Podcasts about exercise medicine research centre

In this episode, we discuss the management of lower limb tendinopathy. We explore: Current evidence based management of tendinopathyDifferential diagnosis of tendinopathy and peritenonRole of compression in tendinopathySpeed of exercises used in rehabilitationPatient specificity for exercise prescriptionImportance of load in rehabilitationRole of inflammation in tendonsDr Seth O'Neill has been teaching and researching at the University of Leicester since 2006. He currently acts as the research director for the school of healthcare and as the deputy head of school. His research spans sporting populations and NHS groups and predominately focuses on tendon disease - tendinopathy or ruptures. He has completed a PhD on achilles tendinopathy. Seth is currently researching tendon structure and changes that occur during health and disease along with biopsychosocial interventions for tendinopathy and back pain and developing an international database of calf injuries.Dr Ebonie Rio is a Sports Physiotherapist at the Victorian Institute of Sport, The Australian Ballet, and she consults to multiple AFL, Rugby, elite Soccer and Basketball clubs. She is the Principle Research Fellow at The Australian Ballet, a joint position with La Trobe Sport and Exercise Medicine Research Centre. Ebonie co-leads activities in the High Performance 2032+ Strategy in Research and Innovation. She is the Deputy Manager of the Physiotherapy Department at VIS and co-chairs the research council. Do you want to learn more about tendons? Ebonie recently did a practical with Physio Network on this topic. With Practicals you can see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster.

Did you know that only about 10% of the participants in sports medicine and sports physical therapy research are women? When people are under-represented in research, it might mean that clinicians and researchers miss key concerns of women and girls when working with them to achieve the best outcomes of treatment. Melissa Haberfield - physiotherapist and PhD candidate at the La Trobe Sports and Exercise Medicine Research Centre in Melbourne, Australia - shares the results of her work with women who have experienced serious knee injury, about what they wanted to know about managing knee health. ------------------------------ RESOURCES Systematic review of self-reported activity and knee-related outcomes after ACL injury (sex and gender differences): https://pubmed.ncbi.nlm.nih.gov/36889918/ Sex/gender equity in sport and exercise medicine/physical therapy publishing: https://pubmed.ncbi.nlm.nih.gov/36631242/ What do women (with serious knee injury) want to know about knee health (article): https://www.jospt.org/doi/10.2519/jospt.2025.12869

Send us a textIn this episode with Dr Allison Ezzat we talk about the GLA:D Program (Good Life With Osteoarthritis Denmark) which is a rehabilitation program for hip and knee Osteoarthritis. We discuss: GLA:D outcomes for individuals with hip and knee osteoarthritisPros and cons of GLA:D delivered in-person vs telehealthHow to assist patients to self-management from the programHow we can market this rehabilitation program better to patientsThis episode is closely tied to Allison's Practical she did with us. With Practicals you can see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster.

Introducing our new, longer form podcast, Physio Discussed, where 2 expert guests and our host explore everything you need to know about your favourite topics!In this episode we dive deep into hip pain and hip osteoarthritis. We discuss: When can you consider pharmacological treatments in a patent with early hip OA/OA.What role does hip morphology play when considering treatment optionsWill all patients with FAI syndrome and hip dysplasia develop hip osteoarthritis? Does exercise have a role in treating hip pain in younger people, if pain is coming from structural things like labral or cartilage tears? How can exercise work in this scenario? Why would you choose exercise over surgery?What is the evidence for exercise and does this type of exercise matter?Are there other things alongside exercise that are important? - exercise different in younger people than older people with hip OA?Want to learn more about hip osteoarthritis? Dr Jo Kemp has done a brilliant Masterclass with us called, “Hip Osteoarthritis: Optimising your Assessment and Treatment” where she goes into further depth on all things assessment and treatment of hip osteoarthritis. 

Achilles. Rotator cuff. Patella. Hamstring. They're all structures involving tendons, and you probably either know someone who's injured them, or have experienced the dreaded tendon injury yourself. Aaron Rodgers experienced an acute Achilles tendon rupture on Monday Night Football in September 2023, just 4 plays into his first season as QB for the New York Jets. Fans watched as he dramatically pulled up lame after a tackle, having snapped his Achilles, and subsequently sitting out the 2023 season. Just this week he stated in an interview "my summer ends Sunday", confirming that he is back to play this upcoming 2024 football season for the Jets. So what the heck is actually going on? Why do tendons hurt sometimes? Why do they snap? Is it all just degenerative, "getting old"-type stuff? How can we prevent an injury like Rodgers' from happening to US?? In this episode, we reveal it all, friends! We have a world's expert in tendon pathology, treatment and injury prevention to tell us why our tendons get injured, what we can do to treat them and most importantly, the things we can do prevent them from breaking down. Jill Cook, PhD is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill's research areas include sports medicine and tendon injury. She is the "tendon guru" and has dedicated her career to learning about and improving our care of tendons. Jeremy recently had the privilege of attending Jill's educational lecture at the NBA Team Physician's national meeting, and she so graciously agreed to be our guest for this episode! Your Doctor Friends bring the professional-level expert education straight to you, friends! Topics covered in today's episode include: What actually ARE tendons? What do they do? Types of tendon injuries- including acute tears, "overuse" injuries, and degenerative "wear and tear". Risk factors associated with tendon injuries. What is "tendinopathy"? Is it there forever? What is the role of imaging/MRI in the diagnosis and treatment of tendon injury? What about shots? Do cortisone or platelet-rich plasma (PRP) injections help in tendon injuries? How do you actually treat tendinopathy? Can it be "cured"? Thanks for tuning in, friends! Please sign up for our “PULSE CHECK” monthly newsletter! Signup is easy, right on our website, and we PROMISE not to spam you. We just want to send you monthly cool articles, videos, and thoughts :)  For more episodes, limited edition merch, to send us direct messages, and more, follow this link!  Connect with us: Website: https://yourdoctorfriendspodcast.com/ Email us at yourdoctorfriendspodcast@gmail.com @your_doctor_friends on  Instagram - Send/DM us a voice memo or question and we might play it/answer it on the show! @yourdoctorfriendspodcast1013 on YouTube @JeremyAllandMD on Instagram, Facebook, and Twitter/X @JuliaBrueneMD on Instagram

Dr. Joanne Kemp is a Sports Physiotherapist, Principal Research Fellow, & Associate Professor at Latrobe Sport & Exercise Medicine Research Centre in Australia.  She publishes research on hip osteoarthritis and femoroacetabular impingement and is also an editor for the British Journal of Sports Medicine. Enjoy! -------Become a better physiotherapist with Physio Network's Masterclass video courses. Use this link and enter the code "Noah10" for an exclusive 10% off on Masterclass:Masterclass Video Courses - Physio Network (physio-network.com)------Jo's Twitter------Noah's InstagramFor questions and business inquiries: noahmandelphysio@gmail.com

In this episode, Dr Joanne Kemp discusses the difference in assessment and management between hip and knee Osteoarthritis. We differentiated between back pain, local pain and red flags as well as how there may need to be consideration for flexibility training in the hip vs the knee. Want to learn more about Hip Osteoarthritis? Dr Jo Kemp recently did a brilliant Masterclass with us, called Hip Osteoarthritis: Optimising your Assessment and Treatment where she goes into further depth on this topic. You can watch her whole class now with our 7-day free trial: https://physio.network/masterclass-kempDr Joanne Kemp is a Sports Physiotherapist and Senior Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Australia. Her research is focused on hip pain including FAI and early onset hip OA in young and middle-aged adults, and its impact on activity, function and quality of life. 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!Our host is Michael Rizk from Physio Network and iMoveU: https://cutt.ly/ojJEMZs 

In this episode, Dr Joanne Kemp covers key takeaways from a subjective history that can be valuable in assessing a hip as well as what objective tests she still finds valuable and not so valuable. Most importantly Jo gave us wonderful insight into her clinical thinking around the hip joint.This episode is closely tied to Jo's Practical she did with us. With Practicals you can see exactly how top experts assess and treat specific conditions – so you can become a better clinician, faster. Watch Jo's Practical here with our 7-day free trial - https://physio.network/practicals-kempDr Joanne Kemp is a Sports Physiotherapist and Senior Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Australia. Her research is focused on hip pain including FAI and early onset hip OA in young and middle-aged adults, and its impact on activity, function and quality of life.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!Our host is Michael Rizk from Physio Network and iMoveU.

About 50% of people who have an anterior cruciate ligament (ACL) injury will go on to develop osteoarthritis later down the track. What determines who will go on to develop OA? And is it possible to reduce your risk of developing OA? On this week's episode, Dr Adam Culvenor joins us to discuss.Dr Adam Culvenor is a Senior Research Fellow and Head of the Anterior Cruciate Ligament (ACL) Knee Injury Group within the La Trobe Sport and Exercise Medicine Research Centre. His research focuses on the outcomes of ACL injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction.RESOURCESWebsitesLaTrobe University Sport and Exercise Medicine Research Centre BlogThe OPTIKNEE group is working to prevent osteoarthritis after knee injuryJournal articlesOPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritisKnee Extensor Strength and Risk of Structural, Symptomatic, and Functional Decline in Knee Osteoarthritis: A Systematic Review and Meta-AnalysisEarly Knee Osteoarthritis Is Evident One Year Following Anterior Cruciate Ligament Reconstruction: A Magnetic Resonance Imaging EvaluationCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgEmail: hello@jointaction.infoWebsite: www.jointaction.info/podcast Hosted on Acast. See acast.com/privacy for more information.

Today we're diving into hip osteoarthritis, especially the link between hip joint loading in younger years and the risk of developing hip osteoarthritis later in life. What causes hip osteoarthritis in athletes? How can clinicians and athletes work together for healthy, happy hips? Dr Josh Heerey—physiotherapist and Research Fellow at La Trobe University's Sport and Exercise Medicine Research Centre—has thought deeply about the answers to these questions through his clinical and research career, and he joins us to explain more. ------------------------------ RESOURCES More on the prevalence of hip morphology in athletes: https://www.jospt.org/doi/10.2519/jospt.2021.9622 Physiotherapist-led treatment for hip-related pain: https://pubmed.ncbi.nlm.nih.gov/31732651/ Unravelling the relationship between cam morphology and hip OA: https://pubmed.ncbi.nlm.nih.gov/30175856/

Dr. Joshua Heerey chats on this podcast to BJSM's Dr. Liam West about hip joint imaging. Josh gives us a sneak peek into the findings from the “Femoroacetabular impingement & hip OsteoathRitis Cohort (FORCe) study & how they may help clinicians manage their patients with hip and groin pain. The podcast is heavily based around clinical scenarios that are commonly faced in the clinic or sports team settings. Dr Heerey is a physiotherapist and Hip Osteoarthritis Research and Development Lead at La Trobe University's Sport and Exercise Medicine Research Centre in Melbourne, Australia. Dr Heerey obtained his PhD in 2021, with his research programme focusing on understanding the relationship between hip joint imaging findings and pain, and risk factors for development of early hip osteoarthritis in football players. He has published numerous articles examining the diagnosis and treatment of intra-articular hip conditions and is a current member of the International Hip-Related Pain Research Network and Young Athlete's Hip Research Collaboration, which are multi-disciplinary international research teams created to improve the care of people living with hip and groin conditions. Dr Heerey works clinically at Lifecare Prahran Sports Medicine Clinic. He has a particular interest in the management of longstanding hip and groin conditions Relevant links: - Heerey et al. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med. 2018;52(9):581-93. http://dx.doi.org/10.1136/bjsports-2017-098264 - Heerey et al. What is the prevalence of hip intra-articular pathologies and osteoarthritis in active athletes with hip and groin pain compared with those without? A systematic review and meta-analysis. Sports Med. 2019;49:951-972. https://doi.org/10.1007/s40279-019-01092-y - Heerey et al. Prevalence of early hip OA features in high- impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthritis Cartilage. 2021; 29(3): 323-334. https://doi.org/10.1016/j.joca.2020.12.013 - Heerey et al. The size and prevalence of bony hip morphology do not differ between football players with and without hip and/or groin pain: Findings from the FORCe cohort. J Orthop Sports Phys Ther. 2021; 51(3): 115-125. https://www.jospt.org/doi/10.2519/jospt.2021.9622 - Heerey et al. Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain. BMJ Open Sport & Exercise Medicine 2021;7:e001199. http://dx.doi.org/10.1136/bmjsem-2021-001199

People with osteoarthritis are encouraged to exercise and stay physically active, but what does the evidence say about running? Running has been often perceived as bad for the knees. Long-term exposure to running has raised concerns about the development and progression of knee osteoarthritis. If you have knee osteoarthritis, you might be wondering if it is safe continue running. Dr Christian Barton works in both research and private practice treating sports and musculoskeletal patients in Melbourne. He currently holds a Post-Doctoral Research Fellow and is the Communications Manager at La Trobe's Sport and Exercise Medicine Research Centre. He is currently studying a Communications Masters focussed on Journalism Innovation. Dr Barton is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine. Christian's research interests focus on knee, running injuries and knowledge translation including the use of innovative digital technologies. RESOURCESInfographic. Running Myth: recreational running causes knee osteoarthritisWebsitesTRAIL - Trajectory of knee health in runnersLaTrobe University Sport and Exercise Medicine Research Centre BlogTREK educationCONNECT WITH CHRISTIANTwittter: @DrChrisBartonCONNECT WITH USTwitter: @ProfDavidHunter @jointactionorgEmail: hello@jointaction.infoWebsite: www.jointaction.info/podcastIf you enjoyed this episode, don't forget to subscribe to learn more about osteoarthritis from the world's leading experts! Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

