Tendinopathy patients may present for treatment with an ultrasound or MRI report in hand, unsure how you can help them, or how they can possibly recover when they have so much tendon pathology. To add insult to injury, they may even have a partial tendon tear on their imaging report thrown into the mix. How do imaging results impact your treatment and your patient's recovery? Are the imaging findings relevant to their pain?

In this Physio Edge podcast with Dr Sean Docking (Physiotherapist, PhD), you will explore what information imaging actually provides in your tendinopathy patients, how to explain imaging to your patients, and whether partial tendon tears identified on imaging will effect your treatment. You will also discover:

• Who develops tendon pathology
• If patients have tendon pathology on imaging, is this responsible for their symptoms, or will it cause future tendon pain
• Asymptomatic tendon pathology in sports people
• How tendon pathology can actually be linked to better performance
• Can we prevent tendon pathology
• The advantages and disadvantages of different imaging types, including
• MRI
• Ultrasound
• Ultrasound tissue characterisation (UTC)
• Why a thickened tendon may actually be helpful in recovery
• How can we actually diagnose tendinopathy
• When is imaging useful
• Differential diagnosis of Achilles pain, including - Achilles tendinopathy - Paratenonitis - Plantaris associated tendinopathy
• Partial tendon tears, the accuracy of identification, and how they impact your treatment

• Twitter - @SIDocking
• Sean Docking - La Trobe University website
• Sean Docking - Research gate
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership

Alfredson. 2011. Midportion achilles tendinosis and the plantaris tendon

Brown et al. 2011. The COL5A1 gene, ultra-marathon running performance and range of motion

Docking et al. 2016. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC).

Docking et al. 2015. Tendinopathy: Is imaging telling us the entire story?

Lieberthal et al. 2014. Asymptomatic achilles tendinopathy in male distance runners

McAuliffe et al. 2016. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis

Simpson et al. 2016. At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis

PE 068 - Lower limb tendinopathy loading, running and rehab with Dr Pete Malliaris

PE 042 - Treatment of Plantaris and achilles tedninopathy with Seth O'Neil

PE 041 - Plantaris involvement in achilles tendinopathy with Dr Christoph Spang

Femoroacetabular impingement (FAI) may contribute to hip and groin pain, buttock pain, pelvic or low back pain and referred pain into the thigh. Is conservative management effective in patients with FAI, or is surgery required? If we can treat FAI conservatively, what is the best treatment, and how can you tailor your treatment to your individual patients?

In episode 74 of the Physio Edge podcast with Dr Joanne Kemp you will discover:

• What is FAI, and how can you identify it?
• Common clinical presentations
• Key subjective questions to ask
• Types of FAI morphology and how they are identified
• Is FAI just a normal finding?
• How you can perform an objective assessment in patients with FAI
• Differential diagnosis
• Components you need to include in your conservative treatment for FAI
• Which objective markers to use when treating FAI
• How to address common impairments in your rehabilitation, including strength, functional tasks, cardiovascular training and range of movement
• When to refer for a surgical opinion
• Outcomes of surgical treatment
• Future risk of developing OA in presence of FAI

Sports Injuries virtual conference presentation

As mentioned in this episode Joanne will be part of the Sports Injury virtual conference. Her pre conference presentation will discuss FAI and the diagnostic process in more detail. Her subsequent conference presentation will be available on 9-10 December 2017, with access for up to 12 months following the conference, and will discuss:

• Conservative management of FAI
• Specific exercise progressions you can use
• Return to sport for athletes

Enrol on the 2017 Sports Injuries virtual conference by CLICKING HERE

• Get your free access to Sports Injuries presentations with Dr Ebonie Rio, Jack Hickey, Dr Adam Weir, Dr Michael Rathleff, Jo Gibson and Prof Bill Vicenzino
• Enrol on the 2017 Sports Injuries virtual conference
• Twitter - @JoannaLKemp
• Joanna Kemp - Research gate
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• LaTrobe Sports and Exercise Medicine Research Blog
• Twitter - @LaTrobeSEM
• GLA:D Australia
• Lake Health Group

• Griffin et al. 2016. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

• Articola et al. 2014. A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players. A Prospective Study With Minimum 2-Year Follow-up.

