JOSPT Insights

Frozen shoulder is an enigma characterized by uncertainty, pain, stiffness and disability. It is difficult for patients and clinicians to know how best to manage the symptoms and what is the likely prognosis. In today’s episode, Part 1 of a 2-part series, you’ll hear ideas about how you might approach assessing a painful and stiff shoulder, and how you might talk with patients to make a decision together about the best way forward. Framework for assessing and managing frozen shoulder: https://pubmed.ncbi.nlm.nih.gov/25107826/ Effectiveness of non-surgical interventions: https://pubmed.ncbi.nlm.nih.gov/31233183/ UK FROST trial: https://pubmed.ncbi.nlm.nih.gov/33010843/ Prof Lewis’ new book "The Shoulder: Theory & Practice" is available from Handspring Publishing: https://www.handspringpublishing.com/product/the-shoulder-theory-and-practice/

Professor Nicola Phillips is here to guide us through how to best load the upper extremity after injury. She shares her expertise on how rehabilitation professionals can change the way we prescribe functional exercise to maximize the benefits of how patients learn. She also provides insight into considerations for both short- and long-term programming for an upper limb rehabilitation plan. For more, check out: http://dx.doi.org/10.1136/bjsports-2014-094443

How would you approach diagnosing concussion for an athlete with underlying balance problems? Or for an athlete who is blind? The usual concussion tests simply may not be appropriate. Dr Osman Ahmed is a physical therapist on a mission to improve how athletes receive and experience care after concussion. Tune in to hear all about the work of the Concussion in Para Sport Group. Download the position statement of the Concussion in Para Sport (CIPS) Group: https://pubmed.ncbi.nlm.nih.gov/33837003/ Find out more about the CIPS Group’s work: https://www.parafootball.com/our-projects/concussion-in-para-sport

Join JOSPT Insights hosts Drs Chelsea Cooman, Dan Chapman and Clare Ardern as they revisit their favorite episodes from a jam-packed 2021, from treating ACL injuries and shoulder pain to designing quality rehabilitation for patients with meniscus repair and building authentic connections with patients. Share your favorite episodes on social media using #JOSPTInsights.

Athletes, large and small, old and young, elite and recreational experience low back pain at some time in their sporting lives. So, how do you best help athletes manage their pain, stay healthy and perform to their full potential? Dr Fiona Wilson from Trinity College Dublin shares the latest evidence with the JOSPT community, including the 2021 consensus on preventing and managing low back pain in rowers. Download the 2021 consensus from: https://pubmed.ncbi.nlm.nih.gov/33685861/ Delphi study of clinicians’ opinions: https://pubmed.ncbi.nlm.nih.gov/33431498/ Systematic review of treatment strategies: https://pubmed.ncbi.nlm.nih.gov/33355180/

You’ve figured out contributing impairments—now what? Exercise therapy or taping? Foot orthoses or manual therapy? Dr Christian Barton continues his chat with Drs Dan Chapman and Chelsea Cooman in the second episode of our 2-part patellofemoral pain CPG series to share the most effective treatment strategies for reducing pain and improving function. The patellofemoral pain CPG is freely available on JOSPT's website at the following link: https://doi.org/10.2519/jospt.2019.0302

Dr Christian Barton joins Drs Dan Chapman and Chelsea Cooman to dive into the patellofemoral pain CPG published in JOSPT in April 2019. In the first episode of this 2-part series, we hit the highlights of this extensive CPG, including the true definition of patellofemoral pain syndrome, as well as the 4 categories of impairments the CPG lays out to allow for a simplified diagnosis. Dr Barton makes the case for looking beyond the research—widening the clinical lens for better diagnosis and better musculoskeletal care. The patellofemoral pain CPG is freely available on JOSPT's website at the following link: https://doi.org/10.2519/jospt.2019.0302

When it comes to rehabilitation after ACL injury, return to running can get a bit overshadowed by return to sport. Yet running is a key function milestone for athletes. Why is return to running so important and how do you help set the athlete up for successful return to running? Dr Rich Willy from the University of Montana is here to help.

