Be Strong Physio

I'm a Physiotherapist with a passion for evolving my own practice to reflect the best available evidence. I aim to continue to learn and evolve as I talk to industry leaders who share their story along with clinical insights and tips. My goal is to provide interesting, light-hearted and easy to digest conversations that can ultimately help us all learn and reduce the time it takes for the latest science to inform clinical practice.

Healing ACL Injuries: A Deep Dive into the Cross Bracing Protocol 10/25/2024

#19 Mastering Clinical Decision-Making: Insights with The Rehab Podiatrist, Alex Murray 08/28/2024

Understanding Bone Stress Injuries for Runners with The Stress Fracture Physio 07/17/2024

What's wrong with Osteopathy with Dr Oliver Thomson 05/22/2024

Dr. Tom Cross: Cross Bracing Protocol for ACL Injuries 02/16/2024

16. A process-based approach for truly person-centred care with Cameron Faller 08/28/2023

16. A process-based approach for truly person-centred care with Cameron Faller On this episode I sat down with Cameron Faller, physical therapist and educator to discuss some of the shortcomings of the current approach to evidence-based practice and how a move to process based therapy may be the answer. We went through the following topics: Q 1: To begin with, do you mind if we dive into some of the issues or shortcomings of evidence based practice as we know it? Shortcomings of the current approach to therapy (biomedical model) Focussed on biology Has saved lives Struggles to capture the interplay between biological, social and psychological Reductionist problem solving Mechanistic world view View body like a machine The focus is on fixing isolated parts The idea that we can understand individual trajectories by understanding normal and the deviation from normal. They thought that between subject variability was a good estimate of within subject variability. Falsely homogenized group and situationally decontextualised individual units The Bell Curve of the collective only to decontextualized individuals (which is no one) Normative concepts may not be applicable to specific individuals (as they are non-ergodic) It's a kind of individualism but not related to a real individual Question 2: Issues with the application of the biopsychosocial approach to clinical practice Question 3: What is process-based therapy? What core biopsychosocial processes should be targeted with this client given this goal in this situation, and how can they most efficiently and effectively be changed? Process based therapy approach: What creates the problem for the individual What historical factors may have contributed What are the factors that maintain the problem Create a network of nodes of possible factors [network functional analysis] What strategies can we use to perturbate this complex system? How can we introduce healthy variation or retention?” What treatment kernels do we have available to us to do this in the particular context? We are aiming to perturbate the system to turn it from maladatpive to adaptive. This has to be done in the right context. What is the network in the process that you are targeting? Use data to track progress and to test hypotheses. Adjust as needed. ACT - incorporates functional contextualism - what works (functions) in a given situation or context. Unique to the individual Does this work in this moment? Is this moving us towards the type of life we want to have? To reduce suffering and engage in our values Q: How does it address some of the issues with the current approach to therapy? Q: Does a systems based approach bastardize Evidence-Based Practice? Does it come down more to clinicians appreciating the evidence then being able to skillfully apply it to the person in front of them and their individual context? Q: To help me and any of the listeners understand how it is actually applied, do you have any examples we could run through? Q: Example of a network analysis? Eg thought of keeping back in neutral when bending. Q: What can we do with this information from a network analysis to create positive change of an individual ? Q: For listeners who want to learn more about process based therapy - what can they do / where can they go to learn more? You can find out more about Cameron here: https://www.instagram.com/camfallerdpt/?hl=en You can find out more about the Human Rehabilitation Framework here: https://hrfhome.com/ /episode/index/show/4e94e974-2ed7-495e-9586-8de36f3ebd44/id/27865809

#15 Human movement, ecological dynamics and how we can better help our patients to move well with Jeff Morton 08/08/2023