• Physio Edge 054 - Hip and groin pain part 2 with Benoy Matthew
• Physio Edge 053 - Hip and groin pain part 1 with Benoy Matthew
• Physio Edge 009 - Lateral hip pain with Dr Alison Grimaldi
• Physio Edge 004 - Hip injuries and labral tears with Nicole Hamilton

Strengthening is not commonly used in neck pain treatment and rehabilitation, however athletes may place large demands on their neck during training and play that require a high level of strength or endurance.

When should you include strength training in your rehabilitation? What patients will benefit from strength training? How can you incorporate strengthening into your treatment?

In episode 73 of the Physio Edge podcast, we explore the role of neck strengthening with Kay Robinson, Physiotherapist working with Australian sailing, and previously with the British Olympic Skeleton team.

In the podcast you will discover:

• Objective assessment of patients with neck pain
• Range of movement and strength tests you can use with your neck pain patients
• How to assess neck strength in your patients
• Indications for strength training
• Is strength training suitable in the early stages of neck pain rehabilitation?
• Early-stage cervical spine rehabilitation exercises you can use
• Exercise progressions to improve neck strength
• Neck strengthening in concussion
• Is neck strength training suitable for whiplash patients?
• Aspects incorporated into a typical neck strengthening program

Kay Robinson will also be presenting at the 2017 Sports Injury virtual conference. Her conference presentation on neck strengthening will discuss:

• How to incorporate neck training into rehabilitation post injury
• Neck strengthening for injury prevention
• How to make exercise patient or sport specific
• Other consideration with neck training
• Case studies

• Kay Robinson on Twitter - @kaylourob
• Kay Robinson at Total Physiotherapy
• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• Book - Sports Injury Prevention and Rehabilitation: Integrating Medicine and Science for Performance Solutions
• High-Performance Training for Sports

• Durall. 2012. Therapeutic Exercise for Athletes With Nonspecific Neck Pain: A Current Concepts Review.

• Falla et al. 2003. An electromyographic analysis of the deep cervical flexor muscles in performance of craniocervical flexion.

• Falla et al. 2007. Recruitment of the deep cervical flexor muscles during a postural-correction exercise performed in sitting.

• Jull et al. 2009. The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain.

• PE 013 - Cervical Spine Artery and VBI Testing with Roger Kerry

• 5 Minute Physio tip - Manual therapy for the cervical spine - Is there any evidence?

• 5 Minute Physio tip - Contraindications and red flags to cervical spine manual therapy.

Injured athletes like to recover and return to play as quickly as possible, and we need to balance return to play against impaired strength, performance and risk of reinjury. Initial injury rehabilitation often commences with isometric exercises, progressing into concentric/eccentric style exercises when isometric tests are pain-free. Finally high load eccentric exercises such as the Nordic hamstring are introduced for their positive effects of increased strength, fascicle length and reduced injury risk.

High level and eccentric exercises are often avoided in the early stages of rehab, for fear of aggravating the injury. What if we could commence higher-level and eccentric exercises safely at an earlier stage? Would this impair or accelerate your patients' recovery?

In this podcast with Jack Hickey, currently completing a PhD with the QUT/ACU hamstring injury research group, we explore an accelerated hamstring injury rehabilitation program, and how this can be implemented with your patients. You will discover:

• The limitations of traditional rehabilitation
• What is the evidence for only using isometric exercises in the early stages of rehab
• Why eccentric exercises are commonly thought of as too high a load for initial rehab
• More modern rehabilitation programs for hamstring strain injuries, including the Askling (2013), Aspetar (2017) and Mendiguchia (2017) programs
• An accelerated rehab program, introducing higher-level and eccentric exercises at an early stage
• When you can start your patient's rehabilitation
• Which exercises you can use with your hamstring injury patients
• How to know when to progress your patient's exercises
• How often high-level exercises need to be performed
• When your patients can return to running
• How to progress your patients through a return to running program
• When your patients are suitable for return to sport

• Sliding discs to use in hamstring slider exercises in your clinic - available in Australia. Use the code "clinicaledge" to get 20% off your order (at the above link, not applicable on Amazon)
• Amazon (outside Australia)- Sliding discs to use in hamstring slider exercises

• PE 071 - Hamstring strengthening, lengthening and injury prevention with Dr David Opar
• PE 019 - Hamstring strength, flexibility and injury reduction with Dr Kieran O'Sullivan
• PE016 - Preventing hamstring injuries with Dr Kristian Thorborg