Profs Lori Michener and Joe Donnelly, Vice President and President, respectively, of the APTA’s Academy of Orthopaedic Physical therapy (AOPT), share the inside track on the AOPT’s new strategic framework, opportunities for grants, and how you can get involved with AOPT. Visit http://www.orthopt.org to find out more about the Academy and its work.

Sports physical therapist Elisa Nédélec heard so many harmful myths about when and how girls and women should play sport that she decided to start a PhD. In today’s episode, Elisa explains why girls and women should stay active, and what research can (and can’t) tell us about the relationship between reproductive hormones and musculoskeletal injury. Elisa co-leads the FAIR-ACL Project with Professor Kirsty Elliott-Sale, which tracks female athletes’ hormone profiles at the time of ACL injury. Find out more about the FAIR-ACL Project at: https://fairaclproject.isrg.org.uk

In the second episode of our 2-part masterclass on late-phase ACL rehabilitation, Dr Dan Lorenz shares what it means to bring sport specificity to rehab. It’s not about replicating every drill the athlete will do at practice. Rather, Dr Lorenz encourages clinicians to understand how the athlete moves during sport and treat the impairment that’s preventing the athlete from unleashing powerful movements.

In Part 1 of this 2-part podcast, Dr Dan Lorenz joins Drs Dan Chapman and Chelsea Cooman to dig into what quality rehab looks like in the late stages after an ACL reconstruction. Dr Lorenz covers the importance of loading, including where to start, how to load for the demands of the sport, and how it can look different at 4 vs 8 months. He shares his criteria for returning to run, prerunning drills, when and how to progress into plyometrics, and a peek into what he thinks the early stages should look like to prepare for later success.

A young handball player walks into your clinic tomorrow—she tells you her shoulder pain is bad, and getting worse. What should she do? Sports physical therapist Suzanne Gard is here to help untangle shoulder instability. Tune in for tips on assessing and treating shoulder instability and building strong and supportive lines of communication with youth athletes. The International Federation of Sports Physical Therapy (IFSPT) World Congress will take place in Denmark in August 2022. Head to http://www.ifspt.org to find out more.

Dr Caitlin McGee is back for the second of a two-part episode to outline the challenges and opportunities for diversity and inclusion in esports. Like many industries, esports is grappling with a past that did not embrace the rich and diverse gaming community as much as it could have. How is change happening, and who is driving it? Dr McGee is the co-owner and Performance & Esports Medicine Director of 1HP, a company that provides health and performance services to esports players, teams, and organizations. For more on the role for the musculoskeletal rehabilitation practitioner in esports, check out Dr McGee's recent editorial in JOSPT: https://www.jospt.org/doi/10.2519/jospt.2021.0109

Ease your way into the billion-dollar esports industry in this first of a two-part episode as Dr Caitlin McGee explains what esports are and the common musculoskeletal problems seen in gamers, then walks through how she approaches an initial clinical evaluation. Dr McGee is the co-owner and Performance & Esports Medicine Director of 1HP, a company that provides health and performance services to esports players, teams, and organizations. For more on the role for the musculoskeletal rehabilitation practitioner in esports, check out Dr McGee's recent editorial in JOSPT: https://www.jospt.org/doi/10.2519/jospt.2021.0109

Dr Marcie Harris-Hayes joins Drs Dan Chapman and Chelsea Cooman to share her extensive knowledge of hip-related groin pain. We dive into 3 of her papers to get to the bottom of 3 important questions: What counts as hip-related groin pain? Can physical therapy help? Which treatment interventions are most effective for improving function?

2021 has been a big year for trials studying the benefits of different approaches to rehabilitation for rotator cuff–related shoulder pain. Keeping up with the latest research can feel a bit like chasing your tail—today, Professor Lori Michener is here to help! We look at the latest research, explain what it all means, and how to apply it tomorrow in the clinic. GRASP trial: https://pubmed.ncbi.nlm.nih.gov/34265255/ SExSI trial: https://pubmed.ncbi.nlm.nih.gov/34048281/

Join Kate Mahony—sports physical therapist and Head of Performance Health at the New South Wales Institute of Sport—for a post-Olympics wrap-up of the achievements and advocacy of women athletes, clinicians and coaches in sport. Kate shares her tips for supporting women athletes to help them perform at their best and her advice for clinicians who aspire to work in elite sport.

