Podcasts about achilles tendinopathy

Patellar tendinopathy (also known as Jumper's Knee) is a common issue in dancers. Similar to achilles tendinopathy, we often see a spike in the rates of patellar tendinopathy early in the dance season.In this episode you'll learn: exactly what patellar tendinopathy iscommon signs & symptoms of ittreatment & management strategies for dancersOther episodes mentioned in this podcast:Episode 50: Tendonitis in DancersEpisode 59: Patellofemoral Pain Syndrome in DancersEpisode 97: Achilles Tendinopathy in Dancers Learn more about Erika Mayall:Follow me on Instagram: @dancephysioerikaLearn more about me on my website: https://www.allegroperformance.comSign up for my newsletter: Click hereSend me an email: hello@allegroperformance.com

Achilles tendinopathy is a common issue in dancers, especially among styles with a lot of relevé, pointe work or jumping. In this episode, I talk about why we see a spike in achilles tendinopathy early in the season and what we can do about this.In this episode you'll also learn: exactly what achilles tendinopathy iscommon signs & symptoms of ittreatment & management strategies things to consider for preventionOther episodes mentioned in this podcast:Episode 50: Tendonitis in DancersEpisode 24: Posterior Ankle ImpingementEpisode 28: Growth Plate Injuries in DancersLearn more about Erika Mayall:Follow me on Instagram: @dancephysioerikaLearn more about me on my website: https://www.allegroperformance.comSign up for my newsletter: Click hereSend me an email: hello@allegroperformance.com

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

PodChatLive 192: Some papers that get us thinking about correlation/causation, and should we use heel lifts for Achilles tendinopathy?Contact us: getinvolved@podchatlive.comLinks from this week:Avelo: Meet the world's smartest running shoeDengue Fever with Sever's Disease: A Case ReportBreastfeeding-injury link: are concerns warranted?Efficacy of Heel Lifts for Managing Mid-Portion Achilles Tendinopathy (the LIFT Trial)

Jaryd Bourke is a podiatrist and PhD candidate at Monash University Physiotherapy.  In this episode, Jaryd discusses Achilles tendinopathy and his research investigating heel lifts and changes in patient outcomes and biomechanics. Edit: Sorry for saying Wodonga is a city in NSW! At least I know people are listening...  it's on the border... Thanks to Jaryd for a great conversation. Use the timestamps below to jump to relevant sections. In this episode: 0:00 About this episode and welcome Jaryd 2:20 What is tendinopathy? 3:30 What is Achilles tendinopathy? 5:30 Heel lifts for Achilles tendinopathy - research 7:18 How could heel lifts help with Achilles tendinopathy symptoms 10:00 Jaryd's trial on heel lifts for Achilles tendinopathy – key methods 17:00 Clinical implications 23:33 Final thoughts Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus study, link to paper:  https://bjsm.bmj.com/content/59/13/891.abstract Follow Jaryd on LinkedIn: https://www.linkedin.com/in/jaryd-bourke-86932b200/?originalSubdomain=au If you are finding this content helpful, we would appreciate a review and rating for the Physio Foundations podcast. This really helps promote the podcast to others. Hit the follow button and give us a review and 5-star rating. Stay connected: Read more at Perraton.Physio or the Perraton Physio LinkedIn page. Watch us on YouTube: https://www.youtube.com/@PerratonPhysio Follow @PerratonPhysio on Facebook, X (Twitter), Instagram and Linked In. This discussion is intended for health professionals and health professional students. Always seek guidance from a qualified health professional regarding any questions about your health or medical condition.

[Download] The Ultimate Achilles Guide for Runners Is stubborn Achilles pain keeping you from running the way you want to? In this powerful episode, we sit down with a former professional runner and CEO of Running for Real, Tina Muir who shares her personal journey through insertional Achilles tendinopathy — from the frustration of chronic pain to the difficult decision to undergo surgery, and ultimately, her triumphant return to running. You'll hear what it really takes to recover both physically and mentally, how she navigated setbacks, and what made the biggest difference in finally running pain-free.  Whether you're managing heel pain now, considering surgery, or want to avoid it altogether, this conversation is filled with real talk, hard-earned wisdom, and hope.

Chris Hughen sat down with Rodrigo Scattone Silva to discuss all things achilles tendon pain. We dive into the complexities of diagnosing and managing achilles-related pain, the importance of a thorough assessment, treatment options, and much more.  Watch the full episode: https://youtu.be/iDwJiTv7eJg  Episode Resources: Traweger, 2025 Scott, 2015 Rodrigo's Twitter Rodrigo's Instagram --- Follow Us: YouTube: https://www.youtube.com/e3rehab  Instagram: https://www.instagram.com/e3rehab/ Twitter: https://twitter.com/E3Rehab --- Rehab & Performance Programs: https://store.e3rehab.com/  Newsletter: https://e3rehab.ck.page/19eae53ac1  Coaching & Consultations: https://e3rehab.com/coaching/  Mentoring: https://e3rehab.com/mentorship-intake-form/  Articles: https://e3rehab.com/articles/  --- Podcast Sponsors: The Science PT: Get 5% off all online courses using “E3podcast” at checkout! - https://thesciencept.com/courses/online-courses/ Legion Athletics: Get 20% off using "E3REHAB" at checkout! - https://legionathletics.rfrl.co/wdp5g  Vivo Barefoot: Get 15% off all shoes! - https://www.vivobarefoot.com/e3rehab --- @dr.surdykapt @tony.comella @dr.nicolept @chrishughen @nateh_24 --- This episode was produced by Kody Hughes

We're always told to avoid dorsiflexion with insertional Achilles tendinopathies, but is this accurate?We discuss the 2025 paper - Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trialhttps://bjsm.bmj.com/content/59/9/640.long

Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial Pringels L, Capelleman R, Van den Abeele A, et al. Br J Sports Med. Published Ahead of Print. doi:10.1136/bjsports-2024-109138 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik/Jason/Chris's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux

We welcome Dr. Humbyrd once again in this episode as we explore the continuum of Achilles tendinopathy. From tendinosis & microtears to peritendinitis, we break down the clinical signs, imaging findings, and the latest treatment options—both non-operative and surgical. Dr. Humbyrd received her B.A. from the University of Pennsylvania and her M.D. from the Mount Sinai School of Medicine. During medical school, she participated in a month-long ethics fellowship at the University of Oxford. After medical school, Dr. Humbyrd completed her residency in Orthopaedic Surgery at Johns Hopkins School of Medicine followed by a foot and ankle fellowship at Mercy Medical Center. Dr. Humbyrd specializes in the treatment of post-traumatic arthritis and complex sports injuries of the foot and ankle, as well as foot and ankle deformities and arthritis. She has extensive surgical experience in complex reconstructions, including ankle replacement. Dr. Humbyrd is Chief of Foot and Ankle Orthopedics at the University of Pennsylvania, Founder and Director of Program in Surgical Ethics and Health Policy at the University of Pennsylvania, USA. Goal of episode: To develop a baseline knowledge of achilles tendinopathy. In this episode, we discuss: ✅ How to recognize Achilles tendinopathy in the clinic ✅ Imaging clues: X-ray vs. MRI findings

In this Questions in Cars episode of BFR Radio, I answer a rugby player's question about using Blood Flow Restriction (BFR) training to manage Achilles tendinopathy and arthritis in the big toe. With pre-season in full swing, high running loads are a challenge for tendon health, making rehab strategies crucial. We break down how BFR can be used as both a pain management and strength tool, how it compares to traditional high-load isometric and eccentric training, and how to incorporate morning activation sessions for optimal recovery. Tune in to learn how to integrate BFR into your routine for long-term tendon resilience. Timestamps: 00:36 Listener's Question: Rugby Player's Tendinopathy 01:35 Traditional Methods for Tendinopathy 02:53 Benefits of BFR for Tendinopathy and Arthritis 03:45 Morning Activation Routine with BFR 05:54 Daily BFR Protocols for Pain Management 07:14 Strength Training with BFR 11:14 Pre-Running BFR Routine 12:37 Hormonal and Recovery Benefits of BFR 15:25 Long-Term BFR Strategies Links & Resources: BFR cuffs & online training programs: www.thebfr.co Instagram: @thebfr.co Twitter: @thebfr_co

