Episodi
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Neuromuscular electrical stimulation (NMES) hasn't quite had the coverage it deserves, especially when one considers the strength of evidence supporting NMES as a musculoskeletal rehabilitation intervention
Today, Drs Elanna Arhos (Ohio State University) and Naoaki Ito (University of Wisconsin - Madison) are re-visiting how NMES is applied in sports clinical practice. Get the low-down on why you need NMES in your sports rehabilitation toolkit, and how to figure out dose and intensity.
In part 2 we discuss how to support patients to get the most out of NMES, and which equipment is best for your clinic.
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RESOURCES
Who's afraid of electrical stimulation? Let's revisit the application of NMES at the knee: https://www.jospt.org/doi/10.2519/jospt.2023.12028
Find out more about the Pain Science in Practice courses delivered by Prof Lorimer Mosley: https://tinyurl.com/25kzcfmh
Direct links for each of the North American Pain Science in Practice courses:
Vancouver, Canada (27-28 September, 2024): https://clinicalsportsmedicine.com/lorimer-moseley
San Francisco, USA (5-6 October, 2024): https://www.noigroup.com/event/pain-science-in-practice-moseley-san-francisco/
New York City, USA (12-13 October, 2024): https://www.noigroup.com/event/pain-science-in-practice-moseley-nyc/
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Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy.
In part 2 of this series, Dr de Vos covers the multitude of options for treatment, outside of exercise therapy. Should you and the patient consider corticosteroid injections, PRP injections, heel lifts, shockwave, NSAIDs, or surgery? And when? What are the important clinical considerations when patients choose these options? Part 2 has it all!
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RESOURCES
Terminating corticosteroid injection in tendinopathy? https://www.jospt.org/doi/10.2519/jospt.2023.11875/
Dutch multidisciplinary guideline on Achilles tendinopathy: (https://pubmed.ncbi.nlm.nih.gov/34187784/
Platelet-rich plasma injection for chronic Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/20068208/
Time to put down the scalpel when treating tendinopathy? https://pubmed.ncbi.nlm.nih.gov/31653777/
Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/
Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/
Clinical tool for identifying spondyloarthropathy: http://tinyurl.com/3my87hma
More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/
Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/
Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/
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Episodi mancanti?
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Dr Robert-Jan de Vos, sports physician and associate professor at Erasmus Medical Centre in Rotterdam, The Netherlands, dives deep into all things Achilles tendinopathy. As lead author of the Dutch Multidisciplinary Guideline on Achilles Tendinopathy (https://pubmed.ncbi.nlm.nih.gov/34187784/), he shares the key messages from this in-depth review.
In today’s episode, Dr de Vos covers the important tendon anatomy to guide your differential diagnosis, what information he is most focused on communicating to patients, and the key factors that can affect your choices when managing Achilles tendinopathy.
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RESOURCES
Why tendons like load: https://pubmed.ncbi.nlm.nih.gov/29920664/
Clinical diagnosis of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34692248/
Clinical tool for identifying spondyloarthropathy: https://www.researchgate.net/profile/Paul-Kirwan/publication/332275130_D18_SCREEND%27EM_BEFORE_YOU_TREAT%27EM_A_CLINICAL_TOOL_TO_HELP_IDENTIFY_SPONDYLOARTHROPATHY_IN_PATIENTS_WITH_TENDINOPATHY/links/5cab530da6fdcca26d06aaf1/D18-SCREENDEM-BEFORE-YOU-TREATEM-A-CLINICAL-TOOL-TO-HELP-IDENTIFY-SPONDYLOARTHROPATHY-IN-PATIENTS-WITH-TENDINOPATHY.pdf
More on the pain monitoring model: https://pubmed.ncbi.nlm.nih.gov/17307888/
Dosing your resistance training in tendinopathy: https://pubmed.ncbi.nlm.nih.gov/37169370/
Best treatment for Achilles tendinopathy (living systematic review): https://pubmed.ncbi.nlm.nih.gov/32522732/
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Sports Corner is back for 2024! Today, we revisit ice hockey, and focus on acute injuries—preventing and managing them.
Dr Joe Robinson is the head physical therapist for the National Hockey League’s Boston Bruins. He skates into Sports Corner to explain the physical demands of hockey, the typical acute injuries he sees and how to prevent them, and runs through how the medical team responds during emergency scenarios.
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Does the thought of managing elbow pain leave you reaching for your orthopaedics textbook? Maybe you've got lateral elbow tendinopathy sorted, but how confident do you feel about managing elbow fractures and dislocations?