In this episode, Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Dr Joanne Kemp PhD, talks about hip pain treatment and research. Today, Joanne talks about the common causes of hip pain, the difference between men's and women's hip pain, and the outcomes for patients that “wait and see”. How can PTs design and conduct evidence-based treatment programs? Hear about treating overachievers, referring out and using other treatments, and the upcoming Fourth WCSPT, all on today's episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “It's important that patients understand that exercise is good for them and is not going to cause damage.” “With any strengthening program, you only need to do it 2 or 3 times a week to be effective.” “It's probably going to take 3 months for our rehabilitation programs to reach their full effect.” “If you don't get it right the first time, and if it takes you a little while to find your space, that's actually okay, because it's about the long journey, and you'll get there eventually.” “Don't stress about failure. It's about what you learn from that failure and how you adapt and change what you do.”   More about Joanne Kemp Associate Professor, Dr Joanne Kemp, is a Principal Research Fellow at Latrobe Sport and Exercise Medicine Research Centre and is a titled APA Sports Physiotherapist of 25+ years' experience. Joanne has presented extensively on the management of hip pain and hip pathology in Australia and internationally. Her research is focused on hip pain including early onset hip OA in younger adults, and its impact on activity, function, and quality of life. She is also focussed on the long-term consequence of sports injury on joint health. She has a particular focus on surgical and non-surgical interventions that can slow the progression and reduce the symptoms associated with hip pain, pathology, and hip OA. Joanne maintains clinical practice in Victoria.   Suggested Keywords Healthy, Wealthy, Smart, Pain, Hip Pain, Pain Management, Injuries, Research, Osteoarthritis, Exercise, Physiotherapy, WCSPT, To learn more, follow Joanne at: Email:              j.kemp@latrobe.edu.au Website:          https://semrc.blogs.latrobe.edu.au/ Twitter:            @joannelkemp ResearchGate   4th World Congress of Sports Physical Therapy.   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, Joe, welcome to the podcast. I'm so happy to have you on. I've been wanting to have you on this podcast for such a long time. So thank you so much.   00:10 Thanks, Karen. It's great to be here, finally.   00:13 And of course, today we're going to be talking about hip pain, hip pathology, that is your zone of genius. So let's just dive right in. So let's talk about some common causes of hip pain in adults. And does this differ between women and men?   00:36 Yeah, look, it's a great question. And I think probably, we, I think we're starting to change our perspective on that difference between men and women and the causes of hip pain. I think that previously, we've sort of been very aware of the burden of hip pain in men and particularly young male athletes that there's been, you know, a growing body of research that's looked at at the prevalence and burden and causes of hip pain in young men. And probably that's led to a misconception that it affects men more than women. But it's only really that the research has been done in men, less and less so in women, like we see across, you know, the whole medical space. So if we think about the common causes of hip pain across the lifespan, when we're looking in sort of the adolescent and young adult population, you know, typical causes can be things like hip dysplasia, and that's actually is more common in women or young girls and women than boys and men so probably affects three times as many girls and women as it does men. And I think the prevalent when we're you know, the prevalence is perhaps higher than we previously thought. So, some studies are suggesting that up to 20% of adults have some form of hip dysplasia are shallow, hip socket shallow, so turbulent, and, and that that does lead to an increased risk of developing hip osteoarthritis in later life in later life. And even as young adults, sometimes we see patients with hip dysplasia, presenting with arthritis who need to go to hip replacement at a really young age in their 20s and 30s. So, hip dysplasia is a really common one. Another one that we've heard a lot about in the last 10 years is femoral acetabular, impingement syndrome, or FAI syndrome. So that's traditionally thought to be where there's impingement between the ball and the socket, either due to extra bone on the ballpark of the hip, which is can morphology or deep or retroverted socket, which has pencil morphology. And that's probably where a lot of the studies have been done, particularly in that young male adult adult population. But what we're now seeing when we look at the big cohorts, particularly of patients that end up presenting to hip arthroscopy is that it's about 5050. It's about 50% men and 50% women. So that burden is pretty equal across men and women. And that's another thing that does lead to an increased risk of hip osteoarthritis in later life. But the risk is not quite as high in FAI syndrome as it is in hip dysplasia. And it certainly is, it tends to be a slower burn. So these patients present for their hip replacements probably in their 50s and 60s, whereas hip dysplasia, we're seeing these patients in their 20s and 30s, with hip osteoarthritis. So that's probably the second most, the you know, the second cause in that younger age group. Then as we move into older adults, so sort of, you know, people 35 Plus sort of middle aged and older adults, that's where we really see hip osteoarthritis presenting itself, and it can be due to dysplasia or FAI syndrome. But it can also just sort of be that idiopathic arthritis that might be due to occupation, lots of different things. And again, that's reasonably equal men and women, but we do see women probably having a little bit more arthritis than men and more women going to hip replacement than men. And the outcomes for hip replacement are not as good in women as they are in men. So that burden is still probably skewed towards being higher in women than men. And then the other cause of hip pain that we see particularly in the middle age and older women is other gluteal pathologies or lateral hip pain, sometimes called you know, TRAQ, enteric, besides gluteal, tendinopathy, gluteal tendinitis, it has lots of different names. But that's a burden that definitely disproportionately affects women, over men. And particularly, once women get into that perimenopause, or menopause or post menopausal age group, there seems to be a relationship with with with hormones and with estrogen levels and the likelihood of gluteal tendinopathy becoming symptomatic as women sort of transition through that change. And so that's another really common cause. And we're now starting to be aware that often these women will present with combined hip osteoarthritis and gluteal tendinopathy. And that's where it can get really, really, really tricky as well. So yeah, look, it does. There's different, you know, different things that you see across the lifespan, but the burden is definitely I think, disproportionately higher in women than in men in a number of those conditions.   04:58 Yes, and I am firmly In the last group that you mentioned, I am just getting over, if you will, getting over gluteal tendinopathy, where I have to tell you it that is some serious pain. And, you know, when you're a physical therapist and you have people coming in, and they're explaining their pain to you, and you try and sympathize or empathize now I'm like, it is painful. Like I couldn't walk, I couldn't stand for more than like, four minutes. Yeah,   05:29 at least I've had the same thing. And, and I've been lucky that mine, I was sort of able to get on to it, knowing what it was and what to do fairly quickly. But it's very, and I think this is the thing with hip pain until you've had hip pain, whether it's glute tendinopathy, or intra articular, hip pain, it's really disabling. And it really affects everything you do in life, you can't sit without hurting, you can't walk without it hurting, you can't stand without it hurting, you can't lie on your side, without it hurting, you're getting in and out of the car, getting dressed, you know, trying to put your shoes on, it just affects every aspect of your life. And you know, and the pain can be quite intense and severe. So it does. You know, for people who are affected by hip pain, the burden is huge. And we see it reflected in the studies as well, where if you look at outcome scores for quality of life, young people with things like displays your FAI syndrome, their quality of life scores are as bad as people who have hip arthritis who are waiting for hip replacement. So it does, it's very, when you've got it, it's very, very impactful. And I think people until you've experienced it, perhaps people underestimate how bad it can be.   06:33 Yeah, and it can be really, like you said, it's very, very disabling. And it also can can make you very nervous. So you know, when these patients come in to see you. So as the physio, when these patients come in to see you, it really behooves you to sit and listen and really get that whole story so that you can make that differential diagnosis as best you can, if you don't have the diagnostic test to back it up, which often happens. Yeah, absolutely.   07:01 And I think that's the thing when the patient's present to you, and they're complaining of pain in that hip area, you can't just go to one test or one scan and say, Oh, it's definitely these, it's actually there's lots of pieces of the puzzle puzzle that you've got to put together, it can be really complex, and you absolutely have to listen to the patient. And I think fear, like you just said, is a huge thing. And we've seen this in our some of our qualitative work that's currently under review, but others as well that these patients are terrified to move, or to do exercise because they think it's going to hurt more. And they're really scared that it's going to cause more damage. And, and the irony is that exercise is the thing that we know is like is going to make them better. And once they get moving, they do feel better, but they're so scared to move because they're scared, they're gonna break something or make it worse or end up needing a hip replacement that they they don't they don't move. And it fear is a huge problem, you know, with these people.   07:53 Yeah, I mean, even myself as a physio I knew I needed to exercise, I sort of outsource my physio exercises to a friend of mine, Ellie summers, who's on the, on the west coast here in the United States, and she sent me exercises and even doing them, like it's not super comfortable. But within a month, I felt so much better. And now, you know, I'm back to running on the treadmill and doing all the things. But oftentimes, these patients and I may be wrong, but they're not sort of picking up on this within the first month of pain, you know, they might say, Oh, um, it'll go away. Let me give it another couple of weeks and have a couple of weeks. Whereas I was like, Okay, this is really painful. I'm getting to a doctor asap and starting these exercises ASAP. So what have you seen, even through the literature about when patients start to seek out care for this? And how can that affect their outcomes?   08:52 I think it's one of the things with hip pain that patients often will just leave it and they'll wait and see. And so we do know that in the younger age group, like if you think about FAI syndrome, for example, people will often not present for two or three years, they will pull up with the pain because it kind of comes and goes so they'll have a flare up, they'll be bad for a few weeks, it'll go away for a few weeks and have another flare up. And so because it's coming and going, they, I guess remain optimistic. It's human nature to be optimistic that it's going to get better by itself. And so it can often be a couple of years. We see this in the literature, you know, two or three years, but I see that in my clinical practice. And I'm sure you do, too, Karen, that patients, they'll come to you and they'll say, oh look, I've had this for two or three years, I was waiting for it to go away and now it's you know, suddenly getting worse and that's when they seek out care. And I think too, you know if we think coming back to what we were talking about with women is that these problems affect women who are really busy so they are often have busy careers. They're looking after families often, they they might be studying as well. They're juggling lots of things. So for them to try and fit in the medical care or, you know, physio care or whatever they need. It's really hard for them to find to make the time to do that. And I think that that's probably why they potentially delay seeking, seeking treatment as well.   10:12 Yeah, so many factors go into it. But bottom line is it hurts. Now, how let's talk about the physio side of things. So how can PTS design and conduct an evidence based treatment program? For, we'll say, for adults with hip pain? Yep.   10:31 So I think we probably the first thing is to set really good expectations for the patient. So often patients will come potentially looking for the quick fix. And so I think it's important that right up front, we say to our patients, that it does take a while for things to work, you should be starting to improve over that time, but they need to be committed to an exercise program that we know needs to be now at least three months long. So I think both the therapist and the patient need to be prepared for that longer term commitment as well. So I think that's the first thing is setting expectations, right. And then around those expectations, it's also really important that patients understand that exercise is good for them and is not going to cause damage. So you're really trying to get the confident to be able to exercise part of that is an understanding that it will like you just said like when you did your exercises, it's not super comfortable. But that's okay, they need to they don't want to be in a lot of pain, but they will probably have some pain and that that's actually okay and normal to have that. And it doesn't mean that they're causing more damage. That's just a normal part of the body adapting to the exercise process. Sometimes I find with patients to you in order to convince them of that, because sometimes they're a bit skeptical, they don't quite believe you that they give you know, they will do exercises for a week, just look, just have a week off the exercise and see what happens to your pain. And what they find is pain is no better when they're not exercising. But sometimes it's worse, it's usually worse or the same. And so then they're like, Oh yeah, now I understand the exercises and actually making my pain any worse. And so sometimes you might need to do that to get them to buy in. So I think getting them to buy into the timeframe the commitment that they're going to need to do and the fact that they will have a bit of pain, that's probably the biggest thing, then once you've done that, then you can start to develop your exercise program and the foundations of our exercise program. I like to think of it as being sort of two pronged. So the first one is the local exercise that we're doing for the hip joints. So that's where we do a lot of our strengthening exercises. So strengthening up the muscles around the hip. So the hip abductors, and the adductors flexes in the extensors. But then also really focusing on the core and the trunk is important because that controls the acetabulum, which controls the socket. So putting that in and then you know functional exercises as well. So teaching them how to do things like squats and lunges and going up and down stair. So our local rehab exercises should have primarily a strength focus, they might also need to have a range of motion focus as well. But we need to be careful with ranges of motion because sometimes those ranges of motion might be provocative for patients. So going into a lot of rotation or a lot of flexion could provoke pain. So strength is probably our big biggest focus. But then the second prong of our rehab program should be around general fitness in general activity. So you know, we know that the physical activity guidelines say that everybody should be doing 150 minutes of moderate activity a week or 75 minutes of vigorous activity, then that's just to be a healthy person, regardless of whether you've got a sore hip or not. So I think trying to get them to do general fitness, cardio, whatever you want to call it alongside their hip specific rehab is, is the thing that you need to do. And then what I try and do is I try and make that hip specific rehab, sort of normalize it as fitness training, rather than rehab. Because people get, they're going to be like, don't want to do rehab, everyone gets bored of rehab, you know, at home with your little bands. So trying to get them to do things like you know, incorporated as part of their twice a week strength training, where they go to the gym, for example, is really important. And with any strengthening program, you only need to do it two or three times a week to be effective. So people don't have to do it every day. So I think that's important too to for them to know, they'll get they'll have days off where they don't have to do it. But to find two or three days a week where they can commit to this the strengthening component of the program, the cardio fitness component of their program can fit in around their schedule. And something that I really like to do with patients is to sit down and actually look at their weekly schedule and help them schedule it into their diary. So don't just say to them, you go do this, you know, five times a week, you actually have to fight help them find those chunks of time where they can do it and they can find 30 minutes in their day to be able to commit to that exercise program.   14:50 Yeah, I really love that you said to emphasize that the strength thing has to be done two to three times a week, because oftentimes Well, I mean, I'm in New York City where you have a lot of is like very driven, sort of type A folks. And they think if you're not doing it every day, then it's not working. Yeah, you know, so to be able to reframe that for them and say, Hey, listen two to three times a week is what our goal is, and be very forceful on almost holding them back. Do you have any tips on how to hold people back? For those folks? Who are the overachievers?   15:26 It's hard. Yeah, it's really tricky, isn't it? I think sometimes I think people have to learn for themselves. So you kind of have to let them find out the hard way, maybe, and be prepared with some painkillers to settle things down. But ideally, you don't want to do that, if you can help it, I think, I find that presenting the evidence can be really, really helpful. So you know, talking about the strengthening guidelines that that show that two to three times a week is where you're going to get the maximum effect of strength. And if you do more than that, it's not going to really add to that you'll have already sort of hit that ceiling, and potentially give them something different to do on those other days, if you don't want them doing strength training two to three times a week. If there's someone who wants to do something every day, helping them find other things on those other days, so perhaps, you know, mixing it up with some cycling, walking or jogging, if they are able to do that some swimming, you know, sometimes, you know, it might be appropriate or safe for these patients, if they enjoy things like yoga or pilates, they can do that if it if it doesn't hurt in addition to their other things. So I think those type A personalities, you might need to fill the space on those other days. Give me something else to do.   16:33 Yeah, I think that's great advice. And now, sometimes, as physiotherapist we have to refer out. So when is it appropriate to refer out or to use other treatments such as surgery? How do we navigate that as a physio?   16:50 It's tricky. And I think the most important thing is that that has to be a shared decision that we make with our patients. And at the end of the day, they will have their beliefs and their priorities that will probably take them in certain directions. Having that three month rule is a good rule, I think that we know it's probably going to take three months for our rehabilitation programs to reach their full effect. But but it doesn't mean to say you keep doing things for three months, if you're not getting any improvement, we really want to see them starting to head in the right direction, probably within around about four weeks. Within, you know, two or three treatments, you should be starting to see some change even though we know it's gonna take longer than that to get the full effect. I think that if you're not seeing change within that first month or so, you have to start asking yourself questions about well, why why why aren't I getting changed? Do I need to look at this and red flags here? Do I need to potentially refer the patient to their GP? For some imaging, we know that, you know, people have a history of cancer, that breast cancer and the gynecological cancers and prostate cancer really caught the hip joint is a really common point from you know, where the cancer metastasizes. So, I think bearing in mind our red flags, you know, women with guide other gynecologic non cancer, but other gynecological issues, you often get pain in that same area. So, being open minded about some of the non musculoskeletal causes of pain and being prepared to refer on if someone's not improving in that time is important. Imaging, you know, we don't want to jump to imaging straightaway, it's not always necessary, but it is sometimes it is necessary. And I think don't be frightened to refer for imaging. If someone's not improving. The one thing that I and it's different in every country and our health systems are all different. But here in Australia as physios, we can refer for imaging, but I if I'm if I'm suspicious that there's a red flag, that's a medical thing that's outside my scope of practice, I will refer them to the GP for the GP to refer for imaging. And the reason for that is I if you refer for imaging, you need to be able and confident to tell the patient the results of their imaging and interpret them and then refer them on for appropriate care now, for those medical things. I think as physios that's way outside our scope of practice and we shouldn't be you know, if the scan comes back with cancer, like we can't that's way outside our scope and we shouldn't be having to to explain those results to patients, I think only refer for imaging yourself with your confidence of what you'll be able to interpret those findings. So don't be afraid to refer to the doctor. Some patients often need pain relief as well or anti inflammatory. So that's, you know, if you're not getting improvements in that four weeks, you may need to refer them to the doctor to get pain relief or anti inflammatory medication. Things like injectables again, we don't want to inject give people lots of injections but we know that the hip joint is often sign up at green flame. So you know a judiciously used cortisone injection can be helpful in in some cases. So I think it's been not afraid to refer on you know, when you just turn the video off, when you need when you need to, to, you know to those other things and then surgery is probably your last resort, but There are a small number of people who will potentially need surgery as well. So, but you wouldn't actually be looking at surgery until you really finish this full three months of rehab.   20:09 Yeah, that all makes perfect sense. And now as we kind of start to wrap things up, where there, is there anything that you know, we didn't cover, that you would really like the listeners to know, or to take away, whether that's from the literature or from your experience when it comes to hips?   20:31 Yeah, I think, look, I think we've covered most things. But I think what it is, is just being really confident to prescribe a good quality exercise program. And if you don't feel like you have the knowledge or skills to do that, don't be scared to either refer to a colleague who who might have more knowledge or skills, or to, you know, to look up the evidence with, you know, that the evidence is has really grown in the last couple of years. And we published a consensus paper in V jsme, 2020. That was a consensus paper on what physio treatment for hip pain in young and middle aged adults would be. So that's a really good resource, it's got some some good examples in that paper of the types of exercise that you should be doing. And then my colleague from the US might Raman also lead a consensus paper in that same series on the diagnosis and classification of hip pain. So that's another really good resource that you can go to that will help you clarify the different diagnosis in the hip and what what what sort of things you can do to confirm your clinical suspicion and your diagnosis.   21:34 Perfect. And now, you will also be speaking at the fourth World Congress of sports, physical therapy in Denmark, which is August 26th, to the 27th, you're doing to sort of 15 minute 15 minute talks repeated twice. So one talk repeated twice. On the second day of the conference, can you let the listeners know a little bit more about that. And if you have any sneak peak that you want to share?   22:04 Yeah, so I'm going to be doing that talk in combination with a with a great colleague of mine, a Danish colleague, Julie Jacobson. And so we're going to be talking about hip pain in women specifically. So looking at the common causes of hip pain in women and as as physios, or physical therapists, what we should be doing to manage to manage that, because it's a congress of sports, physio, or sports, physical therapy. It'll be slanted probably towards the younger, more athletic population. But I think there'll be some really great takeaways for anyone treating women in particular with hip pain. So we're going to be really, I think, trying to focus on what it is about women with hip pain that's unique and different to men, and really helping the therapist develop a rehab program that really targets the things that are important for women. So the impairments that women have the physical impairments, but also really targeting some of those, you know, we've got to think about the biopsychosocial model. So some of the psychological challenges that people with hip pain have that we've sort of touched on in terms of being fearful to move, but then the social challenges too, because we know that we do live in a gendered environment. And it's no different for women with hip pain, where they might face additional barriers to, you know, in this the way society is constructed to be able to access the best care. So it's also helping helping the clinician really become an help patients navigate some of those challenges as well.   23:27 I look forward to it. It sounds great. Now are what is there anything that you're looking forward to at the conference in Denmark? Have you looked through the program? Are there talks that you're looking forward to?   23:40 I look, there's there's going to be so many great talks there. Like it's such a I can't believe how many how much they've packed into two days, like for two day program, I'm actually really excited. by so many of the different tools, I think the thing I'm most excited about is after two years, it'll be nearly three years by then that we've actually been able to see each other face to face, just to have the opportunity to catch up face to face with so many great colleagues that I've worked with before, but also meet new colleagues as well, and have the chance to travel to beautiful Denmark. You know, I haven't been to the conference venue, but it looks amazing being on the coast. In summer, it's going to be beautiful. I know the conference Organizing Committee has got a great social program as well organized and the Danish conference dinners are always a highlight, I think of any program. So I'm really excited about that as well. Yeah, I just I just can't wait.   24:31 Yeah, it's it. You have the same answer that so far everyone has said as they just can't wait to be in person and to network and to hang out with people and to meet new people. So you're right along with everyone else that I think a lot of the other speakers that are going to the conference, and now where can people find you if they have questions, they want to see more of your research, where can they go?   24:55 So, um, so I'm on Twitter, so my Twitter account is at Joanne L. him. So L is my middle initial. And you're welcome to send me a message via Twitter. But you can also contact me via email. So my email address is the letter j.camp@latrobe.edu.au. And then our sports medicine allotropes sports and exercise Medicine Research Center has a has a webpage and a blog page where a lot of our research is highlighted there as well. So if you just Google up Latrobe, Sport and Exercise Medicine Research Center, that's the first thing that will pop up as well. And we have a lot of, you know, a lot of really good information. We've got a really our Research Center has a really strong knowledge translation arm and so a lot of my colleagues, which credit to all my colleagues who work in this space, have developed a lot of really great resources to infographics, videos of exercises, lots and lots of different things that can be found on our on our research, our centers, webpage and blog page as well. So lots of good resources there.   25:57 Excellent. And we'll have links to all of that in the show notes for this episode at podcast at healthy, wealthy smart.com. So one click will take you to all of the resources that that Joe just mentioned. And last question that I ask everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? So maybe straight out of physio I pick pick a year, any year you'd like?   26:22 It's great question. And it's funny because I was actually talking to my son's girlfriend the other night, who's at university, and she's finding it stressful and hard. And I actually shared with her something that I'm not afraid to share that I actually nearly failed my first year of university, because I was too busy enjoying the social aspect of uni life. And I think what I would say to my young, and that stressed me out and really upset me at the time. And I think what I would say to my younger self is if you don't get it right the first time. And if it takes you a little while to find your space, that that's actually okay, because it's about the long journey, and you'll get there eventually. And so if you hit hurdles and bumps and you don't, you're not always successful every time, it actually doesn't matter. Because as long as you keep on trying, you'll you'll get there in the end. So don't don't stress about failure. It's about what you learn from that failure and how you adapt and change what you do.   27:12 What excellent advice. Thank you so much. And thank you for coming on to the podcast. This was great. And I think the audience now has a better idea of what to do with their patients when they have hip pain. And if they don't, they can head over to Latrobe, they can go over to the website and get a lot of great resources from from you all and also look up a lot of your research. And if we can also put your Research Gate. Yeah, we can put that up in the show notes as well if that's okay, so that way people can kind of get a one stop shop on all of your research because it's extensive. So we'll have that up there as well. Thanks, Karen. Thank you so much. And everyone. Thanks so much for tuning in listening and we hope to see you in August in Denmark at the fourth World Congress Sports Physical Therapy again, that's August 26 and 27th. If you haven't registered, I highly suggest you get on it and hopefully we'll be able to see you in Denmark. So I look forward to seeing you then. And everyone have a great couple of days and stay healthy, wealthy and smart.

