Gregs social: https://www.instagram.com/greglehman/

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Gregs Website: https://www.greglehman.ca/

Chapters

00:00 Evaluating Shockwave Therapy in Tendinopathy

00:44 The Role of Exercise in Rehabilitation

03:43 Understanding Patient Ecosystems and Health

06:23 Case Studies: Practical Applications in Treatment

08:49 The Complexity of Pain Management

11:43 Research Critique: Shockwave Therapy and Evidence

14:10 Psychological Factors in Pain Perception

17:02 Clinical Decision-Making in Patient Care

26:00 Trusting Experts and Knowledge Translation

27:21 Challenging Established Beliefs

28:30 Comparing Treatment Philosophies

31:03 The Role of Patient Understanding

33:35 Exercise vs. Alternative Treatments

34:26 Load Management in Rehabilitation

35:54 Creative Approaches to Running Rehabilitation

37:06 Resistance Training for Runners

40:12 Skepticism Towards New Research

42:50 Understanding Bone Stress Injuries

54:53 Understanding Pain and Structural Changes

58:59 Navigating Risks in Running Injuries

01:04:20 The Role of Social Media in Health Information

01:09:39 Strength Training and Recovery Insights

01:12:24 Research Aspirations and Future Directions

Keywords:

shockwave therapy, tendon rehabilitation, exercise, pain management, sports medicine, patient education, metabolic health, case studies, research appraisal, individualized treatment, training protocols, bone health, stress fractures, plyometric training, rehabilitation, pain management, social media, health information, research ethics, performance.

Summary:

This conversation delves into the complexities of sports medicine, focusing on shockwave therapy, exercise rehabilitation, and the importance of understanding patient ecosystems. The speakers discuss recent research findings, the role of exercise in pain management, and the need for individualized treatment approaches. They also explore the psychological factors influencing pain and the critical appraisal of existing research in the field. In this conversation, Blake Withers and Greg delve into various aspects of training protocols, bone health, and the complexities of rehabilitation. They discuss the importance of flexibility in training, the role of frequency in plyometric exercises, and the nuances of managing pain in relation to structural changes. The dialogue also touches on the ethical considerations of pain in research, the impact of social media on health information, and future directions in rehabilitation research.takeaways

• Shockwave therapy may not provide additional benefits compared to exercise.
• Exercise should be critically evaluated just like other treatments.
• Improving a patient's overall health ecosystem is challenging but essential.
• Patient motivation is crucial for successful rehabilitation.
• Understanding the mechanisms of pain can enhance treatment outcomes.
• Research in sports medicine often lacks strong evidence for certain treatments.
• Individualized treatment plans are necessary for effective rehabilitation.
• Psychological factors play a significant role in pain perception.
• Exercise can positively influence peripheral nociception.
• Critical appraisal of research is vital for informed clinical practice. People can improve despite not following traditional protocols.
• Flexibility in training is crucial for optimal results.
• Frequency of training may be more important than intensity.
• Understanding bone health is essential for preventing stress fractures.
• Pain is not always a reliable indicator of injury severity.
• Social media can be a double-edged sword for health information.
• Research ethics play a significant role in studying pain management.
• The relationship between structure and pain is complex and often misunderstood.

We discuss the latest review PMID: 39704142 with Prof Peter Malliaras

✅ Identifying early responders – Can we predict who will benefit?

✅ Effect – Does it work?

✅ Diminishing returns – When does adding SWT to exercise stop being beneficial?

✅ Types of shockwave therapy – Why radial shockwave was chosen in this study

✅ Sham treatments – Do they still have a therapeutic effect?

✅ Mechanisms of action – Neuromodulation, therapeutic alliance, and tendon adaptation

✅ The ‘Big Machine Effect’ – Is patient belief in SWT part of its effectiveness?

✅ Comparisons to exercise – Would fewer appointments with exercise yield similar outcomes?

We also discuss clinical implications—will these findings change how shockwave therapy is used in practice?

