Physiopedia Podcast

Rachael Lowe from Physiopedia talks to Dr Chris Littlewood about his research and experience with shoulder pain. Be ready for some interesting and potentially controversial perspectives! Chris is a senior lecturer in clinical trials based at Keele University in the UK. For more info. about Chris see: https://twitter.com/physiochris https://www.keele.ac.uk/pchs/staff/researchers/chrislittlewood/ https://www.researchgate.net/profile/Chris_Littlewood2

Rachael Lowe speaks to Elia Bernabeu Mira from the ICRC team in Sudan. Elia shares her experiences in working in the clubfoot clinics and helping the children and families involved. This interview was recorded as part of the clubfoot course on Physiopedia Plus. https://www.linkedin.com/in/elia-bernabeu-mira-5a954577/?trk=seokp-title-professional-name https://members.physio-pedia.com

Denise Watson is an Paediatric Orthopaedic Extended Scope Physiotherapists working at Chelsea and Westminster Hospital where she is responsible for the clubfoot related services. In this interview recorded as part of the 2017 open clubfoot course, Rachael Lowe from Physiopedia chats to Denise to explore her experience as a clinician and also running this service. https://members.physio-pedia.com https://twitter.com/curvyfeet http://www.chelwest.nhs.uk/services/therapy-services/childrens-therapy/paed-ortho-esp http://globalclubfoot.com/ http://walkforlifeclubfoot.org/ https://www.ndorms.ox.ac.uk/research-groups/global-surgery/projects/africa-clubfoot-training-act

Rachael Lowe from Physiopedia talks to Rosalind Owen from the Global Clubfoot Initiative (GCI http://globalclubfoot.com/) who provides her overview of this organisation, the training available and the global situation regarding clubfoot. More info. about Rosalind https://www.linkedin.com/in/rosalind-owen-8b88a3125/ The interview was recorded as part of the Physiopedia - ICRC open course on clubfoot: https://members.physio-pedia.com/learn/clubfoot/

Rachael Lowe from Physiopedia speaks to Dr Tim Nunn and Dr Rick Gardner from Cure who describe their work with children with clubfoot in Ethiopia. This interview was recorded as part of the Clubfoot course on Physiopedia Plus. https://cure.org/staff/tim-nunn/ https://cure.org/staff/rick-gardner/ https://members.physio-pedia.com

Prem Saggurthi from the ICRC introduces the 2017 open course on managing children with clubfoot to Rachael Lowe of Physiopedia. https://members.physio-pedia.com/learn/clubfoot/ More info on Prem: https://www.linkedin.com/in/prem-saggurthi-52255a12/

In this interview recorded as part of the 2017 course on Neck Pain delivered on Physiopedia Plus, Rachael Lowe chats to neck pain specialist Chris Worsfold. In this excellent interview Chris provides concise and practical advice to clinicians on how to approach clients with neck pain and how to go beyond the current research evidence in effective management. For more information about Chris and his neck pain courses see: http://www.chrisworsfold.com/ For the PP+ Neck Pain course see: https://members.physio-pedia.com/

Rachael Lowe of Physiopedia talks with Roelie Wolting about her experiences in working with children with cerebral palsy. This interview is part of the Managing Children with Cerebral Palsy MOOC on Physiopedia Plus. https://members.physio-pedia.com

Rachael Lowe of Physiopedia talks with Lurinda Prinsloo about occupational therapy and cerebral palsy. This interview is part of the Managing Children with Cerebral Palsy MOOC on Physiopedia Plus. https://members.physio-pedia.com

Manual therapy textbook author, clinician and and IFOMPT President, Kenneth Olson took time out from his busy schedule to share his insights and experience of using manual therapy to treat individuals with neck pain. This interview was recorded as part of the Cervical Spine course on Physiopedia Plus (https://members.physio-pedia.com/) Find out more about Ken Olson and his text here: https://www.elsevier.ca/ISBN/9780323263061/Manual-Physical-Therapy-of-the-Spine https://northernrehabpt.com/kenneth-olson/ http://www.ifompt.org/About+IFOMPT/Privacy++Legal+Policies.html

Joanne Morris is a co-editor of the recently published Pharmacology handbook for physiotherapists and in this interview with Rachael Lowe from Physiopedia she shares her insights from creating this book and gives tips to clinicians relating to working with patients taking medication. More about the handbook: https://www.elsevier.com/books/pharmacology-handbook-for-physiotherapists/reznik/978-0-7295-8361-9 More about Joanne: https://www.researchgate.net/profile/Joanne_Morris3