• • Askling et al. 2013. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols
  • Aspetar Hamstring Protocol
  • Hickey et al. 2016. Criteria for Progressing Rehabilitation and Determining Return-to-Play Clearance Following Hamstring Strain Injury: A Systematic Review
  • Jacobsen et al. 2016. A combination of initial and follow-up physiotherapist examination predicts physician-determined time to return to play after hamstring injury, with no added value of MRI.
  • Järvinen et al. 2007. Muscle injuries: optimising recovery.
  • Mendiguchia et al. 2017. Hamstring rehab for football players.
  • Silder et al. 2013. Clinical and Morphological Changes Following 2 Rehabilitation Programs for Acute Hamstring Strain Injuries: A Randomized Clinical Trial

Hamstring injuries are the most common injury in football and AFL, and we can help our patients strengthen their hamstrings while significantly reducing their risk of injury with the right exercise program. What are the best exercises to use to strengthen and lengthen the hamstrings, and to prevent hamstring injury?

In this Physio Edge podcast with Dr David Opar, we discuss hamstring injury prevention, which athletes will benefit, which exercises to use, the most important aspects of each exercise and how to incorporate these with your athletes. You will discover:

• What does the latest research around hamstring exercises and injury reveal?
• Which players are most at risk of hamstring injury?
• How can we prevent hamstring injuries?
• How does hamstring muscle architecture adapt to training, and how does this relate to your exercise selection or prescription?
• How can we increase hamstring muscle fascicle length?
• How can we tailor our patients hamstring program based on whether they are preseason, in-season, uninjured or previously injured?
• Which exercises are important in hamstring rehabilitation and prehabilitation?
• How can you start and progress a hamstring injury prevention program?
• How quickly do patients lose their hamstring gains, and how much maintenance do they need to perform?
• What happens to hamstring muscle strength and flexibility following injury?
• What neuromuscular inhibition happens following hamstring injuries, and how can we address this in our rehab?

There has been a lot of great research performed recently on hamstring injuries, and to share this and help you with your hamstring injury patients, we have invited Dr David Opar to present at the upcoming Sports Injuries virtual conference in December 2017. You can access six free preconference sports injury presentations by CLICKING HERE.

• David Pope on Twitter
• Clinical Edge on Facebook
• Have a free trial Clinical Edge membership
• ACU open access hamstring journal repository

• Bourne et al. 2017. Impact of exercise selection on hamstring muscle activation.
• Opar et al. 2015. Eccentric hamstring strength and hamstring injury risk in Australian footballers.
• Petersen et al. 2011. Preventive Effect of Eccentric Training on Acute Hamstring Injuries in Men's Soccer.
• Timmins et al. 2015. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study.
• Timmins et al. 2016. Architectural Changes of the Biceps Femoris Long Head after Concentric or Eccentric Training.
• van Dyk et al. 2016. Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries: A 4-Year Cohort Study.

Athletes with groin pain will commonly play with pain until the end of the season, and rest during the off-season in the hopes this will aid in their recovery. Unfortunately this offseason rest period rarely results in recovery, and athletes head into the preseason with long-standing groin pain and an extended recovery period.

In this episode of the Physio Edge podcast with Dr Adam Weir , you will discover how to treat adductor related groin pain (ARGP) and complex patient presentations with multiple areas of pathology or pain.

This podcast follows on from the Physio Edge podcast episode 69, where Dr Adam Weir and I discussed in detail how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

You will explore:

• Treatment of acute adductor strains
• Long term adductor related groin pain (ARGP)
• Is rest during the off season helpful or harmful for groin pain
• What pain level is ok during rehab exercises
• How can you describe ARGP to decrease patient fear
• Is ARGP a tendinopathy or different pathology?
• How to answer your patients when they ask how long until they can return to training (RTT) or return to play (RTP)?
• What is and how can you incorporate the Copenhagen Adductor exercise?
• Is there a role for passive treatment?
• Is hand held dynamometry useful during recovery?
• Treatment for adductor related groin pain (ARGP)
• Starting treatment
• Exercise progressions
• What criteria can you utilise for treatment progressions?
• What criteria can you use prior to allowing your patients to return to running, change of direction and RTP
• How to progress running and change of direction training
• Adductor to abductor strength ratios your athletes can achieve prior to RTP

