores the components of rehabilitation; part 2 covers the clinical pearls to help you design and deliver the most effective rehabilitation plans possible. Our guides are experienced Irish sports physiotherapists, Dermot Simpson and Simon Wallace, of the Aspetar Orthopaedic & Sports Medicine Hospital in Doha, Qatar.

Dermot has spent over 10 years at Aspetar, working with athletes from a range of sports. His clinical and research work is in thigh muscle and groin injuries. Simon applies his expertise to complex thigh muscle injuries, also calf and foot & ankle injuries. Before joining Aspetar, Simon worked for a decade in professional rugby. To learn more from Dermot and Simon, check out their new Reload-Ed platform.

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RESOURCES

Aspetar Hamstring Injury Rehabilitation Pathway: https://www.jospt.org/doi/10.2519/josptopen.2026.0213

Aspetar Rectus Femoris Injury Rehabilitation Pathway: https://www.jospt.org/doi/10.2519/josptopen.2026.0212

JOSPT Insights episodes often explore what well-functioning teams look like and how they function. Why? Well there's at least 2 important reasons:

1. Effective athlete centred care depends on the sports medicine, rehabilitation and performance team all co-ordinating to help the athlete get the best out of themselves.

2. Working in teams and leading those teams well is not about telling people what to do - it's about shaping the path and working together to achieve goals. Effective leaders shape the path and bring people along with them - they don't make it all about themselves.

Today's guest embodies those leadership qualities. Agnes Makowski is a registered International Sport Physiotherapist and has served as Chief Physiotherapy Advisor for Skate Canada since 2014. Agnes has extensive experience working in interdisciplinary teams and supporting athletes from the recreational level all the way to the pinnacle of Olympic performance. Today, Agnes shares her experiences and approaches to working in interdisciplinary teams.

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RESOURCES

Why screening tests to predict sport injury do not work: https://pubmed.ncbi.nlm.nih.gov/27095747/

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