Physio Edge podcast with David Pope

Anterior knee pain can occur in your elite sports patients right through to office workers and weekend warriors. In this podcast with Kurt Lisle, we discuss anterior knee pain, the causes, how to diagnose the source of the pain, and the best ways to treat and rehabilitate these patients. Kurt Lisle is the Australian Socceroos Physio and co-owner of The Knee Joint Physio in Queensland. Kurt and I discussed acute knee injuries on the Physio Edge podcast in episode 29, and I really wanted to get Kurt back on the podcast to discuss the anterior knee. In this fantastic, detailed episode of the Physio Edge podcast, Kurt and I explore: Subjective clues that give you ideas about differential diagnosis Fat pad - location of pain, activities that irritate Patellofemoral joint - aggravating activities and DDx Patellar tendon - subjective clues, location of pain Objective examination of the anterior knee Tests for PFJ Functional tests first or examination on the treatment table? Palpation of the anterior knee Fat pad palpation and tests Is the fat pad tender medial and laterally, or can it be tender only on one aspect Neuromuscular patterning Squat and one leg squat examination What causes “catching” pain on movement Chondral defects - identifying Is there value in the grind test When to refer for MRI and other imaging Important factors that may contribute to AKP Gait contributors to AKP Treatment of PFJ pain Modifying PFJ aggravating activities Using EMG Quadricep rehabilitation and strengthening When to incorporate squats into your rehabilitation program The role of taping for PFJ or fat pad irritation Red flags causing knee pain Links of Interest Kurt Lisle The Knee Joint Physiotherapy, Bokarina, QLD Socceroos Review the Physio Edge podcast in iTunes Clinical Edge

