106. Cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, and strength testing with Paula Peralta, Simon Olivotto, Nick Kendrick & David Toomey
Release Date: 09/17/2020
Physio Edge podcast
Patellofemoral pain (PFP) rehabilitation doesn’t end when your patient gets stronger. The real challenge is getting them back to running, training and racing without triggering another flare-up. In this final episode of the four-part series, Tom Goom (Running Physio) and David Pope explore the fourth pillar of successful PFP rehabilitation: a planned return to running. Continuing Alice’s journey from the previous episodes, a HYROX athlete preparing for competition, Tom and David break down exactly how to rebuild running volume, progress training safely, and help runners hit their goals,...
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Strengthening exercises are a key part of successful patellofemoral pain (PFP) rehabilitation. Squats, lunges and single leg squats are often painful early on and can aggravate your patients pain, but on the flip side, we want to build up their tolerance and confidence with these movements. If you introduce an exercise your patient isn’t ready for, progress too quickly, or overload the knee too early, you’ll often flare your patients pain and set their rehabilitation back. In this episode, Tom Goom (Running Physio) and David Pope explore the third pillar of successful PFP treatment:...
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Many runners patellofemoral pain (PFP) is aggravated by the activity they love. They either stop running to let their pain settle, and then it returns as soon as they start back up again, or keep running despite the pain getting worse. They may know (and you may have told them) they should reduce their training….but what happens when they can’t? Or won’t? In this episode, Tom Goom (Running Physio) and David Pope explore the second pillar of successful PFP rehab: education and empowerment. Using the real case of Alice, a HYROX athlete preparing for competition, you’ll discover how and...
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Patellofemoral pain (PFP) is one of the most common running injuries, and the high recurrence rate can make it a frustrating injury for patients to experience and clinicians to treat. In this episode, Tom Goom (Running Physio) and David Pope break down why PFP has such a high recurrence rate, and what most rehab plans miss. You’ll also discover: The "Four pillars" framework Tom uses to treat PFP and other running injuries How and when to keep patients running or exercising when it is essential for their mental health and social life How to find a manageable starting point when a...
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When is your patient's shoulder pain from their neck? Are you missing a cervical spine component in your shoulder patients? After a day in clinic reviewing patients with years of unresolved shoulder pain, Shoulder Specialist Physiotherapist Jo Gibson breaks down the five most common mistakes clinicians make when ruling in — or out — the neck. In this podcast, Jo covers: Why you don't need neck pain to have neck-driven shoulder pain (and which pain locations are most pathognomonic) Why referred symptoms below the elbow don't automatically point to the cervical spine Why active range of...
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Should you prescribe isometric or isotonic exercises for your patient's lower limb tendinopathy? When is it safe to add plyometric loading, and how do you progress running or jumping without flaring your patients tendon pain? Why do some "tricky tendons" refuse to respond to your best loading programs? Dr Ebonie Rio (Post-Doctoral Senior Research Fellow, La Trobe University) reveals the evidence-based answers as she guides you through the clinical reasoning and practical strategies for managing patellar, achilles, and other lower limb tendinopathies. In this conversation, you'll follow...
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Have any of your shoulder patients improved and then plateaued, unable to regain their full range of movement, or get rid of their painful arc? Sometimes it’s not the cuff, capsule, nerves or neck—it’s the acromioclavicular joint (ACJ) holding things back. In this episode, Jo Gibson sheds light on this often-overlooked contributor to persistent shoulder pain. From real patient case studies to the latest research and simple clinic-ready symptom modification tests, Jo shares practical strategies you can use immediately. Learn how to identify ACJ involvement, and use targeted rehab...
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Anterior hip pain is often blamed on the hip flexors, but in runners, that’s rarely the diagnosis. So how can you identify the real cause and guide patients to a safe, effective recovery? In this episode, Tom Goom (Running Physio) explores the function of the hip flexors in running, key differentials for anterior hip or groin pain, and practical rehab strategies you can use right away. You’ll discover: Why true hip flexor tendinopathy is uncommon in endurance runners Red flags and key tests to identify bone stress fractures and intra‑articular pathology Early‑stage loading strategies...
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Your patient presents with shoulder pain, and straight away you need to identify: Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely? Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely? Is the pain actually coming from the shoulder? Could it be the cervical spine? Is there a tear that needs urgent referral? Should you order imaging? Refer to a surgeon? Or confidently continue with rehab? In this podcast, Jo Gibson (Upper Limb Rehabilitation Specialist Physio) guides you through a simple,...
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Your patient is running, playing sport, or jumping or lunging forward - an activity with fast eccentric or concentric activity in dorsiflexion,and suddenly they feel like they’ve been kicked in the back of the leg. They might hear a snap and have difficulty weightbearing, walking and pushing off. What’s your likely diagnosis? You picked it - an Achilles tendon (AT) rupture. AT ruptures are a devastating injury that can drastically impact a patient’s ability to walk, run, or return to sport. Despite their frequency, there’s a lot of uncertainty among clinicians, patients, and even...
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Explore cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, & strength tests for athletes with Simon Olivotto, Dave Toomey, Paula Peralta & Nick Kendrick.
The Clinical Edge Senior Physio Education & Presentation team and I sat down to answer Clinical Edge member questions, and we wanted to share this one with you, so you can benefit from it too. In this Q&A, we discussed:
Cervical radiculopathy patients with an irritable presentation
- Do imaging findings such as modic changes, alter our management
- How can you approach treatment of cervical radiculopathy?
- Are medications indicated?
- Red flags you need to rule out
- Are sliders and gliders a useful treatment?
Sensitivity to cold or ice
- How can you use tests to identify sensitivity to cold or ice to guide your treatment?
- Does ice sensitivity indicate central sensitisation?
- How does this impact management?
- If your whiplash patients have sensitivity to cold or ice, how does this impact treatment & prognosis?
- Which research articles cover this topic?
Calf & achilles strengthening
- When is it best to perform calf raises into dorsiflexion (DF)?
- When should you avoid strengthening the calf into end of range (EOR) DF?
- What ankle issues may lead you to avoid strengthening or stretching into EOR DF?
Hip joint pain and the acetabular labrum
- Can we identify when the labrum is responsible for hip or groin pain?
- What tests are important to perform in patients with hip or groin pain?
- If deep structures such as the hip joint are painful or injured, does this mean more superficial structures such as the acetabular labrum are also pain generators?
Strength assessment & screening of athletes
- What strength screening tests can you perform in athletes with large demands such as motorcross?
- Which areas do you need to assess?
- What are simple and more complex ways to assess strength in different regions of the body?
- What are important considerations when designing a S&C program for a motocross athlete?
- Making sense of pain
How can you make sense of pain? How can you describe pain to your patients in a way that makes sense, and doesn’t tell them “it’s all in your head”? Find out how to improve your confidence with acute and persistent pain in the upcoming “Making sense of pain” module.
Warning: Contains swearing.
Links associated with this episode:
- Download and subscribe to the podcast on iTunes
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- Improve your clinical reasoning, assessment and treatment effectiveness, efficiency and results with a free trial Clinical Edge membership
- Clinical reasoning module - simplify complex patients, clarify your assessment and get great results with clinically reasoned treatment
- “Making sense of pain” module
- Let David know what you liked about this podcast on Twitter
- Review the podcast on iTunes
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- Infographics by Clinical Edge
- Clinical Edge Education & presentation team
- Simon Olivotto
- Paula Peralta
- David Toomey
- Nick Kendrick