Rachael Lowe from Physiopedia talks to Dr James Elliott from Northwestern University, Chicago to explore his extensive knowledge and research relating to whiplash and neck pain. James provides extensive advice on appropriate clinical predictions rules, outcome measures and subsequent approaches to treatment based on the latest published research. There are many tips here relevant to clinicians looking to improve their practice! This interview was recorded as part of the cervical spine course on Physiopedia Plus (https://members.physio-pedia.com/) Learn more about James: https://twitter.com/elliottjim http://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=20211 https://shrs.uq.edu.au/profile/122/james-elliott https://www.linkedin.com/in/james-elliott-53048148/ Jame's research group: http://www.nirl.nu/NIRL__Northwestern_University_Neuroimaging_Research_Lab/Home.html Clinical prediction rules, outcome measures and research mentioned in this interview: https://www.ncbi.nlm.nih.gov/pubmed/25827122 https://www.ncbi.nlm.nih.gov/pubmed/23831865 https://www.researchgate.net/publication/235332073_A_new_stratified_risk_assessment_tool_for_whiplash_injuries_developed_from_a_prospective_observational_study http://www.physio-pedia.com/Fear%E2%80%90Avoidance_Belief_Questionnaire http://www.tac.vic.gov.au/__data/assets/pdf_file/0004/27454/tampa_scale_kinesiophobia.pdf http://psychotherapy-center.com/counseling-issues/trauma-and-stressors/ptsd-post-traumatic-stress-disorder-therapy/measuring-the-emotional-impact-of-an-event/ https://help.jtechmedical.com/support/hardware/commander?kbartid=143 https://www.researchgate.net/publication/306073718_Cluster_Analysis_of_an_International_Pressure_Pain_Threshold_Database_Identifies_4_Meaningful_Subgroups_of_Adults_with_Mechanical_Neck_Pain https://www.researchgate.net/publication/50420479_Pain-induced_Changes_in_the_Activity_of_the_Cervical_Extensor_Muscles_Evaluated_by_Muscle_Functional_Magnetic_Resonance_Imaging http://www.uib.no/ipq/

Prof. Gwendolen Jull shares a lifetime of research knowledge and clinical experience working with neck pain and the cervical spine. In this interview with Rachael Lowe from Physiopedia she reviews current understanding and identifies issues and tips for clinicians. The interview was recorded as part of the Cervical Spine course on Physiopedia Plus (https://members.physio-pedia.com/). For more information about Gwen see: http://researchers.uq.edu.au/researcher/7582 https://www.researchgate.net/profile/Gwendolen_Jull

Rachael Lowe from Physiopedia talks to founder and president of WebPT, Heidi Jannenga. This conversation explores the remarkable success of the company in the past 9 years, what Heidi has learned along the way and her opinions on how Physical Therapy (physiotherapy) the profession and its members can work address the challenges of the future. www.webpt.com https://twitter.com/HeidiJannenga https://www.linkedin.com/in/heidijannenga/ https://www.bizjournals.com/phoenix/news/2017/05/12/2017-az-top-tech-awards-tech-titan-heidi-jannenga.html

Anna Lowe chats to Clare Lait about her work in promoting the adoption of physical activity in cancer treatment and discusses the role of physiotherapists as leaders. This interview was recorded as part of the Physiotherapy, Exercise and Physical Activity Course delivered by Physiopedia and ExerciseWorks. More about Clare: http://www.cancer-physio.com/ https://twitter.com/clarelaitphysio

Alessandro Demaio of the World Health Organisation talks to Rachael Lowe about NCDs and the role of physiotherapists. This interview was recorded as part of the Physiotherapy, Exercise and Physical Activity Course delivered by Physiopedia and ExerciseWorks. More information on Sandro: http://sandrodemaio.com/ https://twitter.com/SandroDemaio

Recorded as part of the Physiotherapy, Exercise and Physical Activity Course delivered by Physiopedia and ExerciseWorks, this interview explores strategies to promote physical activity within a population or community with Prof. Rob Copeland from Sheffield hallam University. More information on Rob see: https://www.shu.ac.uk/about-us/our-people/staff-profiles/robert-copeland https://twitter.com/drrobcopeland

Professor Stuart Biddle has a rich history and a wide experience in the area of physical activity and behaviour change. PE teacher by background with a PhD is psychology applied to the area of public health, Stuart is more than qualified to guide policy and guidelines at governmental levels. And he has done just that. Currently programme leader at Victoria University for active living and public health, he has published over 250 research papers and 14 books: Physical Activity and Psychological Well-being (https://www.routledge.com/Psychology-of-Physical-Activity-Determinants-Well-Being-and-Interventions/Biddle-Mutrie-Gorely/p/book/9780415518185) Managing sedentary behavior to reduce the risk of diabetes and cardiovascular disease (https://www.ncbi.nlm.nih.gov/pubmed/25052856) Twitter Profile (https://twitter.com/stuart_biddle) University Profile (https://www.vu.edu.au/contact-us/stuart-biddle)

