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Summary

In this episode, Dr. Bart Dingenen, a sports physiotherapist and ACL rehab specialist, discusses the complexities of rehabilitating multidirectional athletes. Topics include movement demands, deceleration, agility vs change of direction, and best practices for late-stage rehab.

Guest

Bart is a sports physiotherapist, researcher, educator, and ACL rehab specialist from Belgium, known for his work on multidirectional movement, deceleration mechanics, agility, and return to performance.

Chapters

00:00:00 — Intro 00:01:02 — What is a multidirectional athlete? 00:06:07 — Real sport vs clinic movement demands 00:08:48 — Sponsor: WriteUpp 00:10:29 — Agility vs change of direction 00:12:33 — What linear running misses in rehab 00:15:38 — Are athletes taught to decelerate and cut well? 00:18:36 — Neurocognitive errors in non-contact injuries 00:22:07 — Common movement patterns behind injuries 00:24:46 — Why deceleration is undertrained 00:29:00 — Sponsor: Physiotutors courses 00:30:00 — Why the best movers are great decelerators 00:31:35 — Tissue loads during braking and cutting 00:34:42 — What good deceleration technique looks like 00:40:11 — Sponsor: Physiotutors membership 00:41:18 — Do extra braking steps reduce efficiency? 00:42:38 — Why symmetry numbers are not enough 00:44:47 — Best field-based testing for multidirectional athletes 00:47:58 — Common late-stage rehab mistakes 00:51:55 — Adding perception and unpredictability to rehab 00:56:06 — One thing to change in sports rehab education 00:57:38 — Key takeaways for physios 00:59:01 — Where to learn more from Bart 01:00:43 — Outro

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Summary

In this episode, physiotherapist Bahram Jam shares his 34 years of experience in understanding and treating chronic pain, emphasizing the importance of shifting from structural fixes to a focus on primary pain and the psychological aspects of pain management. Discover insights on how to better approach persistent pain, debunk common misconceptions, and explore innovative concepts like pain as a musical.

00:00:00 Introduction

00:01:28 How has your understanding of chronic pain changed over time?

00:04:14 When does pain stop being mainly tissue-driven?

00:06:27 If tissues have healed, why can pain still persist?

00:08:43 What do patients with persistent pain get told that makes things worse?

00:11:36 Sponsored segment: Physiotutors courses

00:13:20 How do you explain persistent pain in a way that helps patients move forward?

00:16:32 What is primary pain versus secondary pain?

00:22:43 What are you trying to figure out in a first consultation?

00:25:17 How do you handle resistance when patients are skeptical?

00:27:09 Sponsored segment: Physiotutors membership

00:29:05 Where do clinicians go wrong with persistent low back pain?

00:39:04 How do you approach patients who have tried everything?

00:41:49 How do you explain MRI findings that do not match symptoms?

00:45:44 What makes TMJ disorders tricky and what do clinicians miss?

00:49:29 Sponsored segment: WriteUpp

00:51:04 What exercise approach do you use for persistent low back pain?

00:57:08 How do you balance manual therapy, exercise, and education?

00:58:41 How important are lifestyle factors in persistent pain?

01:01:42 What is your one piece of advice for clinicians treating persistent pain?

01:06:18 Is there anything else you want to add?

01:08:08 Outro

Bonus Material

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Summary

This episode explores the critical role of breathing in health, recovery, and performance, featuring Steven Zwerink, a breathing physiologist. Discover how dysfunctional breathing impacts the body, the importance of CO2 over oxygen, and practical techniques for physiotherapists to incorporate breathing exercises into their practice.

Guest

Steven is a breathing physiologist and the founder of the Dutch Institute for Breathing Physiology. His work focuses on how breathing influences health, recovery, and performance.

His interest in breathing started after a serious cycling accident, where he experienced a long and difficult recovery with symptoms like a concussion and whiplash. Traditional approaches only got him so far, but when he started working with breathing, things began to change. That experience became the foundation of his work today.

