We had Dr Peter Malliaris on this week talking tendons.  Its great to hear different researcher clinicians provide their different takes on the same topic.  Dr Malliaris is a full time professor at Monash University with a keen interest in Tendinopathy.  He teaches the popular online course Tendinopathy rehab.

We talk about:

The role of injections in tendinopathy (hint: not much) The limitations of the literature and research surrounding exercise and tendinopathy

The role of load management in tendinopathy and why we don’t have a lot of research on it despite it probably being the most important thing we can manage

The role of heavy loading, strength changes and tendinopathy recovery

Strength testing and tendinopathy rehab

Kate Jochimsen, PhD, ATC is a Researcher at the Center for Health Outcomes and Interdisciplinary Research (CHOIR) at Massachusetts General Hospital and a Member of the Faculty in the Department of Psychiatry at Harvard Medical School. Her work “bridges the gap” between sports medicine and psychology by developing interventions to improve patient's pain-related cognitions (‘how they think’) and emotions (‘how they feel’) to improve their health behaviors and increase physical activity. She is passionate about advancing psychologically informed practice and teaching clinicians how to communicate about mental health and intervene when appropriate. Her work has been funded by agencies such as the National Institutes of Health and the American College of Sports Medicine.

The big questions we try to answer: 1. When you have hip pain why does it hurt? 2.  What is the mechanism behind psychological factors influencing pain? 3.  How do we address these psychological factors? 4.  What is cognitive restructuring and how can you do it to help pain?

Dr Stephanie Mundt (PT, PhD Candidate) is on talking about bone stress injuries and optimizing the health of athletes to keep them performing and living well.

We talk about: - can you run with pain when you have a bone stress injury

- why bone stress injuries occur

- high risk versus low risk stress fractures

- how to build bone and manage injury risk

Greg speaks with Jeff Beran of Evolution PT and Jeff's partner Frank Tardi.  They run a successful private practice with exercise, health and optimal training as the foundation of their intervention.  They teach a popular course on energy systems training to improve outcomes entitled "Practical Programming: A Clinician's Guide to Maximizing Physical Potential

They share their thoughts on both exercise prescription and manual therapy AND offer mentorships to those looking to learn more about their model.

Their Bios are here

Dr Johan Lahti PhD is a strength and conditioning coach and an expert in the prevention and training on hamstrings.

Johan is a great thinker related to all aspects of strength and conditioning but has a special interest in mitigating the risk of hamstring strains.

• In this episode we talk about: potential risk factors for hamstring strains
• how to best train the hamstrings for performance and injury risk
• using EMG to assess hamstring exercises
• and the role of technique in injuries

Some relevant references

Johan's injury prevention study

Training hamstrings

Sprinting and hamstrings

Dr Gerard McMahon is a sports scientist out of Ulster University with a special interest in how we can train tendons for both performance and rehab.

We talk:

Partial range vs full range squats for vertical jump

Partial range vs long range training to build tendon mechanical properties (e.g stiffness)

Is there a sweetspot for tendon loading (e.g 4.5-6% strain) and why it may be greater than this range.

Why knowing the actual tendon strain may not be required to prescribe exercises to increase tendon stiffness and strength

Dr McMahon's Ulster University Profile

Another very practical and pragmatic podcast.  Dr Falk Mersmann is a leader in how tendons adapt to load and I would say an accidental leader in the minumum effective dose to get tendons to adapt.

Some topics we covered:

• Why having a good balance between tendon stiffness and muscle strength is important for tendinopathy prevention and treatment
• How personalized tendon loading can address this potential risk factor
• Specifics of tendon loading to achieve tendon positive tendon adaptations (e.g increasing stiffness).
• Why plyometrics don’t seem to influence tendon strength
• Why only doing the goal activity (e.g running) may not be enough for a healthy tendon
• Why stretching can’t decrease tendon stiffness
• Limitations of shear wave elastography versus measuring mechanical stiffness

Some relevant papers (all open access) 1.  Addressing tendon - muscle imbalances 

2. Comparing different loading volumes and frequencies to achieve tendon adaptations

3. A functional high load program to prevent/treat tendon related pain in athletes

We had Colin on today to primarily talk about the pragmatic aspects of rehabbing an Achilles tendon in the sporting population.

Part of Colin's PhD thesis was looking at this specific topic.  In my opinion, a lot of the researched tendon loading programs aren't pragmatic, are boring, are hard to stick to and just don't seem like they would contribute to performance.  Colin's program is NOT like that.

His simple, progressive, performance based and pragmatic tendon and lower extremity program should be used as your "recipe" for care.

Have a look at his paper here that outlines the full rehab program. More about Dr Colin Griffin

Colin is a strength and conditioning coach at the UPMC Sports Surgery Clinic with a role that includes the rehabilitation of lower-limb injuries and the delivery running performance services.

He completed a degree in Strength and Conditioning with Setanta College in 2015 and completed Masters Degree in Coaching and Exercise Science in University College Dublin in 2016. He is an IAAF Level 4 certified endurance coach, coach eduaction tutor with Athletics Ireland and an accredited professional member of the Sport Ireland Institute in High Performance Sport Strength and Conditioning.

He has over 15 years experience in high performance sport having represented Ireland at the 2008 and 2012 Olympic Games in the 50km walk as well as a number of top 12 perofrmances at world and european level. He has also coached other Irish athletes to Olympic level.

In 2011 he founded The Altitude Centre Ireland and pioneered the development of Irelands first residential altitude training centre at the University of Limerick.

His main areas of interest include the rehabilitation of tendinopathies and muscle overload injuries, biomechanics, physiology and athletic development.

Colin is undertaking a PhD on the biomechanics of muscle-tendon interaction at the achilles during exercise, working under JB Morin at the University of Côte d’Azur and in collaboration with SSC Sports Medicine.

We talk what role Motivational Interviewing plays in working with patients.  We talk about how to do it and of course how not to do it.

Have a listen

More about Guillaume:

Graduated from Bordeaux (France) in 2005, Guillaume began his career as a physiotherapist working full-time for a professional football club in France. Since 2007, he has been practicing in private practice, specializing in the treatment of musculoskeletal conditions. He has developed a coordinated practice with general practitioners to provide patients with his expertise in musculoskeletal rehabilitation. He now focuses exclusively on shoulder pathologies.

Guillaume holds an MSc in Physiotherapy and Education from the University of Brighton (UK). During this Master's program, he explored and synthesized literature on the prescription of home therapeutic exercises, shared decision-making and reflective practice which was the subject of his final dissertation.

As a trainer, he teaches Motivational Interviewing, Reflective Clinical Practice, and his course titled "Motivating Patients to Do Their Home Exercises." He also hosts the French podcast "Evidence Based Physio Podcast." Lastly, Guillaume is the co-founder and co-manager of l'Agence EBP, a continuing education organization for healthcare professionals that offers training based on the latest scientific evidence.

Dr Stu Phillips, Tier 1 Canada Research Chair in Skeletal Muscle Health, shares his expertise on the importance of strength, power and muscle hypertrophy for healthy aging.

As is often the case Stu discusses how simple exercise programming can achieve the physical attributes that help us all age well.  

The fast recap is: - something is better than nothing

• strength train 2x/week, 2-4 sets, 5-20 repetitions with an effort of 8/10.  
• progress this over time
• train power but moving a much lighter faster!
• eat a little bit of protein within 24 hours of your workout.
• easy peasy