Physiotutors Podcast

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

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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

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In this podcast episode, Barbara Cagnie, a physiotherapist and manual therapist, discusses the topic of dry needling, providing valuable insights into its definition, physiological effects, and clinical applications. Dry needling is described as a technique used by physiotherapists to treat myofascial pain, with the insertion of thin filiform needles into specific trigger points aiming to reduce pain and restore muscle function. Barbara highlights the physiological basis of dry needling, emphasizing its effects on peripheral and central systems, as well as its potential impact on pain and inflammation.

The discussion delves into the differences between active and latent trigger points, reliability in identifying trigger points, and the mechanism of referred pain. Barbara also addresses the evidence supporting the efficacy of dry needling in various musculoskeletal disorders, particularly in neck pain, highlighting the need for ongoing research to further explore its clinical applications.

The conversation touches on the contraindications and potential risks of dry needling, emphasizing the importance of proper training and anatomical knowledge to minimize adverse events. The future of dry needling is also considered, with mentions of ultrasound-guided and electrical dry needling techniques.

Barbara's expertise and comprehensive explanations serve to demystify dry needling and shed light on its clinical relevance. Her insights not only provide valuable information for physiotherapists but also instill curiosity about the potential of this technique in optimizing patient care.

Chapters

• 00:00 Intro
• 00:46 Defining Dry Needling
• 01:49 The Physiology
• 07:26 Difficulty of human studies
• 08:15 Active vs. Latent Trigger Points
• 10:05 Reliability Issues of TP Therapy
• 12:00 Referred pain in Trigger Points
• 15:40 The local twitch response
• 17:50 In-situ vs. winding technique
• 18:36 Research vs. Clinical Practice
• 20:22 Dry Needling for Tendinopathy?
• 23:58 Evidence for MSK Complaints
• 28:01 Contraindications and Risks
• 30:45 Needles vs. Hands
• 32:16 Kai's Dry Needling Anecdote
• 33:06 Are we chasing short-term effects?
• 35:26 Top 3 Reasons to learn Dry Needling
• 40:01 Closing thoughts
• 41:06 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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In this episode, Dutch researcher Corinne Visscher discusses temporomandibular disorders (TMD) with a focus on prevalence, risk factors, diagnosis, and treatment. She provides insights on the research she is currently focused on, particularly in understanding the journey of patients with chronic complaints related to TMD. Corinne also emphasizes the importance of screening for TMD, providing counseling and advice on habits, and referring patients to oral facial physical therapists or dentists when necessary. She also highlights the link between TMD and secondary headaches, and offers ways to reach out to her for further information.

Content

00:00 Intro

00:35 What is TMD?

01:18 TMD Prevalence/Incidence

02:20 The typical TMD Patient

03:23 Risk Factors

06:38 Red Flag Screening

09:20 The Diagnostic Process

14:05 Special Tests

15:25 Questionnaires

17:47 TMD & Headaches

19:30 Am I clenching my teeth?

20:40 Is posture a factor for TMD?

22:50 The course of TMD

27:09 A place for Dry Needling?

28:29 Other Manual Therapies?

31:50 Current TMD Research

35:05 Top 3 Takeaways

40:20 Tension-Type or TMD Headache

42:28 How to get in touch

43:08 Outro

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In this Physiotutors podcast episode, Canadian researcher Yannick Tousignant-Laflamme introduces the Pain and Disability Drivers Management Model, a groundbreaking approach to understanding and managing chronic musculoskeletal pain, particularly low back pain. This model identifies five key domains across three dimensions, going beyond biomechanics to reveal the root causes of pain and disability. It underscores the significance of interdisciplinary collaboration and effective communication among healthcare professionals.

By integrating classification systems and prognostic tools, this model optimizes its effectiveness. Classification systems pinpoint patient subgroups, while prognostic tools screen for psychological factors affecting pain outcomes. Clinicians are encouraged to utilize these tools for screening, delving deeper for medium or high-risk patients. The incorporation of questionnaires and patient-reported outcome measures informs evidence-based decision-making. The ultimate aim? Personalized, evidence-based care for musculoskeletal conditions, addressing both physical and psychosocial factors.