This week Zuzana and I spoke to Dr Matt King from the La Trobe Sport and Exercise Medicine Research Centre.  Matt is a physiotherapist, researcher and educator with a special interest in hip pain and biomechanics in athletes. Zuzana and I asked Matt about his PhD research on men and women with hip-related pain and the use of biomechanics to understand why some people with femoroacetabular impingement syndrome (FAIS) develop osteoarthritis later in life. We also spoke about rehabilitation for people with hip pain and differences between men and women in movement patterns in sport. We then had a really interesting conversation about biomechanical research, women in sport and how clinicians can get involved in research.  This is a discussion aimed at health professionals and health professional students. Always seek the guidance of a qualified health professional with any questions you may have regarding your health or a medical condition.  In this episode: 0:00 Welcome Matt 2:25 What got Matt interested in research? 4:09 Biomechanical risk factors for progression of FAIS and hip osteoarthritis (OA) 5:07 Are higher demand tasks associated with faster progression of hip OA?  5:43 Low level vs high level tasks 7:52 What is it about walking that we should be looking at in athletes? 10:10 Stair running in athletes with hip pain - Load the hip without hip extension 12:50 Backwards walking and running for rehabilitation 14:40 Men vs women in high and low impact tasks 17:28 The trade-off between the ankle and the hip 20:15 How to women move compared to men? 22:31 Participation rates are increasing in women and girl's football 25:25 How do you measure biomechanics? 30:55 How can you measure forces and joint angles in the clinic? 32:57 The FORCE project 33:32 The prep-to-play program 34:15 ACL and knee osteoarthritis – Adam Culvenor and colleagues 35:15 How can clinicians get involved in research? 38:30 Volunteer for research – doors will open 40:26 The importance of support, mentoring, reflection and teamwork 44:19 How to re-open the bar at a conference – essential skills for face-to-face conferences Read more about Matt: https://scholars.latrobe.edu.au/m2king Contact Matt on Twitter: https://mobile.twitter.com/mattking_physio Follow the La Trobe Sport and Exercise Medicine Research Centre on Twitter: https://twitter.com/LaTrobeSEM Matt talked about this paper in the episode: ‘Lower limb biomechanics during low- and high-impact functional tasks differ between men and women with hip-related groin pain' Link here: https://pubmed.ncbi.nlm.nih.gov/31181339/ Follow and subscribe to Physio Foundations on your favourite podcast app. Join the conversation in the YouTube comments or via social media @PerratonPhysio For a list of episodes, transcripts and associated blogs, visit perraton.physio/physiofoundations   Follow @PerratonPhysio on Facebook, Twitter, Instagram and Linked In. Do you have a topic you would like me to cover on the podcast? Email me: luke@perraton.physio, or DM me on Twitter @lukeperraton Always seek the guidance of a qualified health professional with any questions you may have regarding your health or a medical condition.

In this episode with Dr Jill Cook, we explore the tendon continuum model and the pathophysiology of tendons according to current research. We then delve deeper into what is clinically relevant and how we might prescribe rehabilitation for a real case. Jill challenges us on the notion of not just loading a tendon heavy and slow, and has practical tips around measuring load, not just pain. Dr Jill Cook is a Professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill's research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas.Our host is Michael Rizk from Physio Network and iMoveU: https://cutt.ly/ojJEMZs 

In this episode we with chat with Dr Joanne Kemp about hip pain, and more specifically about femoroacetabular impingement (FAI). We discuss the pathophysiology and morphology, diagnostic criteria, radiographic findings, surgical options, and conservative management best practice. Dr Kemp is a Sports Physiotherapist and Senior Research Fellow at Latrobe Sport and Exercise Medicine Research Centre, Australia.

Dr Tania Pizzari and Brady Green both hail from Latrobe Sport and Exercise Medicine Research Centre. Tania Pizzari PhD is prolific in the sports injury research space regularly presenting at international and national sports medicine conferences, lecturing at Latrobe University and having contributed to in excess of 130 research publications while also fulfilling a clinical role at Milpark physio therapy in Melbourne Victoria. Brady Green has submitted his PhD which focuses on calf muscle strain injuries, Brady works with the Essendon AFL Football Club. In 2017, Brady and Tania co-authored a paper "calf muscle strain injuries in sport: a systematic review of risk factors for injury". This systematic review looked at 518 strains and we'll discuss some of the findings from this review. Tania and Brady share around the what, where, when, why and how of calf muscle strain injuries, share tips around how to get on top of the problem recurring calf strain scenario, discuss contemporary evidence based best practises when it comes to the rehabilitation of calf strains, debunk common myths around what is effective for calf strain rehabilitation and of course issue a great physical challenge for the week. Show Sponsor: earSHOTS earSHOTS is a disruptive action sport headphone company dedicated to unlocking human potential through sound.  earSHOTS bluetooth headphones utilise an innovative, first of its kind proprietary magnetic ear clip design. This unique design ensures it can withstand the sharp shocks, speed and functional movements of action sports, unlocking new freedom of movement without compromising on sound. For 10% off earSHOTS use the code TPPS at checkout or use direct link here earSHOTS are giving away one set of their earSHOTS Bluetooth headphones designed for peak performance per month for the next 3 months, Enter Here  Join the The Physical Performance Show LEARNINGS membership through weekly podcasts | Patreon If you enjoyed this episode of The Physical Performance Show please hit SUBSCRIBE for to ensure you are one of the first to future episodes. Jump over to POGO Physio - www.pogophysio.com.au for more details Follow @Brad_Beer Instagram & Twitter The Physical Performance Show: Facebook, Instagram, & Twitter (@tppshow1) Please direct any questions, comments, and feedback to the above social media handles.

In episode 53 of the podcast I chat all things recovery with Premax founder Randall Cooper. Randall is an experienced Sports Physiotherapist, Founder and CEO of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, and Fellow of the Australian College of Physiotherapists. He knows a thing or two about recovery and how to get the best out of yourself.  Premax have very kindly supported me with products to use for some of my challenges including 107TDF and 91 Descents. Thank you!  I've also set up a Patreon if you'd like to help support the channel for less than the price of a fancy London coffee and croissant: https://www.patreon.com/chrishallrides https://www.chrishallrides.com​​​​​​​ https://www.instagram.com/chrishallrides​ https://twitter.com/chrishallrides​​​​​​​ BUY SOME ZERO LEMON MERCH: https://www.zero-lemon.com/​​​​​​​ The following companies (that you'll see in my content) support me either financially or with free stuff, so huge thanks to these guys for helping me with the challenges I take on Attacus Cycling,  Cervélo, Lazer Helmets,  Shimano, Schwalbe Tires, Parcours Wheels, Aerocoach, Sungod Eyewear, PedalSure

On this week's episode of the podcast Matt talks with Dr. Jo Kemp. Dr. Kemp is a practicing Sports Physiotherapist and Senior Research Fellow at The La Trobe University Sport and Exercise Medicine Research Centre. Jo's research focuses on the management of hip pain in both adolescents and adults and emphasizes the importance of activity, function, and quality of life.

We're excited that today we have a dynamic duo on the podcast: Dr Andrea Bruder and Dr Adam Culvenor. Adam is a Physiotherapist and Research Fellow at the La Trobe University Sport and Exercise Medicine Research Centre, Australia. He has combined a clinical career in sports medicine together with research investigating prevention, management and long-term outcomes of sports-related injuries, and life-span osteoarthritis. He has a particular interest in anterior cruciate ligament (ACL) injuries; in optimising return to sport, identifying risk factors for poor long-term outcomes, and developing and testing novel osteoarthritis prevention strategies. Adam has written more than 50 publications on the subject of ACL injuries and osteoarthritis, has been invited to speak at numerous international conferences, and is currently leading the first clinical trial in the prevention of osteoarthritis in young adults following ACL injury. Andrea is a physiotherapist, Lecturer in Physiotherapy at La Trobe University and Post Doctoral Research Fellow in the La Trobe Sport and Exercise Medicine Research Centre. Her research focuses on improving injury prevention and rehabilitation practices after musculoskeletal injuries. Andrea has a particular interest in reducing the risk of ACL injuries among women and girls playing Australian football, and for those who do sustain an ACL injury, how we can improve rehabilitation practices to reduce the long-term burden.   In this podcast we talked about: - what the ACL is and how it can be injured - some risk factors for ACL injury (in males and females)- including some of the social, environmental factors - some of the current programs that exist that have been shown to reduce lower limb injuries...but how the uptake has been poor - surgical versus non surgical (sexy, cutting-edge rehab) management - why a trial period of this kind of rehabilitation may be of benefit, even if the client goes on to have surgery further down the track - how the rates of arthritis are similar between the two treatment options   If you'd like to check out their blog, head to http://semrc.blogs.latrobe.edu.au/blog  Their website details: https://scholars.latrobe.edu.au/display/abruder  https://scholars.latrobe.edu.au/display/a2culvenor    Email addresses: a.bruder@latrobe.edu.au a.culvenor@latrobe.edu.au aclstudy@latrobe.edu.au   Twitter: @AndreaBruder Twitter: @agculvenor

Brooke Patterson is a physiotherapist who is currently completing her PhD at the La Trobe Sport and Exercise Medicine Research Centre, investigating the impact of ACL injuries on the lives of young adults. Brooke played several seasons in the Australian Football League national women’s competition (WAFL), and has recently transitioned to becoming a coach. You will be hearing more from Brooke, who will be hosting some BJSM podcasts over the coming months, so we thought we’d take this opportunity to get to know Brooke and her research. In this podcast we discuss: The latest ACL injury prevention & early-onset osteoarthritis research The next big breakthroughs to expect in the next decade from a research perspective do Advice for people wanting to/working in elite women’s sport Links: 1. Making football safer for women with Brooke Patterson and Dr Ben Mentiplay. Episode #445 https://soundcloud.com/bmjpodcasts/making-football-safer-for-women-with-brooke-patterson-and-dr-ben-mentiplay-episode-445 2. Building on a BJSM podcast – and celebrating good news! #WomensFootball https://blogs.bmj.com/bjsm/2020/10/22/building-on-a-bjsm-podcast-and-celebrating-good-news-womensfootball/ 3. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players https://bjsm.bmj.com/content/54/18/1089

In this episode you will learn how to best manage Femoroacetabular impingement (FAI) through exercise rehabilitation and advice/education. We have chatted with hip expert Dr Joanne Kemp. Jo is a titled APA Sports Physiotherapist and Senior Research Fellow at Latrobe Sport and Exercise Medicine Research Centre. She recently did a brilliant Masterclass for us. You can watch it for free with our 7-day free trial: https://www.physio-network.com/join-masterclass/

Why are females more at risk of ACL injuries in football? What can we do to reduce the risk for our athletes? On this week’s episode, we are joined by Brooke Patterson and Dr Ben Mentiplay to discuss their latest review of injury prevention programmes reducing the risk of injury in women’s football. Brooke (T: @Knee_Howells) is a physiotherapist who is currently completing her PhD at the La Trobe Sport and Exercise Medicine Research Centre, investigating the impact of ACL injuries on the lives of young adults. Brooke played several seasons in the Australian Football League national women’s competition (WAFL), and has recently transitioned to becoming a coach. Dr Mentiplay (@MentiplayB) has a background in sport and exercise science and completed his PhD in 2017. Ben is currently a lecturer and research Fellow at La Trobe, with a strong interest in biomechanics.

