In Episode 72 of the Physiotutors podcast, we interview Dr. Daniel Belavy, a professor with a prolific research background in muscle, bone, and joint health, specifically focusing on low back pain. The discussion explores various aspects of back pain research, including disk herniations in astronauts, the role of mechanical loading in disk health, and the challenges of classifying non-specific low back pain.

Dr. Belavy shares insights from his studies on physical exposure and spine postures, contextual effects in treatment, and exercise training for back pain. He emphasizes the importance of understanding how treatments work to optimize clinical care and highlights the ongoing quest to identify subgroups and optimal exercise prescriptions for back pain. The episode underscores the complexity of back pain and the multifactorial elements influencing it, advocating for continued research and collaboration in the field.

Content

00:00 Intro

00:57 Disc Herniations in Astronauts

04:08 Discs need (de-)loading

08:04 Is there a U-curve for loading?

10:15 NSLBP Classification Challenges

19:20 SI Joint Pain Classification Challenges

24:30 Physical Exposures and Low Back Pain

29:04 Physical Function/Activity and Low Back Pain

31:40 Contextual Effects in Low Back Pain

40:09 How to harness contextual effects in treatment

41:21 Which type of exercise is best for LBP

47:01 Exercise variables and pain reduction

50:29 Daniel's closing thoughts

53:00 Contact info

55:52 Outro

Bonus Material

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In this episode of the PhysioTutors podcast, Dr. Annina Schmid, a specialist in musculoskeletal physiotherapy and a professor of pain neurosciences at Oxford University, discusses entrapment neuropathies, focusing on conditions like carpal tunnel syndrome and cubital tunnel syndrome. She explains that these conditions occur when nerves are compressed or irritated as they pass through narrow anatomical spaces, leading to symptoms such as pain, tingling, numbness, and sometimes motor changes like weakness. The conversation covers common types of entrapment neuropathies, diagnostic challenges, and distinctions between peripheral and nerve root entrapment. Dr. Schmid emphasizes the importance of pattern recognition, detailed patient assessment, and understanding the anatomical and neurological aspects of each case. Dr. Schmid also delves into the importance of deep clinical phenotyping and precision physiotherapy, highlighting the need for detailed understanding of patient presentations and individualized treatment approaches. She discusses the potential benefits and mechanisms of neurodynamic treatments and other interventions, stressing that education and managing patient expectations are crucial. The discussion touches on the role of advanced imaging techniques like ultra-high field MRI in diagnosing and treating entrapment neuropathies, and the significance of surgical intervention in severe cases. The episode concludes with Dr. Schmid's takeaways for clinicians, emphasizing the need for careful diagnosis, patient education, and innovative research approaches.

Content

00:00 Intro

00:48 What are entrapment neuropathies?

01:48 Typical presentations

02:45 Does Piriformis syndrome exist?

05:10 Causes and Riskfactors of PNE

07:23 Differential diagnosis

13:00 How reliable is dermatome examination

15:25 What is Deep Clinical Phenotyping?

20:20 What is Precision Physiotherapy?

24:37 Effects of Neurodynamics

26:49 Effectiveness of other Interventions

31:35 Interface treatment

34:40 When to refer for surgery

36:48 Nerve repair

41:25 Ultra High Field MRI Explained

44:48 Three Take Aways

47:03 Annina's Closing Thoughts

48:13 Contact Info

49:39 Outro

Bonus Material

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In this episode of the Physiotutors podcast, Kai interviews Serena Simmons, a seasoned psychologist with over 30 years of experience, about behavioral change and patient buy-in in healthcare. Serena highlights the challenges that healthcare providers face due to the lack of psychological training in their initial education, which often leaves them unequipped to effectively promote behavioral change in patients. She emphasizes the importance of understanding both the practitioner's and the patient's psychology to foster meaningful interactions and facilitate change. Serena discusses the significance of the patient-provider relationship, suggesting that building trust and rapport is crucial, and that understanding and addressing the patient's intrinsic motivations can lead to better adherence to treatment plans.