Today, Val Jones, Clinical Lead Physiotherapist at the Sheffield Shoulder and Elbow Unit at the Sheffield Teaching Hospital Foundation Trust, shares practical advice to help you feel confident about managing elbow pain.
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RESOURCES
CT versus MRI for assessing osteochonritis dissecans of the capitellum: https://pubmed.ncbi.nlm.nih.gov/36342019/
Shoulder arm return to sport test battery: https://pubmed.ncbi.nlm.nih.gov/31203142/
Lateral elbow pain clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2022.0302
2022 Bern shoulder consensus: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952
JOSPT Insights episode 136 (lateral elbow pain with Drs Lucado and Day): https://podcasts.apple.com/us/podcast/ep-136-lateral-elbow-pain-2022-clinical-practice-guideline/id1522929437?i=1000617533681
JOSPT Insights episode 103 (baseball pitching biomechanics with Wake Forest Pitching Lab): https://podcasts.apple.com/us/podcast/ep-103-baseball-pitching-biomechanics-with-the-wake/id1522929437?i=1000581372250
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Did you know that calf injuries are one of the most common soft tissue injuries in team sports? How comfortable do you feel assessing and managing calf pain, especially designing and progressing a program to help someone get back to their sport?
Today, Dr Seth O'Neill from the University of Leicester, joins us to blend the latest science in calf injury with high-level clinical reasoning. You'll get something out of today's chat whether you're beginning in your clinical career or whether you're looking for suggestions for advanced clinical practice.
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Two (gentle) giants of physiotherapy/physical therapy research and practice join JOSPT Insights today.
Associate Professor Peter Kent and Professor Peter O'Sullivan (Curtin University, Perth, Australia) share, on behalf of the whole trial team, the results of their RESTORE trial. Does cognitive functional therapy herald a revolution in how clinicians can support people to live well with back pain? Let's find out.
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RESOURCES
For the published trial: https://pubmed.ncbi.nlm.nih.gov/37146623/
Find out lots more about the RESTORE trial, including how patients and clinicians feel about cognitive functional therapy: https://www.restorebackpain.com/
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Someone walks into your clinic with a sore shoulder. Are you dealing with a stiff shoulder? A rotator cuff problem? The acromioclavicular joint? Or something else entirely?
Today, Dr Angela Cadogan (PT, PhD) - Specialist Physiotherapist and clinical consultant - is helping you hone your clinical reasoning in differential diagnosis of subacromial pain.
Dr Cadogan shares her practical approach to diagnosing subacromial pain in a way that you can take straight to the clinic tomorrow.
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Welcome to part 2 of our masterclass with Dr Sam Bunzli (Griffith University, Brisbane, Australia) and Dr JP Caneiro (BodyLogic Physiotherapy, Perth, Australia) on understanding, talking about and shifting the narratives we all carry about musculoskeletal pain.
We are exploring the explicit and implicit messages that you communicate with your words and actions when you work with patients. Drs Bunzli and Caneiro share tips on communicating, and on developing your own practice as a musculoskeletal rehabilitation clinician.
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RESOURCES
For more on pain narratives, check out the 3-editorial series led by Dr Bunzli, "Broken Machines or Active Bodies", including 5 recommendations to shift the way you communicate with people in pain: https://www.jospt.org/doi/10.2519/jospt.2023.11879 and https://www.jospt.org/doi/10.2519/jospt.2023.11880 and https://www.jospt.org/doi/10.2519/jospt.2023.11881
More on how people communicate about knee osteoarthritis (qualitative review): https://pubmed.ncbi.nlm.nih.gov/33502513/
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We're wrapping up the 2023 JOSPT Insights year with a 2-part chat with physiotherapists, researchers and educators, Dr Sam Bunzli (Griffith University, Brisbane, Australia) and Dr JP Caneiro (BodyLogic Physiotherapy, Perth, Australia).
In part 1, we discuss the way that patients understand pain. Dr Bunzli kicks off by summarising the best research evidence, and Dr Caneiro shares some compelling clinical examples to explain how to apply the research to deliver quality musculoskeletal rehabilitation practice.