You start feeling pain in your Achilles tendon– should you still go for an easy run?   Dr. Duane Scotti, DPT, PhD, OCS is a running physical therapist, Board-Certified Orthopaedic Clinical Specialist, run coach, host of the Healthy Runner podcast, and founder of Spark Healthy Runner.   We talk about: Differences between Achilles tendinopathy and tendonitis Why you don't need to give up running due to Achilles pain A pain monitoring tool to guide treatment Exercises for Achilles tendinopathy Preventative measures and shoe considerations Why do men 40+ suffer from this injury more often?   Share this episode with a friend who's dealing with Achilles pain!   Links & Resources from the Show: Duane on Instagram: @sparkhealthyrunner Duane on YouTube: @sparkhealthyrunner Duane on TikTok: @sparkhealthyrunner Duane's Healthy Runner Group on Facebook Duane on LinkedIn Healthy Runner Podcast on Spotify and Apple Podcasts Ultimate Guide to running healthy without achilles pain: https://learn.sparkhealthyrunner.com/achilles  Get our free injury prevention email series at strengthrunning.com/prevention.   Thank you Ketone-IQ! Ketone-IQ increases the levels of ketones in your blood - and raised blood ketone levels do increase focus and alertness, which is why I take a shot before every podcast recording and have for almost two years even before their sponsorship. I feel dialed in and quick for these high-stakes conversations. There's also promising research - and loads of anecdotal evidence - that ketone supplementation can help with recovery if taken post-exercise. I know some of the best ultra runners in the world, Boston Marathon champ Des Linden, and the pro cycling team that won the TdF in 2022 and 2023 all take ketones post-race to aid recovery. Go to Ketone.com/strengthrunning to save 30% on your first subscription and receive a free 6-pack of Ketone-IQ and try for yourself today.   Thanks to 2Before! We are supported by 2Before, a powerful sports supplement made from New Zealand Blackcurrant berries designed to increase endurance, manage inflammation, support immunity, and promote adaptation. 2Before helps to boost performance by increasing blood flow, making it more efficient for the body to pump oxygenated nutrient-rich blood into the muscles. So, if you want to try to boost your performance and immune system, use code JASON for 30% off 20 packs and multi-serve packs at 2Before.com.  Pro tip: get the caffeinated version. You'll get the vasodilatory benefits of blackcurrant berries with the powerful performance and mental benefits of caffeine. Thank you to 2Before for supporting Strength Running!   Thanks DrinkLMNT! A big thanks to DrinkLMNT for their support of this episode! They make electrolyte drinks for athletes and low-carb folks with no sugar, artificial ingredients, or colors. They are offering a free gift with your purchase at DrinkLMNT. And this does NOT have to be your first purchase. You'll get a sample pack with every flavor so you can try them all before deciding what you like best.  DrinkLMNT's products have some of the highest sodium concentrations that you can find. Anybody who runs a lot knows that sodium, as well as other electrolytes like magnesium and potassium, are essential to our performance and how we feel throughout the day. If you're not familiar, LMNT is my favorite way to hydrate. They make electrolytes for athletes and low-carb folks with no Sugar, artificial ingredients, or colors. I'm now in the habit of giving away boxes of LMNT at group runs around Denver and Boulder and everyone loves this stuff. Boost your performance and your recovery with LMNT. They're the exclusive hydration partner to Team USA Weightlifting and quite a few professional baseball, hockey, and basketball teams are on regular subscriptions. So check out DrinkLMNT to get a free sampler pack and get your hydration optimized for the upcoming season.  

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

Would you have ever considered injection someone with mid-portion achilles tendinopathy 3 times in the space of 12 weeks? Johanssen et al (2022) did in todays paper and the results might surprise you! This is the closest we have come on having genuinely different views on a paper and was a fun conversation! Please note, this episode does not constitute medical advice.

Patreon: ⁠https://patreon.com/SportsMedicineProject?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink 1. Keep Intensity the Same This is the biggest and easiest mistake. If your Achilles is sore, what will aggravate it most is higher rates of loading—formally, this happens more when you run faster. Yes, it might warm up during the run, but you'll pay for it 24 hours later. You need to stress it just a little, see how it responds, and build from there. 2. Rest, Then Go Straight Back to Full Load You shouldn't completely rest and then jump straight back to the same training load. If you usually do speed work on Tuesdays, and you've had a week or two off, that first run back shouldn't be the same session. Don't do that. Start gradually—try something like 6 x 1-minute efforts and progress from there. 3. Wear Flat Shoes Heel pitch helps Achilles tendon pain. A higher heel reduces both tensile and compressive forces by limiting dorsiflexion. Achilles pain isn't just about the run—it's about everything you do throughout the week. If you're on your feet all day, even if it's not sore at the time, that will contribute to your pain during training. 4. Not Question the Diagnosis Sometimes, it's not Achilles tendinopathy. Yes, if you've had it before, you can get it again—but not always. Other things mimic Achilles pain. Be sure. 5. Keep Training Load the Same If you're dealing with Achilles pain, take something away. Reduce intensity or volume—adjust something. If you're not sure how, see someone who can help you make it graded. 6. Think the Adjuncts Are the Answer They can help, but they're not the solution. Shockwave, massage, needling—useful, sure. But if you're not loading appropriately, nothing else will fix it. 7. Not Load It Properly You have to load it. Strength, plyometrics, progressing appropriately—it all matters. 8. Smash the Anti-Inflammatories and Think That's Enough Anti-inflammatories aren't bad, but if that's all you're doing, you're missing the point. This isn't an inflammatory condition—it's a load issue. 9. Think Injections Are the Quick Fix Too many people jump to injections too early. They can have a role in specific cases, but they're not a cure. 10. Ignore the Psychology Behind Injury This is huge. Achilles pain isn't just about the tendon—it's about the mental load of not running, the frustration, the identity shift. Understanding this can change everything. Achilles tendinopathy, injury management, running injuries, health professionals, rehabilitation, load management, resistance training, anti-inflammatories, psychological impact, running performance

Chris Hughen sat down with Ruth Chimenti to discuss Achilles Tendinopathy. We dive into the recently revised Clinical Practice Guideline on mid portion achilles tendinopathy, treatment options, continued uncertainties, common misconceptions, and much more. Watch the full episode: https://youtu.be/qNUow-leX5Q  Episode Resources: Midportion Achilles Tendinopathy CPG Previous Episode on Achilles Tendinopathy: #93 w/ Karin Silbernagel --- Follow Us: YouTube: https://www.youtube.com/e3rehab  Instagram: https://www.instagram.com/e3rehab/ Twitter: https://twitter.com/E3Rehab --- Rehab & Performance Programs: https://store.e3rehab.com/  Newsletter: https://e3rehab.ck.page/19eae53ac1  Coaching & Consultations: https://e3rehab.com/coaching/  Mentoring: https://e3rehab.com/mentorship-intake-form/  Articles: https://e3rehab.com/articles/  --- Podcast Sponsors: Legion Athletics: Get 20% off using "E3REHAB" at checkout! - https://legionathletics.rfrl.co/wdp5g  Vivo Barefoot: Get 15% off all shoes! - https://www.vivobarefoot.com/e3rehab Tindeq: Get 10% off your dynamometer using code “E3REHAB” at checkout - https://tindeq.com/ --- @dr.surdykapt @tony.comella @dr.nicolept @chrishughen @nateh_24 --- This episode was produced by Matt Hunter

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

PodChatLive 158: Three new papers on falls risk, and why taking a detailed history is important Contact us: getinvolved@podchatlive.com Links from this episode: Comparison of Achilles Tendinopathy in regular and irregular prayer offers The Effects of Ankle and Foot Exercises on Ankle Strength, Balance, and Falls in Older People Decreased foot-related quality of life is a risk factor for falls in patients with rheumatoid arthritis Relationship of foot pain with the increased risk of falls in patients with Parkinson's disease

We welcome first time guest, Achilles tendinopathy specialist, Dr. Shawn Hanlon from Cal State Fullerton, to discuss the evolving injury which has kept one of the best players in the game sidelined. Learn everything you need to know about Christian McCaffery's injury, the first pick in just about every single fantasy football draft, from one of the premiere experts in the field.

We had Colin on today to primarily talk about the pragmatic aspects of rehabbing an Achilles tendon in the sporting population. Part of Colin's PhD thesis was looking at this specific topic.  In my opinion, a lot of the researched tendon loading programs aren't pragmatic, are boring, are hard to stick to and just don't seem like they would contribute to performance.  Colin's program is NOT like that. His simple, progressive, performance based and pragmatic tendon and lower extremity program should be used as your "recipe" for care. Have a look at his paper here that outlines the full rehab program. More about Dr Colin Griffin Colin is a strength and conditioning coach at the UPMC Sports Surgery Clinic with a role that includes the rehabilitation of lower-limb injuries and the delivery running performance services.   He completed a degree in Strength and Conditioning with Setanta College in 2015 and completed Masters Degree in Coaching and Exercise Science in University College Dublin in 2016. He is an IAAF Level 4 certified endurance coach, coach eduaction tutor with Athletics Ireland and an accredited professional member of the Sport Ireland Institute in High Performance Sport Strength and Conditioning.   He has over 15 years experience in high performance sport having represented Ireland at the 2008 and 2012 Olympic Games in the 50km walk as well as a number of top 12 perofrmances at world and european level. He has also coached other Irish athletes to Olympic level.   In 2011 he founded The Altitude Centre Ireland and pioneered the development of Irelands first residential altitude training centre at the University of Limerick.   His main areas of interest include the rehabilitation of tendinopathies and muscle overload injuries, biomechanics, physiology and athletic development.   Colin is undertaking a PhD on the biomechanics of muscle-tendon interaction at the achilles during exercise, working under JB Morin at the University of Côte d'Azur and in collaboration with SSC Sports Medicine.  

PodChatLive 143: GTN for achilles tendinopathy, ant bites on the feet, and kinesophobia & nail surgery Contact us: getinvolved@podchatlive.com Links for this episode: Medical college apologises after Dean participates in “frenzies of abuse" Influence of the kinesiophobia and its pain intensity relationship in subjects with onychocryptosis A surgical site abscess caused by an ant bite on foot 7 years after mastectomy Physio Grateful For Musculoskeletal Lesson From Patient Who's Watched A Few Videos On Instagram Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy

Send us a Text Message.This episode with Dr Ebonie Rio is a snippet taken from our Practicals live Q&A sessions. Held monthly, these sessions give Practicals members the chance to ask their pressing questions and get direct answers from our expert presenters. Learn more about Physio Network's Practicals here - https://physio.network/practicals-rio1Dr Ebonie Rio is a world-leading expert in tendinopathies. Ebonie completed her PhD in tendon pain and continues to research this topic at La Trobe University, Melbourne. She also holds a Masters of Sports Physiotherapy degree.If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!