I was very fortunate to be able to record this conversation with Dr Patricia Miller of McMaster University, in which we explored Pat’s extensive experience in researching, teaching and assessing reflection with physiotherapists. Her key messages in this conversation are that: Reflection is a key skill and activity for professional physiotherapists to improve practice. Studies have shown an individual’s quality and depth of reflection distinguishes novice from expert practitioners. Reflection is about seeking and exploring alternative perspectives and is supported by involving others (peers, mentors, tutors, family etc) and also by using a framework that challenges your thinking. She clarifies the difference between reflection in-action (during practice) and reflection on-action (after the event). The Canadian Physiotherapy Association Clinical Specialty Program includes the evaluation of the candidate’s ability to use clinical reflection in their practice because clinical reflection is integral to the practice of a clinical specialist and leader in their field. If you struggle with reflection or are embarking on a written reflection as part of your studies, for annual registration requirements or as part of the CPA Clinical Speciality Program I think you will both enjoy and benefit from listening to this enlightening conversation To find out more about Pat and connect with her see: Pat Miller’s ResearchGate profile https://www.researchgate.net/profile/Patricia_Miller6 Patricia Miller’s LinkedIn profile https://www.linkedin.com/in/pat-miller-291b0a39 Pat also refers to and recommended the following additional sources of information regarding reflection: Paterson C, Chapman J. Enhancing skills of critical reflection to evidence learning in professional practice. Physical Therapy in Sport. 2013 Aug 31;14(3):133-8. (In particular the appendices) Wainwright FS, Shepard KF, Harman LB, Stephens J. Novice and experienced physical therapist clinicians: a comparison of how reflection is used to inform the clinical decision making process. Physical Therapy 2010;84(7):830-7. Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med 2012;87(1):1-10. Donaghy M, Morss K. An evaluation of a framework for facilitating and assessing physiotherapy students’ reflection on practice. Physiotherapy Theory and Practice, 2007; 23(2):83-94. Mann K, Gordon J, MacLeod A. Reflection and reflective practice in health professions education: a systematic review. Adv Health Sci Educ Theory Pract 2009;14(4):595-621. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teacher 2009;31:685-95. Williams RM, Wessel J, Gemus M, Foster-Seargeant E. Journal writing to promote reflection by physical therapy students during clinical placements. Physiotherapy Theory And Practice 2002; 18 (1): 5-15..

John Driscoll is an internationally recognised expert in clinical reflection who is also the developer of a very popular 3 step framework for reflection What? So what? What now?. This interview was recorded as part of the development of a short course on clinical reflection that will be made available on Physiopedia Plus in 2017. In this conversation John talks about his extensive work on reflective practices and Continuing Professional Development for a range of health professionals both as a UK academic and as a freelance consultant. He has worked on the implementation of large-scale reflective Clinical Supervision schemes for practitioners in health organizations in the UK, Australia and more recently Canada. More about John: http://www.supervisionandcoaching.com/

Rachael Lowe talks to Dr Paul Kelly from the University of Edinburgh about his teaching and research relating to physical activity and its impact on health. This interview is part of the #PEPA16 MOOC on members.physio-pedia.com For more info on Paul: http://www.ed.ac.uk/education/about-us/people/academic-staff/profile.php?person_id=532

Jacqueline Reznik is the co-editor of the recently published Pharmacology handbook for physiotherapists and in this interview with Rachael Low from Physiopedia she shares her insights from creating this book and gives tips to clinicians relating to working with patients taking medication. More about the handbook: https://www.elsevier.com/books/pharmacology-handbook-for-physiotherapists/reznik/978-0-7295-8361-9 More about Jacqueline: https://www.jcu.edu.au/college-of-healthcare-sciences/physiotherapy/jcu-physiotherapy-clinical-educators-network/jackie-reznik https://www.researchgate.net/profile/Jacqueline_Reznik

In this interview recorded as part of the Physiopedia Plus stroke course (https://members.physio-pedia.com), Dr Janne Veerbeek explains the implications of her extensive research into stroke rehabilitation. In particular the use of outcome measures to predict likely outcomes relating to activities of daily living and the implications of these predictions on the approach to rehabilitation used. Learn more about Janne and her research: https://www.ncbi.nlm.nih.gov/pubmed/?term=Veerbeek%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=25772900 https://www.researchgate.net/profile/Janne_Veerbeek https://www.linkedin.com/in/janne-veerbeek-4538b528/?ppe=1

Dr. Kathleen Norman of Queen's University, Kingston Ontario, describes her experiences of running an assignment where her students write pages on Physiopedia and offers tips to other educators considering doing the same. Details of her project: http://www.physio-pedia.com/Queen%27s_University_Neuromotor_Function_Project More information about Kathleen: https://rehab.queensu.ca/people/faculty/kathleen_norman Physiopedia http://www.physio-pedia.com/ Please note that initial audio issues resolve as the interview progresses.