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RESOURCES
For more on pain narratives, check out the 3-editorial series led by Dr Bunzli, "Broken Machines or Active Bodies", including 5 recommendations to shift the way you communicate with people in pain: https://www.jospt.org/doi/10.2519/jospt.2023.11879 and https://www.jospt.org/doi/10.2519/jospt.2023.11880 and https://www.jospt.org/doi/10.2519/jospt.2023.11881
More on how people communicate about knee osteoarthritis (qualitative review): https://pubmed.ncbi.nlm.nih.gov/33502513/
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In part 2 of this series, we continue chatting about designing and implementing a rehabilitation program after cervical discectomy with Drs Justin Lantz, Jessica Evaristo and Joseph Derian.
Today we work through phases 3 and 4 in the rehabilitation program: re-modeling and maturation occurring around 12-weeks after surgery.
We cover nerve glides and how to dose them, the goals and areas of focus for manual therapy and therapeutic exercise, incorporating proprioception training, and important clinical milestones to consider along the way.
The patient’s goal was to return to manual labor, and we talk about how healing timelines impact on clinical decisions in the later stages of rehabilitation.
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RESOURCES
Read more about the case: https://www.jospt.org/doi/10.2519/josptcases.2023.11608
Catch part 1 here: https://podcasts.apple.com/us/podcast/ep-158-planning-a-rehabilitation-program-after/id1522929437?i=1000637409917 or https://open.spotify.com/episode/0Ci1ya1CHXB8FgYYBO4Q3q?si=94b548f8e3bd4b4e
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Join a group of experienced orthopaedic clinicians as they review the background of anterior cervical discectomy and fusion surgery in a 2-part podcast series.
In part 1, we cover who does well with surgery, the indications andsurgical procedure, plus a deep dive into evidence-based pre- and post-operative rehabilitation.
There's not much hard research evidence to guide your decisions on how to structure and deliver, so tune into hear how expert clinicians approach things.
You'll learn about the phases of rehabilitation (we tackle the first two in today's episode), what’s normal, what’s not, strategies for collaborating with surgeons, and suggested interventions.
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RESOURCES
Read more about the case: https://www.jospt.org/doi/10.2519/josptcases.2023.11608
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Dr Jeremy Graber joins us to help answer the question: how often should patients with total knee arthroplasty come to rehabilitation? To answer this and more, we dive into the 2023 JOSPT article, “Expert Consensus forthe Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study.”
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RESOURCES
Dr Graber and his colleagues led a expert consensus process to establish recommendations for how often and for how long you might consider scheduing rehabilitation visits. The group also discussed discharge planning, how to implement telerehabilitation, andmonitoring the patient's progress to guide clinical decisions
Check out the JOSPT article: https://www.jospt.org/doi/10.2519/jospt.2023.11840
For more on predicting outcomes after total knee replacement: https://www.medrxiv.org/content/10.1101/2023.10.23.23297404v1 (preprint)
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What you can do to help prevent neck pain? What are the best exercise approaches?
PhD candidate, Florian Teichert, and Professor Daniel Belavy, from The University of Applied Sciences in Bochum, Germany, discuss which exercises and why they might work. We use their recent systematic review published in JOSPT as a launching point for the discussion.
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RESOURCES
To read the full systematic review: https://www.jospt.org/doi/10.2519/jospt.2023.12063
Blog and infographic: https://www.jospt.org/do/10.2519/jospt.blog.20231011/full/
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How do you help someone manage cancer-related fatigue or get back to exercise after their treatment? Is it safe for someone with bone metastases to exercise?
PhD candidate and recent Master of Physical Therapy graduate, Kendra Zadravec, and Professor Kristin Campbell (Department of Physical Therapy at the University of British Columbia, Canada) share their research and clinical expertise in developing physiotherapy interventions for people with cancer to help answers to these questions and more.
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RESOURCES
Canadian Physiotherapy Association Oncology Division: https://www.oncologycpa.ca/
American PT Association Oncology: https://oncologypt.org/
Australian Physiotherapy Association - Cancer, Palliative Care and Lymphodema: https://australian.physio/membership/national-groups/cancer-palliative-care-and-lymphoedema
Macmillan UK: https://www.macmillan.org.uk/healthcare-professionals
ACSM guidelines for exercise and cancer: https://www.acsm.org/news-detail/2019/10/16/expert-panel-cancer-treatment-plans-should-include-tailored-exercise-prescriptions
One stop shop for cancer and exercise information: www.cancerexercise.ca (direct link to resources for health care providers: https://cancerexercise.med.ubc.ca/resources-hcp/
Recommendations for exercise with bone metastases (open access): https://pubmed.ncbi.nlm.nih.gov/34990293/
Systematic review on exercise for people with bone metastases: https://pubmed.ncbi.nlm.nih.gov/34358650/
Physical activity recommendations for cancer survivors living with bony metastases: https://pubmed.ncbi.nlm.nih.gov/33604871/
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Does the thought of managing elbow pain leave you reaching for your orthopaedics textbook? Maybe you've got lateral elbow tendinopathy sorted, but how confident do you feel about managing elbow fractures and dislocations?
