Episodes
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Today's episode builds on last week's discussion of how changes in the way that the nervous system works after injury can compensate for impairments like joint instability, pain and muscle inhibition.
Dr Meredith Chaput (University of Central Florida) extends the 5 phases of the visual-cognitive control chaos continuum, to link the ways to assess for cognitive compensations and how to progressively load the visual-cognitive system during sports injury rehabilitation.
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RESOURCES
From control to chaos - visual-cognitive progression during recovery: https://www.jospt.org/doi/10.2519/jospt.2024.12443
The control-chaos continuum adapted to basketball: https://www.jospt.org/doi/10.2519/jospt.2023.11981
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Sports injury rehabilitation has moved well beyond simply focusing on physical function and recovery. There's various emphases on psychological responses to injury, mental readiness to return to sport, and now, the visual-cognitive components of recovery and return to sport.
Today, Dr Meredith Chaput (University of Central Florida) introduces the visual-cognitive control chaos continuum as a framework for sports injury rehabilitation. Her research uses functional MRI to evaluate neuroplasticity after knee injuries, focusing on understanding how people use visual attention to compensate for motor control, and how rehabilitation may better target these compensations.
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RESOURCES
From control to chaos - visual-cognitive progression during recovery: https://www.jospt.org/doi/10.2519/jospt.2024.12443
The control-chaos continuum adapted to basketball: https://www.jospt.org/doi/10.2519/jospt.2023.11981
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Missing episodes?
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You don't have to go foar to find a media story warning people off the high impacts of running, especially on concrete, and claiming that running is no good for your knees.
Maybe you've had someone in the clinic who worries that running will wear their joints out? My guest today has dedicated his career to helping runners stay healthy and running for life, and is adamant that running is a great physical activity choice, even for people with osteoarthritis and joint replacement.
Dr Jean François Esculier is a physiotherapist based in Kelowna, Canada. He leads the Research & Development team at The Running Clinic, and teaches at The University of British Columbia; his clinical practice is at MoveMed Physiotherapy.
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RESOURCES
Survey about perceptions on running and knee health: https://pubmed.ncbi.nlm.nih.gov/36199830/
Education resource on running and joint health, in 7 languages: http://hdl.handle.net/2429/82767
Evaluation of the education resource: https://www.jospt.org/doi/10.2519/josptopen.2024.0149
Free webinar (account required) about the influence of running on cartilage: https://therunningclinic.com/tv/?VideoId=185711&SelectedCategory=185731
Running with osteoarthritis case report: https://pubmed.ncbi.nlm.nih.gov/38725598/
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The relationship between musculoskeletal pain and mental distress is complex. Sometimes it can feel challenging to know where to start when supporting people to get their life back when they're struggling with chronic or persistent pain.
Today, Dr Pavlos Bobos (Western University, Canada) shares his own story of recovery from serious musculoskeletal injury, and how that experience drives the work he does now as a researcher. He discusses the results of a network meta-analysis of digital interventions for managing musculoskeletal pain and depression.
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RESOURCES
Network meta-analysis of digital interventions: https://www.jospt.org/doi/10.2519/jospt.2024.12216
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Were you someone who started delivering telerehabilitation for the first time during the pandemic? Or perhaps you're an early adopter?
Have you ever wondered how effective delivering rehabilitation via a screen is versus seeing the patient in the clinic?
Dr Belinda Lawford (The University of Melbourne) shares the latest research illustrating the benefits of telerehabilitation for managing chronic knee pain.
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RESOURCES
More on patients' perceptions of telerehabilitation/digital health: https://www.jospt.org/doi/10.2519/jospt.2024.12383
PEAK trial of telerehabilitation vs. in-person care for knee osteoarthritis: https://pubmed.ncbi.nlm.nih.gov/38461844/
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What are the pros and cons of using AI chatbots in musculoskeletal rehabilitation? What are chatbot applications in education, clinical practice, and research?
How does the chatbot advice compare to the recommendations of trusted clinical practice guidelines? Dr Giacomo Rossettini shares the results of 2 new papers from his research team to answer these questions.
This episode is about the best ways clinicians can think about using AI chatbots to advance their clinical practice, while avoiding the pitfalls.