Chris Hughen sat down with Jake Tuura to discuss all things tendons. We dive into the management strategies, and misconceptions of, acute and persistent achilles and patellar tendinopathies. More about Jake:  Jake's Instagram Jake's Twitter Jake's Website Jacked Athlete Podcast --- Follow Us: YouTube: https://www.youtube.com/e3rehab  Instagram: https://www.instagram.com/e3rehab/ Twitter: https://twitter.com/E3Rehab --- Rehab & Performance Programs: https://store.e3rehab.com/  Newsletter: https://e3rehab.ck.page/19eae53ac1  Coaching & Consultations: https://e3rehab.com/coaching/  Articles: https://e3rehab.com/articles/  Apparel: https://store.e3rehab.com/collections/frontpage  --- Podcast Sponsors: Vivo Barefoot: Get 15% off all shoes! - https://www.vivobarefoot.com/e3rehab CSMi: https://humacnorm.com/e3rehab  --- @dr.surdykapt @tony.comella @dr.nicolept @chrishughen @nateh_24 --- This episode was produced by Matt Hunter

Watch and Read This Episode HereEver wondered how the pros manage running injuries? Find out in this episode!Picture this - you're a runner and you got hurt. You're searching the internet for quick hacks and fixes so you can keep running but you just get more confused and don't know who to trust. In this article, we'll hopefully cut through the sh*t and make it easy for you to get back on the road of recovery with pro-medical advice.You'll learn three simple steps to fix three common running injuries in new and advanced runners. You'll also get the diagnosis, short-term and long-term treatment from a professional physio/physical therapist of the following; Runner's Knee, IT Band syndrome, and Achilles Tendinopathy - yes, not tendinosis because… that's not even a thing for most people anymore and we'll tell you why.Time Stamps of what you'll learn [00:01] - Introduction to runner's knee and injury prevention[02:32] - Case Study 1: Diagnosis and immediate treatment strategies for runner's knee[03:54] - Incorporating strength training in early treatment[06:09] - Detailed discussion on gait retraining for runners[09:41] - Case study 2: Iliotibial band syndrome diagnosis and treatment[12:39] - Ongoing management and prevention of ITB syndrome[16:18] - Case Study 3: Addressing Achilles tendinopathy in endurance athletes[19:50] - Concentric vs Eccentric[24:00] - Long-term strategies and personal insights on managing Achilles issues[27:39] - Closing thoughts and additional resources for runnersLinks & Future LearningsWatch & Read this hereDownload the 10W2S Strength Training for Runners App hereTop 10 tips of managing running injuries10W2S on InstagramDLake Runs on InstagramSponsorDLake One Percent Better Newsletter - The truth is, most running info is repetitive. So to make your life easy, I spent the last 11 years reading, watching, talking to experts and doing as much as I could so you don't have to make the same mistakes as me. Join 1,100 + other smart runners and sign up now! Hosted on Acast. See acast.com/privacy for more information.

João Mendes is a coach who helps injured athletes recover and get back to elite performance.    João on Instagram Check Out My Game Speed Course and Programs at www.multidirectionalpower.com   

On this episode we were joined by special guest researcher Dr. Mikel Joachim from the University of Wisconsin-Madison Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy Joachim MR, Kliethermes SA, Heiderscheit BC. Med Sci Sports Exerc. 2024;56(1):128-133. doi:10.1249/MSS.0000000000003276 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by our sponsors at: CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight Koal Challenge – Sam Roux

PodChatLive 122: What questions to ask patients with achilles tendinopathy, LLD & abdominal pain, and foot typing (again) Contact us: getinvolved@podchatlive.com Links from this episode: Parietal abdominal pain with lower leg discrepancy: a case report Forefoot Morphotypes in Cavovarus Feet: A Novel Assessment of Deformity Are we asking the right questions to people with Achilles tendinopathy? The Nocebo Effect: When Words Make You Sick

Fear of Running Injuries? Learn How to Prevent and Strengthen!   January and February are crucial months for building strength and preventing injuries as you start your running journey for the year.     If you have ever been told that you have “weak glutes” or “glute amnesia”, suffered from achilles tendinopathy, or a bone stress injury from running then you will want to hear what I learned at the national physical therapy conference this past month.   In this episode, I am also sharing 4 key strength training and running tips to help you build a solid foundation for which all future half marathon and marathon training will be built upon. I'm not holding anything back as I share my secrets to strength, injury prevention, and running tips that I have learned the first 2 months of this year! You will learn about these topics and more!   - Single best muscle group to strengthen for injury prevention - 3 step process to getting stronger glutes as a runner - Achilles Tendinopathy updates - Bone stress injuries and how to prevent them - Base training and running races - Running when travel and weather are roadblocks - 4 keys to strength training for runners - Best shoes to wear when strength training   Whether you're a beginner runner or an experienced runner who has been struggling to figure out the right recipe for strength training and running, this episode is for you!   Join me as we explore how to approach strength training, injury prevention,and running in the early months of the year.  Stay tuned for valuable tips, the latest research, techniques, and insights on how to make the most out of your running journey during the beginning of the year!   Listen to my previous episode on Achilles Tendonitis Treatment and Prevention here Listen to my previous episode on Winter Running Gear here Listen to my previous episode on Base Training Updates for Your Best Race Season   Watch and follow along with coach Cat's 30-Minute Treadmill Workout   [Download] My Free Resource: Strong Glute Guide   [Download] How to grow as a runner (6 Steps)   There are six parts of your running journey that need to be optimized so you can run strong and last long! Learn them here   Want Dr. Duane to answer your question on the podcast?  Submit questions here   Want the structured strength, recovery, nutrition, and run plan with support and accountability to reach your highest potential as a runner so you don't get injured again? Book a call and learn more about Healthy Runner coaching here    A big thanks to Naboso for your support for this episode! Want to know how I prioritize foot health as a runner?  Kinesis board and toe splays from Naboso.   Naboso's newest product, the Kinesis board features dual sensory stimulation, a micro-wobble system and a single-leg platform to improve my stability for running!   Click here and use code HEALTHYRUNNER for 20% off your entire Naboso order!    Connect with Dr. Duane: - Instagram - @sparkhealthyrunner - Join Our Healthy Runner Facebook Community - Subscribe to our YouTube Channel - duane@sparkhealthyrunner.com - www.sparkhealthyrunner.com Listen & Subscribe: Apple Podcasts Spotify Stitcher Google Play iHeartRadio Amazon Music Website  

On this episode of The Soft Tissue OT, we're focusing on Achilles tendinopathy, a condition affecting the largest and strongest tendon in the body. This condition often affects runners, but also affects non-active population too! Tune in as we discuss the causes, symptoms, and treatment strategies for Achilles tendinopathy. In this episode we discuss:What is Achilles tendinopathy the anatomy of the Achilles and calf musculature The risk factors for developing this condition Step-by-step rehab protocol to fix this issue And much more!if you have enjoyed this podcast episode, please share and SUBSCRIBE to the podcast to ensure you don't miss any future episodes.  #SoftTissueOT #OT #occupationaltherapy #mindfulness #holistichealth #health #wellness

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/

Most people will experience a painful foot or ankle condition at some point in their lives. JAMA Associate Editor David Simel, MD, MHS, discusses diagnosis and treatment of Morton neuroma, plantar fasciitis, and Achilles tendinopathy with Minton Truitt Cooper, MD, of the University of Virginia, Charlottesville. Related Content: Common Painful Foot and Ankle Conditions Diabetic Foot Ulcers What Are Diabetic Foot Ulcers?