With a background in elite sports and extensive training in different breathing methods, Steven now works with physiotherapists, healthcare professionals, and athletes. His goal is to make breathing practical, evidence-informed, and clinically applicable.

Chapters:

00:00:00 Introduction to breathing in physiotherapy

00:01:17 Steven Zwerink's accident and recovery journey

00:07:57 Sponsor: Physiotutors membership and learning platform

00:09:04 Dysfunctional breathing, CO2, and nasal vs mouth breathing

00:16:38 Why nasal breathing can feel difficult

00:20:26 Early-life habits, jaw development, and airway problems

00:24:38 Sponsor: Physiotutors courses

00:25:39 Why breathing matters in everyday physio practice

00:31:45 How to assess when breathing is part of the problem

00:36:05 Three practical breathing techniques for therapists

00:42:26 Box breathing dosage and workplace applications

00:46:23 Advanced breath control and prolonged exhale training

00:50:55 Coherent breathing and nervous system regulation

00:50:54 Sponsor: WriteUp practice management software

00:52:30 When breathing is complementary vs primary treatment

00:56:46 Sleep-disordered breathing, recovery, and injury risk

00:59:14 Clinical case: post-COVID recovery with breathing work

01:01:34 Mistakes to avoid when adding breathwork to physio

01:04:20 Key myth, nervous system regulation, and therapist takeaways

01:06:13 Diaphragm, psoas, and overlooked physical links

01:08:11 Where to find Steven and final outro

Bonus Material

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Summary

In this episode, Firat Kesgin, founder of the German Institute for Vestibular Rehabilitation, discusses the controversial topic of cervicogenic dizziness. He challenges the validity of this diagnosis, arguing that dizziness often associated with neck pain and limited cervical mobility should not be considered a distinct disorder. Kesgin references the Barani Society's stance, which suggests that the connection between cervical issues and dizziness lacks high-quality evidence. He explains that patients with vestibular disorders often restrict head movement, leading to neck problems over time, which can be mistaken for cervicogenic dizziness.Kesgin emphasizes the importance of accurate diagnosis and the risks of relying on exclusion-based diagnoses. He highlights the need for specialized knowledge in vestibular disorders to avoid misdiagnosis and unnecessary treatments. The discussion also touches on the psychological aspects of dizziness, comparing it to chronic pain conditions where the central nervous system plays a significant role. Kesgin advocates for a more comprehensive understanding of vestibular disorders and cautions against simplistic mechanical explanations for complex symptoms.

Guest

Firat is the founder of the German Institute for Vestibular Rehabilitation and has been teaching postgraduate courses throughout Europe. His work focuses on helping clinicians better understand and treat patients with dizziness and balance disorders. Alongside his clinical and teaching work, Firat is currently pursuing a PhD on the standardization of BPPV testing and the implementation of structured vestibular rehab programs in outpatient care.

Chapters

00:00:00 Intro 00:01:22 Why "cervical dizziness" isn't a valid diagnosis 00:03:36 Neck pain/limited ROM as consequences of vestibular issues 00:04:26 Sponsor: WriteUpp 00:06:00 Temporal link to neck pain doesn't prove causation 00:08:15 Does treating the neck fix dizziness? Short-term vs long-term 00:10:51 Risks of diagnosis by exclusion 00:12:24 Diagnostic gaps in routine ENT practice 00:14:20 No specific test: is that enough to reject it? 00:16:59 Vestibular migraine vs "cervical dizziness" 00:20:51 Sponsor: Physiotutors Premium 00:21:27 Common mislabels: BPPV, hypofunction, and 3PD 00:25:45 Cervical proprioception: acute vs chronic relevance 00:32:32 Interpreting cervical torsion and SPNT tests 00:36:53 Sponsor: Physiotutors Courses 00:37:55 Parallels with chronic low back pain 00:38:41 Why the research persists and biomechanical bias 00:45:19 Clinical guidance for dizzy patients with neck pain 00:46:54 Myth-busting: negative ENT and psychology factors 00:49:23 Closing thoughts 00:50:33 Where to find Firat 00:51:19 Outro

Bonus Material

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Summary

In this episode, Karl Jacobs, a renowned anatomist and educator, explores the complex world of fascia—its structure, function, and clinical significance. Discover how fascia influences movement, pain, and tissue adaptability, and learn about the latest research and practical insights for clinicians.