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Adam Culvenor on the show to discuss ACL injury. Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction. In this episode, we discuss: -The short-term and long-term burdens following ACL injury -Why patient rapport is integral to effective treatment post-ACL injury -Optimal loading strategies for non-surgical and post-surgical cases -The latest research on prevention for early-onset osteoarthritis -And so much more!   Resources: Adam Culvenor Twitter La Trobe SEMRC Twitter Email: A.Culvenor@latrobe.edu.au La Trobe Adam Culvenor La Trobe University Blog For knee injuries, surgery may not be the best option     A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Adam: Dr. Adam Culvenor is a physiotherapist, leader of the Knee Injury and Osteoarthritis Research Group and Senior Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Australia. Adam’s research focusses on the outcomes of anterior cruciate ligament (ACL) injuries, in particular the prevention and management of early knee osteoarthritis in young adults following ACL injury and reconstruction. His work has identified important clinical and biomechanical risk factors for post-traumatic osteoarthritis, and he is currently testing novel osteoarthritis prevention strategies in young adults following injury in a world-first clinical trial. He has published over 60 peer-reviewed articles in international journals. Adam has worked in teaching and research at universities in Australia, Norway and Austria and is a graduate of Harvard Medical School’s Global Clinical Research Program. His research has been awarded American Journal of Sports Medicine most outstanding paper 2016, Australian Physiotherapy Association Best New Investigator 2013 & 2017 in musculoskeletal and sports research, and Sports Medicine Australia best Clinical Sports Medicine paper 2019.   Read the full transcript below: Karen Litzy (00:01): Hey, Adam, welcome to the podcast. I'm so happy you're here. And I'm excited to talk about ACL injuries with you. So welcome. Adam Culvenor (00:08): Thanks very much for having me, Karen. It's great to be here and chat. Karen Litzy (00:11): So now the bulk of your research is in ACL injuries and not the mechanism of injuries for ACLs, but what happens after that injury? So before we get into, and we'll talk about the burden of ACL and optimal treatment and osteoarthritis and why that happens. But what I would love to know is why are you interested in this subject matter? Sort of, why did you make this kind of the centerpiece of your research? Adam Culvenor (00:43): It's a good, good question. So about 10 years ago, also, now I had done a couple of years of clinical practice as a physiotherapist in Melbourne where I'm based and was interested in pursuing a bit more of the research line into ACLs because we had a patient come to myself and one of my colleagues who was a young guy, about 35 years old, who had a very active, healthy life up to that point, he'd suffered an ACL injury about when he was 20 years old, he was about 35. Now it had a number of issues. He'd got back to sport without any problems, but then now about, you know, 10 to 15 years later, started having some pain, unable to do the things he normally would love to do. Couldn't go back and play anymore. Adam Culvenor (01:33): Sport couldn't start, couldn't really play with his kids. He'd seen an orthopedic surgeon, he'd had an Arthroscope, had a bit of a cleanup now going back to the surgeon and he was really in want of a knee replacement because he could no longer do the things that he wanted. And the surgeon basically said to him, you're too young to have a knee replacement go and see, Adam and Tom, our colleague. And so what we can do, and that really opened our eyes from a clinical perspective about these types of patients and this particular young guy had on x-ray most of his changes were actually in his patellofemoral joint. So in the patella and the trochlea, and that really set my mind up to go and look into the literature in this space and see what's out there in terms of not only osteoarthritis in these young people. And clearly it was very burdensome to this young guy, but also why are we seeing this in the patella femoral joint in particular and why is it causing so many problems? And so that really set us off for my PhD, about 10 years ago, looking into these medium to longterm outcomes, ultimately trying to help these people get back to do the things they wanted to do without the pain and the symptoms that come with osteoarthritis a lot of the time. Karen Litzy (02:48): Yeah. Oh, great story, that's a shame 35 years old. Gosh, that's so young. I can understand why that would really peak your interest because you don't want to see these patients coming into you or when you do see them, you want to be able to help them with the best evidence and best things that you can. So you had mentioned in your explanation there as to why this subject interests you, is that there is this sort of burden after having this ACL injury. So could you talk a little bit more about the burden of an ACL injury and subsequent surgery? Adam Culvenor (03:27): Sure. So I'm sure it goes through a lot of people's minds, as soon as they hear that pop or click, that if they know they've had an ACL injury, that's the initial burden is, you know, that worry of, I can no longer play sport. And often if you do go and have a reconstruction surgery, it's often the nine, 10, 12 months of extensive rehabilitation, as we know, and not going back to sport that often people find a lot of personal satisfaction and get a lot of mental health benefit from playing sport and from their peer involvement and social interaction. So it's that initial burden of the extended period out of sport. Some people do really well with great rehab. They can get back to their sport. They want to play at back to the same level of performance, but there's a certain percentage at about 50% of people we know in the evidence will develop longer term, not only persistent symptoms from a patient reported outcome perspective, but also ongoing functional limitations. Adam Culvenor (04:26): And ultimately the development of osteoarthritis be that on radiographs, on x-rays. And some of our work is which we can go into a little bit more detail in a moment is looking at the earlier changes on some more sensitive imaging like MRI to try and detect these types of people who might be more at risk of developing longer term changes. So as I said, some people do really well following an ACL injury, but rehab only, or surgery. And we can chat about the differences in the treatment options later as well, but about 50% of people at the moment. And the evidence suggests that they will have osteoarthritis within about 10 years of their ACL injury. So if we think of the typical patient is, you know, the adolescent or the young 20 year old patient playing sport, they rupture their knee only 10 years, 15 years down the track. Adam Culvenor (05:16): They're still only 30, 35. That young gentleman I spoke to earlier. And they've got a knee of essentially that looks like on imaging of a knee of a typical 70 or 80 year old. And we know that imaging findings on x-ray don't necessarily match up particularly well with what we see clinically. So that's not necessarily, you know, a sign that they're definitely going to have functional limitations on symptoms, but it certainly increases the risk of that happening. And that burden at a time when people often have really important family commitments and young family commitments work commitments, and they often still want to be active in participating in sport. And so when you bring all of those in to a knee that might not be has have recovered as well, following an ACL injury, you might still have some muscle weakness if that wasn't addressed initially and create the picture of more of a persistent pain problem, then you start getting into being quite a burdensome condition that we say these types of patients clinically come back in often five, 10 years following their injury. Karen Litzy (06:20): Yeah. And I can imagine along with that, persistent pain comes decreased activity, decreased movement, and we all know all of the sort of cascade of events that can happen when you're not getting an exercise. You're not getting in movement. You know, then you have risk of obesity, risk of diabetes mental health issues. So all of that stuff can kind of stem from, you know, this burden of an ACL, which, you know, for a lot of people, I don't think that even would flash in their mind when you're looking at a 20 something year old who just tore their ACL, because we know that population who does tear are usually pretty athletic. Adam Culvenor (07:03): Exactly. And that's the thing prior to their injury. They're often very healthy and, you know, never seen a doctor or never been to hospital before and having the ACL injury can often be that initial. Unfortunately, you know, the cascade where you become less physically active in, might not be able to get back to the sport. You really want to start putting on weight. And that increases the risk of all of these other conditions, as you've just said. And I think there was a recent article a research paper actually showing that having an ACL injury increased your risk of a cardiovascular disease by about 50% longer term. So for me, that was a real wake up. This knee is not just a knee, it's actually affecting the whole person. Exact reasons you just mentioned that it can spiral into, you know, less physically activity, the pain putting on and then being the increased risk of all of the comorbid conditions as well. Karen Litzy (07:55): Exactly. And now, so you mentioned a couple of minutes ago about treatment. So you could have surgery, you can not have surgery. So can you talk a little bit as to what the optimal treatment is after an ACL and how one comes to that decision, whether you're the clinician or you're the patient, how does that work? Adam Culvenor (08:18): And that's the $64 question. And so I can have extreme of the spectrum. You can have one end, you can have everyone has surgery. The other end is no one has surgery and the truth probably lies somewhere in the middle. So if we look to what the evidence suggests in the literature, there's very little high quality evidence comparing the two treatment options. There's really only one, what we call randomized control trial. That's compared about 120 people. Who've had an acute ACL injury and they were either allocated to having early surgery. So a couple of months of having the injury and then an extensive rehabilitation period I've nine months or so, and then the other group. So exactly the same rehabilitation. The only thing is they didn't have the surgery. And so the only difference between these two groups of patients was the surgery or not. Adam Culvenor (09:15): Now the group who didn't have the surgery initially could have the option of having surgery later on if they had ongoing problems or symptoms, or desired to have the surgery later on, and they could cross over to the surgery arm. And what this study showed is initially this was published back in 2010 now. So we've not done this for over a decade, is that there's very little differences both at two years after surgery five years. And I think that the authors are about to publish their 10 year outcomes, but certainly the two and five year Mark, there's very little differences, whether you have surgery or not, in terms of pain symptoms, strength returned to sport the need to have more surgery, quality of life, and indeed radiographic knee osteoarthritis. So I was fortunate enough during my time in Europe, conducting a research fellowship recently to work with this group of researchers based in Sweden. Adam Culvenor (10:07): And we looked at the MRI outcomes in this population, as I said earlier, trying to identify people maybe earlier in the process initially after that ACL injury, to see if we can identify those more at risk of longer term problems, which might present opportunities to intervene a little bit earlier to stop that cascade of negativity and what we found really, interestingly, when we looked at the cartilage on MRI between the time of injury to two years and to five years, is it the group that had early surgery actually had more cartilage loss compared to the group that didn't have surgery and you sort of asked, well, why might that be? Because, and I think I haven't had an ACL reconstruction, I'm injuring myself, but I know from colleagues and working clinically that the ACL surgeries is almost a secondary trauma. Like you're going in there, you're drilling tunnels, you arthroscopically opening the joint. Adam Culvenor (11:04): You come out of surgery, having a very angry, hot red, swollen knee. And so I think that whole cascade of inflammation can soften the cartilage, can create a knee that's not particularly happy. And then when you go and potentially, you know, put that knee through load, maybe going back to sport and whatnot, then that might actually be related to the development of osteoarthritis more so than if you don't have the reconstruction. And so we've actually done a little bit more work on the return to sport type of thing. And, thankfully in a group with ACL reconstruction, it doesn't seem to increase the risk of osteoarthritis if you do go back to sport. So that doesn't seem to be the main things. That's a good thing for patients knowing that if you've had an injury or reconstruction, you can go back to sport knowing that you're not going to put your knee at more risk, but it's probably more the inflammatory markers, the secondary trauma of that that's reconstruction surgery that increases the risk even longer term as well. Adam Culvenor (12:03): So I think what I always tell my patients is that you should always trial a non-operative period. First, you can always go and have surgery later. And I think, I always say, you need to prove to me that your knee is unstable. So some people can do really well without having surgery because their neuromuscular and muscle systems can compensate for that ruptured ACL and the mechanical instability, the neuromuscular system, the humans are very clever. They can really compensate quite well, and they feel you don't need the ACL. If you're only going to perhaps not go back to that high level pivoting sport, where you put your knee at high stress, a lot of the time, then if you just want to run straight lines and play with the kids, then you're likely not needing to have the reconstruction. If for instance, you try a really intensive, progressive rehab strengthening program and you're starting to run, or you're starting to get back into a bit of sport and your knee starts to become unstable at that point at the level that you want to get back to, then that sort of probably instigates the conversation. Adam Culvenor (13:12): Well, maybe your knees actually not able to overcome the structural instability to the level of activity that you want to achieve. Maybe let's have the discussion of a reconstruction as a potential option, but always get them. You need to prove that your knee's unstable by going through this rehab and putting yourself through these activities. But it's not going to do well without surgery because we know that the outcomes that are quite similar for the majority of people if you have early surgery or even delayed surgery and doing a period of rehab, irrespective of whether you go and have surgery or not, will be beneficial, if you do go and have surgery. So that prehab, if you like. So that's, I think it's my take home is it's probably actually just educating the patient to empower them with the evidence because they're the ones ultimately that need to make the decision. And so presenting them with all the best available evidence and guiding them for the initial rehab stage often can change their mind that they need surgery once they realized they were actually doing quite well without it. Karen Litzy (14:17): And when you're saying to the patient, let's do a trial for a non-operative phase, so that you can prove to me that this knee is unstable. What kind of length of time are you talking about for that rehab process and knowing that it's going to vary person to person obviously. Adam Culvenor (14:37): Oh, of course, of course. So I think a period of two to three months is sufficient to provide an intensive strengthening program. Let the knees settle down initially and then actually start you know, within the first month and even two months getting them to start really loading their knee. That's the thing, if you actually don't have surgery and actually responds a lot quicker because you don't have any of the graft morbidity, you're not taking out some of the hamstring or the patellar tendon. There's no real reason why we need to be conservative about you know tearing a hamstring or whatever that might be cause of the graft or rupturing the graft because you haven't had the graft reconstructed. So it's different for everyone because different people will respond differently, but actually there's no real hard and fast rule with this because you need to rehab them to get them to a point where they're starting to do the activities that they want to get back to. Adam Culvenor (15:37): And at any point in that step ladder of increased physical activity demands that they might fail or start having, you know, severe giving way episodes. Then that's the point that you might have that conversation with someone, but if you're running and you start giving Y and these people want to go back and play elite football, then clearly maybe you're not getting, being able to run without a stable knee. You're probably not going to be able to play football with that with a stable knee. Then that might be the point where you revisit, you're running no problems and you tried playing football and it starts giving way, but really you actually just want to run, right? Playing football is just something you tried, but didn't really want to do. Then you probably don't need the structural stability. If you just want to run off another thing, I like to set a patient's, is it like a seatbelt? Adam Culvenor (16:28): Is it, we all wear a seat belt when we drive, but very rarely do we have a crack and we rely on that seatbelt to keep us safe. So if you're someone who walks around and might run, then the ACL is a bit like a seatbelt, is that you actually don't need that seatbelt on because you're not having a crack. You're not putting the need through that real pivoting type movement to rely on it. So unless you're going to go back to a high level sport and, you know, put your knee through those pivoting jarring mechanisms of movement, then you probably don't need that seat belt. You don't need that ACL to protect the knee. Does that make sense? Yeah, Karen Litzy (17:06): That's perfect. That's really great. And it sounds to me like when, if you're the clinician working with this patient during, let's say this non-operative trial period where they have to prove, again, the instability, every single person is different. So what you're going to be looking at is different meaning, right? So if I just want to be able to play with my kids, I wasn't a runner before I don't really need to run. I just want to ride a bike or, you know, you want to put people through the things that they want to be able to do. And that would kind of be the way you would test for that instability. But are you also using sort of standardized tests when it comes to seeing if people have the stability in the knee? Adam Culvenor (17:54): Exactly. so it's really a goal based discussion with the patient come. The desires of the return to activity comes is driven by the patient. And as clinicians, you know, it's good to have that discussion to then work out, you know, what level do we need to get at, but certainly there's a number of standardized clinical tests and really great patient reported outcomes that we can use with these patients. So the very common ones are the strength tests. So if you have the resources, you know, a dynamometer, an isokinetic dynamometer in the clinic to look at the three range of quads and hamstrings strengths and making, you know, the criteria we typically use in the literature is meeting 90% of the strength compared to your uninjured side. Now, there's obviously some pros and cons about doing that. Adam Culvenor (18:44): And the other tests are typically hop tests. So single leg hop, as far as you can, with a balanced landing site, decide hop tests. There's a number of different tests we can use to try and assess the stability, the functional stability and confidence of the knee. Having said that though, we've actually just done some work I've led by Brooke Patterson here as part of our team, looking at the limb symmetry index, which is the ACL rate constructively comparing to the, I mean, delayed and what we found sort of between one and five years after their reconstruction is that often the non-injured leg isn't that healthy gold standard cause that often deteriorates because it's a period of an activity, you be back playing the sport you’re back to. So that's sort of the crisis in capacity. So it's not that reference standard that we should necessarily be comparing our rate constructed. Adam Culvenor (19:44): And so there's been a couple of other bits and pieces that people have looked at alternatives to this type of measurement. And whether it's, if you have say someone initially after injury, it's a great opportunity to start doing these tests is actually the estimated pre-injury capacity. So to estimate that it's best to try and do it as soon after injury as possible, given that patients might have some fear and confidence, you know, respect that obviously, but actually trying to do a hop test quite early before that other leg has the chance to start decreasing in capacity because often the limb symmetry index overestimates, what the reconstructive legs capacity actually is. And so they're the functional type of measures that I think we should be using in this patient population, not only to assess outcomes, but also patients get in my experience really like seeing their improvements and getting feedback about having, going along their journey totally. And then an objective test of strength or a hop test they can see right in front of their eyes, how far they're hopping and if they are improving and if they're not, then why not have that conversation. And so that can be great for adherence motivation because this journey of a rehab, irrespective of whether you have a reconstruction or not, can be quite long and tedious, it can be boring. You're sitting there doing strength exercises, you know, any type of motivation to get people to continue is going to be beneficial. Karen Litzy (21:14): It's always, one of the biggest complaints is, gosh, these exercises, when do we get to the X, Y, Z, you know, that you see on, on Instagram or on YouTube. And I was like, you know, you're a month in buddy. This is it. Adam Culvenor (21:28): Exactly. And I think as physios and the evidence suggests that, we're very good at doing the early stage of the rehab because patients are probably more compliant at that point as well. But there's evidence actually coming out of Australia that less than 5% of people who have had an ACL reconstruction, so less than 5% actually go through a period of rehab beyond six months and include and return to sport type training. So I think whether it be a lack of understanding from a clinician standpoint, or also that, you know, financial and motivational points of view from the patient after six months of like, I've had enough, I'm out, I've good enough. I don't need that extra, you know, icing on the cake to get back to sport. They tend to drop off. And that's when not having that really high level agility capacity returned to school at top training, you increase the risk of re rupture. And that obviously is a devastating impact for these patients and increases the risk of longer term negative outcomes as well. Karen Litzy (22:27): Yeah. And I know here in the United States, not so much in other parts of the world, but insurance will oftentimes cut people off at three or four months. Adam Culvenor (22:36): Okay. So it's different everywhere. Yeah. Karen Litzy (22:38): So it's like, okay, so the person can walk and run and then, then what do they do? You know what I mean? So it kind of depends on your clinic model and things like that. But I mean, I've been lucky enough that I've been able to stay with my patients for 12, 13 months and upward. So it's been really great to be there the week they are out of the OR to getting them on the field and actually doing things that are going to, you know, mimic their soccer, their football place. So, but it's, yeah, there's so many obstacles. It seems. Adam Culvenor (23:25): Totally. And I think there's some really great evidence coming from Scandinavia that for every month that you delay the return to sport up to nine months, it actually reduces your injury risk by 50% that's mind blowing for me. So not only, you know, it was it from a rehab point of view, but actually from a range, point of view, having that nine months will actually you know, reduce your risk substantially of re rupturing when you do go back to sport. And I think that is why it's so heavily on people's minds when they're first going back to sport. That fear that's a huge impact psychologically for these types of patients. And I think often an ACL injury can happen. So innocuously, like you've done this movement a thousand times at training before, so why this time and that fear of, Oh, it wasn't a major blow when I first did it, like it wasn't someone running across and really hitting my knee. It was, I was on my own. And so what's stopping that from happening again. And that's that, I think that feeds into the fear of what could happen anytime again. Yeah. So I think I often try and say to patients while you injured your ACL, initially let's get your knee back to better than it was before you injured it, to prevent it from happening again. Because once we know once you have one injury, the biggest risk factor. So the biggest risk factor for a second injury is having a first. Karen Litzy (24:51): Exactly, exactly. And I've quoted that that study of that nine months reducing 50%, especially when you're working with kids who think I'm fine. Now I can walk. And I was like, listen, this, and you have to have that conversation with the child and with the parents. And once the parents hear that, they're like, okay, like we get it. Even though her physician was onboard, like you're not playing until you're one year out from surgery. I mean, wherever it is on the same page, but it's hard to keep. It's hard to keep everyone on the same page, but being able to use the literature and say, listen, I'll send you the study here it is. Adam Culvenor (25:34): When actually pulling it's actually for some people it's not in needing to encourage them, it's actually needing them to pull them back. That's where your education and clinical reasoning and discussions with patients will differ quite a bit is that some people are so gung ho in their rehab and they just want to get back to sport. You actually have to, as I said, pull them back, whereas the opposite might be true for some alpha people. So it's really interesting how different people respond differently to this type of quite devastating injury. Karen Litzy (26:03): Right. And how they respond, how you can use, like you mentioned the study of Scandinavia, how we can use that study with both of those extremes of people, right? So the people who are afraid and the people who are gung ho, so again, it's having this good rapport with your patient and their other stakeholders to kind of get them through safely through their rehab. But now we talked about it earlier on and that's osteoarthritis. So 50% of people will develop some sort of osteoarthritic changes in their knee. So what do we do about that? Are there prevention strategies? What can we do? Adam Culvenor (26:54): So this is something that we've been looking at for a few years now and obviously you know, we'd love to be able to have a treatment to stop this from happening, but we're not actually there yet. There's a lot of really nice longitudinal studies investigating risk factors for the increase prevalence of osteoarthritis in this population. And there's a number of risk factors that we can start informing how we might treat these people initially as well. So the number one risk factor is having a combined injury with a meniscus tear or a cartilage lesion. So if you have not only an ACL injury and very rarely, is it just an ACL injury, it can often be combined with a meniscus tear, cartilage lesion, bone marrow lesion, et cetera. So that more severe sort of type of injury will automatically put you at risk longer term of having osteoarthritis. Adam Culvenor (27:46): That's not that exciting because as clinicians, we can't do much about that. It's not really modifiable. So we're really trying to identify some factors that might be modifiable that we can address. So things like BMI being overweight, we know increases the risk of osteoarthritis longer term not only after injury, but in people of older age who have the traumatic type of osteoarthritis what's coming emerging from the literature more and more is the quadriceps weakness. So quadriceps in particular the muscle weakness in that muscle and also the functional impairments. So we talked about hop tests and in a balance in your muscle control a little bit earlier. So they're actually starting to become more and more prominent as risk factors for the medium and longterm outcomes for osteoarthritis. So we've just published a paper in the British journal of sports medicine, which looked at this exact question. Adam Culvenor (28:44): So do functional outcomes. So typical tests, we might use to clear someone to return to sports, a hop tests and strength tests. Do these actually have a relationship with future osteoarthritis? And what we found is, so this is a one year we tested them. And then at five years we measured their osteoarthritis on MRI. So quite sensitive measure of osteoarthritis, but also an X ray. And what we found is we combine a lot of these tests together into a test battery. So side to side hop test, single leg forward hop test. If you have a poor outcome at one year in these tests, then you're more likely to develop osteoarthritis at five years down the track. And so there's other studies that show quite similar findings in this space as well, which is really, I mean, it's upsetting because they're more at risk of osteoarthritis, but it's quite encouraging as clinicians. Adam Culvenor (29:34): This is our forte. We can actually do something about it in the initial stages of rehab. And again, this can be a great education motivational tool to say on this test, you're not achieving at a level that you need to achieve. This is not only going to put you at risk of reinjury. The research shows that this is actually going to increase your risk of developing arthritis. And we need to be a little bit careful about how we inform our patients about this. Cause as I said, some people can be really fearful and terrified about reinjuring and worried about what it is going to look like. And so presenting them with, Oh, you're going to be, you're going to have arthritis in 10 years as well. Might not be quite the right moves to allay that fear at that point in that patient. Adam Culvenor (30:16): Whereas other people having a knowing that information can be really motivating to try and get them feedback to the best possible condition that it can be. So again, it's very personalized how we educate our patients, but I think it's really important to educate them along the journey about that increased risk of OA and encouragingly. There's some, some really positive signs that we might start to be able to modify that risk with some really great rehab, getting back to the strengths, getting back to improving function in our clinical work as well. So I think that's really, really exciting moving forward. Karen Litzy (30:50): And that's great news for physical therapists because this is where we live, so wow. We can really make a difference in someone's life by good comprehensive rehab within that first year after ACL injury. And again, that's, regardless of whether they have surgery or not, is that correct? Adam Culvenor (31:08): Exactly. Yep, exactly. And as I said earlier about the return to sports, so we've also done some research which should be published shortly, hopefully looking at the fact that again, encouragingly, if you have an ACL injury or reconstruction and then decide to go back to these pivoting type sports, some people say, well, you shouldn't go back to that. You know, the high impact sport, because that's going to put your knee at undue stress and you're going to have more arthritis longer term, is that what we've found is actually that's not the case. So we can be confident that we can give these people you know, the advice to go back to sport. If that's what they really want to, for their quality of life and mental health, they do drive a lot of social pleasure from playing sport. The good thing is, is if you have a great functional and strong knee, then that's not going to put your knee at further risk by going back to sport. Sure. It's going to perhaps increase your risk of re injury compared to sitting on the couch at home. I heard that from a lot of mental health and also physical health being physically active and involved in sport has so many more benefits to our general health as well. Karen Litzy (32:11): Absolutely. And now can we, if you don't mind talk about the patient that I think a lot of physiotherapists are going to see, and it's like the patient that you saw 15, 20 years after their ACL. So we're not, we're not seeing them one to five years, but now we're seeing them 10 to 15 to 20 years later. That's when a lot of people are going to come to us with knee pain. So what can we do for these patients? Do we want to look at these hop tests in these patients? Does that make a difference? What happens then? Cause that's a big bulk of our population. Adam Culvenor (32:54): You're exactly right. And it varies about again what their goals are, but often if they're 10 to 20 years down the track and they've got osteoarthritis, we can look to the literature in the osteopath writers field. And in that space, it's very, very compelling evidence that exercise therapy and education provides the strongest effect for pain and symptoms and function in this population. And so that's almost reassuring that it's quite similar to what we're seeing in the early post-operative or post-injury stage is that whatever level on the spectrum you are post-injury and the development of osteoarthritis, essentially your treatment's going to be quite similar where you're developing the strength that underlies everything that we do in day to day activities. And indeed, if we want to get back to sport and also the functional capacity, so ask for the, what they want to do, what they can't do because of their pain and symptoms and make it a really goal oriented treatment. Adam Culvenor (33:54): And I think it's really important to also ask them what physical therapy have they actually done. A lot of those people come to us and they've seen five different surgeons and they've got different opinions. And when you actually question them and interrogate them, they've actually never had a gym program or they've never done any strength training. And it's like, well, of course you're having a few problems. So let's start you from the very basics. And not, you know, not flare them up by going too hard, too fast, but actually educate them around the importance of strength and functional control that the knee will benefit a lot from that. As well as from a function symptomatic point of view and start building on their strength, capacity and functional capacity to be able to meet whatever goal that they want to get back to. So I don't see it as being a totally separate patient from the post-injury one to the osteoarthritic, it's on a spectrum. And a lot of the treatments going to be very similar in principle depending on what their goals and their goals might change over time. So the treatment can as well. Karen Litzy (34:58): Yeah. Yeah. Well, thank you for that. That's great. Now, can we talk about the study that you are currently undertaking at La Trobe University. So can you tell us a little bit more about that? What is it and what are your goals for it? Adam Culvenor (35:18): We're super excited. Pardon the pun. So this is a project that's really stemmed from over the last 10 years of our work. Looking at identifying those risk factors, as I've talked about earlier to then be able to get some funding. So we've got some funding from the Australian government health and medical research council to perform this really world first randomized control trial, to see if we can actually prevent early osteoarthritis and improve symptoms and function through an exercise therapy intervention. So in essence, we're going to get a whole lot of people, about 200 people who are one or two years following there ACL reconstruction. So they've had that initial period of rehab to get better. Cause some people do really well. We need to remember that, that some people do great following the injury and surgery and don't need more intervention longer term. Adam Culvenor (36:14): So we want to try and capture the ones that have some ongoing symptoms and functional impairments. Haven't got back to doing what they want to do at one year post op to two postop at a point where they should be able to do those things and because they are going in out by some of the research, that's just, those people are more at risk of developing longer term problems. So we want to capture those at high risk and we're going to separate them into two different groups. In our clinical trial. One group will get a really intensive physio therapist, led exercise therapy program. So a lot of strengthening, agility, neuromuscular control, education, around physical activity you know, loading of the knee return to sport. And then that's over a period of four months initially. And then the other group gets what we're trying to say is usual care. Adam Culvenor (37:06): So very little intervention, they get a little bit of education and some booklets with the types of exercises I could do if they want to essentially, which is what they'd probably get it from their GP or their surgeon. Similarly, am I going to then assess their needs and their general health and symptoms and function from baseline and that changes over four months. And then also look at the changes up to 18 months as well because the MRI is one of our main outcomes looking at early collagen changes, which is our osteoarthritis marker. And some of these can take a little while to show up. So if you have an MRI on one day and then go and have an MRI the next week, chances are, you're probably not going to see much difference. So we need that period of, you know, 12 to 18 months to be able to see an effect of our exercise therapy intervention. Adam Culvenor (37:56): Whereas the symptoms of function we're expecting to be able to improve quite a bit within the first four months, which is going to be the most intensive period. And so yeah, our hypothesis is yeah, is that there's really strong, intensive, progressive rehab program strengthening, getting nice knees back to better than what they were before is going to be beneficial for their symptoms, function, general health quality of life, but also hopefully be able to show that that's actually preventing the early changes that we see on MRI or indeed maybe slowing the changes. So we know that cartilage thickness decreases. So we have a loss of cartilage, bone marrow lesions can start developing also for small osteophytes and bony spurs can start developing over a course of one or two years. And so we want to see if there's a difference in the development of those features in the two different groups. So we are ready to hit, hit, go on this study and a little bit delighted with COVID effecting us at the moment as well. So we're really excited to get going on this study and hopefully be a really impactful research project, moving the field forward and empowering clinicians to say, we actually can make a difference in this space for these patients. Karen Litzy (39:07): Yeah. I love it. Well, I look forward to when you guys can actually get started and maybe 12 to 18 months from then. So it sounds like a great study. And like you said, it's something that can be so empowering for physical therapists or physiotherapists to then pass on to their patients and kind of transfer that power from the physio to the patient to give them a greater sense of wellbeing, which is exactly that's what we do, right. That's why we became PTs or physios. So before we sign off, I have a couple other things. Number one. What are your biggest sort of takeaway messages for the listeners? Adam Culvenor (39:55): So I think the biggest thing is probably when you first see the patient, whose had an acute ACL injury in front of you and they're devastated. They often might come into your rooms and have heard particularly here in Australia. Our media is very centric on if you've had an injury, you need reconstruction because the elite athletes tend to have the reconstruction and I want the best treatment. And therefore I need a reconstruction is actually having a conversation with them and saying, presenting them with the evidence as I spoke about earlier. And there's no problem trialing a period of non-operative management for a couple of months, because that's going to be a great help if you do go down and have surgery afterwards. And it's, I think the reality is that a lot of people given the opportunity to do is to not pretty, very happy, actually can change their mind over the course. Adam Culvenor (40:45): And I realized actually, my knees gone really well. I actually don't need to have surgery where I was. I thought I would. So that's instead of just going gung ho into surgery, I think the evidence is very clear that a period of non-operative management is beneficial. Most patients almost all. And then the second key take home for me is, is during a postoperative or post-injury rehabilitation is actually working these patients intensively and progressively, I think we tend to shy on the side of being a little bit cautious, particularly after they've had a reconstruction, we worry about the graft rupturing. And of course we have to respect the surgeons requests of what we need to do with the patient from a restriction standpoint. But I think there's evidence growing now that we can be a lot more intensive early on and progressive with our exercises and looking to the strengths and conditioning research like these guys are trained specifically to develop strength and conditioning programs. Adam Culvenor (41:46): And I think as physios where we're pretty good at it, some better than others. And I think meeting the American college of sports medicine, you know, criteria for strength gains is actually, you need to work really hard. You need to get sweaty, you need to actually be working at an intense level. And so unless we put our patients through that, those sort of levels of intensity, we're not going to see the best outcomes that these patients can then can achieve. So there my two take homes is I think try non-operative period of rehab initially and revisit that along the course of the program. And then don't be afraid to actually build a lot of strength in those people because that's going to be beneficial. So they short term prevent re injury and the longterm of preventing arthritis, likely down the track as well. Karen Litzy (42:31): Awesome. And then number two, next question is, and it's something I ask everyone knowing where you are now in your life and in your career, what advice would you give to yourself right out of a physiotherapy school? Adam Culvenor (42:51): Ooh, good question. I'd say don't worry so much about things. Things will work out. I think in the research I'll probably have my research hat on a little bit, is often clinicians who want to start in research or even researchers who want to continue in research is that the funding can be really you know, tricky and really competitive and can often make and break careers. But I think some general, you know, I'd tell myself is don't worry too much about that. Just link up with good people and strong mentors. So, and I think finding, I'm sure you've had other guests say this as well, but finding good people who can mentor you really well and put your interests or your goals in your career sort of forward to their collaborators. So you can meet new people and open doors. Adam Culvenor (43:46): I think I was always worried that it wasn't gonna be enough doors opening, but I've been really lucky in my career that I've been surrounded by a great team throughout and doors have inevitably even though I don't expect them to keep opening. And so having the being in the right place at the right time is important, but you can, you can help to create more instances of being in the right place and more instances of being in the right time by putting yourself out there and meeting new people and surrounding yourself with really good mentors. Karen Litzy (44:20): Great advice. And number three, last question. Where can people find you? Adam Culvenor (44:25): Peak pool can find me in my lantern at the moment I'm up? No. So I'm have a Twitter account @agculvenor. My profile's on the Latrobe sport and exercise medicine research center page at Latrobe university. So we have a blog at our research center with a lot of really nice impactful easy to digest, short blogs, short videos, infographics designed for clinicians designed for patients. So you can take them off the blog and give them to your patients so I can not recommend that resource highly enough. And then my email, feel free to email me. You can find that email address on the La Trobe website page as well. Karen Litzy (45:13): And, we'll have all the links to that at the show notes for this podcast over at podcast.healthywealthysmart.com. So we'll have a link to your Twitter and to your page at Latrobe and also to the blog. So people want to get those resources, they can, and we'll also put in links to the papers that we spoke about today so that people can go and kind of read those papers as well. So we can link up to all of that. So, Adam, thank you so much was a great conversation. I appreciate your time. Adam Culvenor (45:44): That's been fantastic. Thanks Karen. Karen Litzy (45:46): You're welcome. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