🔗 References & Studies Discussed:

• Alsulaimani et al. (2024) - Achilles tendinopathy & shockwave RCT

• Benli et al. - SWT vs. exercise alone

• Heide et al. - Shockwave therapy for plantar heel pain

Find out about Peter and upcoming course:

https://www.tendinopathyrehab.com/home

Socials: https://www.instagram.com/tendinopathyrehab/

https://www.linkedin.com/posts/petermalliaras_my-new-tendinopathy-rehabilitation-framework-activity-7296743926009368576-GNRW/?utm_source=share&utm_medium=member_ios&rcm=ACoAAAexDmkBlV5e4jGTX2E4X9J6s8ZitO8yX0M&fbclid=PAZXh0bgNhZW0CMTEAAabnnAaDDYH_S3We7eJaZZbOHWHxrtGYC_5AiRO-rDUtmh29GdmHqrWh9fI_aem_FLbCehDnORljxK3cgMA8fQ

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1. Keep Intensity the Same

This is the biggest and easiest mistake. If your Achilles is sore, what will aggravate it most is higher rates of loading—formally, this happens more when you run faster. Yes, it might warm up during the run, but you’ll pay for it 24 hours later. You need to stress it just a little, see how it responds, and build from there.

2. Rest, Then Go Straight Back to Full Load

You shouldn’t completely rest and then jump straight back to the same training load. If you usually do speed work on Tuesdays, and you’ve had a week or two off, that first run back shouldn’t be the same session. Don’t do that. Start gradually—try something like 6 x 1-minute efforts and progress from there.

3. Wear Flat Shoes

Heel pitch helps Achilles tendon pain. A higher heel reduces both tensile and compressive forces by limiting dorsiflexion. Achilles pain isn’t just about the run—it’s about everything you do throughout the week. If you’re on your feet all day, even if it’s not sore at the time, that will contribute to your pain during training.

4. Not Question the Diagnosis

Sometimes, it’s not Achilles tendinopathy. Yes, if you’ve had it before, you can get it again—but not always. Other things mimic Achilles pain. Be sure.

5. Keep Training Load the Same

If you’re dealing with Achilles pain, take something away. Reduce intensity or volume—adjust something. If you’re not sure how, see someone who can help you make it graded.

6. Think the Adjuncts Are the Answer

They can help, but they’re not the solution. Shockwave, massage, needling—useful, sure. But if you’re not loading appropriately, nothing else will fix it.

7. Not Load It Properly

You have to load it. Strength, plyometrics, progressing appropriately—it all matters.

8. Smash the Anti-Inflammatories and Think That’s Enough

Anti-inflammatories aren’t bad, but if that’s all you’re doing, you’re missing the point. This isn’t an inflammatory condition—it’s a load issue.

9. Think Injections Are the Quick Fix

Too many people jump to injections too early. They can have a role in specific cases, but they’re not a cure.

10. Ignore the Psychology Behind Injury

This is huge. Achilles pain isn’t just about the tendon—it’s about the mental load of not running, the frustration, the identity shift. Understanding this can change everything.

Achilles tendinopathy, injury management, running injuries, health professionals, rehabilitation, load management, resistance training, anti-inflammatories, psychological impact, running performance

Mr. Ian Reilly qualified as a Podiatrist in 1988 and became a Podiatric Surgeon in 1996. Over his career, he has performed more than 11,000 surgical procedures under various anaesthesia types, showcasing his extensive expertise.

You can out more below by clicking the link on his website.

From 2001 to 2024, he led Podiatric Surgery at Northamptonshire Trust, significantly advancing podiatric care. Now retired from NHS practice, he focuses on private care, operating weekly at Three Shires Hospital in Northampton and treating patients across self-pay, insured, and NHS pathways.

Mr. Reilly specializes in:

Injection Therapy:

• Cortisone Injections

Podiatric Surgery:

• Cyst and ganglion excision (soft tissue lumps and bumps)

• Morton’s neuroma surgery (trapped nerves)

• Subungual and other bony exostectomies (bony bumps)

• Lesser toe correction (hammer toes)

• Metatarsal surgery for forefoot pain

• Surgery for hallux limitus (arthritis of the great toe)

• Surgery for hallux valgus (bunions)

• Haglund’s deformity (heel bumps)

• Plantar fasciitis (heel pain)

• Flatfoot surgery

Minor Surgery:

• Verrucae, corn, and skin surgery

• Nail surgery

Dr Ian Reilly website:

https://podsurgeon.co.uk/

Youtube: https://youtube.com/@ianreillypodsurgeon?si=rDK6BHAwRGBu4L3F

What it takes to become a Podiatric surgeon?

file:///Users/blakewithers/Desktop/ian%20pod/The%20Royal%20College%20of%20Podiatry.html

Mary PoppinsProbably Needed Orthotics article https://podiatrym.com/Highlights2.cfm?id=3286

Patreon: https://patreon.com/SportsMedicineProject?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink

00:00Introduction to Dr. Ian Riley02:07Career Progression in Podiatry05:53Surgical Experience and Case Studies07:24Injection Therapy in Podiatry13:55Managing Neuritis and Injection Guidelines18:43Understanding Osteoarthritis and Injection Therapy23:41Patient Case Study and Emotional Impact26:50The Role of Podiatry Post-Surgery32:22The Evolving Perspective on Orthotics35:12International Standards in Podiatry37:06The Importance of Imaging in Diagnosis39:42The Forefoot Examination Process42:28Understanding Morton's Neuroma46:02The Role of Imaging in Treatment Decisions48:31Surgical Indicators for Forefoot Conditions01:03:10Understanding Patient Concerns and Predictions01:05:14The Role of Orthotics in Treatment01:06:53The Importance of Communication in Healthcare01:08:57Navigating Conflicting Opinions Among Clinicians01:11:18Injection Therapy and Its Efficacy01:15:29Challenges in Treating Mid-Foot Osteoarthritis01:22:33Research Aspirations in Injection Therapy01:24:45Interviewing Historical Figures for Insight01:26:24Future Teaching and Learning Opportunities

We get so many questions each week that need more then a voice note or instagram post to answer so we're doing it here.

Casual yarn about what it is being a health professional with questions we get asked over the week.

Support the shoe - new content out on Patreon. How to assess the 1st MPJ (30 min how-to video) + how weekly video realises on the treatment of those common big toe pathologies, joint/sesamoid/adventitialbursa/met stress/FHL, PF.

https://patreon.com/SportsMedicineProject?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink

Cheers,

Blake and Kelly (sub 20 parkrunners)

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Takeaways

Bone health is crucial for injury prevention.

Resistance training is essential for building strong bones.

High strain rates and magnitudes are key for bone loading. In this episode, you will hear me talk about moving quickly to increase strain rate. I briefly touch on you can try to move the weight quickly (despite it moving slowly) and still a fast loading rate.

Bones adapt better to varied and dynamic movements.

Short bouts of loading can effectively stimulate bone health.

Recovery and nutrition are vital for bone remodeling.

Consult professionals for personalized rehabilitation plans.

Incorporate plyometrics for better bone stimulus.

Regular strength training benefits overall health.

Understanding bone mechanics can enhance athletic performance.

In this episode, we discuss the importance of understanding bone health, particularly in relation to stress injuries and rehabilitation. We explore the role of resistance training in building stronger bones and break down key principles for effective bone loading. You'll also hear why keeping exercises dynamic is crucial to prevent bones from adapting to repetitive movements. Backed by research insights, this conversation offers practical applications for improving bone health and preventing injuries—essential listening for athletes, clinicians, and anyone passionate about optimizing physical performance.

Chapters

00:00 Understanding Bone Health and Injury Recovery

04:21 The Importance of Resistance Training for Bone Strength

08:45 Key Principles for Building Strong Bones

16:21 The Role of Variability in Bone Loading

23:48 Recap and Research Insights on Bone Adaptation

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Follow Dr Bradley Neal, Ph.D. & Dr Simon Lack, Ph.D. and their upcoming education. It is well worth it.

https://linktr.ee/teampfp?fbclid=PAZXh0bgNhZW0CMTEAAabq-xxjXZLjaBghdw5ljiKbvKlw7yoHNqJVS3UoeWtqVhyEhsEsCjpPPUk_aem_NyxdN3NoW2Jz8S6V2LppPA

Agenda. Chapters available.

Clinical recap - Foot orthosis and PFP, Surgical case rehab & PRP for chondromalacia patella - good or bad?