Guest

Karl is an accredited anatomist, presently working at the Department of Medical Biology, Section Clinical Anatomy & Embryology of the University of Amsterdam. As an anatomist, his area of special interest is the functional anatomy of the musculoskeletal system, head and neck region and Karl has a particular focus on fascia. He graduated with merit for his MSc Functional and Clinical Anatomy at the University of Birmingham (United Kingdom) in 2017; and wrote his final dissertation on the embryological, histological, physiological, and morphological aspects of the fascial system.

Chapters

00:00:00 Intro & guest bio

00:01:34 Path from physio to fascia

00:02:54 What is fascia?

00:03:51 Why fascia was overlooked

00:04:59 Fascia in movement & force transmission

00:06:06 Common oversimplifications

00:06:55 Fascia's role in stability

00:07:52 Fascia, nociception & pain

00:10:52 Sponsor: Physiotutors Courses

00:11:50 Continuity vs predictability

00:12:50 Can we diagnose fascial issues?

00:14:26 Do therapies change fascia?

00:16:47 "Releasing" fascia vs influencing biology

00:17:40 Sponsor: WriteUpp practice software

00:19:19 How adaptable is fascia?

00:21:12 Imaging fascia with ultrasound

00:22:41 Adhesions and layer gliding

00:24:17 How dissection changes clinicians' views

00:25:08 Lifestyle, load, and fascia

00:26:22 Sponsor: Physiotutors Premium

00:26:59 What "better" fascia means (function-specific)

00:28:08 Where the field is heading

00:29:08 Clinical takeaway

00:31:10 Where to find Karl

00:31:28 Courses: Fascia in a Nutshell & Discovering Fascia

00:32:38 Outro

Bonus Material

Discovering Fascia Online Course

Fascia in a Nutshell Masterclass

Anatomy Insight Institute

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Summary

In this episode of the Physiotutors podcast, Andreas Delaere discusses the critical role of physiotherapy in promoting healthy aging. He emphasizes the importance of prevention, strength training, and power training for older adults, while also addressing common mistakes made in their treatment. The conversation explores the hallmarks of aging, the significance of sleep in rehabilitation, and effective strategies for tracking progress and overcoming barriers to adherence. Andreas advocates for a holistic approach to physiotherapy, focusing on empowering patients and maintaining their functional independence.

Guest

Andreas Delaere is a physiotherapist, scientific researcher, and co-owner of Praktijk ROBUUST in Merchtem, Belgium. He combines clinical practice with research, with a strong focus on prevention, muscle health, strength training, and sarcopenia in older adults. Since 2015, he's been connected to the VUB, has contributed to multiple scientific publications, and to the Belgian Sarcopenia Guideline validated by CEBAM. Andreas also has an extra expertise in sleep and completed training in Cognitive Behavioral Therapy for Insomnia, CBT-I.

Chapters

00:00:00 Intro 00:01:32 Why focus on prevention? 00:03:15 Healthy aging and missed aspects 00:06:21 Twelve aging hallmarks? 00:10:48 Sponsor: Physiotutors courses 00:13:01 Recognizing sarcopenia 00:17:13 Common muscle-building mistakes 00:22:06 Strength versus power differences 00:25:19 Safe power training for elders 00:27:42 Non-negotiable movements, adaptations 00:34:23 Sponsor: WriteUpp software 00:35:58 Programming variables and frequency 00:40:40 Tracking progress and mismatches 00:42:27 Barriers and boosting adherence 00:46:25 Handling passive-treatment seekers 00:50:17 Strength-function translation issues 00:51:55 Sleep's role and myths 00:58:20 Sponsor: Physiotutors membership 00:59:16 When to refer sleep issues 01:01:01 Three actions for this week 01:02:10 Controversial view on training 01:04:56 Contact info & Outro