Curious to learn more about this innovative approach? Tune in to the full episode for a comprehensive exploration.

Guest

Canadian researcher Yannick Tousignant-Laflamme is a professor at the School of Rehabilitation at the University of Sherbrooke. His research activities target the management of chronic pain associated with musculoskeletal disorders, particularly low back pain.

Content

00:00 Intro 00:40 What is the PDDM? 03:19 The 5 Drivers of Pain & Disability 07:56 The struggle with interdisciplinary care 11:15 Lifestyle within the PDDM 13:28 Why is PDDM more than a classification system? 17:23 Patient History within the PDDM 30:57 Why so many PROMs? 32:45 NSLBP - is it a helpful diagnosis? 39:37 Can Physiotherapists cover all 5 domains? 43:18 Is it all talking? 45:42 What has changed since 2017 49:28 How can we apply the PDDM? 3 Tips 51:26 Yannicks closing thoughts 53:15 Outro

Bonus Material

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In this podcast, we explore scapular dyskinesis, the abnormal movement of the shoulder blade. We discuss related terms like scapular misalignment and sick scapula, questioning the practicality of assessing it through visual observation. We highlight that identifying it as normal or abnormal may not guide treatment decisions or pinpoint the cause of shoulder pain. We also address its prevalence in athletes and non-athletes and suggest using various tests to assess scapular dyskinesis. Intriguingly, we'll reveal a surprising connection between scapular dyskinesis and an unexpected aspect of training, which might change the way you think about shoulder issues. So, join us for the full episode to uncover this fascinating insight.

Guest

Filip Struyf is a sportsphysiotherapist and professor at the Department of Rehabilitation Sciences and Physiotherapy at the University of Antwerp, Belgium. According to Expertscape, he is the #1 shoulder researcher world-wide. He teaches shoulder courses nationally and internationally and has created an online course together with us called "Rotator Cuff Related Shoulder Pain: Separating Facts from Fiction".

Content

00:00 Intro

01:15 The "correct" definition

04:05 What is "normal"

12:05 Prevalence

14:21 Is it a functional adaptation?

16:46 Scapula Dyskinesia as a risk factor?

26:09 How do we assess it?

28:51 How reliable or valid is assessment?

32:39 Can we improve scapula movement?

39:09 What's up with focussing on the lower trapezius?

42:26 What about Rhomboid Pain?

46:21 Is there a place for scapula mobilization techniques?

49:42 Filip's closing thoughts

52:15 Outro

Bonus Material

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In this podcast episode, sports physiotherapist and lifestyle expert Jaap Wonders discusses the several aspects of successful lifestyle interventions as part of the treatment plans in physiotherapy practice. He outlines the guidelines on proper sleep hygiene, diet and other important factors to take into account when prescribing a healthy lifestyle. We discuss the challenges of adopting healthy habits and what we can do about this.

Content00:00 intro 00:45 Why the interest in Lifestyle? 02:50 How to deal with unhealthy lifestyles 05:52 Failing to meet movement goals 10:43 Movement snacks 12:28 10K Steps a Day. What's the deal? 17:55 Recommendations on Nutrition 20:55 Healthy vs unhealthy Protein 24:55 The importance of sleep 31:16 How we address stress 36:09 Positive Stress 38:15 Mindfullness 39:05 Cold Showers 42:10 What doesn't kill you makes you stronger? 47:22 Lifestyle interventions in chronic conditions 58:00 3 steps to a healthier lifestyle 01:03:20 Closing thoughts 01:05:08 Outro

Bonus Material

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In this podcast episode, physiotherapist Sarah Michiels discusses somatic tinnitus, a type of tinnitus that is often caused by dysfunctions in the upper cervical spine and jaw. She highlights the prevalence of somatic tinnitus and the importance of a comprehensive diagnosis to rule out other causes. The talk provides insights into her evaluation and treatment approach, emphasizes the role of physiotherapy in improving muscle function and coordination to manage this debilitating condition.