Dr. Matthew Klein is a professor of Physical Therapy at West Coast University Center for Graduate Studies. He is a residency and fellowship-trained clinician and professor specializing in orthopedic, geriatric, and sports rehabilitation.  He is further specialized in running sports and treating runners of all ages and abilities. He graduated from Western University of Health Sciences in 2016 with his doctorate, passed boards the same year. He studies Achilles Tendinopathy, has an extensive history in the footwear world, working in the running industry for years prior to becoming a Doctor of Physical Therapy.  He has participated in and written research on footwear and running and continues to discuss and learn about those and more. He currently consults for several footwear companies helping with the development of shoes with appropriate biomechanics in mind. EPISODE OUTLINE:(00:01) Choosing the Right Running Shoe(12:26) Weight's Impact on Shoe Selection(15:31) Impact of Shoe Selection on Injuries(32:45) Transitioning to Super Shoes, Injury Risk(42:58) Age and Running Performance Impact(50:49) Sharing Information on Foot HealthTRANSCRIPT:https://share.transistor.fm/s/d1841dae/transcript.txtEPISODE LINKS:Matt's Website: https://www.doctorsofrunning.comMatt's Instagram: https://www.instagram.com/kleinrunsdpt/?hl=enShow Notes:PODCAST INFO:Podcast Website: www.relaxedrunning.comApple Podcasts: https://podcasts.apple.com/au/podcast...Spotify: https://open.spotify.com/show/2MMfLsQ...RSS: https://feeds.transistor.fm/relaxed-r...SOCIALS:- Facebook: https://www.facebook.com/relaxedrunning- Instagram: https://www.instagram.com/relaxed_run...MORE FROM RELAXED RUNNINGPersonal Running Coaching: https://www.relaxedrunning.com/personal-coachingTechnique Analysis: https://www.relaxedrunning.com/techniquecoachingFalls Creek Run Experience: https://www.relaxedrunning.com/falls-creek

In this week's episode, we talk to researcher and professor Keith Baar, Ph,D., about:What to do when you have injuries to your tendons/ligamentsHow to support and maintain healthy tendons and ligamentsCollagen use - does it work?Pro tip - watch this on our YouTube channel!Keith is the head of the Functional Molecular Biology Laboratory in the Department of Neurobiology, Physiology, and Behavior at the University of California, Davis. He is a molecular exercise physiologist and is leading a team of researchers attempting to develop ways to improve muscle, tendon, and ligament function.The goal of his laboratory is to understand the molecular determinants of musculoskeletal development and the role of exercise and nutrition in improving health and performance. To achieve this goal, he and his team work on muscle, tendon, and ligaments from 2- and 3-dimensional tissue culture, in vivo wild type and genetically modified animals, and humans.His study interests include the interplay between nutrition and exercise and the mechanistic target of rapamycin complex 1 (mTORC1) in the maintenance of muscle mass; the role of a ketogenic diet in improving age-related declines in muscle and brain function; and the role of different types of loading on the development and mechanics of ligaments.Please note that this podcast is created strictly for educational purposes and should never be used for medical diagnosis and treatment.See you in the next episode!***1:1 Coaching: Through 10/1/23, NEW CUSTOMERS can get $300  off 1:1 support! (Must pay 3 months in advance) Book your session today.Supplements That Improve Performance Mini CourseMentioned:Stay up-to-date with all of Keith Baar's exciting research and workTwitter: @MuscleScienceKeith's Google ScholarThe Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth BasketballAncient Egyptians & wooden splints/castsStress shielding of patellar tendon: effect on small-diameter collagen fibrils in rabbit modelMORE NR New customers save 10% off all products on our website with the code NEWNR10 If you would like to work with our practitioners, click here: https://nutritional-revolution.com/work-with-us/ Save 20% on all supplements at our trusted online source: https://us.fullscript.com/welcome/kchannell Join Nutritional Revolution's The Feed Club to get $20 off right away with an additional $20 Feed credit drop every 90 days.: https://thefeed.com/teams/nutritional-revolution If you're interested in sponsoring Nutritional Revolution Podcast, shoot us an email at nutritionalrev@gmail.com.

Kirsty Wood won the free race entry to the IRONMAN 70.3 Sunshine Coast. We hear from Kirsty about how it all went. We discuss the benefits of supplementing with creatine plus we share Mikki's interview with Professor Darren Candow – an expert in the field. Kate Baldwin of Endurance Movement and Valere Endurance comes back on the show to share her expertise in the field of Achilles Tendinopathies. We learn about what we can do to prevent this type of injury plus the different ways we can manage the recovery. We also hear about the kind of rehab work we can focus on in the gym to aid recovery.  (0:10:57) – Kirsty Wood talks about her race at the IM703 Sunshine Coast (0:18.26) – Infinit Nutrition 10% discount using the code FITTER10 (0:22:23) – Prof Darren Candow on Creatine (0:34:00) – Dr Kate Baldwin and Achilles Tendinopathies LINKS: Infinit Nutrition 10% discount using the code FITTER10 at  https://www.infinitnutrition.com.au/ Note: For the code to work you need to have created an account and be logged in. IRONMAN 70.3 Sunshine Coast at https://www.ironman.com/im703-sunshine-coast Dr Kate Baldwin of Endurance Movement at https://endurancemovement.com/ Valere Endurance at https://valereendurance.com/  The full episode with Mikki and Professor Darren Candow “Exploring the benefits of creatine” at https://podcast.mikkiwilliden.com/71

How can you successfully treat hip pain and instability associated with your patients' hip dysplasia? Find out the eight critical steps to excellent results with hip dysplasia in this podcast, which is part 3 in this three-part podcast series with Tom Goom (Running Physio). Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs Free video series: Achilles Tendinopathy from start to finish line! with Tom Goom In this free Masterclass "Achilles tendinopathy: Assessment & rehab from start to finish line" presented by Tom Goom and hosted by Clinical Edge, you'll discover: 3 common conditions that cause Achilles pain. How to assess patients with Achilles pain to get a clear diagnosis, and know where to start treatment. Rehab exercises that will help your patients overcome their Achilles pain. How to successfully return your patients to running or sport, and achieve their goals, without stirring up their pain. CLICK HERE to register for your free access to this three-part video series with Tom Goom CLICK HERE for your access to three free videos with Tom Goom Links associated with this episode: Free Achilles tendinopathy videos Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom Physio Edge podcast 154 - Part 1 of 3 - Hip dysplasia key signs & symptoms with Tom Goom Physio Edge podcast 156 - Part 2 of 3 - 3 Types of hip dysplasia and How0 to identify them Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Join Tom live on Facebook & ask your shoulder related questions every Friday Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Tom Goom on Twitter Tom Goom's website David Pope - Twitter David Pope & why I started Clinical Edge Review the podcast on iTunes Infographics by Clinical Edge Articles associated with this episode: CLICK HERE to download the article associated with this podcast Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. The Journal of arthroplasty. 2017 Sep 1;32(9):S20-7. Chapters:  05:36 - Step 1: Assessment 07:10 - Step 2: Investigations 08:35 - Step 3: Patient education 10:07 - Step 4: Settling symptoms 16:25 - Step 5: Strength 18:15 - Step 6: Control and proprioception 20:08 - Step 7: Co-existing pathology 21:09 - Step 8: General health 22:32 - Key points  

Effect of Symptom Duration on Injury Severity and Recovery in Patients With Achilles Tendinopathy. Hanlon SL, Scattone Silva R, Honick BJ, et al. Orthop J Sports Med. 2023;11(5):23259671231164956. doi:10.1177/23259671231164956 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight

This month's clinical corner article is a very recent research report that covers the study of different subgroups of patients that all experienced Achilles Tendinopathy and the differences in their recovery/trajectories. Learn about the subgroups that were split into structural, activity/functional, and psycho-social and why it was important to study them separately.Read the article here: https://www.jospt.org/doi/10.2519/jospt.2023.11330Did you know that you don't need a doctor's prescription to receive physical therapy? The laws of Direct Access allow you to receive physical therapy without a referral and still use your insurance benefits! Learn more on how Direct Access can help YOU! Our website: https://www.oxfordphysicaltherapy.com/

Hosts: Carolyn McMakin, MA, DC Kim Pittis, LCSP, (PHYS), MT   Editing and transcription mistakes: Kevin   0:04 Golden Gate Bridge 2:25 Translating Harry Van Gelder's ideas 3:45 Philadelphia FSM Core 4:18 Ehlers-Danlos patient 9:09 Dirt dart 11:19 Every patient teaches you something 13:23 Sports course in May 14:56 Constant presentation updates 17:25 Achilles Tendinopathy. what happened 19:18 Emotional component when treating pain 20:34 Treating more efficiently 22:20 "Where there's motivation there's possibility" 22:39 Recovering faster in athletics matters a lot 23:22 FSM makes you think then you learn 26:00 Chronic injuries are easy 26:45 Inflammation and pain 30:45 Inflammation and the athletic population 31:38 "When you rob the body of inflammation right after recovery it's not going to happen" 34:53 Look at the method section when reading published papers 43:10 Ehlers-Danlos - they don't have a way to treat it so why would they look for it? 44:44 John Sharkey on Kims Game Changers Podcast fascia and levers debate 54:13 Think of emotions as derivative.  

Chris and Sam sat down with Karin Silbernagel to discuss achilles tendinopathy and achilles tendon ruptures. In the first half of our conversation with Karin, we discuss tendinopathy versus tendinitis and tendinosis, diagnostic criteria, biggest findings over the past 1-2 decades regarding tendon related research, insertional versus mid portion achilles tendon pain, average recovery timelines, pain during rehab and training, and much more. In the latter half of our conversation, we chat about achilles tendon ruptures including risk factors, surgical versus non-surgical considerations and recommendations, and objective testing. Karin is a researcher, professor, clinician, and the Associate Chair of the Physical Therapy Department at the University of Delaware. More about Karin:  Karin's Twitter Karin's ResearchGate --- More about us:  YouTube: https://www.youtube.com/e3rehab  Website: https://e3rehab.com/  Instagram: https://www.instagram.com/e3rehab/ Twitter: https://twitter.com/E3Rehab --- Sponsors: Minimalist Footwear: https://www.vivobarefoot.com/ (Discount code: E315 for 15% off) VALD: www.vald.com --- @dr.samspinelli @dr.surdykapt @tony.comella @chrishughen --- This episode was produced by Matt Hunter.      