​Dr Joanne Kemp is a Senior Research Fellow at the Latrobe Sport and Exercise Medicine Research Centre, Latrobe University, Australia. She is also a titled APA Sport & Exercise Physiotherapist of 25+ years’ experience, and still practices clinically on a weekly basis. She has 60+ peer-reviewed publications in hip pain (OA) in young and middle-aged adults, and the consequence of injury on joint health. She has received over $3 million in grant funding and has been awarded several prizes including best paper for Sports Physiotherapy Australia in 2015 and 2017. She is co-project lead for GLA:D Australia. Joanne has presented extensively on the management of hip pain and OA in Australia and internationally. She has a particular interest in non-surgical, exercise-based interventions that can slow the progression and reduce the symptoms associated with hip pain and OA. In this episode we cover;   Young athletes respond differently to adults Young athletes have immature skeletons, that changes as young athletes develop The shape of the hip bones can change depending on the loads we put through the hip We need to consider how much load we are subjected young athlete The importance of the growth plates - these are still open on growing young athletes We want young athletes to exercise and move in lots of different ways - not the same way all the time 2 main ways that hip pain generally develops in young athletes An outline of the key issues that can occur in young athletes and what to look for How long should you wait before you take your young athlete to a Sports & Exercise Physiotherapist When should you get imaging for hip pain? FAI - or FAI Syndrome, busting the myths about what it is and what it means How and why FAIS develops Are there particular sports that predispose young athletes to hip pain? The importance of parents as load managers Young athletes need an off-season from their main sport to change the loading in their hip Ask young athletes the question "Do you want this to be your career?"   Resources Dr Joanne Kemp Clinical Practice LaTrobe Sports & Exercise Medicine Research Centre Dr Joanne Kemp on Twitter   Young Athlete Podcast youngathletepodcast.com   Young Athlete Podcast on Facebook facebook.com/youngathletepodcast/   Young Athlete Podcast on Twitter twitter.com/youngathpodcast   Bounce Physiotherapy | Bounce Exercise Clinic bounceclinic.com.au  

Jill Cook is a Professor in Musculoskeletal Health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas. We are very pleased to present one of the world's foremost experts in tendon injury.   In this episode we cover; What is a tendinopathy? How is this different to tendinitis? Do tendons need imaging, like MRI or ultrasound? The value of a great practitioner in managing tendon injuries How do the symptoms of tendinopathy develop? Are tendon injuries are big issues in young athletes? Are there particular times in a young athletes development when they are more at risk of tendon injuries? What are "safe" loads to avoid tendon injuries Monitoring loads and loading to help identify tendon injuries What are the implications for young athletes once they have a tendon injury? Do all tendon injuries get treated the same way? The importance of good strength and capacity to protect young athletes from tendon injury Young athletes tendons have a high healing potential What is the healing capacity of tendons once they are an issue? Should tendons be injected? How does managing a tendinopathy differ in season vs off season? What keeps Jill Cook awake at night - what's next in the research and what we are trying to figure out The young athlete should be at the centre of managing tendon injuries

Dr Andrea Mosler is an Australian Specialist Sports Physiotherapist who consults at the AIS in Canberra.  She is also an NHMRC Research Fellow at the Latrobe Sports and Exercise Medicine Research Centre, where she is currently working on hip-related groin pain, injury prevention, and women in sport research projects. She is also and mother of 2 active boys! Andrea really has had an amazing career to date Andrea was a clinician at the Australian Institute of Sport from 1995-2013, working mainly with Australian water polo and gymnastics and was the Sports medicine coordinator for National Women’s Water Polo for seven years.  She has been an Australian team physiotherapist at many sporting events including the 2000, 2004 and 2008 Olympics Games. Andrea completed her PhD at Aspetar over in Qatar, investigating the risk factors for hip and groin pain in professional football players.  She also works as a Senior Physiotherapist and Head of CME/CPD at Aspetar.  Andrea has a unique perspective to share here today,  She has a foot in 3 camps, not 2! As a parent of 2 teenage boys As a Specialist Sports & Exercise Physiotherapist As a researcher and academic n this episode we cover; What is a Specialist Sports & Exercise Physiotherapist How a Specialist Sports & Exercise Physiotherapist can help in the management and care of young athletes Detraining is a factor to watch out for when recovering from an injury Physical and psychological readiness to go back to sport Complete rest should not be prescribed when recovering from injuries There is plenty of other things you can do to stay active during the rehab period Organised sport should not be the cornerstone of physical activity Incidental activity and free play appear to be important in the overall physical development and being more robust Young athletes need to move more to help prevent injuries The value of injury prevention programs What sort of injury prevention programs are out there What is the difference between injury prevention programs High performance and reducing injury are aiming for the same thing  

Fiona had a really interesting chat with physiotherapist Melissa Haberfield who works at North Melbourne during the AFLW season and is also part of a La Trobe Sport and Exercise Medicine Research Centre looking at injury prevention in women’s […] http://media.rawvoice.com/joy_chickstalkin/p/joy.org.au/chickstalkingfooty/wp-content/uploads/sites/323/2019/07/Melissa-Haberfield.mp3 Podcast: Play in new window | Download (Duration: 11:44 — 14.1MB) Subscribe or Follow Us: Apple Podcasts | Android | Spotify | RSS The post Mini Pod – Melissa Haberfield (La Trobe University and North Melb AFLW) appeared first on Chicks Talking Footy.

