JOSPT Insights

In today's part 2 of an NMES masterclass from Dr Elanna Arhos (Northwestern University) and Dr Naoaki Ito (University of Wisconsin - Madison), we're getting into the nitty gritty of how to support patients to get the most out of a very beneficial intervention. Drs Arhos and Ito, and their team have tested a mix of common stimulators available on the market today, and are here to share the results with us. Let them help you make an informed decision about your next equipment purchase for your clinic. ------------------------------ 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

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 (Northwestern 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. ------------------------------ 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

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! ------------------------------ 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/ Achilles Pain, Stiffness, and Muscle Power Deficits - 2024 updated clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2024.0302

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. ------------------------------ 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/ Achilles Pain, Stiffness, and Muscle Power Deficits - updated clinical practice guideline from AOPT: https://www.jospt.org/doi/10.2519/jospt.2024.0302

When patients improve following treatment, how much can be attributed to the intervention delivered, and how much is due to contextual factors and nonspecific effects that lie outside of the clinician's control? Dr. Giacomo Rossettini joins the podcast again as a co-author of a paper (link below) that answers that very question. Dr. Rossettini and his research colleagues tried to quantify the effect of contextual factors with a meta-analysis. They found non-specific effects play a big role in patients' outcomes. Today's discussion covers what these contextual factors are, how the researchers quantified them, and how musculoskeletal rehabilitation clinicians can harness non-specific effects to boost patients' outcomes. ------------------------------ RESOURCES Non-specific effects in musculoskeletal pain treatment outcomes (meta-analysis): https://www.jospt.org/doi/10.2519/jospt.2024.12126

Musicians and athletes might sometimes appear to exist in very different cultures. And yet, the single-minded focus, thousands of hours of practice, and high training loads on their musculoskeletal systems mean that musicians and athletes probably have more in common than they have differences. At least from a musculoskeletal rehabilitation perspective. Today's guest is Marianne Roos - a former clarinetist and forever musician-at-heart, who now practices as a physiotherapist and conducts her PhD research from Laval University, Canada. Marianne explains the physical and psychological demands of orchestra performance on the musician's body, and shares the results of her PhD research in developing programmes to reduce musculoskeletal injuries among orchestra musicians. ------------------------------ RESOURCES Barriers and facilitators to implementing rehabilitation and wellness programs for orchestral musicians: https://pubmed.ncbi.nlm.nih.gov/33853373/ Workplace injury prevention and wellness program for orchestra musicians: https://www.jospt.org/doi/10.2519/jospt.2024.12277

When it comes to serious injury, like an ACL tear, in college sport, how many young athletes return to their previous level of performance? Today's guest led a team that has done the hard yards of synthesising all the available data to find an answer. Dr Cortez Brown is a junior orthopaedic surgery resident at the University of Pittsburgh Medical Centre. In today's episode, Dr Brown shares the results of his systematic review, and guides listeners through the complex factors that affect return to play outcomes for college athletes. ------------------------------ RESOURCES Return to college sport after ACL reconstruction systematic review: https://www.jospt.org/doi/10.2519/jospt.2024.12483 Systematic review of return to competitive sport (all levels) after ACL reconstruction: https://pubmed.ncbi.nlm.nih.gov/25157180/

Dr. Simon Lafrance, a physiotherapist and researcher at the University of Montreal, dives into the pressing challenges in our healthcare system, particularly the growing wait times for musculoskeletal care. He discusses innovative models where physiotherapists lead as the first point of contact, enhancing patient access and reducing costs. Simon also explores the evolution of physiotherapists' roles in rehabilitation, the effectiveness of treatment approaches for spine pain, and how personalized care can transform patient satisfaction and outcomes.

Musculoskeletal rehabilitation clinicians are well versed in the physical and mental benefits of regular physical activity. Unfortunately there is limited evidence to guide clinicians on how to best support return to sport and physical activity after childbirth. That's where today's guest comes in. Dr Jenna Schulz (physiotherapist and postdoctoral researcher from Western University, Canada) specializes in pelvic health and sport, women’s health, and improving longevity in sport for females across the lifespan. Today, Jenna shares how she approaches supporting physical and mental readiness for sport postpartum, and when to refer to your colleagues in the multidisciplinary health care team. ------------------------------ RESOURCES Systematic review of exercise interventions for physical activity and cardiorespiratory fitness: https://www.jospt.org/doi/10.2519/jospt.2024.12666 Scoping review of guidelines for returning to physical activity and sport postpartum: https://pubmed.ncbi.nlm.nih.gov/37898507/ Relative Energy Deficiency in Sport (REDs) and the lactating athlete: https://pubmed.ncbi.nlm.nih.gov/37752008/

Most people who pursue a career in health care do so because they want to help people. Depending on where you work, patients might find it easier or harder to access high-value musculoskeletal care, and you might run into barriers to providing the care you would like to provide. Dr Roy Film is a physical therapist, educator and current President of APTA Maryland. In today's episode, Roy explains his work trying to make it easier for people to choose high-value musculoskeletal rehabilitation. ------------------------------ RESOURCES Racial disparities in outpatient PT use: https://www.jospt.org/doi/10.2519/jospt.2024.12641