Additionally, Serena offers practical advice for healthcare providers, such as spending more time understanding the patient's emotional reasons for seeking treatment and creating small, achievable milestones to reinforce progress. She also stresses the importance of self-awareness and communication skills for practitioners, recommending further education in human psychology and decision-making processes. Serena's insights underscore the need for a holistic approach that combines psychological understanding with clinical expertise to improve patient outcomes. The episode is rich with strategies for enhancing patient engagement, compliance, and overall effectiveness in physiotherapy and other healthcare practices.

Content

00:00 Intro

02:00 Barriers to behavior change

05:19 How to identify psychological factors impeding recovery

08:15 How to create rapport

14:27 Everything starts with you

18:30 How to strengthen your bond with a patient

24:24 How to uncover a patient's "why"

33:40 The benefit of hands-on treatment

35:13 Motivational Interviewing

39:10 My patient doesn't do exercises

46:06 How to secure buy-in

51:09 Recommended reading

53:30 Serena's closing thoughts

54:10 Contact info

54:35 Outro

Bonus Material

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In this episode of the Physiotutors podcast, Kai interviews Niek Vink, a physiotherapist and manager at the National Training Center for Ultrasound (NT-E) in Utrecht, Netherlands. They discuss the role and benefits of ultrasound in physiotherapy. Niek explains the basics of ultrasound imaging, comparing it to other imaging techniques like MRI and X-ray. He emphasizes that while ultrasound offers high spatial resolution and is useful for assessing soft tissues, it cannot see inside bones. The conversation also highlights the importance of dynamic scanning and sono-palpation in physiotherapy, as well as the advantages and disadvantages of ultrasound.

The discussion covers the adoption and application of ultrasound in physiotherapy practices, noting varying levels of usage in different countries. Niek shares success stories and potential pitfalls, stressing the importance of proper training, practice, and patient communication to avoid nocebo effects. He also touches on new developments in ultrasound technology, such as AI and elastography, and offers advice for physiotherapists considering adopting ultrasound in their practice. 

Guest

Niek is a Physiotherapist from Utrecht, Netherlands  and the manager and teacher at NT-e, an educational company focused on teaching ultrasound imaging to doctors, and physiotherapists. He’s been a public speaker on countless international events and today we will talk to him about the role of ultrasound in physiotherapy.

Content

Bonus Material

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In this episode of the Physiotutors podcast, host Kai speaks with Edel Fanning, a lead upper limb physiotherapist from Ireland, about various shoulder pathologies in athletes and effective rehabilitation strategies. Edel discusses common shoulder injuries in different sports, such as dislocations in contact sports like rugby and rotator cuff issues in overhead sports like swimming and tennis. She emphasizes the importance of considering the kinetic chain in rehabilitation, focusing on both local shoulder control and the role of other body parts to optimize recovery and performance. Edel also highlights the significance of proper scapular function and offers insights into the nuances of treating shoulder injuries, including specific exercises and positions to support recovery.

Edel also delves into the challenges of returning athletes to sport post-injury, discussing the importance of objective testing, psychological readiness, and sport-specific considerations. She outlines the differences in rehabilitation approaches for contact vs. non-contact sports, noting the unique demands and injury mechanisms of each. The conversation touches on screening tests, injury prevention strategies, and the development of an online course on athletic shoulder rehabilitation. Edel's expertise and practical advice provide valuable insights for physiotherapists and sports professionals aiming to enhance shoulder health and performance in athletes.

Content

00:00 Intro

00:45 Which pathologies to consider

08:34 The scapula and stability & performance

15:36 Which muscles to consider in rehab

19:08 The importance of strength in the kinetic chain

21:43 How to reduce injury risk

25:03 Shoulder warm-up routines

27:29 Screening tests useful?

33:11 Exercise dilemmas

38:47 AC Joint Injuries

45:50 What is assessed?

51:35 RTP & RTS markers are different

01:00:09 Edel's closing thoughts

01:01:00 Contact Details

01:02:50 Outro

Bonus Material

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Summary

In this podcast episode, we talk with Jente Wachemans, a physiotherapist and researcher specializing in ankle sprains and chronic instability. We discuss the nature of lateral ankle sprains, differentiating them from other types of ankle injuries, and touch on chronic ankle instability, a condition that remains somewhat ambiguous and under-researched. Jente emphasizes that while ankle sprains are common, particularly in sports, the transition to chronic instability isn't always straightforward and requires more prospective data for a clearer understanding. We also explore the prevalence of ankle sprains across various sports and demographic groups, noting higher incidences in females and younger populations.