ACL injuries can be career ending, or they can be an opportunity to sort out movement efficiency, motor control and and technical skills, coming back from the rehabilitation process with more power, speed and efficiency than they had before they injured their ACL. In this podcast, Enda King from the Sports Surgery Clinic in Dublin currently completing his PhD in 3D biomechanical analysis after ACL reconstruction, with the aim to assist in RTP decision making and identifying fully rehabilitated athletes, and David Pope discuss ACL injuries, and the most important factors in pre-operative management and post-operative exercise programming to get your patients back to sport with improved sporting performance. Going deep on the details involved in ACL Rehabilitation, including: 01:20 Enda King and SSC, and working with ACL athletes PhD in 3D biomechanical analysis after ACL reconstruction, aim to assist in RTP decision making and what a fully rehabilitated athlete looks like What does a fully rehabilitated athlete look like? Incorporating performance goals into the rehab process Can athletes achieve better performance post ACL rehab than they were pre-injury Types of ACL grafts Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery Preoperative education Restoring knee extension, balancing pain and improved range of movement, empowering your patient Guidelines for pain, swelling when restoring range of movement Restoring quadriceps activation, normalising gait patterns Clinical Edge Clinical Edge’s free webinar program Preoperative length of time Post-op - initial management To use or not use co-contraction exercises of quads and hamstrings Should you use squatting style exercises Week 1 post op Activating quadriceps - internal quadriceps cues or external exercise focus How much pain should a patient experience during or after an exercise Week 2 post-op When can heavy gym training commence Changing movement patterns throughout the kinetic chain Advice for patients in the early stages of rehab Frequency of exercise Week 2 onwards - exercises incorporating balance and proprioception Open vs closed chain exercises Advice for patients in weeks 2–6 Nutrition and dietary advice for patients Gym based rehabilitation Choosing and modifying exercises for middle stages of the rehabilitation process Various types of squatting movement, and progressing the types of squats Goblet squats Retraining ideal squat patterns Progressing squats, deadlifts and lunges Front squats Front squats and trap bar deadlifts vs back squats during rehabilitation When can an athlete start cycling Disadvantages of using cycling as the main part of a rehabilitation program Hamstring rehabilitation after semitendinosis/gracilis graft Strength and power development Strength testing - mid thigh pull, leg press Should we use open chain strength tests When to perform strength tests Strength vs power and rate of force development Running - incorporating into the program. When can your patient start running? Preparation for running Running drills Ideal movement patterns in running Enda King and SSC, and working with ACL athletes Podcast timeline 3:35 What does a fully rehabilitated athlete look like? 5:40 Incorporating performance goals into the rehab process 6:50 Can athletes achieve better performance post ACL rehab than they were pre-injury 8:20 Types of ACL grafts 11:10 Preoperative ACL Physiotherapy, helping your patient to prepare for the surgery - an opportunity to prepare your patients knee, ROM, strength and educate them on the rehabilitation process 14:20 Preoperative education 14:40 Restoring knee extension, balancing pain and improved range of movement, empowering your patient with 15:40 Guidelines for pain, swelling when restoring range of movement 16:15 Restoring quadriceps activation, normalising gait patterns 17:10 Clinical Edge 18:45 Clinical Edge’s free webinar program 19:30 Preoperative length of time 20:35 Post-op - initial management 23:20 To use or not use co-contraction exercises of quads and hamstrings 24:50 Should you use squatting style exercises Week 1 post op 25:25 Activating quadriceps - internal quadriceps cues or external exercise focus 26:30 How much pain should a patient experience during or after an exercise 27:30 Week 2 post-op 28:30 When can heavy gym training commence 29:30 Changing movement patterns throughout the kinetic chain 31:00 Advice for patients in the early stages of rehab 32:10 Frequency of exercise 32:55 Week 2 onwards - exercises incorporating balance and proprioception 34:10 Open vs closed chain exercises 35:40 Advice for patients in weeks 2–6 37:15 Nutrition and dietary advice for patients 37:45 Gym based rehabilitation 38:50 Choosing and modifying exercises for middle stages of the rehabilitation process 41:00 Various types of squatting movement, and progressing the types of squats 41:45 Goblet squats 42:30 Retraining ideal squat patterns 43:25 Progressing squats, deadlifts and lunges 44:00 Front squats 46:00 Front squats and trap bar deadlifts vs back squats during rehabilitation 47:25 When can an athlete start cycling 48:00 Disadvantages of using cycling as the main part of a rehabilitation program 48:30 Hamstring rehabilitation after semitendinosis/gracilis graft 49:45 Strength and power development 51:00 Strength testing - mid thigh pull, leg press 53:15 Should we use open chain strength tests 54:20 When to perform strength tests 55:00 Strength vs power and rate of force development 55:50 Running - incorporating into the program. When can your patient start running? 57:30 Preparation for running 58:35 Running drills 1:00:30 Ideal movement patterns in running Links: Enda King Enda on Twitter @enda_king Sports Surgery Clinic, Dublin SSC Research Foundation David Pope on Twitter Review the podcast in iTunes

CrossFit is a very popular form of improving strength and fitness, and CrossFit athletes have a variety of common injuries. Training errors and the athlete’s biomechanics often contribute to these injuries, and identifying incorrect biomechanics and other contributing elements in their training is often the key to helping your patients recover from injury, train pain free and importantly for your patients, ultimately get stronger and fitter. In episode 30 of the Physio Edge podcast, David Pope discusses CrossFit injuries, training, biomechanics and injury recovery with Antony Lo. Antony is a Musculoskeletal Physiotherapist with a number of clinics within CrossFit gyms across Sydney, and a large proportion of his patient population are CrossFit athletes. In this podcast Antony and David explore: The most common injuries in CrossFit Factors that contribute to injuries in the Shoulders, Neck, Back, Knees, and lower limb Specific exercises performed in CrossFit Squats Pullups/Chinups Pushups Overhead exercises Double unders Overhead squats Snatch Running Ideal biomechanics for each of these movement Common movement errors and ways to assess each movement Rest from training vs continue training Manual therapy on cross fit athletes Modifying training loads Rhabdomyolisis Urinary continence while training Advice for Physios treating CrossFit athletes Links of Interest Review the podcast in iTunes Clinical Edge – fantastic online and face to face education for Physiotherapists Antony Lo Antony’s Website – physiodetective.com Antony on Twitter CrossFit  Hide

