JOSPT Insights

Recurrent back pain is common, and debilitating for some people. What if there was a simple, low cost way to prevent these recurring flare ups of back pain? Dr Tash Pocovi (Macquarie University, Sydney, Australia) explains the research she's been leading to test a walking + education program for preventing recurrent back pain. Dr Pocovi's research focuses on improving how low back pain is managed, and especially how it is prevented. ------------------------------ RESOURCES Walking, cycling and swimming for nonspecific low back pain systematic review: https://www.jospt.org/doi/10.2519/jospt.2022.10612 WalkBack trial: https://pubmed.ncbi.nlm.nih.gov/38908392/ Effect of WalkBack on duration and severity of recurrences of back pain: https://www.jospt.org/doi/10.2519/jospt.2025.13361

The latest update to the midportion Achilles tendinopathy Clinical Practice Guideline is live! Dr Ruth Chimenti is a co-author of the updated clinical practice guideline, “Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024”, and joins JOSPT Insights to share the key updates relevant for your practice. Dr Chimenti highlights the most important changes from the last CPG update in 2018, including specifics on the best way to exercise, how to approach patient education, and which modalities to consider. ------------------------------ RESOURCES Updated Achilles CPG: https://www.jospt.org/doi/10.2519/jospt.2024.0302 (no paywall) ICON 2019: International Scientific Tendinopathy Symposium consensus on terminology: https://pubmed.ncbi.nlm.nih.gov/31399426/ ICON 2020: International Scientific Tendinopathy Symposium consensus on psychological outcome measures: https://www.jospt.org/doi/10.2519/jospt.2022.11005 Dutch multidisciplinary guideline on Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/34187784/ TENDINopathy Severity Assessment - Achilles (TENDINS-A) outcome measure: https://www.jospt.org/doi/10.2519/jospt.2023.11964

The anterior talofibular ligament (ATFL) and the Achilles tendon captures much of our ankle attention. As JOSPT Insights listeners know, there's plenty more to the ankle than the ATFL. Today, Liz Bayley shares her approach to diagnosing, managing and ideally, preventing ankle pain in active people. Liz covers diagnosing the problem, where imaging fits, and how to support return to function, including high-level sport. Liz is a former professional dancer, who now works as a dance-specialist physiotherapist. Her clinic is in London's West End, in close proximity to the freelance professional and student dancers she works with, at Trinity Laban Conservatoire of Music and Dance, and on 'Matilda The Musical' in Covent Garden. ------------------------------ RESOURCES Lateral ankle ligament sprains clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2021.0302 Updated model of chronic ankle instability: https://pubmed.ncbi.nlm.nih.gov/31162943/ Predictors of chronic ankle instability: https://pubmed.ncbi.nlm.nih.gov/26912285/ Intrinsic foot muscle training systematic review: https://pubmed.ncbi.nlm.nih.gov/35724360/ Neuromuscular electrical stimulation for foot intrinsic muscles: https://pubmed.ncbi.nlm.nih.gov/35142810/

Clinicians appreciate the value of a trustworthy clinical practice guideline for helping guide decisions in practice. Professor François Desmeules (University of Montréal) led an international team of shoulder experts who synthesised the latest evidence on diagnosing and non-surgically managing rotator cuff tendinopathy. Today he shares the headlines of the CPG and explains how the guideline group made sense of all the evidence to come up with recommendations for assessment, diagnosis, treatment and prognosis, including return to sport. ------------------------------ RESOURCES Rotator cuff tendinopathy diagnosis, non-surgical medical care and rehabilitation CPG: https://www.jospt.org/doi/10.2519/jospt.2025.13182

Today, we continue the conversation on the latest consensus for managing acute and degenerative meniscus tears. We jump into non-surgical treatment, and all the return to sport considerations for athletes and active people with meniscus injury. Dr Arielle Giordano (University of Delaware) shares the results of the EU-US Meniscus Rehabilitation Consensus. ------------------------------ RESOURCES EU-US Meniscus Rehabilitation Consensus on prevention, non-operative treatment and return to sport: https://www.jospt.org/doi/10.2519/josptopen.2025.13539 DREAM trial primary report: https://pubmed.ncbi.nlm.nih.gov/38319181/ Should symptoms guide treatment choice in young patients? https://www.jospt.org/do/10.2519/jospt.blog.20240415/full/ Early surgery vs exercise therapy + education for traumatic and non-traumatic meniscus tears: https://www.jospt.org/doi/10.2519/jospt.2024.12245 Ep 224: Saving the meniscus: https://pod.link/1522929437/episode/NTg3YTgzZWUtYTZjZC00ZDYwLWI2OTAtYTczMzAzNTEyNzgz Ep 192: DREAMing of better care for meniscus tears: https://pod.link/1522929437/episode/Yzk2YzkyOWItMDk1MS00YWZkLWI2MjQtNmRlYjIwZGJmOTg0