Today, Val Jones, Clinical Lead Physiotherapist at the Sheffield Shoulder and Elbow Unit at the Sheffield Teaching Hospital Foundation Trust, shares practical advice to help you feel confident about managing elbow pain.
For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.
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RESOURCES
CT versus MRI for assessing osteochonritis dissecans of the capitellum: https://pubmed.ncbi.nlm.nih.gov/36342019/
Shoulder arm return to sport test battery: https://pubmed.ncbi.nlm.nih.gov/31203142/
Lateral elbow pain clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2022.0302
2022 Bern shoulder consensus: https://www.jospt.org/doi/full/10.2519/jospt.2022.10952
JOSPT Insights episode 136 (lateral elbow pain with Drs Lucado and Day): https://podcasts.apple.com/us/podcast/ep-136-lateral-elbow-pain-2022-clinical-practice-guideline/id1522929437?i=1000617533681
JOSPT Insights episode 103 (baseball pitching biomechanics with Wake Forest Pitching Lab): https://podcasts.apple.com/us/podcast/ep-103-baseball-pitching-biomechanics-with-the-wake/id1522929437?i=1000581372250
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Dr Casey Humbyrd—orthopaedic surgeon and Chief of foot & ankle orthopedics at the University of Pennsylvania—shares her expertise and insights on treating ankle sprains that are not responding to non-surgical treatment.
Dr Humbyrd reviews ankle anatomy and her rationale for recommending surgery, how she performs a Broström repair, and explains how she works in close partnership with physical therapists and patients to achieve quality rehabilitation and return to sport outcomes.
For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.
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Do you work with young people with ACL injury? Well, you're in the right place! Today, Drs Chris Kuenze and Adam Weaver walk through the story behind creating a comprehensive normative dataset for knee function and strength outcomes. You'll learn how the project got started, and how you can use the information to help make even more informed clinical decisions.
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RESOURCES
Find the paper "Age-, Sex-, and Graft-specific Reference Values From 783 Adolescent Patients At 5-7 months After ACL Reconstruction: IKDC, PEDI-IKDC, KOOS, ACL-RSI, Single-leg Hop, and Thigh Strength" on the JOSPT website: https://www.jospt.org/doi/abs/10.2519/jospt.2023.11389
To access the normative database: https://dataverse.lib.virginia.edu/dataset.xhtml?persistentId=doi:10.18130/V3/JNPHUB
For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.
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A surfer walks into your clinic with neck pain…What do you do next? And why?
Dr Lynn McKinnis expertly walks through when and how to apply the Canadian C-Spine Rule when a patient presents with neck pain, types of vertebral artery injuries, and tips for diagnosing and treating acute neck trauma.
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RESOURCES
Learn more about the specific case here: https://www.jospt.org/doi/full/10.2519/jospt.2016.0416
Canadian C-Spine Rule: https://med-fom-clone-pt.sites.olt.ubc.ca/files/2014/01/C-spine-Rule-FAQs.pdf
NEXUS Criteria for detecting clinically-important cervical spine injury following blunt trauma: https://www.nejm.org/doi/full/10.1056/NEJM200007133430203
For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.
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Does the thought of dermatomes and myotomes, nerve trunks and nerve roots fill you with confidence or fill you with fear? Physiotherapist and neuroscientist, Dr Annina Schmid (Nuffield Department of Clinical Neurosciences, Oxford University), shares a checklist of what you need to know, and what you need to do, to nail your neurological assessment next time you're in the clinic.
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RESOURCES
Does your neurological examination for suspected peripheral neuropathies measure up? Do a check-up here: https://doi.org/10.2519/jospt.2022.11281
Why you cannot trust the dermatomes: https://www.youtube.com/watch?v=BZYtAR4zUpg&t=283s
More from Dr Schmid's Neuromusculoskeletal Health and Science Laboratory: https://www.ndcn.ox.ac.uk/research/neuromusculoskeletal-health-and-science-lab
For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.
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