Can you tell a bone stress reaction from a stress fracture? What is safe cross-training for the athlete with bone stress injury? Dr Stuart Warden returns with Drs Chelsea Cooman and Dan Chapman to map out key principles for rehabilitation of low-risk bone stress injuries: (1) manage load, (2) consider healing supplements, (3) maintain fitness, (4) address muscle function, (5) recommence and progress running, and (6) reduce risk of subsequent injury. Part 1 covered key rehabilitation principles 1-4; this episode, Part 2, covers key principles 5 and 6. Check out the article on the JOSPT website: https://bit.ly/3BLt4Cz

Can you tell a bone stress reaction from a stress fracture? What is safe cross-training for the athlete with bone stress injury? Dr Stuart Warden joins Drs Chelsea Cooman and Dan Chapman to map out the key principles for rehabilitation of low-risk bone stress injuries: (1) manage load, (2) consider healing supplements, (3) maintain fitness, (4) address muscle function, (5) recommence and progress running, and (6) reduce risk of subsequent injury. This episode, Part 1, covers key rehabilitation principles 1-4; stay tuned for Part 2, which covers key principles 5 and 6. Check out the article on the JOSPT website: https://bit.ly/3BLt4Cz

Delivering quality musculoskeletal rehabilitation practice is a balancing act of art and science. Dr Jason Beneciuk, physical therapist and clinical research scientist at Brooks Rehabilitation and University of Florida, understands the challenges—and he’s here to offer practical solutions. Find the article "What does best practice care for musculoskeletal pain look like?" (Lin et al 2020) here: https://bit.ly/3kMtFxM

Concussion can loom as an intimidating and daunting challenge—there’s much to consider from headaches to heart rates, vision to vestibular function. Dr Kathryn Schneider is at the front line of clinical practice and research in return-to-sport after concussion. Today, she shares her tips to help the JOSPT community feel confident, not confused, about concussion. For more, check out the Berlin Concussion in Sport Consensus: https://bit.ly/3wGHosc

Dr Tracy Blake joins us from a pre-Olympics training camp to give us an inside look at how she and her high-performance team have supported Canada’s men’s volleyball team to reach Tokyo in peak condition. Lockdowns, travel bubbles, COVID tests, and long stints living out of a suitcase: the life of a pandemic-era team physical therapist.

Dr Todd Davenport joins Drs Chelsea Cooman and Dan Chapman to share the headlines from the fresh, updated clinical practice guideline (CPG) for lateral ankle sprains and chronic ankle instability. We discuss the advantages of prophylactic bracing, how ankle dorsiflexion influences mechanics, the importance of neurodynamic control, and why ice is no longer #1. Download the CPG here: https://www.jospt.org/doi/10.2519/jospt.2021.0302

How many times have you reached for the explanation that pain hurts when the brain concludes that the body’s tissues need protecting from an external threat? Specialist clinician and pain educator Laura Rathbone wants to challenge the nociception view of pain and invite clinicians to cultivate a philosophy of pain. For more, check out these links: NoiJam blog: https://bit.ly/35RFH02 Philosophers Chatting with Clinicians podcast: https://spoti.fi/3quCL31 The Words Matter Podcast: http://www.wordsmatter-education.com/blog Why pain experience is not a controlled hallucination of the body: http://philsci-archive.pitt.edu/18770/

Quality musculoskeletal rehabilitation covers more than whether the athlete can run, jump, and land without pain or swelling. But how comfortable do you designing a rehabilitation program to train the brain as well as the body? Ohio University’s Dustin Grooms explains how to harness neuroscience in your sports injury rehabilitation programs and shares his tips for using the latest virtual reality technology in the clinic. For more help getting started with virtual reality, check out Dustin’s helpful guide here: https://bit.ly/3zBL9Sl

Physical therapists Linda Truong and Christina Le share their evidence-based approach to group rehabilitation for athletes of all ages and abilities. The Functional Agility Strength Training (FAST) program is a tailored approach that balances and promotes the physical and mental sides of recovery after serious injury such as ACL tear. Tune in for tips on how you can set up your own group-based program to support patients to reach their sports participation goals.

