JOSPT Insights

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.

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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!

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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.

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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.

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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.

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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.

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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

Neuromuscular electrical stimulation (NMES) hasn't quite had the coverage it deserves, especially when one considers the strength of evidence supporting NMES as a musculoskeletal rehabilitation intervention

Today, Drs Elanna Arhos (Northwestern University) and Naoaki Ito (University of Wisconsin - Madison) are re-visiting how NMES is applied in sports clinical practice. Get the low-down on why you need NMES in your sports rehabilitation toolkit, and how to figure out dose and intensity.

In part 2 we discuss how to support patients to get the most out of NMES, and which equipment is best for your clinic.

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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

Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy.

In part 2 of this series, Dr de Vos covers the multitude of options for treatment, outside of exercise therapy. Should you and the patient consider corticosteroid injections, PRP injections, heel lifts, shockwave, NSAIDs, or surgery? And when? What are the important clinical considerations when patients choose these options? Part 2 has it all!

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RESOURCES

Terminating corticosteroid injection in tendinopathy? https://www.jospt.org/doi/10.2519/jospt.2023.11875/

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

Platelet-rich plasma injection for chronic Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/20068208/

Time to put down the scalpel when treating tendinopathy? https://pubmed.ncbi.nlm.nih.gov/31653777/

Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/

Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/

Clinical tool for identifying spondyloarthropathy: http://tinyurl.com/3my87hma

More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/

Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/

Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/

Achilles Pain, Stiffness, and Muscle Power Deficits - 2024 updated clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2024.0302

Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy. As lead author of the Dutch Multidisciplinary Guideline on Achilles Tendinopathy (https://pubmed.ncbi.nlm.nih.gov/34187784/), he shares the key messages from this in-depth review.

In today’s episode, Dr de Vos covers the important tendon anatomy to guide your differential diagnosis, what information he is most focused on communicating to patients, and the key factors that can affect your choices when managing Achilles tendinopathy.

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RESOURCES

Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/

Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/

Clinical tool for identifying spondyloarthropathy: https://www.researchgate.net/profile/Paul-Kirwan/publication/332275130_D18_SCREEND%27EM_BEFORE_YOU_TREAT%27EM_A_CLINICAL_TOOL_TO_HELP_IDENTIFY_SPONDYLOARTHROPATHY_IN_PATIENTS_WITH_TENDINOPATHY/links/5cab530da6fdcca26d06aaf1/D18-SCREENDEM-BEFORE-YOU-TREATEM-A-CLINICAL-TOOL-TO-HELP-IDENTIFY-SPONDYLOARTHROPATHY-IN-PATIENTS-WITH-TENDINOPATHY.pdf

More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/

Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/

Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/

Achilles Pain, Stiffness, and Muscle Power Deficits - updated clinical practice guideline from AOPT: https://www.jospt.org/doi/10.2519/jospt.2024.0302

When patients improve following treatment, how much can be attributed to the intervention delivered, and how much is due to contextual factors and nonspecific effects that lie outside of the clinician's control?

Dr. Giacomo Rossettini joins the podcast again as a co-author of a paper (link below) that answers that very question.

Dr. Rossettini and his research colleagues tried to quantify the effect of contextual factors with a meta-analysis. They found non-specific effects play a big role in patients' outcomes. Today's discussion covers what these contextual factors are, how the researchers quantified them, and how musculoskeletal rehabilitation clinicians can harness non-specific effects to boost patients' outcomes.

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RESOURCES

Non-specific effects in musculoskeletal pain treatment outcomes (meta-analysis): https://www.jospt.org/doi/10.2519/jospt.2024.12126