Comparing telehealth or hybrid format with in-person physical therapy

In this episode, we review the high-yield topic of Achilles Tendinopathy from the Orthopedics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Notes here: https://jackedathlete.com/podcast-79-achilles-tendon-rehab-with-david-grey-and-matt-mcinnes-watson/

Today we wrap up the mid portion Achilles tendinopathy CPG, but we also take things one step further by summarizing a 2015 article by Karin Silbernagel and Kay Crossley called, "A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation." For further reading, we also recommend taking a look at Silbernagel's "Current Clinical Concepts: Conservative Management of Achilles Tendinopathy" from 2020. If you haven't been using these principles, doing so could really level-up your Achilles tendinopathy rehab.Support the showUse code FIELDGUIDE for 40% off a MedBridge subscription.Support the podcast and get study guides and bonus episodes at Patreon.com/physiofieldguide.Find more resources and subscribe to practice questions at PhysioFieldGuide.com.

We have a ton of information on midportion Achilles tendinopathy, which means it is likely to be an ankle/foot diagnosis that shows up quite a bit on the OCS exam. Today we walk through the first half of the 2018 CPG, including pathoanatomic factors, epidemiology, risk factors, clinical course, diagnosis, and outcome measures.Support the showUse code FIELDGUIDE for 40% off a MedBridge subscription.Support the podcast and get study guides and bonus episodes at Patreon.com/physiofieldguide.Find more resources and subscribe to practice questions at PhysioFieldGuide.com.

On this episode we were joined by special guest Chris Juneau. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial Johannsen F, Olesen JL, Øhlenschläger TF, et al. JAMA Netw Open. 2022;5(7):e2219661. doi:10.1001/jamanetworkopen.2022.19661 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. Brought to you by CSMi – https://www.humacnorm.com/ptinquest Learn more about/Buy Erik's courses – The Science PT Support us on the Patreons! Music for PT Inquest: “The Science of Selling Yourself Short” by Less Than Jake Used by Permission Other Music by Kevin MacLeod – incompetech.com: MidRoll Promo – Mining by Moonlight

