Sports Medicine Project

with Dr Pat Vallance

In this episode:

1. Bent knee versus straight knee calf raises for Achilles rehab
2. Why calf position changes muscle activation
3. Achilles tendinopathy and tendon strain
4. Tendon stiffness and why it matters
5. Whether plyometrics build tendon stiffness
6. Whether running should be stopped during rehab
7. Load monitoring and pain guided rehab
8. Muscular endurance testing with single leg heel raises
9. Normative values for calf endurance
10. Psychological factors in tendinopathy
11. Kinesiophobia and pain catastrophising
12. Cortical versus spinal inhibition
13. How rehab may differ for Achilles compared with patellar tendinopathy

Resources mentioned:

Tampa Scale of Kinesiophobia
https://www.physio-pedia.com/Tampa_Scale_of_Kinesiophobia

Where to find Pat:

Tendinopathy Circuit Breaker
https://tendinopathycircuitbreaker.com/

Instagram
https://www.instagram.com/tendinopathy_circuit_breaker/

Supercharge Your Tendon Rehab course
https://events.humanitix.com/supercharge-your-tendon-rehab-cutting-edge-tendon-injury-rehab

Pat's recent publications:

Vallance, P., Kidgell, D. J., & Malliaras, P. (2026). Greater endogenous pain facilitation is associated with lower spinal excitability and maximal knee extension strength deficits in athletes with patellar tendinopathy. European Journal of Applied Physiology, 1-14.

Vallance, P., Malliaras, P., & Kidgell, D. J. (2026). Temporal motor evoked potential decomposition reveals that cortico-reticulospinal excitability is increased in athletes with patellar tendinopathy. Preliminary evidence of compensatory adaptation for diminished motor drive. Journal of Electromyography and Kinesiology, 103142.

Vallance, P. (2025). Neural deficits relevant to pain symptoms and functional impairments in individuals with Achilles or patellar tendinopathy (PhD Academy Award). British Journal of Sports Medicine.

Vallance, P., Siddique, U., Frazer, A., Malliaras, P., Vicenzino, B., & Kidgell, D. J. (2025). Transcranial magnetic stimulation and electrical stimulation techniques used to measure the excitability of distinct neuronal populations that influence motor output in people with persistent musculoskeletal conditions: A scoping review and narrative synthesis of evidence. Journal of Electromyography and Kinesiology, 103011.

Vallance, P., Kidgell, D. J., Vicenzino, B., & Malliaras, P. (2025). Endogenous pain modulation is not different in basketball or volleyball athletes with patellar tendinopathy compared to asymptomatic athletic controls. Musculoskeletal Science and Practice, 76, 103280.

Every major osteoarthritis guideline in the world lists weight management as core care. Ben Steele-Turner's scoping review pulled together 79 records on what physiotherapists do, and the picture is messy. Clinician surveys have 60 to 94 per cent of physios saying they include weight management. Notes audits and patient interviews put it closer to 8 to 22 per cent.

Ben is a physiotherapist and PhD candidate at the University of Portsmouth, and he joins me to talk through why that gap exists and what to do about it. We get into scope of practice and why so many clinicians find the conversation awkward.

We also cover the part I've always struggled with. Osteoarthritis is a whole system condition, inflammatory, metabolic, psychological, and yet the mechanical side is the bit I know how to do. Sets, reps, load, progression.. Ben and I dig into whether the lifestyle side actually outperforms what we're already doing, what someone can be offered for faster relief in the first few weeks, and where taping, footwear, orthoses and injections sit.

Then there's the steroid question. If a knee is angry and inflamed we know what that environment does to cartilage, but the drug that settles it is itself chondrotoxic. Do we steer people away from it or put it on the table and let them decide? And can we really blame someone for wanting the pain gone now, when most of us wouldn't accept "just live with it" for our own injuries either.

Ben finishes with how he selects exercise for someone with knee OA, whether he starts local or zooms out, and the one thing he wants every patient to walk away understanding about their knee.

Papers discussed:

Steele-Turner B, Gonçalves AC, Shepherd AI, Drummond H, Allison K, Bennell KL, Exell TA. Physiotherapist-led weight management for people with osteoarthritis: A scoping review. Osteoarthritis and Cartilage 2026;34:121-138. https://pubmed.ncbi.nlm.nih.gov/41276008/

Moseng T, Vliet Vlieland TPM, Battista S, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024;83:730-740. https://pubmed.ncbi.nlm.nih.gov/38212040/

Muscle injuries remain one of the most challenging conditions in sport. In this episode, sports physiotherapist Murray Leyland joins us to discuss the latest evidence on muscle injury diagnosis, rehabilitation, and return to play. We cover muscle injury classification, the role of MRI, load management, eccentric training, calf and hamstring injuries, and how clinicians can make more informed return to play decisions. This episode is packed with practical, evidence-based insights for clinicians working with athletes and active individuals.