Understanding patellofemoral pain biomechanics

Evidence-based interventions

Strategies for long-term management

Impact of anatomical variations

Effective patient education

Optimizing foot orthoses and footwear

Gait retraining for pain relief

Developing return-to-running protocols

Exercise programming for symptom management

Tailoring rehabilitation dosages

Advancing sports medicine practice

Breaking down myths about patellofemoral pain

Exploring cutting-edge research in rehabilitation

Learnings:

Takeaways:

Chapters

00:00 Introduction and Background of Brad Neal

02:56 The Journey into Patellofemoral Pain Research

05:20 Collaboration in Research and Clinical Practice

06:11 Case 1: Foot orthosis & PFP - Do or Don't?

07:39 Orthoses in Patellofemoral Pain Management

08:42 Evidence for orthosis and PFP

10:14 Loading Strategies for Patellofemoral Pain

11:25 Foot orthosis and different feet

17:06 case study 2: PFP need surgery?

25:29 Explaining chondromalacia patelli

30:12 Diagnosing PFP

32:14 Understanding Pain: Kneecap vs. Back Pain

33:21 Nociceptive Tissue and Treatment Tailoring

35:35 The Importance of Accurate Diagnosis

37:22 The Role of Physiological Changes in Pain

38:46 Prognosis and Long-Term Pain Management

45:09 Factors Influencing Pain Duration

48:45 The Impact of Structural Variations on Pain

52:01 The Role of Resistance Training in Joint Health

54:34 mindfulness and recreational runners with patellofemoral pain.

56:06 Dosing Activity vs. Traditional Exercise

01:03:49 Pain Neuroscience Education and Its Application

01:04:52 The Impact of Exercise on Osteoarthritis

01:05:18 The Role of Education in Patient Care

01:06:09 Innovative Approaches to Patient Education

01:07:23 Navigating NHS Waiting Lists

01:08:01 The Importance of Accessible Information

01:10:05 The Future of Patient Education

01:11:26 The Balance of Information and Clinical Guidance

01:12:53 Running Rehabilitation Strategies

01:13:34 The Mechanics of Running Retraining

01:17:00 Research Aspirations in Physiotherapy

01:21:35 Personal Insights and Future Directions

In this episode of The Sports Medicine Project, we explore navicular stress fractures—a high-risk injury requiring a unique approach due to the bone’s anatomy, biomechanics, and healing challenges.

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We cover:

This episode is for educational purposes only and should not be taken as medical advice.

Support the show if it brought you value. The only thing we want to do the money is crate a better show and better resources

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00:00 Welcome to Season Two

04:31 Bilateral Insertional Achilles Tendinopathy

22:05 Better Subjective Questioning

28:27 Neck of Femur Stress Fracture

31:39 Understanding Navicular Stress Fractures

32:35 Introduction to Navicular Stress Fractures

35:06 Incidence of Navicular Stress Fractures

35:15 Who Gets Navicular Stress Fractures?

36:57 Time to Diagnosis of Navicular Stress Fractures

38:20 Anatomy of the Navicular

41:46 Biomechanics of the Navicular

45:18 Risk Factors for Navicular Stress Fractures

50:27 Foot Stiffness and Navicular Stress Fractures

55:28 Diagnostic Tests for Navicular Stress Fractures

01:00:11 Differential Diagnosis for Navicular Stress Fractures

01:01:24 Understanding Mid-Foot Pain and Injuries

01:02:57 Blood Supply to the Navicular

01:03:32 Do Naviculars Have Blood Flow?

01:06:25 Healing Variability and Factors Affecting Recovery

01:09:49 Imaging of Navicular Stress Fractures

01:14:00 Differential Diagnoses Not to Miss

01:14:55 Management Strategies for Navicular Stress Fractures

01:14:58 Müller-Weiss Syndrome

01:15:14 Management of Navicular Stress Fracture

Addressing all the myths we hear about Bone stress Injuries and explaining the FACTS.

We're tackling a topic that’s often misunderstood—bone stress injuries. From runners to weekend warriors, many people have heard myths about these injuries that just aren’t true. In this episode, we're breaking down the myths and uncovering the real facts about bone stress injuries.

With Beau Tyrrell

https://www.instagram.com/stressfracturephysio/

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