In this conversation Ben Clarsen discusses many aspects of being a sports physiotherapist and specifically his work developing an athlete monitoring system for identifying and addressing overuse injuries. Resources mentioned in this interview include: Oslo Sports Trauma Research Center - http://www.klokavskade.no/en/ Clinical Sports Medicine text book - http://www.clinicalsportsmedicine.com/ IOC Diploma in Sports Physical Therapies - http://sportsoracle.com/Sports+Physical+Therapies/Home/ Tim Gabbett - http://gabbettperformance.com.au/ Skadefri - http://www.klokavskade.no/no/Skadefri/ Get set training app - https://itunes.apple.com/us/app/get-set-train-smarter/id894609112?mt=8 Ben Clarsen on Twitter - https://twitter.com/benclarsen

Rachael Lowe from Physiopedia talks to Maria Constantinou about her experiences working as a physiotherapist at the world's largest sporting events, gleans her advice about the most important competencies and insights into her expertise in using taping. Maria's taping book http://store.elsevier.com/Therapeutic-Taping-for-Musculoskeletal-Conditions/Maria-Constantinou/isbn-9780729539173/ Maria on LinkedIn https://www.linkedin.com/in/maria-constantinou-4110a640 Maria on Twitter https://twitter.com/mariaconstant

As part of the Physiopedia Plus course on sports physiotherapy Rachael Lowe chats to Mike Reinold, a PT who knows from experience what it takes to get that dream job... For more from Mike see: http://www.mikereinold.com/ https://twitter.com/mikereinold

As part of the recent Physiopedia Plus Stroke course (https://members.physio-pedia.com/learn/stroke/) we were extremely fortunate to record this interview with one of the UK’s leading paralympians, Megan Giglia MBE. In this interview Megan gives her unique perspective as a young stroke patient who has gone on to success at the highest sporting levels, including winning the first gold medal at the 2016 paralympics in Rio. Megan tells her deeply personal story and provides insights that all physiotherapists can learn from about the importance of the personal relationship between the patient and their therapist. She also describes how she challenged the health care team involved in her initial care and ultimately worked with her physios to define and use joint goal setting to motivate and guide her rehabilitation process. We recommend listening to this conversation independent of the clinical area in which you practice as there are messages from Megan that all physical therapists can reflect upon. Learn more about Megan’s story on the Ottobock website (http://www.ottobock.co.uk/orthopaedic-rehabilitation/real-life-stories/megan's-custom-afo-story/) and in this ITV news story (https://www.youtube.com/watch?v=edLXQaE3Nbs). Follow Megan on Twitter (https://twitter.com/megangiglia) and Facebook (https://www.facebook.com/MeganGigliaGB/) Visit Megan’s website (https://www.megangiglia.com/)

As a follow up to the previous interview, this question and answer session with Dr Tasha Stanton was recorded as part of the introduction to pain course on Physiopedia Plus (https://members.physio-pedia.com) http://people.unisa.edu.au/Tasha.Stanton https://www.researchgate.net/profile/Tasha_Stanton https://twitter.com/tash_stanton

In this interview recorded as part of the introduction to pain course on Physiopedia Plus (https://members.physio-pedia.com), Rachael Lowe from Physiopedia speaks with Dr. Tasha Stanton about her research on pain. In this video, Tasha answers three fundamental questions about pain: What is pain? Why do we have it? Why doesn’t it go away? Tasha is a senior research fellow with the Body in Mind Research Group at the University of South Australia and is currently a National Health & Medical Research Council (NHMRC) Early Career Fellow (2014-2018). She is also the recipient of the prestigious 2016 Ronald Dubner Research Prize. Tasha’s research focuses on clinical pain neuroscience, specifically on cortical body representation, somatosensation, multi-modal illusions, and pain. To date, she has received over $1.7 million in competitive research funding and has been invited to speak at 20 national and international conferences. Earlier this year Tasha was awarded the Australian Pain Society’s Rising Star Award and spoke at the APS’ Annual Scientific Meeting. http://people.unisa.edu.au/Tasha.Stanton https://www.researchgate.net/profile/Tasha_Stanton https://twitter.com/tash_stanton

As part of the Physiopedia Plus course Introduction to Pain, we’ve sat down with Dr. Daniel Harvie to talk about virtual reality and technology and its use in treating pain. Daniel is a post-doctoral fellow with Recover Injury Research Centre http://recover.edu.au/(formerly known as CONROD). Recover is an Australian Centre which aims to produce breakthrough research which leads to better outcomes after injury, especially when caused by road traffic crashes. Daniel is conducting pain research using state-of-the-art virtual-reality technology. He is the recipient of the iAward for information and communication technology innovation, and holds several grants that explore the connection between the brain and pain perception. He is also actively involved in supporting undergraduate research. Daniel supervised the Kungullanji Indigenous Summer Research Symposium, which gave undergraduate Aboriginal and Torres Strait Islander students the chance to participate in research projects across areas in Griffith Sciences and Griffith Health programs. Daniel recently published a study on neck pain that found that visual-proprioceptive information modulated the threshold for movement-evoked pain. More about Daniel: http://www.conrod.org.au/cms/people/conrod-staff-profiles/301-daniel-harvie https://www.researchgate.net/profile/Daniel_Harvie