Dr Rob Landel boils down the 75 pages of the concussion clinical practice guideline (CPG) into a 25 min podcast episode. He highlights the key points from the CPG—including how to plan and deliver effective assessment (complete with chart), an efficient way to organize clinical information—and offers practical tips on how to educate patients and take irritability into consideration when choosing interventions. Join Chelsea Cooman and Dan Chapman to learn how to best help patients in a multi-disciplinary approach. Link to the CPG: https://www.jospt.org/doi/10.2519/jospt.2020.0301

More than 10 million people across the world are living with the long-term consequences of COVID-19. But the crushing fatigue experienced by so many with long COVID—the postexertion malaise—is not new. People have lived with postviral illness and postexertion malaise, and they've faced stigma and harm for decades. Sabrina Poirier and Dr Simon Décary are working tirelessly to ensure the mistakes and harms inflicted on so many people living with postviral illness are not repeated for people living with long COVID. For more, please read the recent JOSPT editorial: https://www.jospt.org/doi/10.2519/jospt.2021.0106

Have you pivoted to telerehabilitation during the coronavirus pandemic? Are you wondering what the digital future of musculoskeletal rehabilitation is? Professor Kim Bennell leads a multidisciplinary team designing, implementing, and studying telehealth for musculoskeletal rehabilitation. Join her for a run-down of the key issues to consider when you’re planning and delivering telerehabilitation and an overview of what the research says about its effectiveness.

Dr Saurab Sharma knows first hand the challenges and opportunities of working across different cultures and in different resource settings. From his work as a physical therapist in Nepal, to his research at University of Otago, and his current work at Neuroscience Research Australia, Saurab is committed to improving the lives of people living with chronic pain. Tune in as Saurab shares his ideas for improving how clinicians and people living with pain can talk about and understand pain.

“If we’ve learned anything from all these different studies, it’s that different meniscus tears behave differently, require different treatment, and ultimately have a different prognosis.” Dr James Dreese is an orthopedic surgeon at MedStar Health in Baltimore, MD, who joined Chelsea and Dan to share his thoughts on how different meniscus tears in different locations in the meniscus might influence the choices you make in rehabilitation.

How do you start a clinical consultation, and what do you do with the information that comes from the patient’s story? Jo Belton and Professor Pete O’Sullivan are tireless advocates for patient-centered care in the truest sense of the phrase. They share their insights on building authentic connections with patients—how to be a human to a human.

The Dutch COMPARE trial landed in BMJ at the end of February 2021, adding much needed weight to the nuanced discussion of best treatment for ACL injury: early surgery versus exercise therapy first with the option for late ACL reconstruction if needed. Leading clinician-researcher Dr Hege Grindem dissects the key results and shares her views on who succeeds without ACL reconstruction.

When 2 in every 3 people with a musculoskeletal condition also have at least one other underlying health condition, it’s time for rehabilitation clinicians to up our game in understanding complex health needs. Thankfully, Professor Søren Skou is here to help. Who is best placed to help patients manage their complex health needs? And is exercise—the veritable polypill—always the answer? Link to the START trial: https://pubmed.ncbi.nlm.nih.gov/33591346/

Dr Claire Minshull joins Drs Dan Chapman and Chelsea Cooman to unpack rate of force development (RFD): what it is, what it isn’t, and how to measure it. We take a deep dive into how fatigue affects RFD, differences between the sexes, potential implications for injury, and the best ways to incorporate RFD training into your rehabilitation plans.

Join IFOMPT Vice President Paolo Sanzo for his interview with IFOMPT President Laura Finucane on assessing and managing red flags in practice, and how you can add the international framework for screening for serious spine pathology to your practice tomorrow. Over 50,000 people have downloaded the framework for free from the JOSPT website (https://www.jospt.org/doi/10.2519/jospt.2020.9971). Thanks to IFOMPT and World Physiotherapy for their partnership with JOSPT—together we’re bringing you coverage of important issues in global musculoskeletal healthcare.