Shoulder pain patients often have poor scapula control. Is their shoulder pain caused by poor scapula control, or is their scapula dysfunction caused by shoulder pain?   When your patients present with shoulder pain, should your focus be on scapula control, glenohumeral control, or treatment of the neck and thorax? In this podcast, David Pope talks to Ann Cools, a Physiotherapist and Head of Education for Rehabilitation Sciences and Physiotherapy at Ghent University in Belgium, and is also the founding member and president (2010–2012) of EUSSER - European Society of Shoulder and Elbow Rehabilitation. We discuss in detail assessment of the scapula, the role of the scapula in shoulder pain and how to retrain unruly scapulae. Other topics covered in this podcast include: Research by Ann Cools What we currently know from the research about the role, movement and control of the scapula Scapula dyskinesis - what is it Static vs dynamic assessment of the scapula Altering muscle balance and timing with specific exercises How altering scapula mechanics effects muscle balance around the shoulder Important parts of the subjective history Scapula vs glenohumeral joint How subjective will guide your objective assessment and treatment Red flags around the shoulder, nerve pathology and frozen shoulder Frozen shoulder imaging Nerve injuries - symptoms, objective examination and treatment Assessment of the scapula, Type 1 scapula dyskinesis Differentiating contributors to Type 1 scapula dyskinesis (anteriorly rotated scapula) Testing GHJ IR Clinical Edge and online education on the shoulder Stretching and shoulder joint mobilisation Palpation, stretching and manual therapy for pec minor Type 2 scapula dysfunction Handheld dynamometry - serratus Handheld dynamometry - middle and lower traps Pain when strength testing Type 3 scapula dysfunction Dynamic assessment of the scapula To retract and depress the scapula or not? Shoulder Symptom Modification Procedure (SSMP) by Jeremy Lewis Special tests around the shoulder Laxity tests for the GH joint Posterior GHJ laxity Anterior GHJ laxity Explanations of scapula dysfunction to your patients Links of Interest Anne Cools on Linked In Ann Cools’ Research Ann Cools at Ghent University Ann on Twitter Clinical Edge Show your love for the Physio Edge podcast with a review on iTunes

Specialist Sports Physiotherapist Kurt Lisle joins David Pope on this episode to discuss assessment and management of acute knee injuries. They cover topics such as initial management of ligament injuries, bracing, referrals for orthopedic consults, swelling during treatment, ACL injury management, different types of ACL grafts, post-op rehab, return to training criteria, and PLC injuries.

David Pope and Dr Kristian Thorborg (Physiotherapist, PhD) discuss screening and rehabilitation of groin injuries. Find out in this podcast: Which tests to use when screening for potential groin injuries Prevention tactics Acute groin injuries - initial management and exercise progressions Rehabilitation of adductor related groin pain Rehabilitation of hip flexor related groin pain Rehabilitation of long standing groin pain Conservative management of hip related groin pain and FAI Pubic symphysis Management of acute compared to long standing groin pain Role of manual therapy in the treatment of groin pain Stretching Adductor tendinopathy Load management for groin pain and much more! This episode follows on from Episode 25 of the Physio Edge podcast on Groin Assessment with Dr Kristian Thororg. I hope you enjoy Kristian sharing his experience, research and knowledge of the evidence with us on the treatment of groin pain. Links of Interest Case Study of Adductor tear rehabilitation Dr Kristian Thorborg Dr Kristian Thorborg on Twitter HAGOS Studies that Dr Kristian Thorborg has completed or been involved in PE #025 Groin Assessment with Dr Kristian Thorborg PE #016 Preventing hamstring injuries with Dr Kristian Thorborg Kristian Thorborg’s editorial on BJSM Kristian Thorborg’s PhD Thesis Review the Physio Edge podcast in iTunes Clinical Edge

In this week's podcast,  Dr Nathan Gibbs and I discuss managing sports injuries in a team setting. Dr Nathan Gibbs has worked with many professional sports teams, including the Sydney Swans for 15 years, 10 years with South Sydney Rugby League Football club and is one of the owners of South Sydney Sports Medicine, and in episode 27 of the Physio Edge podcast, we discuss: Ideal working relationships between Physiotherapists and Sports Physicians The role of a Sports Physician Hamstring injury - common factors involved, imaging and return to play Injections - cortisone, PRP Use of PRP in ligament injury, with chondroplasty and OA Links of Interest Dr Nathan Gibbs Sydney Swans South Sydney Rugby League Football club Review the Physio Edge podcast in iTunes Download the Physio Edge podcast from iTunes Clinical Edge