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RESOURCES
Pros and cons of AI chatbots in musculoskeletal rehabilitation practice: https://www.jospt.org/doi/10.2519/jospt.2023.12000
ChatGPT vs. CPGs for managing lumbosacral radicular pain: https://www.jospt.org/doi/10.2519/jospt.2024.12151
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Surveys of elite adult athletes reveal high use of analgesics, particularly non-steroidal anti-inflammatory drugs (NSAIDs). While medications like paracetamol have a generally low risk profile, certainly compared with NSAIDs or opioids, using pain medications to mask an injury or prevent pain might increase the risk of injury or make an existing injury worse.
Julie Pedersen - physiotherapist and PhD student (University of Southern Denmark) - is studying what, how, when and why youth athletes use pain medications. Today, Julie discusses how clinicians, coaches, parents and schools can support safe use of analgesics among youth athletes.
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RESOURCES
Prospective study of Danish youth analgesic use: https://www.jospt.org/doi/10.2519/jospt.2024.12407
Prevalence, frequency, adverse events data from youth athletes: https://pubmed.ncbi.nlm.nih.gov/36100523/
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There's plenty of work going into how AI can make health care better - including in recording consultation notes, or making early cancer diagnoses, or opening up low cost ways of doing musculoskeletal imaging.
The technology and applications of AI in healthcare changes just about every week. Today, we're exploring generative AI as a help, not a hindrance to musculoskeletal rehabilitation practice.
Physiotherapists Rebecca Fechner (Queensland Paediatric Persistent Pain Service), Dr Josh Pate (University of Technology Sydney) and Professor Mick Thacker (Royal College of Surgeons Ireland) talk about ways to use chatbots and generative AI to generate ideas and solve clinical problems.
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RESOURCES
The Prompt Engineering Guide is a deep dive into how to craft effective prompts for generative AI: https://www.promptingguide.ai/
More on the science of active inference: https://pubmed.ncbi.nlm.nih.gov/25563935/
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Welcome to a chat with a physical therapist who is using their orthopaedic and sports skills outside the typical practice environment. Dr Patricia Weber shares her experience as a senior physical therapist in the shock trauma setting–a world that blends orthopedic, neurologic and multi-trauma in a challenging emotional and psychological environment.
Dr Weber is a senior physical therapist at the University of Maryland Medical Center. She primarily treats within the R. Adams Cowley Shock Trauma center in downtown Baltimore.
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In today's episode, Dr Nathan Vannatta outlines some ethical frameworks that the musculoskeletal rehabilitation clinician might use when working through clinical decisions, including about return to play.
Dr Vannatta outlines ethical theories and 4 approaches to bioethics. He explains how one might justify different decisions, depending on the ethical framing, illustrating the complexity of return to play decisions with the clinical example of 'Ellie', who is returning to soccer after ACL reconstruction.
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RESOURCES
More on ethics frameworks and return to sport decisions: https://www.jospt.org/doi/10.2519/jospt.2024.12310
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Specialist shoulder physiotherapists, Marianne van Gastel and Karin Hekman, are back for the second part of their discussion on rehabilitation for peple with anterior shoulder dislocation and Bankart repair.
Marianne and Karin share how they use a psychologically-informed practice type of approach to support athletes and patients to work through and overcome anxiety and apprehension.
The chat focuses on supporting patients to return to high levels of function, including sport, after their shoulder surgery.
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RESOURCES
Rehabilitation guideline for managing apprehension after anterior shoulder dislocation and Bankart repair: https://www.jospt.org/doi/10.2519/jospt.2024.12106To find out more and register for the YAHiR-JOSPT Young athlete’s Hip Webinar Series: https://semrc.blogs.latrobe.edu.au/events/yahir/
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Physiotherapists and clinician-researchers, Marianne van Gastel and Karin Hekman, share a new rehabilitation guideline on managing apprehension in people with anterior shoulder dislocation and Bankart repair.
Over the next 2 episodes of JOSPT Insights, Marianne and Karin will take us through the rehabilitation guideline, explain what's new in shoulder rehabilitation, and share their approaches to helping people feel confident to get back to the sports and recreation activities they love after shoulder dislocation.
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RESOURCES
Rehabilitation guideline for managing apprehension after anterior shoulder dislocation and Bankart repair: https://www.jospt.org/doi/10.2519/jospt.2024.12106
Patients' perspectives after treatment for anterior instability: https://pubmed.ncbi.nlm.nih.gov/37811392/
To find out more and register for the YAHiR-JOSPT Young athlete’s Hip Webinar Series: https://semrc.blogs.latrobe.edu.au/events/yahir/
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Musculoskeletal rehabilitation practitioners spend years honing our clinical skills—how much time do we spend thinking about and practicing skills like listening, working in teams, and making decisions?