Bonus Material

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Summary

In this conversation, Ebonie Rio, a physiotherapist and researcher, discusses the complexities of patellar tendinopathy, including its causes, myths, and effective rehabilitation strategies. She emphasizes the importance of understanding the condition as an overload issue, the need for accurate diagnosis, and the role of strength training in prevention and recovery. Ebonie also highlights the significance of motor control and coordination in managing tendon pain, and the necessity of clear communication among athletes, coaches, and clinicians for optimal outcomes.

Check out the Rehabilitendon App: http://rehabilitendon.com.au/

Guest

Ebonie Rio is a physiotherapist and researcher from La Trobe University in Australia. She holds a PhD in tendon pain and has a background that includes a Masters in Sports Physiotherapy and two bachelor degrees. Her clinical work spans some of the top performance environments in the world. She has worked with the Australian Institute of Sport, the Australian Ballet Company and Ballet School, pro football with Melbourne Heart, the Victorian Institute of Sport, and several major events including the Commonwealth Games, the Vancouver Winter Olympics, the Singapore Youth Olympics and the London Paralympics. She also spent more than a year on tour with Disneys The Lion King. Ebonie has published widely on tendon pain, motor control, load, and rehab, with a special focus on patellar tendinopathy.

Chapters

00:00:00 - Intro: Ebonie Rio (background + welcome)

00:01:02 - Explaining patellar tendinopathy in simple terms (athlete-friendly)

00:02:47 - Biggest myths in patellar tendinopathy (imaging, diagnosis, puberty)

00:04:20 - Why "young jumping men" are most affected (risk factors + load profile)

00:06:06 - Misdiagnosis: patellar tendinopathy vs patellofemoral pain

00:07:15 - What changed most in tendon pain research (and clinical thinking)

00:08:27 - What clinicians still underrate in tendon rehab (getting strong enough)

00:10:16 - Sponsor: PhysioTutors Premium Membership

00:11:12 - Why weakness increases tendon overload (load distribution + performance)

00:12:06 - Where tendon research is heading (better diagnosis + better outcomes)

00:14:01 - Key assessment questions + progressive load testing approach

00:18:43 - Morning stiffness, night pain, and 24-hour response (diagnostic clues)

00:20:09 - Quad tendon vs patellar tendon: does it matter for rehab choices?

00:21:46 - Isometrics debate: what people misunderstand about pain relief

00:26:43 - What is "peritendin" and why it matters (especially in Achilles)

00:28:13 - How to diagnose peritendin vs tendinopathy (progressive load patterns)

00:31:53 - Peritendin treatment options (incl. Hirudoid + Voltaren discussion)

00:34:07 - Sponsor: Writeup (practice management software)

00:35:42 - Tendon rehab plan overview: in-season management vs full rehab

00:40:57 - Rehab strength targets + objective markers (leg press, calf, leg extension)

00:42:33 - Measuring the 24-hour response (decline squat vs hop testing)

00:43:02 - Spanish squat vs wall squat: why Spanish squat wins

00:44:19 - Heavy vs fast loading: why rate of loading matters

00:45:11 - Sponsor: PhysioTutors Courses

00:46:32 - Spring phase progression (energy storage + return-to-sport build-up)

00:50:15 - When is an athlete "cleared" to return to sport?