Complex presentations

• How can you make a diagnosis and tailor your rehab when a patient has multiple areas of pain and positive tests eg ARGP plus Psoas related groin pain or Inguinal related groin pain?
• How your treatment program may evolve as your patient progresses through their rehab

Dr Adam Weir will be presenting at the upcoming Sports Injuries virtual conference on the assessment and treatment of Inguinal related groin pain. You can access his free preconference presentation, along with other free sports injury assessment and treatment videos AT THIS LINK

• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook
• Adductor protocol on Mobile devices
• Adductor protocol videos on Youtube

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

Adductor related groin pain is the most common diagnosis for athletes with groin pain. In this episode of the Physio Edge podcast you will discover how to assess and diagnose adductor related groin pain, identify or exclude differential diagnosis including stress fractures, hip joint involvement, inguinal related groin pain and nerve entrapment.

Dr Adam Weir is a Sports Physician with a PhD on groin pain, the lead author for the Doha agreement meeting on terminology and definitions in groin pain in athletes, who currently shares his time between the Aspetar sports groin pain centre and the Erasmus University Hospital Academic Centre for Groin Injuries in Holland. Adam will take you through exactly how to perform an assessment around the hip and groin, how to interpret your findings and how to explain your diagnosis to your patients. You will explore:

• The common presentation and symptoms of someone with adductor related groin pain
• Structures that are commonly involved
• Aggravating and easing activities
• Area of pain, and new research highlighting unexpected pain referral areas from the adductor tendons
• Differential diagnosis
• Bone stress injuries around the hip and pubic bone
• Genitofemoral nerve entrapments - symptoms, diagnosis and treatment
• Red flags
• Acute versus chronic presentations
• Adductor related versus pubic related groin pain
• How to perform an assessment, including screening tests
• Tests you need to incorporate into your assessment
• Identifying and diagnosing all the structures contributing to a patient's symptoms
• What is the value of imaging and when should it be performed?

• Download your free podcast handout
• Dr Adam Weir on Twitter - @adamweirsports
• Aspetar – Sports groin pain centre
• Erasmus University Hospital Academic Centre for Groin Injuries
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

• Branci et al. 2014. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls.

• Drew et al. 2017. Experimental pain in the groin may refer into the lower abdomen: implications to clinical assessment.

• Drew. 2017. PhD Thesis - Beyond the pathoanatomical explanation of long-standing groin pain in athletes

• Mosler et al. 2015. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis.

• Weir et al. 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes.

• Whittaker et al. 2015. Risk factors for groin injury in sport: an updated systematic review.

There are a range of tendinopathy presentations, from easily diagnosed with a local area of pain and clear pain response to tissue overload; through to patients with trickier presentations and multiple contributors to pain e.g. long term proximal hamstring or gluteal tendinopathy with a lumbar spine radiculopathy.

How can you diagnose and treat patients with complex tendinopathy presentations? How does the latest research around tendinopathy help us? I explore these issues and more with Dr Peter Malliaras in episode 68 of the Physio Edge podcast. We also explore:

• Do tendinopathy patients always present with a small area of pain, or can they have pain in larger, more diffuse areas?
• How will you identify tendinopathy or other structures that may be contributing to your patients symptoms?
• Clues in your patients' history to help you identify and differentiate tendinopathies, lumbar and SIJ referral
• Symptoms and how your treatment will differ in patients with paratenon and fat pad involvement
• How can you measure your patients load tolerance?
• What categories of tendinopathy patients can you use to help differentiate your treatment?
• How can you rehabilitate patients with tendinopathy?
• What role does biomechanics have?
• What advice can you provide to your patients about load management, symptoms and flareups?
• When is it ok for your patients to continue or return to running?
• What strength tests should your patients be able to complete before returning to running?
• If your patients are not tolerating running, which aspects should you modify first - frequency, intensity, type or duration?
• When are isometrics useful in your treatment?
• When can you start isotonic and plyometric exercises?
• How can you incorporate tendon neuroplastic training (TNT)?