Gymnastics places some fairly unique demands on fairly young bodies. In episode 26 of the Physio Edge podcast, I discuss these demands with Kingsley Gibson, a Sports Titled Physiotherapist that has worked with Australian Diving, Synchronised Swimming, Shooting and Hockey teams at a number of Commonwealth and Olympic games, and works with elite gymnasts on a daily basis. For his services to gymnastics, in 2000 the Commonwealth awarded Kingsley with a Sports Services Medal. So Kingsley has a lot of experience to draw on, and we got into detail on a number of topics. In this podcast we discuss: Common injury patterns in the various gymnastic disciplines Important factors to consider when returning gymnasts to training and competition Factors that can influence your gymnasts treatment outcome Communication with parents and coaches How to best implement load management strategies Various motor control patterns in gymnasts that contribute to injuries Screening gymnasts Designing specific upper limb rehab programs Lower limb and lumbar spine rehab programs Management of acute vs chronic injuries Stress reactions in the Lumbar spine Apophyseal injuries – hip flexors, hamstrings, calcaneus (Sever’s) and Osgood-Schlatter’s Management of apophyseal injuries compared to tendinopathy Motor control/“stability” patterns in gymnasts When to order imaging Growth plate injury management – particularly in the wrist The effect of other factors such as training surfaces and equipment on injury Links of Interest Become incredibly flexible by subscribing to the Physio Edge podcast or giving it a review on iTunes Kingsley Gibson Sydney Sports Medicine Centre at Homebush Sydney Wests Sports Medicine at Rooty Hill Clinical Edge

How can you identify the reason your patient has groin pain and the structures that may be causing it? Groin pain is one of the most common issues in a lot of sports, particularly the football codes, and in episode 25 of the Physio Edge podcast, David Pope talks to Dr Kristian Thorborg about assessment of the groin. Some of the topics we discuss on this podcast include: Types of groin injuries Identifying and diagnosing groin pain and injury Groin vs hip pain Tests you can perform to identify the irritated or painful structures The relevance of diagnostic imaging, and when to refer for this Hip and Groin Outcome Score (HAGOS) Using the HAGOS in your clinic Adductor related groin pain Hip flexor related groin pain Abdominal related groin pain The hip joint Pubic symphysis Sports Hernias Testing hip strength Assessment of function and much more! Links of interest Dr Kristian Thorborg Dr Kristian Thorborg on Twitter HAGOS Studies that Dr Kristian Thorborg has completed or been involved in Review the Physio Edge podcast in iTunes Clinical Edge Kristian Thorborg’s editorial on BJSM Kristian Thorborg’s PhD Thesis

The thorax is often considered stiff and stable by Physiotherapists and manual therapists, and precious little of our undergrad or postgrad training incorporates motor control of this area. Is it really important? In episode 24 of the Physio Edge podcast, Dr LJ Lee and David Pope explore the function of the thorax, the impact the thorax can have, not only on thoracic pain, but also on other parts of the body. We discuss the  Thoracic Ring Approach™ created by LJ, which incorporates manual techniques to assess and treat the thoracic rings, and integrates motor control training for this area. In this podcast you will learn: What bones and joints make up a “Thoracic ring” What is the Thoracic Ring Approach™   Is the thorax inherently stiff? What is ideal motor control of the thorax? How can listeners identify non-optimal control of the thorax in their patients How can motor control of the thorax be trained? Identifying articular/joint restriction vs neuromuscular factors interfering with normal thorax movement How can the thorax impact on other areas of the body eg the hip When is manipulation of the thorax ideal? What are some guidelines for manipulation of the thorax? Links of Interest Have an awesome holiday, and review the Physio Edge podcast on iTunes Physio Edge podcast episode 2 – “Analysing movement, and clinical expertise or research” with LJ Physio Edge Podcast episode 6 – TA, “Core Stability”, Drivers and going beyond the pain experience” with LJ Lee