Today, Dr Nicol van Dyk - physiotherapist and Assistant Professor at University College Dublin - is here to make the case for real skills as keys to expert musculoskeletal rehabilitation practice.
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RESOURCES
To find out more and register for the YAHiR-JOSPT Young athlete’s Hip Webinar Series: https://semrc.blogs.latrobe.edu.au/events/yahir/
Essential skills for Physiotherapists led by David Clancy: https://www.us.elsevierhealth.com/essential-skills-for-physiotherapists-9780443111280.html
Seth Godin blog on real skills: https://itsyourturnblog.com/lets-stop-calling-them-soft-skills-9cc27ec09ecb and TED talk https://ideas.ted.com/soft-skills-and-real-skills/
Harvard Business Review - In praise of the incomplete leader: https://hbr.org/2007/02/in-praise-of-the-incomplete-leader
More on listening as a clinical skill: https://pubmed.ncbi.nlm.nih.gov/30279218/
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NICOL'S TOP BOOK RECOMMENDATIONS
How to win friends and influence people (Dale Carnegie): https://www.amazon.com/How-Win-Friends-Influence-People/dp/0671027034
Leaders eat last (Simon Sinek): https://simonsinek.com/books/leaders-eat-last/
Dare to lead (Brene Brown): https://brenebrown.com/book/dare-to-lead/
The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You (John C Maxwell): https://www.amazon.com/21-Irrefutable-Laws-Leadership-Anniversary/dp/0785288376
Amazing discussion about vulnerability from Adam Grant with Brene Brown: https://www.youtube.com/watch?v=uXVhDSBiZCI
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The YAHiR (Young Athletes Hip Research) Collaborative takes over the JOSPT Insights podcast today. Tune in to learn about best practice in diagnosing and managing inguinal-related groin pain. Willem Heijboer, sports physiotherapist and clinical epidemiologist from the Amsterdam University Medical Centre, joins Dr Josh Heerey to share the latest research to inform your practice.
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RESOURCES
Learn more about how the YAHiR collaborative is partnering to promote and protect athletes' hip health through high-quality research: https://www.ndorms.ox.ac.uk/research/yahir
The next Young Athlete's Hip Symposium is on 25-27 September, 2024, at Worcester College, Oxford University
The YAHiR Collaborative, La Trobe University and JOSPT are co-hosting a webinar mini series in May and June 2024. In these webinars, you'll hear more from experienced clinician-researchers Drs Josh Heerey, Jo Kemp, Kate Jochimsen and Mike Reiman. Dr Lindsey Plass and Luke Kearney, who both have lived experience of hip pain limiting their sporting careers, bring the athlete's perspective. For more information, and to register: https://semrc.blogs.latrobe.edu.au/events/yahir/
More on the terminology of inguinal-related groin pain: https://pubmed.ncbi.nlm.nih.gov/36111127/
Reliability and accuracy of clinical tests for diagnosing inguinal-related groin pain: https://pubmed.ncbi.nlm.nih.gov/36643406/
Rehabilitation and return to sport after surgery for inguinal-related groin pain: https://www.sciencedirect.com/science/article/abs/pii/S1060187217300382
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There's an app for just about everything these days, including in musculoskeletal rehabilitation and exercises therapy. Have you been scrolling the app store wondering if there's anything worthwhile to recommend to patients?
Today, we're uncovering what makes a quality app for monitoring and promoting physical activity in chronic conditions, including musculoskeletal pain. Dr Alessio Bricca (Assistant Professor, University of Southern Denmark) and physiotherapist, Nikolaj Nøhr, share their latest research and discuss how to apply it in practice.
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RESOURCES
World Health Organization's global strategy on digital health (2020-2025): https://www.who.int/publications/i/item/9789240020924
More on the quality of health apps available in major app stores: https://pubmed.ncbi.nlm.nih.gov/35119367/
Research waste in musculoskeletal pain apps: https://pubmed.ncbi.nlm.nih.gov/30324177/
Benefits and harms of digital health interventions for promoting physical activity: https://pubmed.ncbi.nlm.nih.gov/37410534/
International consensus on research priorities for telehealth in musculoskeletal pain: https://pubmed.ncbi.nlm.nih.gov/37789304/
Making sense of digital health data in primary care: https://pubmed.ncbi.nlm.nih.gov/37096688/
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If you're looking for a guide to testing function and readiness to return to sport after injury, you're in the right place! Dr Eric Hamrin Senorski (PT, PhD; University of Gothenburg, Sweden) shares how he blends his research training with his clinical skills to help athletes and active people with ACL injury.