LIVE on the Sport Physiotherapy Canada Facebook Page, I welcome Dr. Christian Barton on the show to preview his lecture for the Third World Congress of Sports Physical Therapy in Vancouver, Canada.  Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation.  Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine. In this episode, we discuss: -The inspiration behind TREK Education -Different mediums that facilitate knowledge translation from researchers to clinicians and patients -Common misconceptions around running and injury prevention -The good and bad surrounding social media and knowledge translation -And so much more!   Resources: Third World Congress of Sports Physical Therapy Christian Barton Twitter La Trobe University Sport and Exercise Medicine Research Blog Switch TREK Facebook Group Made to Stick TREK Education Website   For more information on Christian: Dr. Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne. Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.   Read the full transcript below: Karen Litzy:                   00:00                Hey everybody, welcome to our live broadcast. I'm just going to take a look quickly on my phone to make sure that we are in fact live, which I think we are. Yes. Great. All right, so we're live, which is awesome. All right, so thanks to people who are already on and thank you to my guest, Christian Barton, coming all the way in from Australia. So it is my times as you're watching this. It's 9:30 New York time. So Christian, what time is it in Australia right now? Christian Barton:           00:37                11:30 in the morning. That's quite a nice time to do this. Karen Litzy:                   00:43                Yeah. So we're doing this over two different days, so Tuesday for me and Wednesday for you. So crazy. But anyway, thanks for taking the time out to come on to chat with us. So for all the people who are on right now and for as we go through, if you have questions, you can type them in the comments, we can see them and we'll be able to address them as we go along. But before we get started, Christian, what I would love for you to do is just to tell the viewers and the listeners a little bit more about you and how you got to where you are now. Christian Barton:           01:18                Yeah, sure. So I'm a physiotherapist by background have been for nearly 15 years now. So it's getting on. I've always had an interest in research and clinical practice and continuing to try and juggle the two. And that probably started from the very beginning. I finished my undergrad course and well tried to find a position to do some research assistant work on clinical trials and things like that. And quickly my mentors taught me to do your PhD and actually started that about a year and a half out. And so I did that quite early in my career and probably since then I've been probably a mix of half, half clinic and research. So along the way, probably as I've gone through more recently doing more and more research because it gets harder to keep the research, you can do bigger picture things, which is something I've become really passionate about and I'll talk more about later. Christian Barton:           02:05                And so currently I work three main roles. One is my own clinic in Melbourne, which is a sports and an injury clinic. And we work one day a week there and then also work at the Trobe university three days a week. And my main research focus areas around there it's translation and implementation. And then the past couple of years have been doing one day a week with a surgical group. So the Department of Surgery, it's in Newton's hospital in Melbourne and there big project or area of research is around preventing inappropriate surgery. So that aligns very well with what I do of trying to optimize what we do as therapists to prevent unnecessary or inappropriate surgery as we go along. Karen Litzy:                   02:44                Yes. Fantastic. Busy weeks. You have busy weeks. Christian Barton:           02:48                Yeah, I work alongside the three kids at home and yet it's not, not the easiest to juggle at times, but it's certainly all things that I enjoy. Karen Litzy:                   02:55                Yeah, that's amazing. And every time all the interviews ever had with all of the speakers who are coming to Vancouver in October, all do so much. But we didn't do one time is just have an interview on how you manage your time. But that's for another interview. But I think people would really enjoy that. So now let's talk a little bit more about physiotherapy. So why this field? Christian Barton:           03:23                Yeah, I think as a kid I was always active, playing a lot of sports and had a few injuries myself. And I think I always valued the physios guidance about getting back from some of those injuries. So that got me interested in the field and then you go to university, you actually realize physio has a lot more than just train sports injuries. And you need to have to think about pulmonary rehab and cardiac rehab and you're electrical physio. There's a whole range in spectrum that we through. But I think pretty quickly when I come out I would want it to go back to musculoskeletal and sports. And so we went back down that path. And I think what I enjoy about being a physio therapist is just keeping people active. That's your more sedentary person, where you're trying to motivate them through lifestyle changes to get active and manage their persistent knee pain or back pain or whether it's a really elite sports person. I really enjoy trying to get people to achieve their physical activity goals essentially is what I'm enjoying. Karen Litzy:                   04:18                Awesome. And now I can see more and more people joining you. Again, if you're joining, please write like where you’re watching from and if you have any questions, put them in the comments because we'll be talked with, you know, so now let's, you had mentioned this earlier, talking about kind of what you do, part of what you do and you're involved in several knowledge translation initiatives. One of them being the trek group, which I remember I guess it was last year after sports congress and we all changed our social media to the trek elephants logo, which was really great. So this is a nonprofit initiative created to enhance knowledge translation to healthcare professionals, but also to patients and general public. So can you tell us a little bit more about trek and how it all started? Christian Barton:           05:13                Yeah, sure. Also I think my research journeys being quite interesting. When I first started off doing research, I was in a gait clinic doing biomechanics research and I've always found that side of our practice really interesting. And you do this real integral research and you spend a long time for assessing data and finally end up with maybe a couple of things that you can share in the community and they share them. And then I started doing more clinical based research and trials. Firstly looking at biomechanics and then did you that exercise interventions. Very early on I actually worked on a lot of systematic reviews and my passion for doing that was, well we have all this great body of research, we need to bring it together so we can disseminate a little bit better. And then I actually did a project in London where it was actually looking at clinical reasoning of physical therapists and how they integrate evidence into their practice. Christian Barton:           05:59                And what I discovered really quickly is not only were people not using evidence based practice all that often when I actually talked to them about patellofemoral pain, which I'd spent the best part of seven or eight years researching, they've never read any of my papers, never read any of my research. And so it sort of made me reflect a little bit and go, well, why am I doing all this research? And it's not actually being translated into practice. And so I started to have a bit of a flipping all I did and instead of spending time in the lab alongside doing clinical trials, I started to focus a bit more time on actually getting information out there. And so have a good friend of mine, Michael Ratliffe who's based in Denmark and we often catch up and catch up at conferences. Christian Barton:           06:40                And actually one of the first times we spent a lot of time together was when I went to a Danish conference a number of years ago. It was actually after that conference, I was sitting down both quite frustrated, having a couple of Belgium beers talking about this problem and the acronym trek come up with just on a random occurrence sitting his kitchen table. I still remember it. It was like, how do we do this? We'd probably need to brand it with already and get people behind a movement and something happening. So trek stands for translating research evidence and knowledge. So it fits really nicely with that. It actually has more meetings in that. And if you look at English language for trek, it means a long and arduous journey, which I think an old translation very much use when you try and actually make change. And then it also fits with Christian Barton:           07:22                probably one of my favorite books I've ever read, which is called switch, which is how to make change when change is hard. I highly recommend people read this book. It changed my life. And it's a really simple analogy. You have a rider sitting on an elephant and you need to get to a destination. So there's three main parts to that. The rider needs to know where to go. The elephant needs to be motivated because it doesn't matter if the writer tells them how often to go. It's not going to go anywhere to be big beast. Right? Christian Barton:           07:48                We also need an appropriate pathway to get there. So if you picture yourself as an elephant rider on an elephant and an elephant in the middle of the jungle, we want to get to the beach. There's no path to get to the beach and it doesn't matter, you're not going to get there. So the concept of trek is that we have clinicians, we have patients searching for health information who are all motivated to learn more and to do better. They don't really know where to find that information and they certainly don’t know appropriate path to get there. So the idea of trek is to try and improve that. So that sort of started as an idea about how we do this. And then we've, I guess talking and trying to work with lots of people. It's been set up as a not for profit. Christian Barton:           08:25                So it's not meant to be owned by anyone. No one's meant to profit from it. It's trying to bring everyone together and break down the silos of competition between universities because universities don't like to talk to each other and help each other because they're in competition for the same grants and that they might be buried. The knowledge translation. So it's been really important to me from the beginning that yes, we'll try here where I work supports it. But it's not meant to be owned by the tribe. It's not meant to be by myself. It's meant to be everyone seeing. And it comes from a socialist I guess, concept called connective action where we actually, it's basically a meeting which we connect people with the same ideas. And then I did a communications degree and was focusing on journalism and multimedia and social media and writing a whole bunch of stuff around that. Christian Barton:           09:10                And I thought, well, this is a nice platform to use. I think about not just mainstream media, but also social media or whatever people turn. And then our favorite thing, doctor Google, where most people turn to health information. And when you start looking at doctor Google, it's a pretty broken system with a lot of misinformation. And so the concept and my hope is that in time, this trek movement or trek concept could maybe be something that we can't take over with Dr Google, but we can certainly contribute to the information that people find on doctor Google. And so it's getting people around the world to contribute information but create it in an engaging format that will actually get people to rate it and use it. We know there's lots of barriers to reading research for clinicians, understanding your research their reading, but also it's time. Christian Barton:           09:53                And if you can consume the same information sitting on a train, listening to a podcast or looking at a brief video or infographic that maybe gives you the key information from some research and you can trust that source, that it's not biased, it doesn't have an agenda, then that means you can be confident that you can bring that into clinical practice. And for a consumer or a patient that gets that information, they can maybe make health decisions based on that as well. So that was kind of the origins of the project and it's still growing and developing. A lot of people were helped along the way and hopefully we'll get more as well. Karen Litzy:                   10:24                And what has been, so this sort of launched last year, right? Like officially launched. So what metrics have you found from launching last year to where you are now? Christian Barton:           10:39                Yeah, so what I did is actually was lucky enough to get a small grant from the Australian physio association to build a platform to improve physiotherapists knowledge of exercise prescription. And so we did a study last year where we basically built a website, which is exercise.trekeducation.org and before we gave access to everybody, we made them do a test, which is about 20 minutes. And so I have this great data for grants. It's linked with your physios. You've still need to sit down and write up and we see big variations  of knowledge of exercise prescription. And we kind of expected, our hope was that we could then test the evaluate, right? This website helped to improve people's knowledge. Now out of 1,600, I think about a hundred filled in that follow up survey or questionnaire rate. But it was at least as the grant gave us the funding to build a platform. Christian Barton:           11:26                And it's a multisite platform. So since this time we've built a website now for many patellofemoral pain, which is a big area of mine for clinicians. We've actually just finishing up a low back pain site and a knee osteoarthritis sites. So by the time the conference is around, we will have launched them and be available and working with some other researchers to make a shoulder side. So think of all the big musculoskeletal conditions with variables. And we've also been developing platforms, consumer patients as well. And so we have one which a PhD student in new idea, Olivia or Silva has been working with me for the last two years and we did a super little trial looking to see how beneficial that might be by itself. And then in conjunction with physiotherapy intervention. And certainly the website by itself is incredibly helpful for improving patient's knowledge and self management strategies, their confidence in doing things. Christian Barton:           12:17                And it seems to lead to reasonable clinical outcomes as well by itself, but probably better outcomes if we combine it with physio. And we haven't done what to evaluation yet, but we're hoping that we can start to do that more and more as we go along. And most importantly, just have some quality resources that are free. You don't have to pay for it, just there, you can use them. And it's been nice to see the exercise site. And certainly the one with the value at the moment. There's plans to do this as well, but they've been embedded into teaching curriculum as well, which has been really good. So University here at La Trobe is using them, but other universities around the world have also used bits and pieces of content and that's the idea of it is to write and use it all way pointless multiple people around the world creating the same content when we could work, maybe be better together. Karen Litzy:                   13:06                No, that makes a lot of sense. And now you're sort of like you said in the beginning, sort of doing a little bit of both your research and clinician. So why are we, in your opinion, why is it so important to bridge that gap between research and clinical practice? Christian Barton:           13:23                Yeah, I think from, if I put not my research hat that my clinician hat on and I think about our physiotherapy profession, I think we have some amazing physios around. We do really, really good job. We have others who are very good physios that are working really hard to continue to improve knowledge. We have a lot of practice that I would also consider as pretty low value care and sometimes iatrogenic care where actually maybe delivering health education and information is actually detrimental to the patient. And so I think collectively we need to work really hard to establish our brand better and better because we can do better. And a big part of that is actually making sure that what we do know to be beneficial for patients all around the world is actually disseminated into the hands of people who can use it. And that's a big part of that is physios and other health professionals. So that's the big passion for trying to change it. And I see in my clinic second and third opinions and sometimes it's just the patient hasn't been motivated, haven't done the things that I need to do that have actually been given really good guidance. But equally we see cases where they've seen multiple health professionals and just the treatments and information being given is just not aligned with what we know of contemporary knowledge around evidence about what should help that person Karen Litzy:                   14:36                As physio therapists, what do you think we're doing really well and were doing right and what do you think we need a little bit of hopefully they’re not doing wrong. But what they just need a little boost. Christian Barton:           14:57                Yeah, it's a good good question. I think in the most part physio practice and physical therapy practice is moving towards more active management and there's lots of debates on Twitter and social media and people argue about the value or lack of value, whichever side to sit on about manual therapy and things like that. But I think overall we are moving to more active management approaches. We are moving more towards managing the pain science side of things and educating patients better about that. And I think that's probably what we're not doing very well is building that brand of what we deliver. And as a couple of hours to that one is I guess getting collective way across the board that we're all on the same page and delivering similar high value interventions. And what that means is some patients will go to see for therapists or physiotherapists, then they maybe get delivered a lot of electrotherapy or something else and they don't get better in a long time. And then they go back to their doctor or their surgeon and say, oh, I did PT, I did physio. It didn't help. Karen Litzy:                   15:54                Yeah, yeah. Failed PT. Christian Barton:           15:57                It failed. And I think that's something that drives me a little crazy is you don’t fail that profession, you fail an intervention. It's a lot of inappropriate surgeries and other treatments. I think collectively we need to be more on the same page, but that's something the knowledge translation probably helps with a lot. The other part that I think we do very, very poorly and actually worked with Rob Brightly, he's going to be presenting the conference and that is collecting outcome measures. So we don't actually measure what we do very well. We occasionally measured them and this is the same around the world for compensable patients because we're forced to. But if you were to audit most people's clinical practice and say, can you show me that what you do is truly valuable, it's worth something. Christian Barton:           16:48                Most physio practices won't be able to. And I reflect on myself and I can't do this very well. So we need to get better at measuring the value of what we do. So we can take that information to funders and say, hey, we are actually worth something in what we do is worth something. And so I think that's a cultural thing and it's a systems thing and I think it's something we collectively maybe need to work pretty hard to, to try and change. And certainly locally I'm trying to work with the Australian physio association here and it started to come up with some processes that you can, we might do that and knowledge translation. One of the projects I've enjoyed the most here in Australia is a program called GLA:D. I'm going to talk to Ewa recently and that will be certainly discussed at the conference in the biggest strengths of GLA:D isn't it aligns with clinical practice guidelines. Christian Barton:           17:34                That's education and exercise. So I'll bring that standard up across the board. So first to trust that when they send someone to the program they will get exercise with education and it also raises the outcomes related to that as well. So it can turn around and we have some great data in Australia which were yet to publish, but it certainly shows from now data that not only does pain improve, which is something that may or may not be the most often, but also changes things like medication and also changes things like surgical intention. So people may believe I need surgery or going down the line to surgery. Am I saying certainly in Australia that less people are desiring that. But we look at that in GLA:D that's great here. But the rest of  physio practice so you have nothing to contemplate. Suddenly we need to work. You don't run out. Karen Litzy:                   18:19                Yeah. And I know the APTA here in the United States does have an outcomes registry that they started I think maybe a couple of years ago, maybe two years ago is starting to collect that data so that we can take it at least here in the US to insurance companies to show that what we do is valuable and that what we do should be reimbursed. Christian Barton:           18:42                Do people contribute to it, do the people actually give data? Karen Litzy:                   18:51                I don't know the answer to that question cause it is voluntary. So I don't know the answer to that question at the moment. But I would assume some people do, but do the 300,000 physical therapists that work in the United States? No, but hopefully it's something that will grow over maybe the next, I mean it's slow. Right? So it may take like a decade plus to kind of, if we're being realistic. Right? If someone were to audit my books so to speak, I dunno. I can certainly show that. I don't know. I don't know. That's something I need to get better at, so I'm calling myself out, I guess. And it's something that I certainly need to do better at myself. Karen Litzy:                   19:52                So let's talk about your experience as a researcher. So we'll move from kind of the clinical dissemination to do you have any tips for, let's say, new and upcoming researchers or even physio therapy students who maybe want to go into the research track to kind of help maximize their potential for reach and for knowledge dissemination? So, you are the researcher, you're doing great work and then what? It doesn't get to where it needs to go. So what tips would you give to people to help with that dissemination? Christian Barton:           20:37                Yeah, sure. So we put together a paper, which was just recently published in BJSM, trying to remember the exact title, but it's time. I think it's something along the lines of it's time for a place, publish or perish. We've got vanished. Yeah. So we have this in research that if you don't publish your work, then obviously there's no record of you doing it. But also you can't give credibility to your work in peer review processes. Very important to doing that. When we go for job promotions and we got the scholarship, for example, to do a PhD or whatever it might be, they're a competitive process and people look at metrics and one of the key metrics is really simple is how many papers have you published? What journals are they publishing? So it's really hard to get away from that. But ultimately, as we've discussed, that doesn't put the knowledge into the end users hands. Christian Barton:           21:23                And what happens is we end up with commercial companies selling pharmaceuticals and nutraceuticals and surgical interventions. That can be, I guess maximize money. And even pay teams event and for that matter. And so therefore the researchers, good knowledge doesn't get there. And maybe in health information that if news information gets cut through to clinicians and to patients, so you simply have to allocate some time to do it and you have to be quite aware and understanding that that might mean that you take a little bit of a heat on your academic gap or from a publication perspective because when they have so much time in the day. So that's a thing. It's just having that expectation that you can't do it all. That's really important. Spending some time on it. But in saying that it's not a ton of extra time to, after you publish a great RCT that was part of a PhD or whatever it might be, to spend some time with your media team at the university, put out a press release about that RCT and what the implications might be, which there may be ways from a radio interview or getting picked up in papers. Christian Barton:           22:27                And so that's not a lot of extra work on top of maybe two or three years of the study even. Right. I think linking in with me, your teams at different universities is a really good starting point if you can. Then we have the social media world, and the social media world as a challenging one because there's a lot of strong and loud voices on there. Some of them are good, strong amount, Sometimes there's misinformation from those strong loud voices. And so you're going into competition for the microphone essentially on social media to do that. And you can get on and you can have debates and arguments and discussions and conversations about your research that you've done. But ultimately the people who disseminating, interpret that are the ones with the loudest voice and that's kind of, you can lose your information, which is a bit of a frustrating thing. Christian Barton:           23:12                So yeah, so people get very frustrated about that when they've spent two or three years doing some research and then it gets misinterpreted by someone on social media who's got the microphone. So there's a few options around that. I think one of them is either creating a skill yourself or working with someone who has the skills to create knowledge translation resources. So we know from research that we've done and certainly evaluation of this is that the general consumer and that consumer can be the coalition or it can be the patient won't engage with your article, but they are likely to engage with your article but they are likely to engage with an infographic or an animation video. And so spending some time and effort on creating those types of resources to summarize your research findings is probably time and money well spent. So I'd strongly encourage people to price some emphasis on that. Christian Barton:           24:04                And then you've got an asset on social media, and if you already have a big following on social media, you have to be the one that shares that asset because you've created the asset. So you've controlled the narrative of what goes into that asset and the key messages. You can then leverage the people. We do have a market friend and hopefully they can then share for you, et Cetera. We help with so you can spend your time arguing with the people, misinterpreting your work on Twitter or you can spend your time maybe creating some of resources. And I guess the concept of trek is to try and create resources with those types of things can be embedded into a web page. So if you've done research on my back pain and it's game changing research, then those knowledge translation resources can be put onto a platform on trek. Karen Litzy:                   24:50                Yeah. Great Advice. Anything else? So we've got getting to know the media team at your university to release a press release, which is huge because that can lead to other opportunities. And knowing how to either get your original research onto an infographic or an info video or a podcast, and then use that as your vehicle via social media, attaching that to some social media influencers, if you will in order to kind of get that out there. But I definitely think that's much better advice than banging your head against the wall and arguing with loud voices. Christian Barton:           25:34                Yeah, exactly. Probably the other advice, if you go back a step in terms of designing search, it's probably really important and this hasn't been done well, but you engage the end user from the beginning. So going back a step and when you're designing your clinical trial, no good designing an intervention that no patient is going to engage or to use. So you might design an exercise program that you think is amazing and it's fantastic, but actually when the patients in the trial do it because they in a clinical trial, but then you go into the real world, It's too challenging for them to do. It's just too difficult. And therefore you're going to get criticized for your intervention that isn't clinically applicable. You want to cop that criticism in that design phase and people say, this is not clinically applicable. This won't work. Because then you've got time to redevelop on it and evaluating it and then realizing it won't cut through. So that's, yeah, I will probably important thing to think about. So when we talk about engaging the end user, particularly patients as the end user, but also clinicians as well, and getting their input because they're all going to be the ones delivering yet. And just to some extent, funders, they're a little harder to talk to. Karen Litzy:                   26:45                Yeah. Yeah. A little bit easier to get in with the patients or your fellow colleagues, hopefully. And now earlier you had mentioned that you have done research into topics such as patellofemoral pain. We also know that you do research in running injuries, obviously knowledge translation. So let's talk about kind of some common misconceptions around, we'll take running injury prevention and management, right. Cause these misconceptions come about because of poor dissemination of information I think is one aspect of it. So what would you say are some common misconceptions around running and injury prevention? Christian Barton:           27:32                Yeah. So we can go into lots of areas here. Karen Litzy:                   27:35                No, it’s a lot of branches. Christian Barton:           27:37                Yeah. So let's stick to running because it's a popular thing again. Everyone likes to manage runners and treat runners and not a lot of people like to run themselves. We actually put an infographic series out on our trek website. So James Alexander who is a master student environment moment putting together a series and we have the graphics and there's a few key ones for running injury prevention. One being stretching helps. And so that's something that has long been ingrained in people's beliefs that why you’re getting injured is that you haven’t stretched enough then stretching doesn't actually help us prevent injury. So it's not that it's a bad thing necessarily, although there is some evidence that stretching might impair muscle function, might actually reduce your ability to have muscle function but certainly it doesn't prevent injury. Christian Barton:           28:31                So focusing on that as the problem is probably not the answer. Footwear often gets blamed for injuries, prevention and also as though the key focus. Now typically most of the times if you changed before where yes, it could definitely cause the injury drastic change, but a lot of times it's not the fault of a footwear. Someone buys a new pair of shoes, but they also decide they want to get fit and lose weight at the same time. And they go out and they overload and they train too much. Karen Litzy:                   29:01                Yeah. So those things kind of do overlap cause you get motivated, you go out and buy the new shoes and then you blame the shoes and not so much the amount of load that you just put through your body that you haven't put through your body in months or years. Christian Barton:           29:14                Exactly. This is not the shoes that are important because they will moderate where the loads go can to some extent. But I think we get very obsessed and part of that comes back to who controls information that gets out there. And it's shoe  companies, right? They sell shoes. There's all these motion control technology that shock absorption technologies. And so that's a big marketing campaign and that changes what people buy. And what I will say, it's a big problem. People have that answer. And then we have big pushes about minimalist shoes and they're the answer to everything. And in reality it's probably going to be very variable across different people in it. People with running shoes, all their life will be taken into women's shoe. That's a big change. So that will probably injure them. So yeah, might help. They need, they might get some acuities buying. Christian Barton:           29:59                It might help their heel pain or forefoot stress fracture. So again, just that big emphasis on footwear and often because it's a commercial and marketable thing is offering the way what happens? I always love the example of Australia by a guy called cliff young. So some people are watching may know him, but those who don't, he actually run the first ever Sydney to Melbourne ultra marathon. So that's 800 kilometers or so. And one of our quite a few hours now, cause John did most of his training in numbers. He used to run two or three hours on his farm every day chasing sheep in Gum boots. So Wellington boots, clearly he didn't have any significant injuries. Right. And I have some great footage that I take when I teach my running course. That's some great footage of me doing that. And that's not to say everyone should go out and run in gumboots. Christian Barton:           30:46                But certainly for him he was doing it his whole life. So he's adapted to doing that. And if you're adapted to doing something, don’t change it, right? Maybe maybe you might modify footwear to reduce the weight because that we know that helps with performance, but beyond that we don't really have a lot of good evidence that changes footwear will help with injury or performance or anything like that. So my philosophy mostly before where it ain't broke, don't fix it. But there are some nuances around some biomechanical considerations depending on what you want to try and change. But that's probably a couple of the key points of stretching and in footwear and the importance we place on them. I think it's probably more important to get our training loads right. And probably also thinking about, and these are my biases and there's not strong science on this, but doing a resistance training program might be more beneficial for preventing injury. We could do more loading with our muscles and tissues without that impact. And so that's possibly beneficial. And we do see some evidence that may be doing a resistance training program helps with performance as well. And most people get down because they're trying to run personal best times or beat their friends or whatever it might be. So rather than smashing yourself more and more on the training track, maybe get in the gym and do some resistance training would be my advice. Karen Litzy:                   31:57                Great. All right. Now, we're gonna shift gears just a little bit here. So the next question is what is or are the most common question or questions, I'll put an s on there that you get asked. And this could be by researchers, clinicians, patients, maybe you've got one for each. I don't know. What are the most common questions you get asked? Christian Barton:           32:28                Yeah, so I'll start with researchers. So academics, you sort of touched on this a little bit before, but it's often around how to dedicate time and make knowledge translation, but not just that. So creating the resources we've talked about before, but how to navigate media or platforms like Twitter, like you get on Twitter and someone's attacking your research and let me see, interpret it. Or you get on Twitter and you put something out there and someone gets offended and that's a problem as well. And so it's actually, it's very difficult on social media because when you're typing things and writing things in, emotion gets taken out of things and people interpret emotions. So you might write something that has really no emotion attached to it, just a simple statement, right? But someone who thinks that you might be attacking them, we'll take that as an attack and then that creates a problem. Christian Barton:           33:19                All the time. And I know that I offend people at times because they tell me that I've offended them and that's what I really appreciate it at least it gives me a chance to reassure and go look. It's not meant to be offensive when used social media is a positive way of translating knowledge and then other people probably get offended and just don't talk to me anymore. Yeah, I think I've been blocked a couple of times. Christian Barton:           33:51                So my advice usually to people about Twitter is I think it's immediate that you can get a really good understanding about how part of the world is thinking. It's only a small part of the world. And then I think it's important to understand that that's the case. You're only getting a snapshot of some people and often it's people who have louder voices and want to go on talking, but it does give you some insight into that. And I think for me that frame some of my research questions and maybe modify as and move it and helps me narrow it down. It gives me a media where I can use assets that we've created to put them in hands of people who will disseminate them. So I think that's really, so sharing a good infographic or podcasts or video on that platform is one of the influential people there who hopefully then share your message. So I think it's important to have some presence there for that reason, but don't get emotional about it. If you feel like you're engaging in a circular conversation, you probably are engaging in circular conversation. You just stop, don’t keep going. Karen Litzy:                   34:48                Pull yourself out of it. Like I think often times what I see in those circular conversations is like somebody, it just seems like one of the parties within that conversation wants to win more than the other one. Or are they both really, really want to win. And so it's just like, I'm going to get the last word. No, you're going to know I am. No, I am. It goes back and forth and you just like, Christian Barton:           35:14                My advice in those situations, for someone who feels like they're in a circle of conversation, they're beating your head against the brick wall. Just step back for a little bit and just think why is this happening? Why is what I believe or what I think not being interpreted the same way. Right. And it might be that actually you discover your own biases and it might be that. And that's a good reflective thing. It's ok to change you mind and beliefs. That's a good thing. That's a positive thing. Or it might be that actually you don't have as much supporting evidence for what you believe in. And maybe that's because you need to do some better quality research to test your biases and maybe you discovered that actually you were wrong, or maybe you test your biases properly and you discover I was on the right track, so that's good. Yeah. You usually have to prove myself wrong more than I proved myself. Right. That's a good thing. Yeah. Or actually worse what's happening, it comes back to that communications is you're not disseminating your messages very well. So you're actually not providing an adequate messenger. You can sit back and think about that and don’t keep argue with that person. You think about some strategies to disseminate and put together a podcast or a video, or write a blog about the topic that has really good details where you've got more than a couple of hundred characters. Karen Litzy:                   36:30                Yeah, that is really useful. So, and sometimes in these kind of conversations, if you will, sometimes you can also just take the person and send them a direct message where you can write a novel if you want to do as a direct message. And I find that when you do that and you kind of can explain yourself a little bit better, it helps to kind of foster better communication and a better conversation. And oftentimes when it's in private, people are different. Christian Barton:           37:07                Yeah, that's great. And, taking the conversation off the social media platform is often a really good strategy too. Navigate and get over those miscommunications that can happen. Yeah. Karen Litzy:                   37:17                Yeah, I've done that before. Christian Barton:           37:20                That's really spread enemies. Right. And then probably the other advice I'll give to people when I've actually put a tweet about this I think earlier this year or late last year. It's just, I'll refer to them as trolls and I'll call them trolls in until they show their face. People who are on there who don't have a public face. So it's social media. So for me you should have the transparent profile and the reasons for that is you want to know where people come from and where their beliefs come from so you can understand their point of view. And if you can understand that point of view, it makes it a little bit easier to have discussions with. But there's probably people on Twitter who just set up their identify profiles just to kind of attack and stir the pot and it's just not worth engaging with those people's I used to try and have their fun with them and make a few jokes and I've done that a few times. If you'd be probably saying that like, so that's also a time wasting. So it's kind of entertaining, but it's also time wasting as well. So I think when you identify, communicates, asking you persistent questions and almost feels like you're having circular conversations just block that person. There's no, you don't know what their alterior motive is. You don't know what their conflicts of interest are. You don't know where they're coming from. Karen Litzy:                   38:28                Well, you don't even know who they are. Christian Barton:           38:31                Exactly. And so I don't think we should engage with those people. That's my first way. Most people won't like hearing that and they just keep creating new profiles. Right. Well that's okay. I never used to block anyone until six months ago, are quite a few people in racing time for that very reason. In short, if you get it, get into social media and you kind of, so you can learn from it and focus more on giving some quality content and having meaningful discussions rather than arguing. Yeah. Karen Litzy:                   39:01                Yeah. That's sort the idea of social media, especially when you're a professional, you want to be a professional because you're a professional and so, and the point of social media is to be social. Christian Barton:           39:20                Yep. I like that. Karen Litzy:                   39:21                You know, it's not to go on there and be antisocial and argumentative. You're there to be socially it's fine to debate. It's fine to disagree. But some of the things that people hear this all the time that you see on social media, you would never see that kind of an argument with people face to face. It just wouldn't happen. You know? So you have to remember to keep this social in the social media and not be like a maniac. Christian Barton:           39:52                I like that phrase. Keep the social in social media. Karen Litzy:                   39:54                Yeah. So if you could recommend one must read book or article, what would it be? Christian Barton:           40:02                Yeah, so I mentioned earlier about with the trek origins and the concept around that. So switch is probably my book. I think it's influenced my life the most from many respects. I think I gave a really brief, probably poor synopsis of it. It is the elephant, the rider and getting to the destination. But it just changes the way you think. And when you're trying to make a change, it gives you nice, simple way for you where your barriers are. So is it people don't know what they need to do? Is it about the emotion and motivation? There's lots of great analogies that examples within that that I think will kind of really inspire you to think about the rest of your work. Not just research it, it's not just clinical practice but how to change relationships with different people and things like that. So I think it's a really good book to read. I'll give you a second one as well. John Rockwood. Yeah, no, he's translation and dissemination is a book called made to stick and that's basically made to stick. So it's around how to make your messages stick. So that's a really nice book as well. So if you're trying to communicate more clearly, that will hopefully give you plenty of ideas and concepts to look out for. That'd be my to go or recommendations. Karen Litzy:                   41:12                Perfect. All right, now let's get to the conference. It is October 4th and fifth in Vancouver of this year, October 4th and fifth of this year. And can you give us a little bit of a sneak peek about what you'll be speaking about at the Third World Congress? Christian Barton:           41:32                Yeah, sure. So we've got a couple of presentations. One is actually in the session review, which I'm really looking forward to discussing with yourself and all around knowledge translation. And one of the things I want to talk about in that is how healthcare disinformation develops and spreads? Cause I think it's important we understand the mechanisms of that. And that also allows us an opportunity to understand how we can spread good information because we understand how, how can this disinformation grows and spreads. And hopefully that gives us some insight into how we can grow and spread the good quality information. And so we'll go through some of that and break down some of the things we've talked about around using I guess digital assets for knowledge translation in. One of the things I've actually really looking forward to talking a little bit more about is some of the outcomes from the research we've been doing, particularly around patients and finding them and what we can achieve through a good quality website. Christian Barton:           42:23                So we have a review at the moment, which is under peer review looking at patellofemoral literature and it doesn't just do a systematic review of patient education. It also looks at online information sources. Basically when we look at all of those is the vast majority of conflicts of interest, often financial conflicts of interest. There's a lot of missing information on there. And so for the person navigating that, that's really challenging for them. And we've done a lot of qualitative work with people with the patellofemoral pain. And then part of the new ways work I talked about before, we actually did reasonably if we needed to clinical trial where for a period of that trial all they had was a website that we developed for them. And we put multimedia and engaging resources with quality information and accurate information, simple exercise program that they could do. Christian Barton:           43:12                And so we're still pouring through the results and we'll have it done before the conference and I can see from the preliminary stuff was actually do really well by themselves with quality information. And certainly that then makes your life easier as a physio cause you don't have to fill in as many gaps. I can focus on adequate exercise prescription or clarifying some information and things like that. So it makes us more efficient. So yeah, really looking forward to talking about that in our session. And then the second session I'll be talking on is around exercise prescription and I think the title is beyond three sets of 10. And so I mentioned at the beginning my research started in the biomechanics lab and I used to think biomechanics, were the be all end all and I've probably changed my opinion on that over the years and very subtly, very slowly and I still think biomechanics matter, and exercise prescription around that can be important, but equally education alongside your exercise prescription to address things like Kinesiophobia and pain related fear or something that we find is a really important factor in managing people’s pain. Christian Barton:           44:19                So yeah, a huge barrier to actually getting engagement, but even getting, they might do exercise but they won't get as much out of it if you haven't tackled those fears and beliefs. We'll talk some of the research we've done in that space recently around how that can guide exercise prescription and some processes around that. And then I've had some fun almost on the other end of the spectrum where we've actually just got people in the gym and focus more on physiological responses and we just smashed it in with strength and power. And one in physical therapy in sport, which is just a feasibility study. Probably 10 people, people who we just put through a resistance training program of strength and power and the reason we did this study is when you look at all the patellofemoral literature, no one has done a program of adequate intensity of progression and duration. Christian Barton:           45:10                You would actually see any meaningful changes in strength and power despite the fact that a lot of them say that they do strength from your title when you actually look at their protocols are not true strength protocols. So we decided to just put great people through this program and just smashed them in to do. And they did better than I thought they would do. I was actually surprised. And so we'll talk about some of the findings and implications of that and how to put that into your clinical practice. And I think the whole idea for me is we have these programs that physios focus on around motor control and they often low dose exercise. Don't know what the education part alongside that done very well around pain, weighted fear and even exercises to tackle that. And simple great exposure. But equally we don't get the end stage stuff done very well. Actual really good progressive resistance training. Yeah. I think we get the middle part done well, but we kind of miss those two elements that's trying to bring all that together. So I'm looking forward to that where it’s not just three sets of 10 of hip abduction and knee extensions. Karen Litzy:                   46:11                Yeah, no, that sounds great. And, and I know that anyway, they'll probably be a lively discussion around that topic. I know here in the US, if people are using their insurance, they're often cut off before we would ever even remotely get that. Let's get you in the gym and really do it, you know, let's really kind of work and like you said, like smash it out, get them stronger, get them confidence and, and it's unfortunate, but that's the system that we have to play in and yeah. Christian Barton:           46:44                Well, we can put a link up to the paper on the Facebook group. It’s actually open access at the moment? It's appendix of all the exercises. I think they're really simple exercises which was kind of cool about. So we just, we really just pushed it straight away and we only went for 12 weeks. And that was purely from a feasibility perspective of yeah, it just costs money to do these projects over a long period of time. Yeah. But my bargain is that if we kept going and with the clinical hat on, they continue to improve, at least in terms of function. A whole different kettle of fish, but they can do more exercises, more progressive. We make it, the more they can do and wherever their pain usually reduces. But wherever it gets to the point where they're happy or not, at the conference we'll talk about that. Karen Litzy:                   47:29                Yeah. Sounds great. I look forward to it. And are there any presentations at the conference that you're particularly looking forward to? Christian Barton:           47:38                Yeah. So I think, and not just because I'm talking to you now, but looking forward to our presentation, not just from me talking but also hearing from yourself and rod and I, I think one of the things I've appreciated about knowledge translation and using social media experts, there's no person in the world that knows everything you guys had it through. Then over the years I've actually learned quite a bit from yourself with the podcasts and stuff you do and really enjoy some of yours. And I think I like the process and approach you've taken and I think you've been quite inspirational about how you can actually find a model where you can spend time doing it, which is really cool. I'm so looking forward to hearing more about that and maybe you have some good tips for me, but also Rob Whitely presenting in the same session. Christian Barton:           48:22                I really like the way rob thinks, he thinks very differently to most people. He's got my favorite Twitter profile picture that I've seen so enough. Those are not from Australia where I quite understand it, but there's a picture of a kid with his head down looking asleep. We've got ex Prime Minister Tony Abbott talking at the same time. So it's quite a funny picture. But he's, yeah, he's a bit eccentric, but also very clever for instance. The whole conference is really good with lots of, I think clinically focused presentations because everyone presenting going through it has a really strong clinical focus here in what they do. I think that's a real strength of it. The Saturday morning there'll be a couple of really good workshops I was looking at it yesterday and trying to work out knowing that you would ask this question where I want to go. Christian Barton:           49:13                And you've got that and it's allowing presentation with Ewa Roos, Christine, both of which have a huge respect for and I’ve learned a ton about exercise. And so I'm looking to that and saying what other things I could learn from my clinical practice. But at the same time, talk to you about upper limb, the same stuff. Now I see a few cases in shoulders. I don't see as many as Rollin, so it'd be great to learn some things from them, but also I liked to take knowledge from other areas and see how I can apply that to lower limb in my research and yeah. One interesting to do that, but I reckon I'm going to have an apology to those guys for saying that I won’t be able to make both. I'll have to make sure I send someone along. Karen Litzy:                   49:55                It’s going to be hard to choose, but you know, you'd take someone over, you have to divide and conquer. Exactly. You know, can you send someone with that? Yep. Need a team. Yeah, yeah, yeah. Over a beer or wine Karen Litzy:                   50:32                No, for me, like a small little glass of beer. That's right. Yeah. Thanks. Yeah, that's true. That's true. And you know, look at sports congress. This past year I did not have the flu. So drinking those like small little ones kept me awake. Christian Barton:           50:49                Good, good, good. Karen Litzy:                   50:51                I found like this sweet spot. Well Christian, thanks so much for coming on and giving your time. Thanks everyone for coming on and listening. And Christian, where can people get in touch with you? Where can they find you? They have questions or they want to give you some unsolicited feedback or arguing. Christian Barton:           51:26                Very happy, very happy with any feedback or questions. Probably easiest way to engage is probably on Twitter. So do you use Twitter a little bit for that? We also have a Facebook group for the trek exercise group. So if you look that up, I might put a link to that as well. So it's trek exercise group. And so that's not a bad medium to kind of start to engage with the trek initiative. And we'll actually use that to launch the back pain and also arthritis websites and I can put some links on there to the top from a website which we set up. And actually the other thing on that note, and I might put this on the Facebook page here as we have a course for anyone who's interested, it's a free online course learning how to critique randomized controlled trials. Christian Barton:           52:14                So basically it takes you through some modules about how you go back to taking them. Before that we kind of get your knowledge and confidence on your capacity to do that. Do the course and then you could take a few articles and then at the end of it there's a followup test to see how you go. There are actually some prizes as well. So at this point in time we've had I think over a hundred people sign up to this. But only around about 20 finished. Yeah, there are two $500 prize as far as with Australian dollar prize. So at the moment those 20 people will have finished it or, and we've a one in 10 chance we'd pop your dollars. Say I would suggest that you jump on board and have it for learning, but chances to win a prize Karen Litzy:                   52:51                This is 500 Australian dollars or US dollars. Christian Barton:           52:56                It’s about $350 US. So it's not as lucrative. It's not a small amount. So this is actually part of the, the trek project in collaboration at the University of Melbourne who established this. And so that's the sort of stuff that we're trying to do with trek is to put these types of resources out there and Yep. So hopefully we can get a few people on board back. Karen Litzy:                   53:21                Yeah. So you will try and put all the links. I'll find the links to books and everything that you had mentioned. Switch and make a stick and trek and we'll put them all in the comments here under this video. So that way people can click to them, and join the trek group and figure out how to get in touch with if you have any questions. So everyone, thanks for listening, Christian. Thank you so much. This was great, and I look forward to seeing you in Vancouver.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Jason Eure chats with Dr. Jill Cook, international tendinopathy researcher,  on current trends in the development of tendinopathy including unloading effects on tendons, interfascicular sliding, teaching tendinopathy concepts, strength training as a preventative measure for tendinopathy, inflammation/vascular clarification in tendons, tendon structure and effects on pain/outcomes, tendon adaptations, systemic and non-mechanical effects on tendinopathy, genetic factors in tendinopathy, and more.   Other Resources Tendinopathy Rehab Talking Tendons Podcast   Jill Cook  Email Address: J.Cook@latrobe.edu.au  Twitter: @ProfJillCook   Jason Eure Facebook: Jason Eure Twitter: @jmeure Instagram: @jmeure Email: eure1088@gmail.com     Evidence Referenced 1) https://www.ncbi.nlm.nih.gov/pubmed/29253326 2) https://www.ncbi.nlm.nih.gov/pubmed/29961208 3) https://www.ncbi.nlm.nih.gov/pubmed/28972291 4) https://www.ncbi.nlm.nih.gov/pubmed/23401563 5) https://www.ncbi.nlm.nih.gov/pubmed/29570396 6) https://www.ncbi.nlm.nih.gov/pubmed/30067515 7) https://www.ncbi.nlm.nih.gov/pubmed/30098975 8) https://www.ncbi.nlm.nih.gov/pubmed/29649012 9) https://www.ncbi.nlm.nih.gov/pubmed/29856261 10) https://www.ncbi.nlm.nih.gov/pubmed/28619548 11) https://bmjopensem.bmj.com/content/4/1/e000332 12) https://bjsm.bmj.com/content/50/19/1187 13) https://www.ncbi.nlm.nih.gov/pubmed/29928054 14) https://www.ncbi.nlm.nih.gov/pubmed/29527173 15) https://www.ncbi.nlm.nih.gov/pubmed/29373799 16) https://www.ncbi.nlm.nih.gov/pubmed/29974171 17) https://www.ncbi.nlm.nih.gov/pubmed/25979840 18) https://www.ncbi.nlm.nih.gov/pubmed/27852585 19) https://bjsm.bmj.com/content/52/5/284     Biographies:   Dr. Jill Cook is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill's research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas   Dr. Jason Eure is a physical therapist practicing out of Vienna, Virginia with PT Solutions. He got his Bachelor's Degree in Human Nutrition and Exercise from Virginia Tech University in 2011. He graduated from the University of St. Augustine in 2013 where he earned his DPT and was awarded the Stanley Paris and Catherine Patla Award for Excellence in Manual Therapy. He also worked as a volunteer assistant strength & conditioning coach at both the University of Richmond and Virginia Tech University. Jason's  Interview  with Karen Litzy on The Healthy Wealthy and Smart podcast on Intraprofessional Communication  Jason's Interview on the Clinical Athlete Podcast on Tendinopthy    The PT Hustle Website Schedule an Appointment with Kyle Rice HET LITE Tool Anywhere Healthcare (code: HET)