Clinical Practice Guidelines (CPGs) are an incredible resource for clinicians of all experience levels—synthesizing all the research on a topic and packaging it into bite-sized recommendations and flow charts. But how often are clinicians adhering to these guidelines? In today’s episode, Dr Maggie Horn (Duke University) walks us through her research team’s work to assess if, how, and when clinicians follow CPG recommendations. The team worked with clinicians in their hospital system to embed templates in the EMR, and used self-report strategies to answer these questions, specifically for the neck pain CPG. Dr Horn reviews the neck pain CPG, how the research team evaluated adherence, and what the findings mean for CPGs and clinicians. ------------------------------ RESOURCES Neck pain clinical practice guideline (revised in 2017): https://www.jospt.org/doi/10.2519/jospt.2017.0302 Translating the neck pain CPG into practice framework: https://www.jospt.org/doi/10.2519/josptopen.2025.0101

No doubt you've come across people using the analogy of a broken down machine to describe an osteoarthritic joint. Or perhaps that too much loading on the joint is responsible for wearing it out - assuming that each joint has a finite number of movements in its lifetime. You've probably also heard from patients who are concerned that the exercise therapy you prescribe might do more harm to their already worn-out joint. But is that true? Today, Dr Alessio Bricca (Centre for Muscle and Joint Health, University of Southern Denmark) explores the evidence and refutes these beliefs. ------------------------------ RESOURCES Exercise Therapy "Wears Down" My Knee Joint: Myth or Reality?: https://www.jospt.org/doi/10.2519/jospt.2025.13069

Today is part 2 of a 2-part chat about hip health and training load for the youth athlete. Last episode, Dr Sara Lyn Terrell (Florida Southern College) discussed the developing hip, and the important distinction between primary cam morphology and femoroacetabular impingement syndrome. Many athletes have a bony bump on their hip that doesn't cause any problems - it's the morphology in combination with symptoms that clinicians might worry about. Today's episode builds on the foundation of the developing hip, and covers appropriate loads for youth athletes. Dr Terrell discusses how to plan, monitor and progress a loading programs, and how you might incorporate strength & conditioning principles into your practice. ------------------------------ RESOURCES Strategies to deter primary cam morphology in youth athletes: https://www.jospt.org/doi/10.2519/josptopen.2025.0128 Can we reduce injury risk during the adolescent growth spurt?: https://pubmed.ncbi.nlm.nih.gov/37823577/ “My kid is going through a growth spurt – what should I do?”: https://shorturl.at/FqqCM

The hip health of youth athletes as their skeletons grow and mature while the athlete copes with the physical and mental stressors of sport and life, has been receiving renewed attention. Today's episode of JOSPT Insights is part 1 of a 2-part chat about training load and the youth athlete's hip. We discuss how primary cam morphology and femoroacetabular impingement syndrome might develop. Dr Sara Lynn Terrell (Florida Southern College) shares her >20 years of experience in exercise science and strength & conditioning, and walks listeners through the complexity of working with youth athletes to support their best sports performance. ------------------------------ RESOURCES Strategies to deter primary cam morphology in youth athletes: https://www.jospt.org/doi/10.2519/josptopen.2025.0128 Oxford consensus on primary cam morphology and FAI (part 1): https://pubmed.ncbi.nlm.nih.gov/36588401/ Oxford consensus on primary cam morphology and FAI (part 2): https://pubmed.ncbi.nlm.nih.gov/36588402/

In this discussion, Dr. Brad Neal, an Advanced Clinical Academic Fellow at Queen Mary University, shares his expertise on managing patellofemoral pain, a common issue across various demographics. He highlights the importance of individualized treatment approaches, emphasizing education and targeted exercises. The conversation also explores the significance of running retraining for athletes, focusing on biomechanics and symptom management. Dr. Neal underscores the need for effective patient education and tailored strategies, especially for young athletes facing long-term implications.