106. Cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, and strength testing with Paula Peralta, Simon Olivotto, Nick Kendrick & David Toomey

Explore cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, & strength tests for athletes with Simon Olivotto, Dave Toomey, Paula Peralta & Nick Kendrick.

The Clinical Edge Senior Physio Education & Presentation team and I sat down to answer Clinical Edge member questions, and we wanted to share this one with you, so you can benefit from it too. In this Q&A, we discussed:

Cervical radiculopathy patients with an irritable presentation

• Do imaging findings such as modic changes, alter our management
• How can you approach treatment of cervical radiculopathy?
• Are medications indicated?
• Red flags you need to rule out
• Are sliders and gliders a useful treatment?

Sensitivity to cold or ice

• How can you use tests to identify sensitivity to cold or ice to guide your treatment?
• Does ice sensitivity indicate central sensitisation?
• How does this impact management?
• If your whiplash patients have sensitivity to cold or ice, how does this impact treatment & prognosis?
• Which research articles cover this topic?

Calf & achilles strengthening

• When is it best to perform calf raises into dorsiflexion (DF)?
• When should you avoid strengthening the calf into end of range (EOR) DF?
• What ankle issues may lead you to avoid strengthening or stretching into EOR DF?

Hip joint pain and the acetabular labrum

• Can we identify when the labrum is responsible for hip or groin pain?
• What tests are important to perform in patients with hip or groin pain?
• If deep structures such as the hip joint are painful or injured, does this mean more superficial structures such as the acetabular labrum are also pain generators?

Strength assessment & screening of athletes

• What strength screening tests can you perform in athletes with large demands such as motorcross?
• Which areas do you need to assess?
• What are simple and more complex ways to assess strength in different regions of the body?
• What are important considerations when designing a S&C program for a motocross athlete?
• Making sense of pain

How can you make sense of pain? How can you describe pain to your patients in a way that makes sense, and doesn't tell them "it's all in your head"? Find out how to improve your confidence with acute and persistent pain in the upcoming "Making sense of pain" module.

Warning: Contains swearing.

Links associated with this episode:

• Download and subscribe to the podcast on iTunes
• Download the podcast now using the best podcast app currently in existence - Overcast
• Listen to the podcast on Spotify
• Improve your clinical reasoning, assessment and treatment effectiveness, efficiency and results with a free trial Clinical Edge membership
• Clinical reasoning module - simplify complex patients, clarify your assessment and get great results with clinically reasoned treatment
• "Making sense of pain" module
• Let David know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Like the podcast on Facebook
• Infographics by Clinical Edge
• Clinical Edge Education & presentation team
• Simon Olivotto
• Paula Peralta
• David Toomey
• Nick Kendrick

Articles associated with this episode:

• Maxwell S, Sterling M. An investigation of the use of a numeric pain rating scale with ice application to the neck to determine cold hyperalgesia. Manual therapy. 2013 Apr 1;18(2):172-4.

• Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Annals of the rheumatic diseases. 2017 Jul 1;76(7):1269-78.

• Zhu S, Zhu J, Zhen G, Hu Y, An S, Li Y, Zheng Q, Chen Z, Yang Y, Wan M, Skolasky RL. Subchondral bone osteoclasts induce sensory innervation and osteoarthritis pain. The Journal of clinical investigation. 2019 Mar 1;129(3):1076-93.