Rachael Lowe of Physiopedia talks to Peter Moore about the his experience as a patient with chronic pain and how he came to develop the Pain Toolkit. Peter gives advice from the patient's perspectives for physiotherapists treating patients with pain. http://www.paintoolkit.org/ This interview was recorded as part of the introduction to pain course on Physiopedia Plus. https://members.physio-pedia.com

Rachael Lowe chats to Mike Stewart to explore his experience and understanding of working with patients with pain. This interview was recorded as part of the Understanding Pain course on Physiopedia Plus. For more information about Mike see: http://knowpain.co.uk/ https://twitter.com/knowpainmike

Rachael Lowe talks to Stroke researcher Dr Coralie English from the University of Newcastle Australia about her work investigating rehabilitation of individuals following stroke in particular the levels of appropriate activity and exercise. Coralie summarizes the current research understanding and offers clinical advice for physiotherapists and physical therapists. This interview was recorded as part of the stroke course on Physiopedia Plus (https://members.physio-pedia.com) Learn more about Dr Coralie English: https://www.newcastle.edu.au/profile/coralie-english https://twitter.com/Coralie_English https://www.researchgate.net/profile/Coralie_English

Rachael Lowe from Physiopedia talks to Jane Burridge, Professor of restorative neuroscience at the University of Southampton, UK, about her research and experience of rehabilitation of individuals with stroke. Jane talks about her particular technology focused studies and also offers more general advice for clinicians working with stroke patients. This interview was recorded as part of the Stroke course on Physiopedia Plus (https://members.physio-pedia.com/learn/stroke/). Learn more about Jane here: http://www.southampton.ac.uk/healthsciences/about/staff/jane_burridge.page

This interview was recorded as part of the introduction to neurology course on Physiopedia Plus. This week, Rachael Lowe of Physiopedia speaks to Dr. Emma Stack about her research on the management of Parkinson’s Disease and in particular minimising the risk of falls for these patients. Dr. Emma Stack is a Principal Research Fellow at the University of Southampton. Both Emma’s research and her public engagement focus on movement behaviour in Parkinson’s, particularly on maintaining activity levels while avoiding falls. She is the Principal Research Fellow on SPHERE, a project that is developing sensors that predict falls, detect strokes and changes in mood, and analyze eating behaviours. SPHERE envisages using sensors in the home to monitor health across a spectrum of ages and conditions, with a focus on safe mobility in the home. Emma is a headline speaker at Therapy Expo 2016 in Birmingham, UK.

This interview was recorded as part of the introduction to neurology course on Physiopedia Plus. This week, Rachael Lowe of Physiopedia speaks to Rachel Young about her passion for increasing the use of exercise in the rehabilitation of neurology patients. Rachel Young is a senior lecturer and neurology specialist from Sheffield Hallam University UK and has twenty years experience in the field. She has an evolving interest in exercise and physical activity and is active in developing exercise prescription skills amongst physiotherapists through developments within the under-graduate, post-graduate and CPD provision at SHU. Rachel is currently a research assistant for a service evaluation focussed upon a physical activity programme for participants with long term musculoskeletal changes. Her planned doctoral study will involve the evaluation of accessible exercise equipment for people with MS. Rachel was a presenter at Physiotherapy UK’s 2015 conference and where she spoke about enhancing exercise prescription in the physiotherapy curriculum at Sheffield Hallam University.

This interview was recorded as part of the introduction to neurology course on Physiopedia Plus. In this interview, Rachael Lowe of Physiopedia talks to Prof. Lisa Harvey from the University of Sydney, Australia about her extensive experience as a clinician, educator and researcher in neurology. Lisa is a professor and senior research fellow at the University of Sydney, with over 20 years experience in the area of spinal cord injuries. Her primary interest lies in clinical trials designed to determine the effectiveness of different physiotherapy interventions for people with spinal cord injury. Lisa’s research experience covers a diverse range of topics including contracture and hand management of people with tetraplegia, orthotic gait along with exercise and respiratory physiology. She teaches widely both nationally and internationally, and has been the recipient of numerous grants and scholarships. Lisa is the author of Management of Spinal Cord Injuries E-Book, 1st Edition, a guide for physiotherapists. She also initiated and continues to manage a website of physiotherapy exercises appropriate for people with neurological conditions. Lisa was the lead tutor for the Physiopedia’s Physiotherapy Management of Spinal Cord Injuries online course 2014. This course will run again in the future!

This interview was recorded as part of the Stroke course on Physiopedia Plus. We sat down for an in-depth interview with Professor Sarah Tyson to talk about stroke rehabilitation. In this interview, we cover Sarah’s research and experience with patient-led therapy during in-patient stroke rehabilitation. She recently presented some of the content of this interview at the ACPIN-INPA International Neuro Physiotherapy Conference in London, UK. Sarah is a professor of rehabilitation at the University of Manchester in the UK and leads the Long-Term Conditions Research Group. She has over 100 publications and £4million of research funding from the Dept of Health, NIHR, research councils, medical charities, professional bodies and the Knowledge Transfer Partnership/Technology Strategy Board.