Jason Eure chats with Dr. Jill Cook, international tendinopathy researcher,  on current trends in the development of tendinopathy including unloading effects on tendons, interfascicular sliding, teaching tendinopathy concepts, strength training as a preventative measure for tendinopathy, inflammation/vascular clarification in tendons, tendon structure and effects on pain/outcomes, tendon adaptations, systemic and non-mechanical effects on tendinopathy, genetic factors in tendinopathy, and more.   Other Resources Tendinopathy Rehab Talking Tendons Podcast   Jill Cook  Email Address: J.Cook@latrobe.edu.au  Twitter: @ProfJillCook   Jason Eure Facebook: Jason Eure Twitter: @jmeure Instagram: @jmeure Email: eure1088@gmail.com     Evidence Referenced 1) https://www.ncbi.nlm.nih.gov/pubmed/29253326 2) https://www.ncbi.nlm.nih.gov/pubmed/29961208 3) https://www.ncbi.nlm.nih.gov/pubmed/28972291 4) https://www.ncbi.nlm.nih.gov/pubmed/23401563 5) https://www.ncbi.nlm.nih.gov/pubmed/29570396 6) https://www.ncbi.nlm.nih.gov/pubmed/30067515 7) https://www.ncbi.nlm.nih.gov/pubmed/30098975 8) https://www.ncbi.nlm.nih.gov/pubmed/29649012 9) https://www.ncbi.nlm.nih.gov/pubmed/29856261 10) https://www.ncbi.nlm.nih.gov/pubmed/28619548 11) https://bmjopensem.bmj.com/content/4/1/e000332 12) https://bjsm.bmj.com/content/50/19/1187 13) https://www.ncbi.nlm.nih.gov/pubmed/29928054 14) https://www.ncbi.nlm.nih.gov/pubmed/29527173 15) https://www.ncbi.nlm.nih.gov/pubmed/29373799 16) https://www.ncbi.nlm.nih.gov/pubmed/29974171 17) https://www.ncbi.nlm.nih.gov/pubmed/25979840 18) https://www.ncbi.nlm.nih.gov/pubmed/27852585 19) https://bjsm.bmj.com/content/52/5/284     Biographies:   Dr. Jill Cook is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill's research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas   Dr. Jason Eure is a physical therapist practicing out of Vienna, Virginia with PT Solutions. He got his Bachelor's Degree in Human Nutrition and Exercise from Virginia Tech University in 2011. He graduated from the University of St. Augustine in 2013 where he earned his DPT and was awarded the Stanley Paris and Catherine Patla Award for Excellence in Manual Therapy. He also worked as a volunteer assistant strength & conditioning coach at both the University of Richmond and Virginia Tech University. Jason's  Interview  with Karen Litzy on The Healthy Wealthy and Smart podcast on Intraprofessional Communication  Jason's Interview on the Clinical Athlete Podcast on Tendinopthy    The PT Hustle Website Schedule an Appointment with Kyle Rice HET LITE Tool Anywhere Healthcare (code: HET)