In this episode, Physiotherapy Lecturer and Tendinopathy Researcher, Seth O'Neill, talks about tendinopathy. Today, Seth talks about his interest in tendinopathy, and his presentation at the Fourth World Congress of Sports Physical Therapy. What is the warmup response? Hear about Seth's diagnosis framework, the appropriate use of imaging, rehabilitation, and get his advice to his younger self, all on today's episode of The Healthy, Wealthy & Smart Podcast. Key Takeaways “You're going to have some discomfort with these exercises and that's okay.” “Get your diagnosis right in the first place.” “Say yes to things when you can. Push yourself and you'll get there.” More about Seth O'Neill Seth is a Physiotherapy Lecturer at the University of Leicester whilst also maintaining clinical work. He has a PhD on tendinopathy, within this Seth has identified prevalence rates of tendinopathy in UK runners and developed a greater understanding of risk factors surrounding Achilles tendinopathy. His later work has completed a more in-depth analysis of how tendinopathy affects the Plantarflexors. This has focussed on how the strength and endurance is affected and which of the Plantarflexors is most involved. This work has highlighted the involvement of the Soleus muscle in human Achilles tendinopathy. This has led to the further work related to Calf injuries in sports. Whilst Seth's focus is on the Lower limb he maintains a strong interest in all MSK conditions. Seth feels passionately about supporting Physiotherapists to undertake further research either as standalone projects or MRes's or PhD's. Seth is currently examining tendon structure and changes that occur during health and disease along with Biopsychosocial interventions for tendinopathy and LBP and developing an international database of calf injuries. Suggested Keywords Healthy, Wealthy, Smart, Tendinopathy, Physiotherapy, IFSPT, Injuries, Recovery, Rehabilitation, Diagnosis, Exercises, Resources IFSPT Fourth World Congress of Sports Physical Therapy To learn more, follow Seth at: ResearchGate: Seth O'Neill Twitter: @seth0neill Subscribe to Healthy, Wealthy & Smart: Website: https://podcast.healthywealthysmart.com Apple Podcasts: https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify: https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud: https://soundcloud.com/healthywealthysmart Stitcher: https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio: https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927 Read the Full Transcript Here: 00:02 Hey, Seth, welcome to the podcast. I'm so happy to have you on. 00:06 Thanks very much for having me, Karen. It's great to be here. 00:08 Excellent. And today we're going to be talking about tendinopathy, maybe specifically Achilles tendinopathy. But before we get into that, I just want to let the listeners know that you're one of the amazing speakers at the fourth World Congress of sports, physical therapy taking place in Denmark at the end of this month, August 26, and 27th. And you will be talking about tendinopathy. So before we move on, I would love to know why. Why tendinopathy? How did that become sort of your specialty, your interest? 00:46 Yeah, tricky to sometimes answer these type of questions, really. But I've had tendon problems myself. So being active and sporty, I developed an Achilles problem, number of years back when I was a relatively junior physio, and we didn't really understand how we were trying to manage these things. And that took a long time to settle down. So that really sparked it off. And then not long after I developed poutine. And problem as well, my Achilles from wearing sorts of constricted footwear. So wearing wetsuits, boots, for a day, with doing wakeboarding and stuff. So developed the interest because I had the problem myself, which is probably the answer for most people, I think, with how we ended up specializing in one thing and went on to look at Achilles problems and differentiating these out as part of a master's dissertation project that did, and then still had some clinical questions I wanted to answer to help me understand how to manage people better. So I did my PhD in it as well. So yeah, it's one of those sort of sorry, stories of a while me. 01:50 And before this sort of deep dive into the literature, and a master's in a PhD, and maybe even during that journey, are there any cases that you worked on that you were like, Man, I would do it so differently now? Because I'm sure I mean, I know I have that every physio listening to this can probably relate to this. But where have you learned from your mistakes in relation? We'll say, we'll stick to Achilles tendinopathy. Right. So in relation to Achilles, tendinopathy, so that the listeners out there can be like, Oh, I think I just did that. And maybe I'm gonna change my mind. Yeah, 02:28 yeah, we're at a good number of these things, including not too distant past as well. I think like everyone, we're always learning. And we've all just got to admit to mistakes and where we can benefit and do better. So I think my early ones, particularly were around differential diagnosis, getting or missing things that were going on as well. So remember, one relatively young lad with an Achilles problem, sent him off doing Alfredsson Essentrics, this was probably 2001, something like that, came back loads loads worse and had this funny swelling around the back of his money, hola. And I was like, never seen this, this is rare, and didn't know what was going on at all. So sent them off for an MRI scan via our consultant at the time and came back with an accessory soleus, which is where part of the muscle is low lying and actually sort of fills where cake is fat pad is back in money can cause pain and be symptomatic. And the old school approach is to just go in and cut it out. So the surgeon is booked out and ordered and dusted. But I totally missed it. The first time I saw him, I don't know whether the swelling was there at that point, or whether I triggered him off or made him worse with the sort of rehab. So possibly, but also then I've had a couple of people during Alfredsson regimes that have actually ended up with ruptured or partial ruptures, partial tears, as a consequence, and then yeah, you end up sort of feeling terribly bad that what you were doing to try and help someone's actually caused a significant worsening of their function and symptoms, and they even had a patient with this happened last year, who will go and try and write up as a case study because it's really interesting management program afterwards with scans and stuff, but ultimately, they have big problems. 04:15 Yeah, it does. It happens to us all. And how do you from that? You can, you know, we can edit this out if you don't want to answer this. But how do you deal with that from sort of the mental standpoint of oh, shoot, like how do you mentally deal with that? Because I think that when that happens, it can you start to question why am I doing this? Am I the right person for this job? It can lead to burnout, that stress. So how do you manage that from a mental health standpoint, when things like this happen? 04:53 I think the thing is often as a junior therapist, you beat yourself up more because you sort of think I should have known I should sort of understand that, I think as you get more experienced than me, I'm 22 years 23 years qualified. Now you have lots of experiences like this and have to pick yourself up from them. And you just start to accept that that is like that's normal, whatever area of work you specialize in, or work in, whether it's physio, or even being an accountant or something, mishaps in things that you can learn from learning experiences happen all the time. And it's really just then taking what you can from it and developing and getting better. And when you have a bit of a boo boo happen like this, we tend to remember it and you never then miss it in the future. I mean, a couple of examples that I had in the past would be like federal stress fractures wasn't even on my diagnostic radar back when I was a junior therapist. You don't get taught at university and stuff, and then you sort of you miss one. And it's like, right, never missed one again. Now, it's always high up on your index of suspicion. So it's really just not trying to beat yourself up, realize it's a learning experience and identify what you can do. Going forward with it. Part of your CPD of your reflective practice that we're all encouraged to do and often do do but not formally. So yeah. 06:14 Yeah, great advice. Okay, now, let's get into the meat of the podcast here. So what we'll talk about is kind of you mentioned it differential diagnosis. So we'll talk a little bit about that, and then go into some possible treatments and, and outcomes and things like that. So let's say someone comes to you, with posterior ankle heel pain, they haven't been to their GP or to the orthopedic yet, because that happens a lot. Here in the US, I'm sure it happens a lot with you in the UK, as well. So I will hand the mic over to you. And you can maybe walk us through your differential diagnosis framework, what are you looking for when someone comes in with that? 07:03 So the first thing, I think is, as everyone already knows, is not to take whatever the previous diagnostic decision was, if they have seen someone as well, I make sure you do your own workup, because let's face it, we all make mistakes as well. So I'd always look at them with fresh eyes and not go with the the original diagnosis and make my own mind that the three big things that mimic Achilles tendinopathy really then are related to posterior ankle impingement. So in order to try going on, whether it's a bony impingement or not, and they're the ones actually see quite commonly that have been mismanaged that add a cricketer, recently, his professional cricketer, who had been sent from their medical team in one of the counties in the UK, or England, I should say, and unfortunately, that miss that he had a posterior impingement, not an Achilles problem and been trying to manage them and manage him using some invasive procedures, and actually scan and everything else when I scanned in, but absolutely pristine and fine. And that's the one thing I do come across time and time again, it's just people miss the impingement side of it, and normally, the x, so aggravating factors and easing factors that the patient will report to you if you listen carefully, and inquire, will be very, very different. It'll be a totally different set of positions, not about tendon load, it'll be their ankle position. And being in that plantar flexed position that's relatively simple and straightforward. But again, it just, it commonly crops up other common or relatively frequent presentations, then we'll be around several nerve. So one of the branches of your sciatic nerve runs on the lateral aspect of your Achilles, we just want to simply look at something like a straight leg raise with a neural bias for the inverter area. So you do inversion with dorsiflexion. And if movements like that provoked the pain, that's not normal for a tendon, it would normally only hurt when you put larger loads through it. And energy storage demands not simple structures, except in very highly irritable cases. But you can only determine that clinically. So they're the two big things that the third group then is other localized tendinopathies. So to be honest, posterior, or per Nei, which I think you guys call something different in the States. What are the perineal inverters of the foot? We always have problems when we teach anatomy with our students, if they use an American app, it gives it a different name. I forgot this. But anyway, so yeah, so just looking at the differential between those other tendons. So patients may refer and sort of suggest its posterior heel, but actually it's in front of the Achilles. So it's normally relatively localized pain and there's lots of debates on social media about what happens when you get diffuse pain in that area. diffuse pain is really quite rare in this area, and I do see a lot I still work clinically as well as work in that university from a research perspective and I do a lot of consultant work in sports. and wider as well. And we just don't see widespread pain in this region particularly. And the evidence really suggests that tendon off the Achilles particularly will be localized pain. It doesn't sort of spread out. But there will always be some exceptions, I'm sure. 10:15 And it sounds like from what you're saying one of the other really important things is that subjective interview. Yeah, right. So what questions are you honing in on? What are you What do you really want to know? 10:29 So I'm actually take a leaf out of Peter O'Sullivan's approach for back pain and look at the patient's story. How do they describe this originally starting? What's gone on with it from then? And what are their thought processes around that. So we really look at the whole patient, not just that the mechanical bio sorts of components here, but then our teas into the aggravating and easing factors. So where the pain is what makes it worse, what makes it better how long it takes to come on, often expecting a latent response. So the pain is not necessarily happening during this activity, it will be a latent flare up later. Although you'll sometimes get a warm up response during the activity as well. So we're looking for these hallmarks. And what we should pick up in the subjective is progressive tendons stress. So the example would be walking for the Achilles versus running versus hopping or jumping or London being progressive load, the higher you go up that ladder, the more it will flare them up or make them sore. And then what we're trying to do is look at the sin factor, then if you guys use that, as well, so severity, irritability, and the nature, but the irritability is key, the more irritable these are the lower level, we're going to start your rehab. And a lot of this subjective really helps guide our initial intervention program. But of course, on top of all this, we've got to consider the patient and the complexities that we get from our psychosocial component. And we've just had a sort of paper out with Neil Miller, and the group from Glasgow on biopsychosocial approach to tendinopathy. This the icon statement from the international group, that Karen Silverado that you mentioned earlier, and that's really looking at the psychological factors and social factors that are relevant for tendinopathy. Because like any musculoskeletal condition, the person's important, it's not just the the localized tissue that we sometimes can get overly focused on. 12:25 Absolutely, I'm preaching to the choir there. Now you had mentioned something in that, just now the warm up response. So can you explain what that is for the listeners in case they're not quite familiar with that? 12:38 Yeah. So this will be the person that will go for a walk or a run, or whatever their activity tennis, squash, whatever it happens to be, and they'll find it sore initially, and then it will get better, it feels better during the activity. And we tend to see this happens when they've sat for any length of time, if they're an inactive person, they'll get the same response then so the first five minutes of getting up having sat for an hour or two will feel sore, and then it gets better. And this is particularly common in the morning, where patients get up. And they say I was sore for 10 minutes until I've walked downstairs, made myself a coffee or had a shower. And then I feel better ready for the day. And that's typically what we see. So this sorts of pain that is focused around starting an activity when you've been inactive for a period. So that's 13:27 excellent. Thank you so much. So going back to our fictional patients here, they come in, they've got sort of posterior ankle pain, you've ruled out posterior ankle impingement, sural, nerve, local tendinopathies. And now you're really thinking well, given their subjective exam, given the little bit of objective exam that I've done, I think that we're dealing with an Achilles tendinopathy. Right, so you've kind of made that diagnosis. Now, what happens? 