00:51:16 - Motor control + tendon pain: what changes and why it matters

00:53:47 - Metronome training: how to use it clinically (60 bpm setup)

00:55:17 - Managing flare-ups before major events (short-term strategies)

00:58:16 - Meds and injections: ibuprofen, pain relief, and why caution matters

00:59:30 - Key messages to coaches + athletes (performance mindset + heavy is safe)

01:01:08 - Final takeaways: diagnosis confidence + avoiding imaging traps

01:02:16 - Where to find Ebonie + her rehab app (Rehabilitendin)

01:03:18 - Outro: where to listen, app languages, transcript, and review request

Sponsors

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Bonus Material

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Summary

In this episode of the Physiotutors podcast, we discuss the pervasive issue of burnout among physiotherapists, focusing on the business and operational challenges that contribute to this phenomenon. Joined by Claire Braham and Anna Bunch, experts in practice management and virtual assistance, the conversation delves into the daily realities of running a physiotherapy practice. They highlight that burnout often stems not just from long hours or difficult patients, but from the overwhelming mental load, inefficient admin systems, and the constant feeling of being behind. Claire and Anna share insights on how these factors can lead to emotional fatigue and ultimately impact both personal and professional lives. The discussion also emphasizes the importance of recognizing early signs of burnout, such as feeling constantly behind or lacking the capacity to manage tasks that once felt manageable. Claire and Anna provide practical solutions, including the implementation of effective systems and boundaries, to help clinicians regain control over their workload. They stress the need for clinicians to prioritize their well-being and consider outsourcing administrative tasks to alleviate stress and improve overall practice efficiency.

Guests

Clare is a Business Development Representative at WriteUpp, a practice management software used by many healthcare professionals. Her background is in operations, team leadership, and private practice support. She spends her time helping clinics get more organised, save time, and reduce stress around things like compliance, admin, and patient experience.

Anna Bunch is a Virtual Assistant who specialises in supporting psychologists and therapists. Since 2019, she has worked closely with private healthcare practices to improve systems, workflows, and daily operations. She also supports and mentors other VAs who work in this space.

Chapters

00:00:00 Intro 00:01:53 Burnout in daily practice? 00:04:44 Early signs of burnout? 00:08:55 Sponsor: WriteUpp 00:10:30 Constant on-mode impact? 00:16:55 Draining vs energizing patients 00:18:20 Over-responsibility problem 00:21:00 Clinicians hating admin 00:27:11 Sponsor: Physiotutors Premium 00:28:15 Insurance documentation pressure 00:30:30 Better systems for admin? 00:32:06 Tools and human support 00:36:35 Too many tools? 00:39:13 Powerful yet simple systems 00:43:35 Sponsor: Physiotutors Courses 00:44:51 One realistic change now? 00:50:15 Anything we missed? 00:52:09 Contact Details & Outro

Bonus Material

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Note: This episode was recoreded in Dutch and can be listened to in English and other languages on the Physiotutors App. The next episode will be in English again!

Summary

In this episode, we discuss the journey of Ajan Elshof, a former physiotherapist who transitioned to a care-intensive advisor role. We explore the reasons behind his departure from physiotherapy, including changing perspectives on care, the challenges of practice management, and the relationship between physiotherapists and insurers. Ajan shares insights on the future of physiotherapy, the importance of innovation, and the need for collaboration in the healthcare sector.

Chapters

00:00:00 Intro and the big question: why does a passionate physiotherapist leave the profession?

00:03:42 Why physiotherapy was chosen: sports background, injuries, and early motivation

00:05:13 Workload, balance, and no burnout

00:06:40 Sponsor: Premium membership

00:07:17 From patient care to management: views on efficient, hybrid care and the right care in the right place

00:10:24 Overtreatment vs insured sessions: ethics and clinic policy

00:12:06 Ambition, ownership, and scale of impact

00:14:27 The purchasing plan: from the first years to the concrete process

00:16:09 Why the purchasing failed and business lessons learned, market fit, agreements, transition period

00:19:17 Considered paths, education, research, own practice, and the choice for a health insurer to increase impact

00:22:29 Sponsor: WriteUpp practice management software

00:24:20 Low rates, productivity, and admin work: the health insurer's view

00:27:29 Relationship between health insurer and therapist: shared goal and trust

00:30:53 New role at Zilveren Kruis: tasks and the value of a physio background

00:33:23 Clinic vs office: differences in workday, focus, and downtime

00:36:20 How do we keep passionate professionals? Perspective, career paths, and regional primary care cooperation