This interview was recorded as part of the tendinopathy course on Physiopedia Plus. Last week we talked to Seth O’Neill on strength training for individuals with tendinopathy. To conclude our tendinopathy series hear from Alison Hoens, that mastermind behind the achilles tendinopathy and lateral epicondyle tendinopathy toolkits. Alison Hoens is a Physical Therapy Knowledge Broker in Canada. Her role is to facilitate knowledge creation, synthesis, translation, dissemination and implementation with researchers, clinicians and decision-makers. In addition, she develops resources to enhance evidence-informed practice skills. Today she is talking about the tendinopathy toolkits that she has developed with the BC Physical Therapy Tendinopathy Taskforce. Over to Alison….

This interview was recorded as part of the tendinopathy course on Physiopedia Plus. The third interview in our tendinopathy series is with Dr Ebonie Rio. Following our interviews with fellow researchers Jill Cook and Sean Docking, Ebonie talks pain and isometrics. Ebonie is a physiotherapist and research fellow at La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. She completed her PhD looking at tendon pain, how the CNS and motor control might change in individuals with tendinopathy. Over to Ebonie…

This interview was recorded as part of the Physiopedia Plus course on tendinopathy. This week we have another tendinopathy interview, this time with Seth O’Neil who focusses in on strength training for management of tendinopathy. Seth is a lecturer in Physiotherapy at the Universities of Leicester and Coventry in the UK, he also continues to see practice clinically through his own private practice. Seth is currently undertaking a PhD entitled ‘A Biomechanical Approach to Achilles Tendinopathy management’ within this Seth has identified prevalence rates of tendinopathy in UK runners and developed a greater understanding of risk factors surrounding Achilles tendinopathy. Seth’s current PhD projects can be seen on his current research page but he also talks all about it here in the interview, over to Seth….

This interview was recorded as part of the Physiopedia Plus course on tendinopathy. As a follow up to Rachael’s interview with Jill Cook, we have a chat to Sean Docking about imaging in Tendinopathy, in particular Ultrasound Tissue Characterisation (UTC) in relation to a tendon structure point of view and what is clinically relevant. Sean Docking is a research fellow at La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. His PhD research involves the use of Ultrasound Tissue Characterisation (UTC), a new and novel technique that allows measurement of subtle changes in tendon structure that are not detectable using conventional imaging techniques. Over to Sean…

We interviewed Professor Jill Cook as part of the Physiopedia Plus course on tendinopathy. Jill is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas. Jill’s work in this field has been extensive and made an enormous contribution to our understanding of tendinopathy and how physiotherapists can more effectively manage individuals with tendinopathy. In this interview Jill gives us a great insight into the most recent and emerging research, over to Jill….

This interview was recorded as part of the low back pain course on Physiopedia Plus. Jonathan Hill specializes in low back pain and is a senior researcher at Keele University in the UK. His area of research and expertise is the STarT back Tool. At the beginning of this interview, Jonathan discusses the STarT Back Tool. This tool identifies key clinical factors which help to predict outcomes for individuals for back pain which present to primary care. Factors which can be identified by treatment are pin pointed. The STarT back tool serves as a screening tool to help determine prognosis and appropriate treatment paths. Low risk patients have a good prognosis. Medium risk patients mostly have a poor prognosis. High risk patients have larger fear and stress influences and a poor prognosis. Nine factors determine whether someone is low, medium or high risk. Jonathan discusses Stratified Care and the subgrouping low back pain patients. He talks about the possibilities of integrating the STarT Back Tool with other subgroupings that exist. When assessing individuals with low back pain Jonathan states we need to keep a broad mindset. We should thoroughly question the patient. Emphasis should be placed on treating the whole patient. We should discuss the expectations and prognosis. With treating difficult patients, he feels we tend to struggle more on the psychosocial treatment of the individual. He cautions us into grouping patients strictly by their diagnosis.

This interview was recorded as part of the low back pain course on Physiopedia Plus. Mark Hancock, BAppSci(Phty), MAppSc, PhD trained at Sydney University. He later completed his research masters on ankle pain. He finished his PhD in 2007 and is currently a faculty researcher at Macquarie University in Sydney. We recently chatted to Mark about LBP and how all the stratified care approaches fit together. Mark points out that we still have a long way to go regarding low back research but feels that we are making progress. 85-95% of patients have non-specific low back pain which makes it more difficult to treat. Stratifying low back pain or classifying low back pain is the most important thing we can do as physiotherapists to help guide clinical treatment. Mark states that the STaRT Back and Cognitive Behavioral approaches are a step in the right direction. Integrating these models may be an ideal means to treat low back pain and this course has done a great job with covering the most up to date low back classification systems. The most important knowledge a physiotherapist can keep in mind when treating patients with low back pain is that we are responsible for screening red flags or patients with cancer, fractures that may not be therapy appropriate. Prognosis is also critical and explaining to the patient their potential for rehabilitation. Mark feels that with treating chronic back pain, exercise strategies are the best for long term management. For preventing acute to chronic low back pain, the STarT back approach helps to identify the patients which are most at risk and we can then direct them to the appropriate treatment category. It also helps to identify those who are more likely to progress to chronic pain and guides us to treat them appropriately. It’s important to keep in mind that the population which becomes chronic is a very small population.