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RESOURCES
Project ACL ("Project Korsband") registry: https://projektkorsband.se/
Quadriceps and hamstrings strength reference values for soccer/football, basketball and handball: https://www.jospt.org/doi/10.2519/jospt.2022.10693
Hop and jump test reference values for soccer/football, and basketball: https://www.jospt.org/doi/10.2519/jospt.2024.12374
Knee injuries after returning to sport following ACL reconstruction: https://pubmed.ncbi.nlm.nih.gov/27162233/
Return to sport rates after ACL reconstruction: https://pubmed.ncbi.nlm.nih.gov/25157180/
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Dr Carrie Cooper does the lead climbing and helps you belay (see what we did there?) into the world of climbing. From bouldering to sport climbing—there's no need to go free solo (ok, ok...we'll stop now) if you don't know much about climbing. JOSPT Insights has you covered.
Dr Cooper discusses how climbing is like gymnastics, baseball, and rugby, with their shared hand, shoulder, and knee injuries. Some other key take aways from the episode are how to identify weakness that climbers are so good at hiding, and how to progress a return to climb program. Hang on; it’s good one!
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RESOURCES
Knee injuries in bouldering and rock climbing: https://pubmed.ncbi.nlm.nih.gov/32004071/
Classifying and managing flexor pulley injuries: https://pubmed.ncbi.nlm.nih.gov/30904240/
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Health care practice is slowly transitioning from a paternalistic way of delivering care (doing to the patient) to a shared decision-making model (doing with the patient). Health systems, clinical professions and individual clinicians are at different points along the transition.
As a process, shared decision-making provides a scaffold for the patient's values, preferences and circumstances to receive primacy when discussing options, benefits and risks. As a mindset, shared decision-making is a standard of excellence in clinical practice - it ensures your are focused supporting the patient to authentically engage in decisions about their health.
Today, Diane Slater, physiotherapist and educator from Aalborg University, Denmark is helping you self-diagnose your shared decision-making practice. Diane shares tips for staying up-to-date with the best information to support quality shared decision-making, which she has honed through her work as a coach and mentor to musculoskeletal health practitioners.
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Nick Kane, the head physio at Essendon Football Club in Australia, brings our attention back to Australian Rules Football. Like in all Sports Corner episodes, he reviews the demands of the sport, the common injuries, and key things to keep in mind when designing and progressing rehabilitation programs with Australian football athletes.
In today’s episode, we take a deep dive into the hard preseason work that goes into preventing injuries, as Nick shares the specific primary and secondary strategies his team uses to keep athletes healthy and performing at their best.
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RESOURCES
For more on the Sports MAP Network: https://sportsmap.com.au/
Normative isometric plantarflexion strength values: https://www.sciencedirect.com/science/article/pii/S1466853X23000469?via%3Dihub
More on the relationship between fascicle length and hamstring strength: https://bjsm.bmj.com/content/50/24/1524
JOSPT Insights episode 138 with Melissa Haberfield: https://open.spotify.com/episode/0qizZvG0ESHDfvWhOxq1Nd?si=c052ab2987e141f8 or https://podcasts.apple.com/us/podcast/ep-138-sports-corner-footy-the-game-they-play-in/id1522929437?i=1000619109573
JOSPT Insights episode 124 with Dr Seth O'Neill: https://open.spotify.com/episode/4n4wkxGK1hwBykR1MZyzJm?si=be616b82cc9542d6 or https://podcasts.apple.com/us/podcast/ep-124-caring-for-the-calf-with-dr-seth-oneill/id1522929437?i=1000604944985
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How do you approach evaluating psychological health factors when working with people in pain? Do you have an established process for screening? How about an approach to managing the psychological aspects of injury and health?
Athletes say they would like psychological support, while many musculoskeletal rehabilitation clinicians feel ill-equipped to provide appropriate support. What to do?!
Fortunately, Dr Kate Jochimsen (ATC, PhD; Massachusetts General Hospital) is leading a research program geared towards developing and evaluating mind-body interventions for chronic hip pain, and she addresses some of the clinical challenges in today's episode.
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RESOURCES
Psychologically-informed practice when managing sports injuries: https://pubmed.ncbi.nlm.nih.gov/37647239/
More on the prevalence of hip morphology in athletes: https://www.jospt.org/doi/10.2519/jospt.2021.9622
Physiotherapist-led treatment for hip-related pain: https://pubmed.ncbi.nlm.nih.gov/31732651/
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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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