00:37:43 Sponsor: Physiotutors online courses

00:39:18 Career outlook and conditions for a possible return

00:41:21 Advice to the next generation, including his own children, about physiotherapy

00:42:30 Closing message: working together toward sustainable, accessible, local care

00:44:15 Closing

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Summary

This podcast explores the critical role of exercise therapy in oncology, highlighting its importance in cancer treatment, rehabilitation, and survivorship. Experts discuss the evolution of exercise in oncology, current practices, and innovative trials that examine the interactions between exercise and chemotherapy. The conversation also addresses the unique challenges faced by patients with head and neck cancer and the significance of tailored exercise programs in improving patient outcomes. This conversation delves into the critical role of exercise in cancer care, highlighting patient barriers, the importance of personalized exercise programs, and the need for better integration of physiotherapy in oncology. The speakers discuss the life-saving benefits of exercise, the challenges faced in clinical practice, and the necessity of addressing patient fears and misconceptions about exercise. They emphasize the importance of collaboration among healthcare professionals to ensure consistent messaging and support for cancer patients. Looking ahead, they advocate for more research, education, and advocacy to improve exercise oncology practices globally.

Check out our Podcast Sponsor WriteUpp here: https://www.writeupp.com/partners/physiotutors

Guests

Prof. Dr. Nele Adriaenssens from the Vrije Universiteit Brussel is an associate professor and leads the Rehabilitation Research group, focusing on cancer rehabilitation and exercise oncology, with a special interest in side effects of chemotherapy and immunotherapy and how exercise can help. She also coordinates cancer rehabilitation and survivorship at the University Hospital in Brussels and has been a key figure in building cancer rehab services and research infrastructure there.

Dr. Grainne Sheill, clinical specialist physiotherapist in cancer rehabilitation at St James's Hospital in Dublin. Grainne leads work on exercise for people treated for head and neck cancer, looking at the barriers they face and how group based programs can support recovery, fitness and daily function after treatment.

She is the head of the physiotherapy department at Tel Aviv Souraski Medical Center. She is a physiotherapist, educator and long standing leader in national and international physiotherapy bodies, with a strong focus on cancer care, exercise prescription and raising standards of practice and policy.

Time Stamps

00:00:00 - Intro and guest lineup: Exercise therapy in oncology overview

00:01:36 - Why is exercise part of cancer treatment, not just an extra?

00:04:04 - What "exercise" means in cancer care: cardio, strength, or both?

00:05:32 - How the role of exercise in oncology has changed since 2008–2009

00:08:42 - Sponsor: PhysioTutors Premium Membership (ad)

00:09:35 - Policy and health system view: Where oncology rehab stands and gaps

00:12:40 - How drugs/side effects shape exercise plans (exercise–pharmacology examples)

00:16:56 - PAPTOX and FORX trials: What's new vs classic cancer rehab studies

00:20:45 - Exercise goals in palliative care and oncogeriatrics

00:24:17 - Are palliative/fragile patients motivated to exercise?

00:25:30 - Sponsor: WriteUpp practice management (ad)

00:27:05 - Head & neck cancer: Why this group is different and challenging for activity

00:31:34 - National survey findings: Top barriers and surprises to exercise post–head & neck cancer

00:33:49 - Key exercise-oncology messages still missing in day-to-day practice

00:37:33 - Turning position statements into simple clinical routines

00:41:41 - Global online oncology course: Is it available yet?

00:42:15 - Sponsor: PhysioTutors online courses (ad)

00:43:10 - Screening and triage: Group vs 1:1 vs medical referral

00:46:16 - Addressing fear: How to talk about risk and safety to keep patients engaged

00:49:55 - One belief to change among doctors/nurses about exercise in cancer care

00:53:19 - Ten-year outlook: Priorities for research, education, and implementation

00:56:13 - Final messages: Getting physios on board and entry-level competencies

00:58:54 - Congress announcement and closing remarks

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