This interview was recorded as part of the Physiopedia Plus course on low back pain. John Childs started his physical therapy career at the Air Force Academy. He completed his PhD at University of Pittsburgh after his Air Force career. He has worked closely with Anthony Delitto and Julie Fritz. He was later faculty at the Army/Baylor Physical Therapy program. Lately John is doing more health care system based research with the goal of helping patients to enter health care in a more appropriate time or place. John is the CEO of Evidence in Motion which provides residency and fellowship training for physical therapists. John thinks the most important knowledge a therapist can be armed with in treating low back pain patients is paying attention to the patient and not just the injury or anatomy. He notes he has grown away from treating the pathoanatomical cause with experience. The way that the PT communicates with the patient plays a huge role in recovery and the psychosocial contributors can not be ignored. John discusses the Treatment Based Classification System. He talks about looking for signs and symptoms that are associated with a benefit from a particular treatment intervention. Integrating these classifications and clinical prediction rules into clinical practice can assist with decision making for acute or subacute patients. The clinical prediction rules help to subgroup patients into one group; patient’s should not be categorized into multiple treatment based groups. John cautions that there is further research to be done on the clinical prediction rules and that it is still important to later integrate other forms of treatment as the patient progresses.

Interview recorded as part of the low back pain course on Physiopedia Plus. Professor Nadine Foster is faculty at Keele University. She studies management of non-specific back pain and her specialty is Stratified Care for Low Back Pain. In this interview Nadine discusses how research has evolved over the past twenty years in regards to treating non-specific low back pain. Previously, physical therapy involved a lot of passive therapies such as traction or electromodalities. Currently it is much more interactive and she identifies exercise and manual therapy as key components for treating low back pain in modern day care in appropriate populations. Stratified care for low back pain is Nadine’s specialty she has been very involved in the development of StaRT Back approach to LBP. STarT Back is an example of a stratified care approach, it match patients to treatments based on prognosis or risk of poor clinical outcome. It identifies patients who are appropriate for physical therapy and that should do well. Self management is key in prognosis and long term management. Identifying risks for PT failure and trying to match to appropriate care for better outcomes ultimately will assist the patient in being in the proper treatment category. Using the STarT Back approach individuals with back pain may be categorised as: Low risk – These patients can be taught self management. Medication management is often part of the treatment. Prognosis is good for these patients. They have a low level of disability and are able to continue with daily activities. Further testing/imaging not likely necessary for management. Medium risk -Physiotherapy management is utilised to decrease levels of pain and disability. This many consist of exercise with or without manual therapy. Typically patients have up to 6 physiotherapy treatment sessions in the UK. This number may vary based on clinical setting or health care system/location of treatment. High risk – These patients struggle with persistent pain and disability. Psychosocial barriers to recovery exist and typically include depression, anxiety, and/or fear avoidant behaviours. Physiotherapy management and management of psychosocial obstacles is key with emphasis on addressing psychological contributions. In some cases, patients may work with a psychologist. Nadine notes we need to be careful in using any subgrouping for patients. We should identify the most important systems for teaching new therapists but later educating on other systems after gaining clinical experience. Nadine notes its important to continue to research multiple subgroupings and integrating it into various clinical settings, countries, and implementation.

Interview recorded as part of the low back pain course on Physiopedia Plus. Peter O’Sullivan is from physiotherapist originally from New Zealand. He completed later his post graduate manipulative training in Australia. He is a musculoskeletal professor at University of Curtin in Perth, Australia. He is well known internationally as a clinician, researcher and professor of musculoskeletal pain disorders. During the most recent Physiopedia interview, Peter discusses the multidimensional components of pain. He discusses pain beliefs and behaviors and how it affects clinical practice and research. His research focuses on the cognitive functional approach in the lumbar spine largely due to the number of cases that present clinically. Peter discusses how movement related to pain is largely behavioral. Over protecting painful structures because of fear often times causes compensatory issues. Physiotherapists should consider address retraining movement into a means of moving without compensatory pain patterns. Ultimately retraining the concept that movement is safe is key. There are three components of pain that should be addressed: Cognitive behavioral beliefs-pain beliefs Functional behavioral aspect-movement patterns Lifestyle adaptations due to pain and avoidance of activities Peter discusses how picking up a shoe demonstrates motor control patterns that may be pain related. He recommends using a questioning for helping patients to problem solve a more effective pattern of movement without driving compensatory pain such as tensing up when doing particular movements. Peter additionally discusses the difficulty of imaging with MRI. People who pursue imaging typically will have some pathoanatomical finding. This can further complicate pain processing and behaviors within movement patterns. People tend to grasp onto imaging findings and act in a protective manner towards what they perceive to be a significant finding on imaging despite our beliefs that it may at times be incidental. Peter discusses how when patients discuss the lack of benefits with therapy and how it is more helpful in the learning process. In these cases, stress may negatively impact pain and cause flares. Educating patients to focus on extra care towards their body in more stressful times is important. Focusing on good sleep patterns, eating a health diet, avoiding alcohol, maintaining an exercise program, utilizing relaxation techniques are strategies helpful in decreasing sensitivity within the body. It is important for us as physiotherapists to educate our patients on these principles.