Murray's Practice Below:

https://www.valleyphysiotherapy.au/

Paper: https://bjsm.bmj.com/content/early/2026/05/03/bjsports-2025-110986

In this episode, Professor Joanne Kemp discusses the latest evidence on femoroacetabular impingement (FAI) syndrome and challenges common assumptions about hip pain. We explore why structural findings such as cam morphology are often seen in pain-free individuals, how imaging should be interpreted alongside the clinical picture, and what the new PhysioFIRST randomised controlled trial tells us about strengthening versus stretching. Joanne also shares practical advice for clinicians on patient education, treatment decision making, and translating research into everyday practice. Whether you're a clinician, student, or interested patient, this episode provides an evidence-based perspective on the assessment and management of hip pain.

Professor Joanne Kemp is a physiotherapist, researcher, and Professor at La Trobe University. She leads internationally recognised research in hip pain and femoroacetabular impingement (FAI) syndrome, with a focus on improving non-surgical management through high quality clinical trials. Joanne has authored more than 150 peer reviewed publications and is the lead author of the recent PhysioFIRST randomised controlled trial published in the British Journal of Sports Medicine.

Follow Kim https://www.linkedin.com/in/kim-hebert-losier/

Summary

Dr. Kim Hebert-Loser shares insights on calf muscle function, footwear technology, injury prevention, and the future of personalized shoe design. Discover how research, biomechanics, and individual preferences shape optimal running and rehabilitation strategies.

Stress fractures feel like they're everywhere lately but I don't think its changing disproportionately. I dig into why, what's really going on, and which bits of the "epidemic" narrative I think hold up.

Refs:

Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD. Risk factors for stress fractures in track and field athletes: a twelve-month prospective study. American Journal of Sports Medicine. 1996;24(6):810–818.

Knapik J, Montain SJ, McGraw S, Grier T, Ely M, Jones BH. Stress fracture risk factors in basic combat training. International Journal of Sports Medicine. 2012;33(11):940–946.

Changstrom BG, Brou L, Khodaee M, Braund C, Comstock RD. Epidemiology of stress fracture injuries among US high school athletes, 2005–2006 through 2012–2013. American Journal of Sports Medicine. 2015;43(1):26–33.

Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The epidemiology of stress fractures in collegiate student-athletes, 2004–2005 through 2013–2014 academic years. Journal of Athletic Training. 2017;52(10):966–975.

Shi BY, Castaneda C, Sriram V, Yamasaki S, Wu SY, Kremen TJ. Changes in the incidence of stress reactions and fractures among intercollegiate athletes after the COVID-19 pandemic. Journal of Orthopaedic Surgery and Research. 2023;18(1):788.

Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. American Journal of Roentgenology. 2004;183(3):635–638.

Kiuru MJ, Niva M, Reponen A, Pihlajamäki HK. Bone stress injuries in asymptomatic elite recruits: a clinical and magnetic resonance imaging study. American Journal of Sports Medicine. 2005;33(2):272–276.

Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nature Reviews Disease Primers. 2022;8(1):26.

AusPlay (Australian Sports Commission). National participation data on running and jogging, 2015–present. https://www.clearinghouseforsport.gov.au/research/ausplay

In this episode, we explore questions such as:

Why does pain persist despite multiple high-quality treatments?

What does it actually mean to say pain is multifaceted, and how should that change clinical decision making?

How should clinicians communicate about pain in a way that is accurate, validating, and actionable?

What should clinics stop doing, start doing, and measure if they want to improve care?

In this episode, we speak with Dr Nardia-Rose Klem, a physiotherapist and research academic at Curtin University whose work focuses on young people living with persisting pain, particularly the relationship between pain, mental wellbeing, and access to appropriate care.

She is involved in several important clinical translation and public education initiatives, including young painHEALTH, painHEALTH, and the Musculoskeletal Clinical Translation Framework, all of which aim to improve the way pain and musculoskeletal conditions are understood, communicated, and managed. Her research spans young people with chronic musculoskeletal pain, co-existing mental health conditions, pain care experiences, and qualitative work exploring patient experiences across musculoskeletal healthcare contexts. 

Links mentioned

Profile and socials

Curtin University staff profile

Instagram: @physio_nardia

Websites and resources

young painHEALTH

painHEALTH

Musculoskeletal Clinical Translation Framework

Örebro Musculoskeletal Pain Screening Questionnaire, short form

Publications

Characterizing phenotypes and clinical and health utilization associations of young people with chronic pain: latent class analysis using the electronic Persistent Pain Outcomes Collaboration database 

“It’s kind of just like a never-ending cycle”: Young people’s experiences of co-existing chronic musculoskeletal pain and mental health conditions 

Lived and care experiences of young people with chronic musculoskeletal pain and mental health conditions: a systematic review with qualitative evidence synthesis 

A Prospective Qualitative Inquiry of Patient Experiences of Cognitive Functional Therapy for Chronic Low Back Pain During the RESTORE Trial 

What Influences Patient Satisfaction after TKA? A Qualitative Investigation

In this episode of the Sports Medicine Project, Blake Withers is joined by Dr. Gerald Yeo, a renowned foot and ankle orthopedic surgeon, to discuss the intricacies of foot and ankle surgeries, particularly focusing on Achilles tendon and navicular stress fractures. Dr. Yeo shares insights from his extensive experience, discussing the challenges and advancements in surgical techniques, and the importance of a multidisciplinary approach in treatment.

