JOSPT Insights

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.

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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/

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

Today, we continue the conversation on the latest consensus for managing acute and degenerative meniscus tears.

We jump into non-surgical treatment, and all the return to sport considerations for athletes and active people with meniscus injury.

Dr Arielle Giordano (University of Delaware) shares the results of the EU-US Meniscus Rehabilitation Consensus.

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RESOURCES

EU-US Meniscus Rehabilitation Consensus on prevention, non-operative treatment and return to sport: https://www.jospt.org/doi/10.2519/josptopen.2025.13539

DREAM trial primary report: https://pubmed.ncbi.nlm.nih.gov/38319181/

Should symptoms guide treatment choice in young patients? https://www.jospt.org/do/10.2519/jospt.blog.20240415/full/

Early surgery vs exercise therapy + education for traumatic and non-traumatic meniscus tears: https://www.jospt.org/doi/10.2519/jospt.2024.12245

Ep 224: Saving the meniscus: https://pod.link/1522929437/episode/NTg3YTgzZWUtYTZjZC00ZDYwLWI2OTAtYTczMzAzNTEyNzgz

Ep 192: DREAMing of better care for meniscus tears: https://pod.link/1522929437/episode/Yzk2YzkyOWItMDk1MS00YWZkLWI2MjQtNmRlYjIwZGJmOTg0

Clinical Practice Guidelines (CPGs) are an incredible resource for clinicians of all experience levels—synthesizing all the research on a topic and packaging it into bite-sized recommendations and flow charts. But how often are clinicians adhering to these guidelines?

In today’s episode, Dr Maggie Horn (Duke University) walks us through her research team’s work to assess if, how, and when clinicians follow CPG recommendations. The team worked with clinicians in their hospital system to embed templates in the EMR, and used self-report strategies to answer these questions, specifically for the neck pain CPG.

Dr Horn reviews the neck pain CPG, how the research team evaluated adherence, and what the findings mean for CPGs and clinicians.

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RESOURCES

Neck pain clinical practice guideline (revised in 2017): https://www.jospt.org/doi/10.2519/jospt.2017.0302

Translating the neck pain CPG into practice framework: https://www.jospt.org/doi/10.2519/josptopen.2025.0101

No doubt you've come across people using the analogy of a broken down machine to describe an osteoarthritic joint. Or perhaps that too much loading on the joint is responsible for wearing it out - assuming that each joint has a finite number of movements in its lifetime.

You've probably also heard from patients who are concerned that the exercise therapy you prescribe might do more harm to their already worn-out joint. But is that true?

Today, Dr Alessio Bricca (Centre for Muscle and Joint Health, University of Southern Denmark) explores the evidence and refutes these beliefs.

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RESOURCES

Exercise Therapy "Wears Down" My Knee Joint: Myth or Reality?: https://www.jospt.org/doi/10.2519/jospt.2025.13069

Today is part 2 of a 2-part chat about hip health and training load for the youth athlete. Last episode, Dr Sara Lyn Terrell (Florida Southern College) discussed the developing hip, and the important distinction between primary cam morphology and femoroacetabular impingement syndrome.

Many athletes have a bony bump on their hip that doesn't cause any problems - it's the morphology in combination with symptoms that clinicians might worry about.

Today's episode builds on the foundation of the developing hip, and covers appropriate loads for youth athletes. Dr Terrell discusses how to plan, monitor and progress a loading programs, and how you might incorporate strength & conditioning principles into your practice.

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RESOURCES

Strategies to deter primary cam morphology in youth athletes: https://www.jospt.org/doi/10.2519/josptopen.2025.0128

Can we reduce injury risk during the adolescent growth spurt?: https://pubmed.ncbi.nlm.nih.gov/37823577/

“My kid is going through a growth spurt – what should I do?”: https://shorturl.at/FqqCM

The hip health of youth athletes as their skeletons grow and mature while the athlete copes with the physical and mental stressors of sport and life, has been receiving renewed attention.

Today's episode of JOSPT Insights is part 1 of a 2-part chat about training load and the youth athlete's hip. We discuss how primary cam morphology and femoroacetabular impingement syndrome might develop.

Dr Sara Lynn Terrell (Florida Southern College) shares her >20 years of experience in exercise science and strength & conditioning, and walks listeners through the complexity of working with youth athletes to support their best sports performance.

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RESOURCES

Strategies to deter primary cam morphology in youth athletes: https://www.jospt.org/doi/10.2519/josptopen.2025.0128

Oxford consensus on primary cam morphology and FAI (part 1): https://pubmed.ncbi.nlm.nih.gov/36588401/

Oxford consensus on primary cam morphology and FAI (part 2): https://pubmed.ncbi.nlm.nih.gov/36588402/

Patellofemoral pain can affect anyone at any age, which mean you're likely to come across it in your clinical career. What is best practice in managing patellofemoral pain?

Today, Dr Brad Neal (Queen Mary University of London) walks us through how to apply the best research to your practice.

Dr Neal has worked for over a decade in elite sport, private and public health care settings as a specialist musculoskeletal physiotherapist. His PhD work in biomechanics has helped guide understanding of how to manage patellofemoral pain.

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RESOURCES

Best practice guide for patellofemoral pain: https://pubmed.ncbi.nlm.nih.gov/39401870/

Effects of treatment for patellofemoral pain - systematic review with meta-analysis: https://www.jospt.org/doi/full/10.2519/jospt.2022.11359

Patellofemoral pain 2019 clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2019.0302

Pain is often what prompts patients to seek the care of a musculoskeletal rehabilitation clinician.

In today's episode, Dr Paul Mintken guides listeners through different ways to work with a person to help make sense of, and explain, unexplained pain.

Dr Mintken (Hawai'i Pacific University) is a board-certified Orthopaedic Clinical Specialist and a Fellow of the American Academy of Orthopaedic and Manual Physical Therapists.

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RESOURCES

JOSPT Viewpoint article - The Worst Pain is an Unexplained Pain: https://www.jospt.org/doi/10.2519/jospt.2025.13167

In Part 2 of our conversation with Dr Olivia Abdoo (Ultimate Fighting Championship), we dive deeper into one of the most common injuries in mixed martial arts (MMA) - concussion.

Dr Abdoo's experience treating UFC athletes provides an insight into working with athletes for whom skills including wrestling, striking, and grappling are crucial to performing well.

How to approach educating the athlete and everyone involved with them about concussion, ensuring the athlete can participate safely while recovering from concussion, what an MMA-specific concussion evaluation looks like, and the importance of sport-specificity in concussion rehabilitation - we hit on it all!