As part of the Physiopedia Plus low back pain course, we interviewed Chad Cook. Chad is a professor at Duke University. He is well published in the text and journals regarding lumbar pain. Chad Cook recommends getting a thorough history, detailed movement examination, special tests to rule in or out a condition, and taking into considerations which affect prognosis. Chad then utilizes the classification of low back pain based on these findings. For demographic findings, Chad states chronicity, female gender, advanced age, occupation, social situation, presence of wide spread pain or neurogenic pain, emotion and ability to cope with their problem, pain behaviors affect outcomes. This information is primarily found during the subjective examination or by using a thorough new patient form. Chad also discussed the impact of insurance. Chad states those patients on work comp, third party, who have pending litigation tend to have confounding factors to their prognosis and outcomes. For intake forms, Chad recommends the form captures medications, medical history, employment. His text book “100 Orthopedic Patient Cases” has a history form which was built by looking at those of multiple clinics. Chad feels that case based learning is one of the best ways to learn which is what inspired him to publish this text. During the objective examination, Chad focuses on movement based examination. He talks about “comparable sign” based on Maitland theory. This is the movement which reproduces symptoms. Patients who are able to reproduce their comparable sign have better outcomes. A within and between session change of the condition that worsens or improves symptoms impacts outcomes. Within session changes lead to improved outcomes. If there is a between session positive change, this has an even stronger positive predictor of outcomes. Triage special tests rule out hip issues (hip scour), neurological (straight leg raise) can rule out stenosis or lumbar radiculopathy, bike or treadmill test can point to vascular component. Tests to rule out the SI joint are lacking, Laslett’s cluster is utilized more as a confirmatory bundle. Reflex, manual muscle testing, sensory testing are used more towards the end of the examination to confirm neurological involvement. Chad feels imaging is over used and too early. Chad uses referral to imaging more for cases that he feels are outside the scope of physiotherapy. These would be candidates for injection, surgery, or have a fracture. Unusual pain behaviors may occur with cancer and would not have a mechanical presentation. When considering prognosis, readiness to participate in physiotherapy, mechanical behaviors are key. Assessing barriers is also key. Central or wide spread pain is likely to lend to delayed recovery and alter how the physiotherapist proceeds with the patient. Depression, anxiety, coping, self efficacy play a larger role in prognosis then the physical examination. Pearls of wisdom guided towards newer physiotherapists were targeted at two main goals. Chad notes a good based McKenzie based examination will lend to a thorough examination. A good passive physiological and passive accessory examination also is key and engages the patient.

Jeremy received his physiotherapy training in Australia, this was heavy in mobilization and manipulation revolving around the Maitland technique. He moved to UK and completed his PhD looking at postural influences on shoulder conditions. He has been awarded the Fellowship of Chartered Society of Physiotherapy, the highest honor a member can receive. Jeremy specializes in rotator cuff, shoulder instability, adhesive capsulitis, trauma, and surgical rehabilitation. During this interview, Jeremy challenges the postural influences and the existence of shoulder/subacromial impingement. He notes due to a hypothetical paper written, there was an influx of the number of subacromial decompressions performed in the UK and Sweden. Yet there was not much evidence to support the subacromial impingement hypothesis. Exercise therapy has been proven to be more helpful than surgery for rotator cuff tears or impingement when targeting specific muscle imbalances. He believes the muscle imbalance is what causes the humeral head to elevate, rather than the position of the scapula. Jeremy discusses neuromodulation considerations of the shoulder rehabilitation and using this when mechanical changes do not effect symptoms. He notes “What ever works as an assessment becomes the treatment. It does not rely on a structural diagnosis.” Jeremy defines the SSMP model and outcome tool. He discusses postural effects of scapular posture, then humeral posture, then thoracic kyphosis which he has studied extensively. Jeremy also puts a personal spin on his rehabilitation. He notes that it is key to understand how the patient’s shoulder problem is influencing their everyday life, what their expectations are. These are all key to the patient’s rehabilitative success. Jeremy discusses various treatment considerations for adhesive capsulitis. He uses intra articular steroid injections coupled with physiotherapy. His clinic also uses hydro distinction. This uses ultrasound guidance to inject sodium chloride to provide a stretch from inside the joint also coupled with physiotherapy. Jeremy discussed the research supporting use of lidocaine injection with good results up to months and how this is a great alternative to a steroid injection, which can be potentially harmful to the tendon.