• Dr. Gerald Yeo emphasizes the complexity of foot and ankle surgeries compared to other orthopedic procedures.
• The discussion highlights the importance of a multidisciplinary approach involving physiotherapists and podiatrists.
• Dr. Yeo explains the traditional and modern approaches to treating Achilles tendonitis.
• The episode explores the challenges of measuring surgical outcomes for foot and ankle procedures.
• Dr. Yeo shares insights on the use of Richie braces in managing foot conditions.
• The conversation covers the role of imaging in diagnosing and planning surgeries.
• Dr. Yeo discusses the potential of minimally invasive techniques in foot and ankle surgery.
• The episode addresses the common misconceptions about Haglund's deformity and its treatment.
• Dr. Yeo talks about the importance of patient education in managing expectations post-surgery.
• The discussion includes the future of orthopedic surgery and potential advancements in treatment options.

Keywords: Achilles tendon, navicular stress fractures, orthopedic surgery, foot and ankle, multidisciplinary approachTakeaways:

Dr Gerald Yeo is a Queensland trained orthopaedic surgeon (BMedSci, FRACS (Ortho), FAOrthA) with subspecialist fellowship training in foot and ankle surgery. His clinical interests include minimally invasive and arthroscopic techniques, total ankle replacement, and lower-limb trauma, with a focus on supporting recovery through early, functional rehabilitation and multidisciplinary care. He consults and operates in Brisbane, including at Brisbane Orthopaedic Specialist Services and St Vincent’s Private Hospital Northside, and also consults at North Lakes and operates at North West Private Hospital. (drgeraldyeo.com.au)

Confused by all the ASICS “Blast” shoes? In this video I break down the entire Blast family and help you match the right shoe to your running.Megablast – max stack, FF TURBO SQUARED, ultra-bouncy long run and easy day optionSonicblast – dual-foam midsole with Pebax plate, built for tempo and faster long runs Superblast 2 – the super trainer sweet spot for daily training, long runs and some workouts Novablast 5 – the classic bouncy daily trainer, 8 mm drop, big stack without feeling unstable  Dynablast – more affordable, lower stack, flexible Blast option that still feels fun underfoot Which models suit higher weekly mileage and long runsWhen I might lean towards Megablast or Superblast?Where Dynablast and Novablast fit for newer runners or those not used to very high stack shoes?

Summary

In this conversation, Blake Withers interviews Aidan Rich, a sports and exercise physiotherapist, about his research on proximal hamstring tendinopathy and the recent randomized control trial comparing physiotherapy and shockwave therapy. Aidan shares his journey into the field, the challenges of designing the study, and the importance of education in treatment. They discuss the nuances of exercise rehabilitation, patient experiences, and the surprising results of the trial, which showed no significant difference between the two treatment methods. Aidan emphasizes the need for individualized care and the potential for future research in this area.

Paper links:

Main RCT: https://journals.sagepub.com/doi/10.1177/03635465251391134

https://pubmed.ncbi.nlm.nih.gov/41037932/

https://pubmed.ncbi.nlm.nih.gov/40469642/

https://www.jsams.org/article/S1440-2440(25)00275-0/pdf

Aidan Rich:

PhD Candidate | APA Titled Sports and Exercise Physiotherapist | State Manager
A dedicated and passionate physiotherapy professional with extensive experience in both academic research and clinical management. Currently pursuing a PhD with the topic of 'Physiotherapy for Proximal Hamstring Tendinopathy,' where he has conducted two randomised trials. In addition to his academic pursuits, he oversee the clinical, financial, and cultural performance of a network of 20 physiotherapy and sports medicine clinics across Victoria. His role involves ensuring the highest standards of patient care, optimising financial performance, and fostering a positive and collaborative work environment.

Chapters

00:00 Introduction and Background of Aidan Rich

03:48 The Evolution of Tendinopathy Treatment

08:30 Shockwave Therapy: Insights and Experiences

13:13 Designing the RCT: Methodology and Protocols

18:20 The Exercise Program: Structure and Rationale

23:07 Education in Rehabilitation: Importance and Implementation

28:39 The Benefits of Resistance Training

29:52 Qualitative Insights from RCT Participants

31:36 Surprising Strength Outcomes in Rehabilitation

33:42 Effect Modifiers in Treatment Response

35:20 Clinical Applications of Shockwave Therapy

37:01 Patient Preferences in Treatment Choices

38:00 Individualized Treatment Approaches

39:04 Evaluating Shockwave Therapy Effectiveness

41:22 Challenges in Designing Effective Trials

43:22 Comparative Outcomes in Tendinopathy Treatments

45:43 Acute Responses to Shockwave Therapy

48:36 Key Takeaways for Clinicians

50:59 Future Directions in Research