14:03 So once we've determined that we think it's an Achilles problem, we just want to make sure that's the case. And the best, most accurate, sensitive clinical test at this moment, whilst it gets a bad press is actually the site of pain. So asking the patient's point to it, or you look at then gripping it and looking at how Patri pain, they should put them to touch that tendon. If it doesn't, then we perhaps not dealing with an Achilles problems that would set up some alarm bells. The next thing then is to work out what sort of tendinopathy they have. And within that, what I mean is there's this sub entities, so there's different groups that will cause Achilles pain. So you could have a parent teen and disorder, like I mentioned, with myself earlier, which is essentially inflammation of the sheath around the tendon a bit like you get with the equivalence, Tina synovitis in the wrist or thumb is that same process, and that probably needs to be managed very differently because that's about friction of the sheath against the tendon. And so we've managed differently, we'd also then consider insertional, tendinopathy versus midportion, the risk factors, and some of the subtle management may differ. And as part of that, often we'll talk about trying to reduce compression of the tendon, which is what happens when you're in a dorsiflex position where the tendon will swash against the superior aspects of the calcaneus. That is had probably inappropriate interpretation from lots of clinicians, where they've heard about it and then say, we should avoid dorsiflexion. And patients then get told to avoid it. But that is forever. And of course, dorsiflexion is normal. So we've got to make sure we have encourages it. But in a highly irritable case behind center factor, we'd avoid that in the initial phases, or reduce it. So might use a heel wedge, so midportion and insertion burn, then with the mid portion, we're trying to look at whether it's really related to the Para tienen there's a potential of a partial tear. Or you can get these other disorders, which we have academic disagreements about, called splits, where actually, if the fibers run sort of longitudinally, you can get a pull in a part of the fibers. And they're called longitudinal splits, or occasionally get a flat tear where the back of the tendon or deep section and tendon pulls off. 16:18 Clinically, for me, they are much harder to manage. And they're the ones that I have, certainly in the last 510 years, made much worse, both symptomatically, functionally and also structurally. And they're the ones I think we need to be cautious about how we look at differentiating those out clinically is on subjective, again of how did it start? Was this a onset that you develop during a sporting activity or a activity a functional activity, like crossing the road and stepping up a curb? Or going down stairs or making a bed or something? Or did it involve whatever else or did it just come on gradually, you were sore the next day, after you did a long walk or a long run, that's more akin to normal typical tendinopathy being a generalized process of degeneration with some inflammatory elements that we sort of know and love as tendinopathy. But these sub entities seem to be very different, I think for management, the problem with all the research, nobody splits them out. So all the research doesn't differentiate out these sub entities, they stick them all together. And part of this is why I think a lot of regimes have washed out, they they look like people get a generally good response, some get worse, some don't respond. But generally about 70% of people get better. I personally think if we can look at these different entities, we will probably improve our rehabilitation. And Karen silver novels work I've forgotten now is going to go ahead and first author a bit. So I apologize. Currently the senior author, they've looked at actually identifying clinical groups, so psychological. So the profile group, a structural group, and more of a biomechanical sort of weakness group. And that's, I think, got some legs to go forward with how we might look at our patients in the clinic. And remember, if there's one more group, there is one more sort of sub entity which is plant Taris, induced tendinopathy. So typical presentation will be middle section pain, a little bit higher than typical midportion. And they may find that actually been in plantar flexed or dorsiflex positions when contracting the muscle, and therefore loading the tendon actually hurts. And that's because the RENNtech muskies work that he's done has shown that you get some compression of the plantaris tendon against the Achilles tendon, it seems to then set up a tendinopathy based on compression. So we can identify that clinically with palpating, the medial side. But ultimately imaging is probably then the better way to identify it. But it doesn't mean they need surgery, either. That's the other important message for you to take away from it, they've always had that plantaris. It's always been there for that person's life, they've developed the symptoms for whatever the reason, and they will probably respond to normal management, but maybe with some modification to load in in dorsi, flex or plantar flex positions. So we work in the middle a bit more initially until we're starting to settle and improve. Certainly in my clinical work, they will settle just as well as any other area does. But of course, with a lot of the research people are seeing tertiary sort of work failed, we have failed rehab with multiple people. And then of course, they're more likely to go on to surgery. So we've always got to interpret the literature a little bit with caution based on the populations that the research groups or whoever is writing the paper actually see and deal with clinically. 19:45 Yeah, that was a great overview. Thank you so much. Now that you mentioned imaging, so can you explain how you explain to the patient Do you need imaging? Do you not need imaging? When it comes back? Let's say an MRI comes back. And they're all out of sorts, because Oh, the doctor said, I have damage to my tendon, how am I going to fix this? Right? So how do you deal with that? Because if that is what happens, and then people say, well, when we're done, should I get another MRI? So that I can see the tendons back to normal? So how do you respond to that? 20:29 So that last one I'll deal with first, that is that actually, you're probably going to see some residual changes in the tendon that will take a long time to settle down. And this may be akin to scarring. So when you put your hand you end up with the scar afterwards. And that actually, what we're seeing on the imagery at a later date may be similar to that scoring process. And also reminding them that attendance is very slow to remodel and recover. So really, we're talking about imaging a year plus, if we want to look at it. And it doesn't matter what the tendon looks like, it matters, whether their symptoms and their function and good early on, I would have a different conversation in an elite sporting population, though, where actually, we know that attending that has structural changes is seven times more likely to develop symptoms the next season. And actually, I would probably then want to be changing the tendons structure. But again, that will be a discussion I have with the medical team, perhaps not the athletes so much, because we don't want to, we have to be very careful about the psychological impact of our words with our patients. And this is why imaging has had bad press over a number of years. Because it's often given to patients and they get told, Well, you've got tendinopathy, you've got big tearing there, there's loads of fluid and inflammation and the patient's like, well, I need to then rest until it settles, I need to sort of get this better, and how the hell is it loading exercise is going to help me get better when that's actually what's triggered it. So they're the clinical challenges that we have to explain in terms of the first phase, when we do the imaging, I simply try and D threaten them with it. So say, Look, this is typical of what we'd observe for somebody with tendinopathy. So that is tendon pain that you've presented with. This is not out of the ordinary, this isn't something that's particularly severe, assuming that that's the case based on the imaging. And I've also with MRI identify that it's actually a poor technique to look at collagen. So all we're going to see is high signal, really, it's very, very hard, you need to be have an excellent scan and an excellent radiology radiologist to really examine collagen fibers with it. So it will tell us how big the tendon is. And it will tell us how much fluid there is in there. But we know that that doesn't have a strong relationship with pain. And this is again, part of the reason why we wouldn't want to do it down the line say much. Having said that, again, Karen southern handles group, it's got some lovely papers that have come out that showing structural change does occur with functional resolution and improvement in symptoms. So we've got 42 different research groups in the world at the minute the Australians have often said we shouldn't be looking at imaging, whereas actually Karen's group and I think where we're taking it in the UK is that we should it has a use. But we've got to be very careful with that interpretation. And we certainly see changes in tendon structure as we have patients, we don't need to see it in order to get resolution. But that's because structure doesn't correspond to what's likely to be the key chemical factors in the tendon that are actually what's triggering pain. And we know there's lots of different chemicals involved in tendinopathy. So it's sort of trying to tie it all together. My reason for imaging, I use imaging in practice most of the time is to help we lay patients fears because often they're concerned about the risk of rupture. And this has come out in Shama core lifts qualitative work on Achilles patients. So by imaging, I can actually say, Look, your tendon has plenty of healthy tissue here. This, as best we can say, at this moment in time, is a very low risk for rupture is no higher than a normal person, because there's the same amount of tissue as a normal person would have. 24:06 Where we then have to be careful is where we find that's not the case. And we've just been doing a big longitudinal study in premiership rugby in the UK. Looking at this to see about how that changes. And Matt, who's doing a PhD with me, is going to be analyzing and looking at that data. So Matt Lee is head of medicine at Northampton saints. So Matt's got a big bit of work to determine whether really it ties in and whether we can predict who gets more symptoms, how that ties and, and they don't leave those, but we need to test that and so we're going into it to see probably, but yeah, good use, I think for imaging but not longitudinally imaging for most of your patient group. And it's not necessary and most of you patients you've got coming through your front door for a normal practice. But where there was a sudden onset of pain during activity, and they don't respond Do a six week sort of period of intervention or 12 week period, that's when I would want to image to see what I'm dealing with. Or where there's overt metabolic changes in the person. So adiposity, so high lipid levels, high adipose levels, so the waist circumference, and diabetes, then we want to just make sure they've not got some underlying problems, like, sort of gout that's going on or pseudo arthritic complaints. So yeah, that's where we're going, we might just step up a little bit and maybe consider blood tests as well. 25:33 Great, thank you. Now, let's move on to some treatment options. Right? So we've we've done the differential diagnosis, maybe we got imaging, maybe we didn't, we've, we've ruled everything out, we're pretty confident we've got an Achilles tendinopathy, I will leave it up to you, if you want to say well split it from like, you know, lower to sort of an upper you can, I'll let, I'll leave that in your hands, and how the rehab may be different. 26:05 There's no magic. So that's the first thing. There's no exercise, it's better than the other. It's about understanding the basic principles of rehabilitation here. And this is really what we do, I think, for all of our patients we ever see during a normal clinical role is going well, what do they want to do? Where are they now? How do we bridge that gap? And that's essentially what you're trying to do with your patient is, what's their functional ability at this moment in time? What do they want to do going forwards and coming up with a strategy to try and progress through that? Making sure that that allows for appropriate timescales. So tissue recovery, after exercise, if we're trying to adapt muscles, and muscle strength, which is often one of our big aims, we need to allow appropriate timescales. So 12 weeks plus, rather than expecting rapid changes quickly. So what that looks like in practice is going well, initially, we're going to start off with some form of loading for the Achilles tendon. Now, I would use a very, very isolated exercise, because you can compensate by offloading us in other muscles if we do more complex tests often. So an isolated simple exercise will be a heel race, you can't cheat, you can't use your quads and glutes to compensate, you have to use your calf and it puts stress through your tendon. And there's a nice work with Steph Leser, there's just to out on a systematic review, we're just sort of tweeting about earlier today on tendon material properties and how loading modifies the tendon, and part of what we want to do is improve the stiffness of the tendon, because with the Achilles tendinopathy, it will be less stiff. And that's generally pretty accepted. So we want to make it stiffer. And loading does that the loading needs to be progressive in nature. So we use the symptoms to determine that current simple novel, initially pioneered the pain monitoring model. So looking at how sources during the activity and afterwards, getting an appropriate level of discomfort that the patient can tolerate, doesn't impact their function and making it harder. So something like bilateral heel raises if somebody's really Niggli and saw progressed to a unilateral heel raise, that's about four times body weight through the Achilles tendon. For a bilateral erase, again, depending on the modeling method that's used Josh Baxter in the state system, some nice work on this in his lab, and he's got a lovely paper with Karen as well showing exercises that increase tendons stress. And