Drs. Eric Wisotzky and Laura Malmut interview Dr. Benjamin Mentiplay, a Lecturer in Sports and Exercise Science and a Research Fellow within the La Trobe Sport and Exercise Medicine Research Centre in Melbourne, Victoria, Australia. They discuss his recent study, Gait Velocity and Joint Power Generation After Stroke: Contribution of Strength and Balance, which was published in the American Journal of Physical Medicine & Rehabilitation. The objective of this study was to assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke. Dr. Mentiplay and fellow researchers found that ankle plantarflexor and hip flexor strength had the largest contribution to gait velocity.

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Mick Hughes and Randall Cooper on the show to discuss the Melbourne ACL Rehabilitation Guide 2.0. Mick is an experienced Physiotherapist & Exercise Physiologist who consults at The Melbourne Sports Medicine Centre. Mick has expertise in ACL injury management and ACL injury prevention and has previously worked for elite sporting teams such as the Collingwood Magpies Netball team, Newcastle Jets U20s Soccer team and NQ Cowboys U20s Rugby League team. Randall is an experienced Sports Physiotherapist, Founder and CEO of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, and Fellow of the Australian College of Physiotherapists. In this episode, we discuss: -The six phases of the ACL Rehabilitation Guide -Why pre-habilitation objective measures are better comparisons to reconstruction outcomes -How to assess return to sport after ACL surgery -The importance of mental readiness for return to play -Strength and conditioning for injury prevention throughout the athlete’s career -And so much more!   “Every ACL rehabilitation protocol needs to be individualized and clinicians need to take a clinical reasoning approach. It’s athlete specific. It’s sports specific.”   “If you can combine a good story that resonates with the athlete or patient with the statistics and research that’s out there, you can usually paint a powerful message.”   “We shouldn’t be doing protocols.”   “Every ACL reconstruction patient shouldn’t be painted with the same brush.”   “An injury prevention program is really important.”   “Time is a poor indicator for future success.”   “The whole rehab process needs to be criteria driven.”   For more information on Randall: Randall is an experienced Sports Physiotherapist, Founder and CEO of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, and Fellow of the Australian College of Physiotherapists. As a Sports Physiotherapist Randall has worked with some of Australia's most notable sporting organisations including the Hawthorn Football Club, the Australian Winter Olympic Team, and the Victorian Institute of Sport. He consults from the internationally renowned Olympic Park Sports Medicine Centre in Melbourne. Randall has also attained the title of Specialist Sports Physiotherapist as awarded by the Australian College of Physiotherapists in 2008. Randall is the Founder and CEO of Premax. Premax in an Australian company that manufactures a range of sports skincare and massage creams. Premax is available in Australia, Asia, UK and Europe, and will be launched in North America in 2019. As an Adjunct Lecturer for the La Trobe Sport and Exercise Medicine Research Centre, Randall advocates sport and exercise medicine, physical activity, health and well-being for all. He provides support to the Centre, activity assisting in translating research findings to key stake holders including the international research community, health practitioners, and the general public.   For more information on Mick: Mick is an experienced Physiotherapist & Exercise Physiologist who consults at The Melbourne Sports Medicine Centre. He is currently completing a Masters of Sports Physiotherapy. Mick has expertise in ACL injury management and ACL injury prevention and has previously worked for elite sporting teams such as the Collingwood Magpies Netball team, Newcastle Jets U20s Soccer team and NQ Cowboys U20s Rugby League team.   Resources discussed on this show: Premax Website Randall Cooper Twitter Randall Cooper LinkedIn Mick Hughes Website Mick Hughes Twitter Mick Hughes Facebook Mick Hughes Instagram Melbourne ACL Rehabilitation Guide   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!   Have a great week and stay Healthy Wealthy and Smart!   Xo Karen    

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Christian Barton on the show to talk about exercise for patellofemoral pain. Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation. Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine. In this episode, we discuss: -Why exercise is so important in treating patellofemoral pain -Exercise prescription principles for optimizing therapeutic programs -Muscle power and its role in absorbing load during activity -Utilizing graded exposure to address fear around movement -And so much more!   The current literature shows, “Exercise is the key intervention, along with education” for patellofemoral pain. Although uncertainty exists around specific exercise prescription parameters, Dr. Barton has found that, “The exercise that probably should be provided is primarily hip and knee based on current evidence.”   Dr. Barton is a proponent for conservative management over injections and surgical interventions for patellofemoral pain and encourages all clinicians to, “[make] sure that patients take this on board and you stop them from looking for quick fixes.”   While strength and power deficits will exist for individuals with patellofemoral pain, other factors such as recovery expectations and fear of movement can further impact clinical presentation and intervention. Dr. Barton stresses, “Ultimately, you need to treat the patient in front of you.”   For more information on Dr. Barton: Dr Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.   Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.   Resources discussed on this show: Christian Barton Twitter La Trobe University Sport and Exercise Medicine Research Blog The International Patellofemoral Research Network Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review IPFRN Exercise Guide 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions) Hip rate of force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology La Trobe University Blog: Hip muscle rate of force development is impaired in females with knee cap pain   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!   Have a great week and stay Healthy Wealthy and Smart!   Xo Karen    

At the time of this podcast recording it’s summer in the United States and no doubt many people are out enjoying all sorts of activities including sports, exercise and hopefully running around playing with kids. I know that some of those people might also be sitting it out or perhaps taking it a bit easy because they have tendon pain and despite all sorts of treatment, they have yet to find a solution. If you have any kind of tendinitis or tendinopathy in your knee, ankles, shoulder, elbow, my next guest may have the answer to solving your tendon pain once and for all. Joining me today is Dr. Ebonie Rio. She has a Master’s Degree in Physiotherapy and completed her PhD in Neuroscience where she studied in-depthly the health and pathology of tendon as well as how the central nervous system and motor control might change in individuals with tendinopathy. She’s a practicing clinician as well as a research fellow at the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne, Australia.   Sign up for the latest episode at www.drjoetatta.com/podcasts.   Love the show? Subscribe, rate, review, and share! Here’s How » Join the Healing Pain Podcast Community today: drjoetatta.com Healing Pain Podcast Facebook Healing Pain Podcast Twitter Healing Pain Podcast YouTube Healing Pain Podcast LinkedIn

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

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

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

On this episode of the Healthy Wealthy and Smart Podcast, Randall Cooper joins me to discuss the elements of bringing a product successfully to the marketplace. Randall is an experienced Sports Physiotherapist, Founder and Managing Director of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, Fellow of the Australian College of Physiotherapists, and designer of the Cooper Knee Alignment Sleeve by Thermoskin. In this episode, we discuss: -How to asses if your product idea fulfills a niche area in the market -Why you should protect your intellectual property -How to find a distributor that’s right for your product -Unique obstacles healthcare practitioners face when launching a new product -And so much more!   Once an idea is reasonably developed, Randall encourages entrepreneurs to solicit feedback on their product. He stresses, “Most of the time, that feedback you get from other people is extremely refreshing and helps solidify whether your idea is good or not.”   One of the biggest challenges physical therapists face is that they can rely on their stable career paths and potentially not take advantage of more risky but fruitful opportunities. Randall believes that, “The entrepreneurs who have nothing to fall back on, they grit down and they get through those tough times and they get to that next level because they have to.”   Before pursuing a venture, it is important to understand your underlying inspiration. From Randall’s experience, “The primary motivation has to be that you're changing things for the better and not that you want to be a millionaire and retire to the Bahamas.”   For more information on Randall: Randall is an experienced Sports Physiotherapist, Founder and Managing Director of Premax, Adjunct Lecturer at the La Trobe University Sport and Exercise Medicine Research Centre, Fellow of the Australian College of Physiotherapists, and designer of the Cooper Knee Alignment Sleeve by Thermoskin. As a Sports Physiotherapist Randall has worked with some of Australia's most notable sporting organisations including the Hawthorn Football Club, the Australian Winter Olympic Team, and the Victorian Institute of Sport. He consulted from the internationally renowned Olympic Park Sports Medicine Centre in Melbourne, Australia from 1999 - 2016. Randall has also attained the title of Specialist Sports Physiotherapist as awarded by the Australian College of Physiotherapists in 2008. Randall is the Founder and Managing Director of Premax. Premax in an Australian company that manufactures a range of sports skincare and massage creams. Premax is available in Australia, Asia, UK and Europe, and will be launched in North America in 2017/18. As an Adjunct Lecturer for the La Trobe Sport and Exercise Medicine Research Centre, Randall advocates sport and exercise medicine, physical activity, health and well-being for all. He provides support to the Centre, activity assisting in translating research findings to key stake holders including the international research community, health practitioners, and the general public. Randall is also the designer of the Cooper Knee Alignment Sleeve by Thermoskin. This innovative proprioceptive sleeve features an anti-valgus strap, silicone dots within the sleeve to boost activation of the medial quadriceps and hamstrings, a patella sling, and a circular knit to optimise proprioceptive compression.   Resources discussed on this show: Randall Cooper Twitter Premax website Premax Youtube Cooper Knee Alignment Sleeve   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!   Have a great week and stay Healthy Wealthy and Smart!   Xo Karen   P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on the Final Blog Post of 2016: Advice You Need to Know!

“A few years ago, like most doctors, I was pretty ignorant on the topic of food and medicine” is how Peter Brukner, Professor at Latrobe University’s Sport and Exercise Medicine Research Centre opens this podcast. He summarises 4 years of engaging seriously with nutrition for health and in sport. His comments apply to the general public, the recreational athlete and he shares his experience from elite level sport. Peter has been involved in an international nutrition educational leadership group that includes Professor Timothy Noakes, Dr Aseem Malhotra, Dr Sarah Hallberg, Dr Jason Fung, Nina Teicholz and Gary Taubes. Recent reports that the sugar industry paid two Harvard professors to write a piece for the New England Journal of Medicine https://www.statnews.com/2016/09/12/sugar-industry-harvard-research/ makes the opinion of unbiased academic clinicians like Peter Brukner even more timely. Relevant links: Peter Brukner on the other side of the mike interviewing Professor Timothy Noakes: https://soundcloud.com/bmjpodcasts/high-fat-for-health Dr Jason Fung on the impact of diet on obesity and type 2 diabetes mellitus: https://soundcloud.com/bmjpodcasts/dr-jason-fung-on-the-impact-of-diet-on-obesity-and-type-2-diabetes-mellitus Prof Stephen Phinney on the science behind low carb diets for athletes: A rational approach: https://soundcloud.com/bmjpodcasts/prof-stephen-phinney-on-the-science-behind-low-carb-diets-for-athletes-a-rational-approach?in=bmjpodcasts/sets/bjsm-1 If you think that BJSM is only sharing one side of the story please use our various channels to contribute. Papers, blogs, podcasts, Twitter, Facebook - we’d love to hear from you. We haven’t rejected any papers saying that hi-carb is good for you!

Often tendinopathy will be resistant to even the best traditional rehabilitation methods. Liam West chats to Dr Ebonie Rio, a PostDoctoral Fellow at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. Dr Rio’s research aims to explain the role of the primary motor cortex in tendinopathy. She discusses tendon neuroplastic training (TNT) and how it might help your tendinopathy patients regain pain free function in the clinic. Timeline 0.40 – Why traditional rehabilitation for tendinopathy might be unsuccessful 1.40 - Changes in primary motor cortex and motor control in tendinopathy 2.35 – What is TNT & how to utilise it? 5.30 – How long does it take for TNT to help patients? 6.30 – Cross education for tendinopathy Further Reading Tendon neuroplastic training: changing the way we think about tendon rehabilitation – OPEN ACCESS - http://bit.ly/29ergE3 Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK Related Podcasts Prof Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL Prof Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol Defining tissue capacity - http://bit.ly/29iVSKc

Most clinicians who manage patients with tendinopathy will have encountered the situation where the clinical picture and imaging findings do not match up. Sean Docking, researcher at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne, has been using Ultrasound Tissue Characterisation (UTC) to visualise changes associated with tendinopathy in 3D detail. In this podcast he talks to Liam West about how UTC may help us explain this discrepancy between current imaging and clinical pictures in tendinopathy. He also gives the listener an insight into the clinical relevance of UTC and the lessons that have been learnt from his research within the field. Timeline 0.45 – Current imaging modalities used in tendinopathy 3.45 – Disconnect between imaging findings and clinical picture 4.45 – Place imaging in clinical context 6.00 – Deep dive on UTC 7.55 – Tendon response to pathology 10.45 – Treat the donut, not the hole Further Reading  Using UTC to measure game load on tendons in AFL - http://bit.ly/29rSr3k  Pathological tendons have good amounts of normal structure -  http://bit.ly/29iCfiG  Revisiting the continuum model of tendon pathology - http://bit.ly/29rSDPK Further Related Podcasts  Jill Cook revisits Tendon Pathology - http://bit.ly/1UR3tvL  Michael Kjaer on the pathogenesis of tendinopathy and tendon healing - http://bit.ly/29pOZol

Intramuscular Hamstring Injuries Professor Peter Brukner is a sports and exercise physician at La Trobe University’s Sports and Exercise Medicine Research Centre in Melbourne. He is Team Doctor for the Australian Cricket Team and formerly worked with Liverpool FC, Australian football in the 2010 World Cup and numerous Olympic Games. He discusses intramuscular tendon hamstring injuries, a difficult type of hamstring injury, which takes longer to recover than a typical strain. The conversation also branches out to diagnosis, management and rehabilitation of the injury. Here’s the associated paper with some very helpful figures: http://ow.ly/Hsci301NHpx Professor Brukner’s thoughts on recurrent hamstring strain can be found here: http://ow.ly/8NeB301NKCw And more on hamstring strain prevention here: http://ow.ly/PrSL301NLm0 Timeline: 1.00-Why some hamstring injuries are different (and difficult!) 2.30 Diagnosis of intramuscular tendon hamstring injuries. 4.30-Recognition on the MRI 5.30- Management of the injury. 7.50-Rehabilitation and return to play.

I had the honor of sitting down with Dr. Jill Cook and busting some common tendinopathy myths.  This episode with Dr. Jill Cook was recorded live in front of an audience at the Combined Section Meeting in Anaheim, CA about 2 weeks ago.  It was a great experience and one of the highlights of my CSM experience.  A little more about Dr. Cook: She is a professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas.  In this episode we talk about: * Are eccentric exercises are the best and only way to treat a tendinopathy?  * Can use the same tendon therapy protocol for every tendon and every person.  * A tendinopathy always involves inflammation. * Once you are pain free and back to sport you don't have to worry about the exercises you did in PT. * Why we shouldn't be selling messages we can't deliver. * and much more! Dr. Cook shares so much information about tendinopathy in this episode that I think I learned more in 25 min that I have in the past 10 years! Thank you again to the Private Practice Section of the APTA for all of their help to make this happen and thank you to Jimmy McKay, host of the PT Pintcast for the great intro! Enjoy and stay Healthy Wealthy & Smart! xo Karen