Jente shares his approach to managing ankle sprains, from the acute phase to return to sport, advocating for exercise-based rehabilitation and the importance of patient education. He highlights the Peace and Love principles for immediate post-injury care and emphasizes the role of neurocognitive tasks in rehabilitation. We also discuss the use of orthopedic tests, ultrasound, and the significance of understanding which ligaments are involved in the injury for effective treatment. Jente stresses the importance of not underestimating ankle sprains, ensuring proper rehabilitation to prevent recurrence, and the potential role of surgery in persistent cases. 

Guest

Jente Wagemans is a physiotherapist and researcher at the University of Antwerp who is currently doing is PhD in collaboration with Ulster Universtity and Bern University of applied sciences. As part of his PhD he has published several papers about ankle sprains and chronic instability.

Timestamps

00:00 Intro

00:49 What is a lateral ankle sprain?

02:04 How is it different from other sprains?

03:12 At what point do we talk about chronic instability?

08:00 Prevalence

09:36 The typical patient

11:22 Risk factors

14:00 Ankle mobility & strength metrics

15:07 Chronic Instability risk factors

18:45 Red Flag Awareness

23:46 PEACE & LOVE

26:45 Orthopedic Testing

31:20 When is MRI valuable?

32:54 Functional Assessment

36:37 Management Approach 

45:18 Taping & Braces

47:13 Recurrence & Prevention

49:00 When surgery is indicated

52:10 Return to Sport timeline

56:20 Jente's closing thoughts

57:53 Contact Info

59:40 Outro

Bonus Material

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In this podcast, Dr. Claire Minshull shares her insights on teaching strength and conditioning to physiotherapists, emphasizing the practical application of academic knowledge. She discusses common mistakes in S&C practices, the importance of muscular strength in rehabilitation, and the significance of individualized exercise prescription for optimal outcomes. Claire also explores topics like measuring strength, rate of force development, and emerging technologies in strength training, underlining the need for patient-centered approaches and effective rehabilitation strategies.

Guest

Dr. Claire Minshull is a sport scientist, researcher and visiting professor at Leeds Beckett University in the UK. She has published more than 30 papers mainly on strength and conditioning and runs an educational company called Get Back to Sport

Content

00:00 Intro

01:01 Claire's Journey in S&C

04:58 The issue with S&C in Physio

07:38 S&C Mistakes Physios make

13:36 Hypertrophy & Strength is important

18:43 How to gauge Strength

24:03 Compound vs. Isolation Exercises

27:19 How far to push Patients to Fatigue

33:26 Failure to adapt Exercise Prescription in Clinic

36:04 Rate of Force Development explained

42:47 Cross Education Effect explained

50:41 Tips to create Patient Buy-In to Exercise

55:06 Emerging Technology Highlights in S&C

01:01:56 Claire's closing thoughts

01:03:48 Contact Info

01:04:48 Outro

Bonus Material

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In this podcast episode, Dr. Kerstin Luedtkee discusses the topic of migraine headaches, providing insights into the definition, classification, and pathophysiological theories behind migraines. She explains the criteria for diagnosing migraine headaches, including the presence of associated symptoms such as nausea and sensitivity to light or sound. Dr. Luedtkee delves into the role of the hypothalamus as a key structure in triggering migraine attacks and highlights the importance of understanding the central nervous system changes that occur in individuals with migraines. Moreover, she emphasizes the need for a holistic approach in managing migraines, incorporating physiotherapy interventions alongside pharmacological treatments. Dr. Luedtkee suggests addressing musculoskeletal dysfunctions in the neck, providing education on migraine triggers and symptoms, promoting relaxation techniques, and encouraging aerobic exercise. She also mentions ongoing research areas focused on patient perspectives, the effectiveness of physiotherapy in migraine treatment, and the importance of incorporating patient feedback into future studies to enhance the overall management of migraines.