that's a really good paper for your listeners to have a little read off to look at how to progress or to give ideas of exercises and how they would progress through that. Running, for example, be about five to six times body weight for the Achilles per step. So what we're trying to do is go well walk ins for running six, how do we cross that boundary and use other exercises, or just add external load on to heel race, which is probably easiest way. And that then allows very isolated, monitored exercises. At the same time, I would always use walking or running the same period of time, we wouldn't withdraw them unless we're very, very slow and very struggling. So we'd always use that. And in most patients, if we're not talking athletic, we don't need to use plyometric training jumping up in and stuff we can use walking and running, if necessary to do that. But the more elite athletes, I would always be looking at plyometrics. So hopping jump in London, whatever it happens to be accelerations decelerations off tangent runs, they all increase the stress through different fascicles of the tendon. And that's I guess one of the aspects we can consider that's not been researched yet, and it's where we're going with our work is how we might bend the knee or straighten the knee or rotate the foot to isolate the stress through different sections of the Achilles that correspond to where on imaging we see the degradation. So if we ever want to remodel the tendon, we also need to Reese stress To the tendon at an appropriate threshold, that needs to be 85 to 90 or more percent of your maximum voluntary contraction. And let's face it, we have never done that because most rehab doesn't quantify strength. So I'd always measure spend 30 on a lot of you guys, I think in the states have access to isokinetic devices within your clinics or in local clinics, or other force measurement devices. And I, Scott Morrison's, got quite a lot of sort of workout suggesting how you might be able to do this with a handheld dynamometer, then there's methods we can do with that, or even a set of bathroom scales, to actually utilize a measure strength to give a patient a marker. So our normal data in rugby and football on large cohorts is twice body weight is normal. And we've got similar in endurance runners, our patients are typically one and a half times the weight. But that means doing a heel raise with just their bodyweight will not strengthen them significantly. And that's where we lack we have been our rehab has to be a lot heavier than we've often done in the past. So yeah, so in a nutshell, bilateral raises unilateral progressing through I don't use isometrics early as a method for pain relief, because the evidence substantiates it's not actually that good for pain relief, unless patients find it when the fork which case use it, the heel raises. good warm up response anyway. 31:24 Perfect. Yeah. And in the states do a lot of places have isokinetic testing? I don't know. Sorry. I don't I don't know about that. Even here in New York, I don't think you know, outside of like the larger systems. I don't know that a lot of individual physical therapy offices have that i i do have a handheld dynamometer. And I'm lucky enough to be friends with Scott Morrison. So he was able to kind of take me through and and how to use it. And but it's sometimes this setups can be a little complicated, especially if you don't have an office, if you go to people's homes, how do you stabilize one end and use the other end, and I've come up with some interesting options? Yeah, it's work. I use a seatbelts, I have chains, I have like this, the green, you know, the green stretch strap. Yeah, that with all that I started using that, because it doesn't give, you know, it's pretty, it's pretty good. So kind of it kind of along the line of a seatbelt, you know. So I started using that instead of using even some chain link, I found it to be a little bit easier, a little more gentle for people on their phones, 32:49 strap ratchet strap that you might use on a roof bar. So roof rack, you might actually use that strap and those type of straps can be very good, especially if the wider if the narrower than it hurts the person's knee when you strap it on top. But ultimately, I like it because we can showcase that they need to do strength work because they are weak, more data to give them when you haven't got that opportunity, it's really just sort of giving them this sort of step sort of wise approach to go while you're here need to be there, we need to progress through this and you then just target an exercise that is tolerable, but is sort of getting a little bit of reaction afterwards for a short period. So I've said bilaterally raises unilateral, unilateral with weight, or progressive forwards. And if you're a physio or PT that likes lots of different exercises, give them a dozen, that's fine. But if you're like me, I'm very simple, I just give them one or two things to do really well to do very regularly. And what we avoid in that way is they don't do the things that feel comfortable and easy, because that's what patients generally do. And they're avoid the ones that hurt them because they think it's making them worse. But if we educate them that this is critical, we've got to poke it a little bit to stimulate the cells and improve muscle strength to help the muscle shock absorber for the tendon, which is our current understanding of what we're trying to do with rehab. Then we've got to actually sort of work very well in a bit of discomfort. 34:21 And you beat me to the punch that was going to be my next question is how do you talk to the patient about like, this is not going to be pain free, necessarily, you know, you're gonna have some discomfort. So you kind of beat me to the punch on that. But I think it's important that patients know that you're gonna have some discomfort with these exercises and that's okay. Because a lot of people have been told, I certainly I see it, I'm sure you see it their whole life if it hurts, don't do it. 34:47 Yeah. says and what you've got to explain to them and I often use examples of relatives that you might have had that have had a hip or knee replacement done in the hospital and how afterwards they have to bend it have to walk And actually, yes, it hurts when he gets better or if you've broken your arm and you're in a plaster how gently stretching out when you come out of plaster help to get better. And that's then normally enough to help people go. Yeah, I understand that I can see how that would help and I also then often just explain that as you do this and you get the symptoms afterwards that's the cells in the tendon excreting some chemicals that whilst it makes it a bit sore, they also actually be modelled the tissue. And what we're trying to do is wait the cells up to repair the tissue, wait, repair the tendon, but also improve your muscle as well at the same time. And we've got to stimulate it. It's no different from delayed onset muscle soreness if you go to the gym so that's the other one that are commonly used as the example then we'll turn them penis Dom's is this chap called William Gibson in Australia has done a whole PhD on delayed onset soreness, because it's tendons that you've looked at and connective tissue, not muscle fibers sarcomere itself. And his work I think is really pivotable pivotal with our understanding of it. So yeah, flip it around as Dom's most patients have had Dom's at some point in their life. Yeah. 36:11 Oh, that's great. Yeah, I love that. Well, I have to say, I'm gonna have to re listen to this a couple of times, even though I'm here, I feel like I'm missing things. Like you're speaking I'm like, wait, what? Wait, did I miss this? And we have to listen to this over and over again, because everything is so good. And I think thank you for making it so applicable to the practicing therapist. Because I think that there are nothing against researchers. But there are a lot of practicing therapists out there probably more so than researchers who depend on you guys to be able to to some disseminate this information in a way that is practical and makes sense. So thank you for that. Now, as we start to wrap things up, what do you want the audience to take away from our conversation today? What are some key points, 36:56 I guess the most important parts of monitoring and treating people with tendinopathy is just get your diagnosis right in the first place. Differential diagnosis gets a lot of bad press at the moment, I think on social media, and it's been wanting to sort of dumb down and go with just we've got posterior heel pain, but how I treat an impingement versus tendinopathy will be very, very different, you need to differentiate. And then you need to look at isolated tendon and muscle exercises that is progressive in nature. And I think the key message to physical therapists and physios is that we need to load a lot heavier than often we've done in the past. And by getting normative values for certain sports like we're doing at the moment will help guide what we should be targeting. And they have performance relevance as well when you're dealing with athletes. But for a normal patient, this is a difference between crossing the road quickly in front of the car that's coming in, versus actually ended up with the car getting a bit too close to you. 37:55 Got it? Yeah. And and I love that load heavier and looking at the normative values, because like you said, if running is five to six times body weight, and you're working with someone doing a single leg heel raise, just with their own body weight, that's just not going to be enough. Yeah, right, we've got to we've got to push them a little bit more to load a little heavier. So thank you for that. Now, Seth, where can people find you if they have questions they want to ask you or they, you know, they want to find your research, where can they contact you. 38:27 I'm not a huge one for pushing the sort of research out other than via Twitter. So I have a Twitter handle that we sort of use regularly. And we'll put papers on there and things. But I don't have technically got a website that's on my Twitter profile, but I don't update it. So I'm terribly slack and too busy to bother updating it and need to sort it out. But hopefully this next year, I have a bit more time. So Twitter's The best one is just Sefo Neil, but yo is zero, because there's already another stuff anyone in the world someone and then my other handle is Achilles tendons on there. And just so you all know, it wasn't ego thing. We set it as Achilles tendons, because we went on Twitter originally to recruit patients for our research because some cancer specialist at the University had suggested it was a really good way is terrible, because you need loads of followers to be able to recruit patients and actually get your message out there. It was great for networking. And that's I think the big thing with it. So I network predominantly and occasionally advertise research projects that we're doing now. I've got enough followers to actually get some patients through the door that way. But yeah, not ego because it just so we're clear, 39:33 of course, and we'll have links to those Twitter accounts in the show notes at podcast at healthy, wealthy smart.com. And like I said at the top of the our conversation, you are speaking a few times at the fourth World Congress is Sports Physical Therapy in Denmark at the end of this month, August 26 to 27th. So do you want to give a little sneak peek about what you're going to be talking about? At And what are you excited about for the conference? 40:03 So, myself and Karen Silva novel are going to be running a joint session for the British Journal Sports Med breakout on treating people with tendinopathy. So we're gonna do two sort of sessions of that. So replicate it. So hopefully, if you're interested in coming in, you can come in and send that and hopefully, it'll be nice and interactive, and flesh out some of the aspects we've discussed now, Karen, and then I'm chairing the session, which will be the session that I'm most looking forward to with Karen's there, who else have we got, I gotta get it right now. Michael Caja, and also Ben, Steph, Dakin, as well. So really looking forward to that. We're really nice to hear these guys talk because they are literally at the top of that sort of pinnacle of researchers and clinicians really worldwide. And then Denmark's nice. I mean, every conference, all I've ever managed to see is a little bit of Copenhagen. Because it's been sports Congress. And I normally dash in and bash out at conferences. So it's a little bit the same this time around. But I'm actually looking forward to seeing a bit of seen a bit of Nyborg. And also put two hours in the middle of the day for activity. And they've suggested paddleboarding. And whilst I dislocated my shoulder a week ago, or two weeks ago, it's my second time and I'm actually I was paddleboarding at the end of the week. So I'm hoping that there'll be a bit better by then and actually get out and have a decent paddle board and some exercise rather than just sat at the conference. So that's one of the things I'm looking forward to, and of course, enjoying a small beer with yourself. 41:40 That's yeah, it's a small beer. I look forward to it. And I'm looking forward to going in the summer, because I've only been to Copenhagen in February, and it is cold, and snowy and rainy, and all that stuff. So I'm looking forward to going in the summer. And just looking forward to seeing a lot of people that I haven't seen in a while. So that'll be really fun. And now last question, it's a one I asked everyone knowing where you are now in your life and in your career, what advice would you give to your younger self? 42:13 Oh, gosh. Yeah, it's a really hard question. For me. I always fancied doing research, but I was always put off because there was no ability to do it when I first qualified to do a PhD in the UK was rare in physio, and you might have been able to get a stipend which is 15,000, a year, UK, which actually quite peaker often they further physios as well. Whereas now I'd actually say if that opportunity comes up, even if it's a bit of paper, I take it if you can, because it does open a lot of doors as you progress forwards. And I would unlike other people, sometimes I'd actually say yes to everything. Generally speaking, when it comes to work, not anything else in life, to look at options that we can just opens doors, you get so many things that you don't realize where it will lead and you agree to do something and actually, certainly in these uncertain other things that are fantastic and change your career. So say yes to things when you can push yourself. And yeah, you'll get that. So read the next Roscoe put that. 43:21 Perfect. Thank you so much. This was a great interview you gave us so much to think about as myself as a practicing clinician. So this was great. Thank you so much. 43:31 Pleasure, absolute pleasure. And thank you very much for having me, Karen. Yeah. And 43:35 everyone. Thanks so much for tuning in. Have a great, great couple of days, stay healthy, wealthy and smart. And also if you hope to see you in Denmark, so there's still time we've still got a couple of weeks before the end of August. So if you haven't already, sign up because it's going to be great. So thanks, Seth, and thanks everyone for listening and stay healthy, wealthy and smart.