Sports podiatrists and researchers Dr Katrine Kryger and Dr Athol Thomson raise the profile of footwear for improving athletes’ health and performance. Today’s episode jumps into the impact of footwear in sport—how the right footwear can help athletes avoid injury, what athletes should look for when selecting footwear, and the long overdue investment in footwear specifically for women athletes.

A healthier society for less cost? Value-based health care aims to achieve just that by focusing on what matters to patients. Dr Chuck Thigpen from ATI Physical Therapy unpacks value in musculoskeletal care, the rehabilitation clinician’s role in delivering best care, and why you need to be a good team player.

What happens when your ACL rehabilitation plan isn’t going as well as you hoped? In this follow up to episode 25, Dr Erik Meira shares his thoughts on some of the more challenging issues in ACL reconstruction and rehabilitation. We discuss rehab after second and third ACL tears, sleepy quads, underdosing, and concurrent meniscus repair, and aim to help you find concrete solutions.

If you thought concussion was all about big hits in collision sports like rugby and American football, then think again. Dr Kerry Peek— physical therapist, strength and conditioning coach, and researcher—is committed to protecting the next generation of young soccer/football players. Tune in for the latest on exercise programs to prevent concussion in youth athletes.

Dr Sarah Haag brings her engaging brand of practical tips and her down-to-earth demeanor as she demystifies how to assess and treat the pelvic floor, whatever the clinical setting. No longer fear the pelvic floor—instead, head into the clinic this week confident in your skills.

Dr Erik Meira joins Drs Dan Chapman and Chelsea Cooman to discuss ACL rehabilitation at every stage: acute, strengthening, plyometric, and returning to sport. Dr Meira breaks down the typical timelines and priorities, shares his favorite interventions, and outlines progression criteria for each stage of rehabilitation.

Don’t let managing Achilles tendon rupture become your Achilles heel. In Part 2 of this 2-part series on managing Achilles tendon problems, JOSPT Editor Dr Karin Silbernagel outlines the foundations for quality rehabilitation planning, load progression, and return to high performance in sport. Achilles tendon rupture need not sound the death knell on the athlete’s career.

On your marks, get set, go! Get off to a flying start when managing Achilles tendon problems. JOSPT Editor Dr Karin Silbernagel blends the best of science and practice in her approach to diagnosing and managing Achilles tendon problems. In Part 1 of a 2-part series, we dive into Achilles tendinopathy and get the low down on load progression for happy tendons and happy athletes.

Are you delivering musculoskeletal care based on the most up-to-date model of chronic pain? Professor Steve Kamper explains why he’s riding his bicycle around Australia on the Pain Revolution Tour, shares his tips for framing a conversation with a person experiencing chronic pain, and encourages clinicians to move from treating a body part to treating a person. Learn more about Pain Revolution at www.painrevolution.org.

Dr Mike Reinold brings his wealth of experience at the pinnacle of pro baseball to JOSPT Insights this week, sharing his practical advice on how to measure and manage baseball pitchers’ workload, and explaining how he collaborates with coaches to help athletes perform at their best. Don’t miss Mike’s tips for return to sport.

Join Dr Max Paquette on a deep dive into his October 2020 JOSPT article, "Moving Beyond Weekly 'Distance': Optimizing Quantification of Training Load in Runners". How do you measure running load? What about wearables? Dr Paquette will bring you up to speed on the external and internal factors to consider when working with runners and how to figure out which factors are most relevant to the runner you’re working with. You can access Dr Paquette’s article for free at https://www.jospt.org/doi/10.2519/jospt.2020.9533

“My hip still hurts. I’m doing everything you’ve suggested, but it’s not getting better”. In this bonus episode, Dr Alison Grimaldi shares her approach to troubleshooting hip pain when things aren’t going as planned. For more from Dr Grimaldi, check out episode 3 of JOSPT Insights—a deep dive into gluteal tendinopathy and tendon loading.

JOSPT Editor of Patient and Public Partnerships Joletta Belton shares the story of her journey from physical therapy patient to pain patient advocate and describes a day in the life of her work in chronic pain rehabilitation.