#15 Human movement, ecological dynamics and how we can better help our patients to move well with Jeff Morton On this episode I spoke with Jeff Morton who is a physiotherapist Advanced Lower Limb Practitioner in the NHS in the UK and shares some great content on social media around movement science, biomechanics and complex systems theory with some cracking memes. You can find Jeff here: We dived into a discussion about ecological dynamics, which considers the body as a complex system that interacts with its environment. Jeff shared some great insights including how he uses ecological dynamics in the clinic as well as some great examples of how he uses constraints to target key areas such as the quadriceps during ACL rehah. An outine of ecological dynamics follows: Human movement can be viewed as the emergent result of the interaction between the athlete and its surrounding context. The athlete performs in a context that is shaped by three types of constraints Individual constraints Environmental constraints Task constraints Individual constraints Height Weight Strength Limb length Fatigue Anxiety Environmental constraints Terrain Light Weather Boundaries of the field Task constraints Goal of the task Any rules such as for a sport Objects or rules that specify or constrain the athletes response dynamics, eg actions of other players Movement is not produced by an athlete in isolation, but emerges from a dynamic coupling between the athlete's characteristics, the stimulus-rich environment, and the desired actions (ie tasks). There is a non-linear relationship between changes in constraints and the produced movement. Self organized movement, perception and action are inherently coupled and cannot be studied in isolation. Expert athletes aren’t just proficient movers, they excel at perceiving information from the environment and executing actions accordingly. I really hope you gained as much from this episode as I did! Geoff. /episode/index/show/4e94e974-2ed7-495e-9586-8de36f3ebd44/id/27689991

#14 Patient beliefs, behavioural experiments and clinical tips with Ben Darlow 07/25/2023

Can ACLs heal and what is the latest evidence-based management with Dr Steph Filbay 07/10/2023

Can ACLs heal and what is the latest evidence-based management with Dr Steph Filbay On this episode I was joined by Dr Stephanie Filbay to discuss all things ACL rupture. Dr Stephanie Filbay is a physiotherapist, and Senior Research Fellow at Univeristy of Melbourne and is a leading researcher in knee ACL managment including emerging research on ACL healing. The following is an outline of our chat. Reminder: if you enjoyed this episode please consider leaving a 5 star review so that it appears higher in the charts and therefore more people can find it and have access to up-to-date healthcare information. QUICK FIRE QUESTIONS Do early ACL reconstructions lead to better patient outcomes? Are ACL reconstructions necessary to return to sport? Do ACL reconstructions prevent further knee damage? Do ACL reconstructions reduce the chances of osteoarthritis? Are there currently too many ACL reconstructions performed? Can ACLs heal? Cross bracing protocol What is the cross bracing protocol including rationale for it? Study and results. Shortcomings of this study and what future research do we need? What are the implications of this research? Decision making aid Decision making aid for patients and clinicians in light of this new research. What are the consequences of ACL rupture? What are the objectives of management - Restore knee function Address psychological barriers Prevent further injury and reduce risk of OA Optimise long term Quality of Life What management options do people who have just torn their ACL have? Do outcomes differ depending on what management approach is chosen? Knee laxity and functional instability Return to sport Does early surgery prevent additional meniscus and cartilage damage - what does the evidence we have say about this belief? Preventing further knee damage and long term OA Discussing management options and expectations for someone who has just torn their ACL - Steph what do you wish someone had told you when you first tore your ACL? Eg all patients of 181 expected to have normal knee function after ACLR and 91% expected to return to sport - is this realistic? Are there any practical steps that people can take after injury if they want to consider participating in the Cross Bracing Protocol? Are there any less extreme options open for people who want to help their chances of healing but don’t want to have their knee in a brace for 12 weeks? You can find Steph on Twitter (@stephfilbay). /episode/index/show/4e94e974-2ed7-495e-9586-8de36f3ebd44/id/27416667

Allostasis as a model to understand and treat pain with Oliver Crossley 06/27/2023