Links associated with this episode

• Download your podcast handout
• Dr Peter Malliaras on Twitter
• Tendinopathy rehab blog with Dr Peter Malliaras
• Get your free trial Clinical Edge membership
• David Pope on Twitter
• Clinical Edge on Facebook

Other episodes of interest:

• PE 046 - Proximal hamstring tendinopathy with Tom Goom
• PE 042 – Treatment of plantaris and Achilles tendinopaty with Seth O'Neil
• PE 023 – Lower limb tendinopathies with Dr Pete Malliaras

Articles associated with this episode:

• Coombes et at. 2016. Isometric exercise above but not below an individuals pain threshold influences pain perception in people with lateral epicondylalgia

• Rio et al. 2015. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy

• Silbernagel et al. 2007a. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled trial.

• Silbernagel et al. 2007. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy.

Shoulder pain can involve the rotator cuff, scapula, cervical spine, thorax, and other structures in this area. Recent research has also explored the role of patient beliefs and expectations on the outcomes of Physiotherapy for shoulder pain. Which factors are important in your shoulder pain patients? Can we identify the contributing factors to your patients shoulder pain? What information will you get from orthopaedic special tests during a shoulder examination? How can you improve your treatment results with your patient education?

In this episode of the Physio Edge podcast, Dr Chris Littlewood and David Pope discuss shoulder pain, including:

• Classification of shoulder pathology
• How to identify painful vs stiff vs unstable shoulder pain vs cervical spine referred pain
• Questions to ask in your subjective assessment
• Does subacromial impingement exist, and how does a diagnosis of subacromial impingement effect outcomes
• Patient expectations of treatment outcomes
• How to perform an objective assessment
• What information special tests provide
• Is scapular dyskinesis pathological or normal movement variation
• Are painful or non-painful exercises most helipful in chronic shoulder pain
• What role does imaging have in shoulder pain

This podcast adds to Physio Edge podcast 47 - Rotator cuff tendinopathy with Dr Chris Littlewood .

• Webinar - "Exercise for rotator cuff tendinopathy: Does it work as we think it should, and can we do better? with Dr Chris Littlewood

• Download the handout from this podcast

• Cervical spine assessment & treatment online course

• Get your free trial Clinical Edge membership

• David Pope on Twitter

• Clinical Edge on Facebook

• Dr Chris Littlewood at Keele University

• Dr Chris Littlewood on Twitter

• Dr Chris Littlewood on ResearchGate

Experiencing increasing calf pain with running can be an incredibly frustrating experience for your running patients, especially when it is severely limiting or stopping them from being able to run. You can have a lot of success in helping your runners overcome running related calf pain, and in episode 66 of the Physio Edge podcast, we give you practical strategies and exercises you can use in your treatment.

Tom Goom and David Pope helped you explain the causes of calf pain to your running patients, differential diagnosis and red flags, and what you need to assess in episode 64 and episode 65, and in Episode 66 you will explore:

• How to strengthen the calf complex
• Strengthening for local ankle and foot muscles
• Benefits and how to incorporate strengthening for the kinetic chain
• Incorporating neural mobility into your treatment
• Adjusting and progressing training loads
• The role of gait retraining in the treatment of calf pain

• Download and subscribe to the podcast on iTunes
• Download your free podcast handout on treatment of calf pain in runners
• Tom Goom on Twitter
• Let David Pope know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Like the podcast on Facebook
• Infographics by Clinical Edge
• Get your free trial Clinical Edge membership
• Tom Goom's website & courses
• Tom on Facebook Live

• Physio Edge 065 - Differential diagnosis of calf pain in runners with Tom Goom
• Physio Edge 064 What is causing calf pain in runners and how can you assess it with Tom Goom
• Physio Edge 062 How to treat plantar fasciopathy in runners with Tom Goom
• Infographic - How to treat plantar fasciopathy in runners with Tom Goom
• Physio Edge 061 How to assess & diagnose plantar fasciopathy in runners with Tom Goom
• Infographic - How to assess & diagnose plantar fasciopathy in runners with Tom Goom
• Physio Edge 060 Plantar fasciopathy in runners with Tom Goom
• Infographic - Plantar fasciopathy in runners with Tom Goom
• Infographic - Plantar fasciopathy imaging & education with Tom Goom

• Breen et al. 2015. Gait re-training to alleviate the symptoms of anterior exertional lower leg pain: A case series
• Franklyn-Miller et al. 2012. Biomechanical overload syndrome: defining a new diagnosis
• Kerry et al. (2005). Mechanical calf pain in a 23-year-old male due to dynamic functional entrapment of the popliteal artery
• Scarvelis and Wells. (2006). Diagnosis and treatment of deep vein thrombosis