Content

00:00 Introduction

00:37 Definition of Migraine Headaches

01:40 Migraine with Aura

03:30 Pathophysiology

05:30 The role of the Hypothalamus

07:36 Risk Factors for Migraine

13:25 Prevalence

16:44 The typical patient

18:29 Migraine and Chronic Pain

21:30 Red Flags

23:13 Other Diagnostic Measures

29:00 MSK Dysfunctions in Headache

31:18 The role of Vestibular Assessment

33:25 Subtype Vestibular Migraine

34:34 Physical Therapy Effectiveness

40:11 Guideline Management Approach

45:15 Added benefit of moving more?

46:16 Hot topics in Migraine Research

48:30 The Importance of the Patient’s perspective

49:56 Contact Info

51:15 Outro

Bonus Material

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In this podcast episode, Dr. Leanne Bisset, a musculoskeletal physiotherapist and associate professor at Griffith University, shares valuable insights on lateral epicondylalgia, also known as lateral elbow tendinopathy. She discusses the anatomy and function of the affected muscles, highlighting the importance of stability in wrist movements and the role of the extensor carpi radialis brevis. Dr. Bisset emphasizes the shift in terminology from epicondylitis to tendinopathy, debunking misconceptions around inflammation in the condition and providing a comprehensive overview of diagnostic considerations, risk factors, and red flags to look for during assessment.

Furthermore, Dr. Bisset delves into the management of lateral elbow tendinopathy, emphasizing the significance of tailored exercise programs focusing on isometric loading initially, progressing to incorporate global upper limb strengthening for comprehensive rehabilitation. She also addresses the limited efficacy of modalities like shockwave therapy and the potential benefits of orthoses in pain management. Dr. Bisset's evidence-based approach underscores the importance of patient education, individualized treatment plans, and monitoring pain responses to optimize outcomes in the management of lateral epicondylalgia.

Guest Dr. Leanne Bisset is a musculoskeletal physiotherapist and an associate professor at Griffith University at the gold coast, Australia. She has published over 100 papers on a variety of topics and has done extensive research on lateral epicondylalgia.

Chapters

00:00 Intro

00:44 Definition of lateral elbow tendinopathy

05:39 Why Inflammation is inaccurate

11:49 Risk factors

13:46 The typical patient

17:34 Red Flags

27:30 Diagnostic tests

29:49 Leanne's Diagnostic Approach

32:27 Treatment

38:15 Details on Isometric Loading

49:29 Other treatments

54:02 Treatment Progressions

58:45 How much pain to allow

01:01:28 Shockwave and Dry Needling

01:03:56 Elbow Braces

01:05:50 Contact Info

01:06:58 Outro

Bonus Material

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In this episode of the Physiotutors podcast, Tom Goom, also known as the Running Physio, provides valuable insights into medial tibial stress syndrome (MTSS) and its management. He discusses the pathophysiology of MTSS, Risk factors, and emphasizes the importance of gradual training progression and proper footwear selection to prevent MTSS. Tom also shares his approach to assessing and treating MTSS, focusing on finding a pain-free level of loading, incorporating strength training, and carefully guiding patients through a structured return to running program.

It's a value-packed episode so tune in to master your approach to treating shin splints.

This episode is sponsored by Lindy.ai - your A.I. medical scribe. Try Lindy for free by going to lindy.ai/physiotutors and receive 1 week of unlimited patient notes.

Content

00:00 Intro

01:06 What is MTSS?

02:19 Risk Factors

03:34 Typical Patient

04:20 Specific Training Errors

05:40 Influence of Footwear

06:58 Forefoot Running

08:40 Red Flag Diagnoses

12:08 MTSS DIagnosis

13:06 Assessing the Patient

15:45 Muscle Testing

17:18 Sponsored Segment

18:55 Other Strength Parameters

21:05 Running Analysis/Technique

26:15 Treatment

29:29 Strengthening Exercises

31:58 What about Tibialis Anterior?

33:12 How to manage a flare-up?

35:25 Return to running

38:02 Different Mx for Different Sports

40:20 Duration of MTSS

41:35 Adjunct Treatments

43:30 Can MTSS become a Fracture?

44:25 Tom's closing remarks

46:25 Outro

Bonus Material

Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App.

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