Content

00:00 Intro 00:46 Definition of Somatic Tinnitus 01:35 Tinnitus and the Cervical Spine 04:47 Prevalence of Tinnitus 06:22 Epidemiology of Tinnitus 08:15 Physiotherapy Diagnosis Possible? 10:30 ENT Diagnosis of Somatosensory Tinnitus 14:27 Special Testing for Tinnitus 16:00 Cervical Spine Assessments 17:35 Tinnitus and the Jaw 18:51 Red Flags 20:53 Physiotherapy Effectiveness for Somatosensory Tinnitus 22:00 Typical Treatment Course 23:20 What causes Improvements in Symptoms? 25:18 Tinnitus Relapse 27:10 Prognostic Factors 29:30 Sarah's Treatment Approach 31:48 Why Patients get worse 34:15 How to learn more about Tinnitus 35:10 Is MT knowledge required? 36:20 Sarah's Closing Thoughts 37:30 Could Van Gogh have been saved? 38:10 Outro

Bonus Material

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Welcome to Physiotutors podcast episode 56 with Thomas Mitchell. Thomas is a wrist and hand specialist physiotherapist, and working toward his PhD at Sheffield Hallam. He is a physiotherapist of 25 years standing in primary care, private practice and sports. He is a First-contact Practitioner clinical supervisor and member of the British Association of Hand Therapists. He is also a Member of the Mulligan Concept Teachers Association, so the perfect person to talk to about the Mobilizations with Movement abbreviated as MWM.

He is also an instructor for our online courses and has developed the complete upper limb focus together with Andrew Cuff.

Content

00:00 Introduction 00:48 Definition of mobilizations with movement 02:42 Discussion on Mulligan's positional fault concept 04:14 Importance of symptom modification 06:39 Principles of mobilizations with movement 08:20 The concept of "Pill" in mobilizations with movement 10:36 The "Crocks" principle in mobilizations with movement 12:17 Empowering patients through functional positions 13:41 Personal adjustments in practice based on Mulligan's concept 15:33 Importance of Self-Treatment and Patient Expectations 17:03 Discussion on Plausible Fallacies and Patient Beliefs 18:40 Understanding Mulligan Concept and Pragmatic Approach 19:24 Explaining Treatment to Patients 20:40 Thomas Online Course 21:18 Differentiating MWM from Other Manual Therapy Techniques 23:16 Patient Control and Bottom-Up Approach in MWM 27:51 Evidence and Systematic Reviews on MWM 33:23 Importance of self-treatment and clinical expertise 35:57 Application of MWMS in chronic pain patients 37:40 Challenges with musculoskeletal rehab in the UK 40:13 Effectiveness of MWMS for lateral epicondylalgia and De Quervain's disease 44:34 Benefits of mobilizations with movement 47:36 Learning resources for Mulligan concept and MWMs 49:17 Thomas closing thoughts 51:08 Outro

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This episode of the Physiotutors podcast features Julia Treleaven, a researcher and physiotherapist, who discusses cervicogenic dizziness and its diagnosis. We delve into the condition's pathophysiology and prevalence in patients with chronic neck pain. We also discuss red flags to watch for during patient history taking and differentiating cervicogenic dizziness from other forms of dizziness. The episode covers functional tests used to assess balance and motor control and treatment options, including sensory-motor exercises, manual therapy, and posture correction. The discussion emphasizes the importance of focusing on the neck's role in such cases rather than just diagnosing the condition.

Content

00:00 Introduction

01:20 Definition

06:36 Characteristics of Cervicogenic Dizziness

12:08 Physical and Orthopedic Tests for Cervicogenic Dizziness

15:03 Functional Assessment for Cervicogenic Dizziness

18:25 Treatment for Cervicogenic Dizziness

26:10 Progressing Sensory Motor Control Exercises for Cervicogenic Dizziness

29:46 Role of the neck in dizziness

32:08 Research endeavors in neck-related dizziness

34:58 Determining the role of the neck in dizziness and the controversy of cervicogenic dizziness

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