Allostasis as a model to understand and treat pain with Oliver Crossley Today Oliver Crossley (Yogic Physio) and I discussed allostasis as a model to better understand and treat pain. Allostasis potentially helps us to better understand how apparently disparate things like psychological stress and social pressure can place a cumulative load on our bodies and ultimately combine with other stressors to produce or enhance pain, using principles more in line with a more recent understanding of pain such as neuro-immune-endocrine factors that can lead to nociception. Oliver included some great examples along the way to better illustrate and explain the model and also included some great tips and takeaways about how he uses allostasis to help people with persistent pain. Outline What is Allostasis? What is the Allostasis model and how can it help us to explain or understand pain? What are the possible mechanisms of allostatic load and pain? Stress can produce a paradoxical response within the immune response within the immune and nociceptive systems. Acute stress - analgesia Chronic stress more variable and can produce stress-induced hyperalgesia Top down of central governance of stress response Brain determines what a person perceives as threatening or stressful in a particular context, influenced by past experiences and beliefs. For example muscular strain during lifting could be perceived as threatening or non-threatening depending on the person’s expectations and previous experiences. If person has negative beliefs - your inhibitory responses may be lost and you experience a stress response in the absence of tissue trauma. Multiple dimensions possibly contributing to, and interacting in pain presentations: Central and peripheral nociceptive processes Movement Psychology Social Genetic + Epigenetic factors Health + lifestyle Oliver Crossley https://www.yogicphysio.com/ /episode/index/show/4e94e974-2ed7-495e-9586-8de36f3ebd44/id/27288627

Exercise as part of a biopsychosocial approach to pain with Dr Mitchell Gibbs 06/19/2023

10 back pain facts + movement, posture and recovery from low back pain with Kevin Wernli 05/17/2023

Bone density, osteoporosis and what you can do about it with Physiotherapist Frances Brown 04/20/2023

Adam Meakins' back injury: how he managed his low back pain and got back to deadlifting 04/03/2023

Adam Meakins' back injury: how he managed his low back pain and got back to deadlifting On this episode of the podcast, I was incredibly excited to be joined by Adam Meakins to discuss his back injury and how he recovered from it. The aim of the podcast was to provide people who might be in a similar situation with acute, severe low back and possibly leg pain an example of how a Physio was able to self manage and get back to full health and fitness without anything fancy. It's my hope that this episode is a resource for clinicians and people in pain alike. When you are severe pain it is normal to have fear and concern but I hope this episode can provide some hope of the amazing ability of the body to heal. If you want to check out Adam's original back injury video you can do so here: All of the videos are great to watch and you can find them on Adam's Instagram if you scroll back to August 2021: More details about what we chatted about follow. --------------------------------------------------------------- We dived into a great discussion about what happaned as well as the reocvery process he went through. Some of the recovery principles that came up include: Stay active but also allowed to rest Do movements that feel good - do you need to push into pain to restore eg extension Analgesics and sleeping medication Hot baths / water bottles Patience Criticism he copped Should see a physio, get scans etc Manual therapy Specific exercises (McKenzie) Self blame - technique Evidence about specific treatments / exercises What does the evidence say about whether any specific treatments are superior to others? Do people need to get manual therapy for acute back pain? Does this mean they shouldn’t get manual therapy just to anticipate a common strawman argument? Is this negative or does it provide people more choice? If people want to see a physio Advice for members of the public who might want some guidance from a healthcare practitioner, what should they look for and what should they be wary of? Why did he get injured? Upon reflection with the aid of hindsight, what factors do you think might have contributed to your injury? Can we take any lessons from this? Technique? Evidence Programming - RPE, Training history with COVID External factors that could have placed a stress on your system? Shit happens? Fear avoidance - deadlifts How hard was it to get back into deadlifts? Do you still have any residual fears or concerns in the back of your mind? I really hope you enjoyed this episode. If you did I would be incredibly grateful if you could please leave a review on your favorite viewing platform. Geoff Ford from Be Strong Physio /episode/index/show/4e94e974-2ed7-495e-9586-8de36f3ebd44/id/26436321

How effective is hardstyle kettlebell training with Neil Meigh AKA The Kettlebell Physio 03/22/2023

ACL Injuries with Geoff Ford 03/17/2023

Optimising your diet if you're injured with dietitian Jono Steedman 03/01/2023

Critical thinking and applying principles rather than following methods with Steve Collins 02/15/2023

Surgical v non-surgical ACL management with Specialist Physio Kieran Richardson 02/01/2023

How a chiropractor practices evidence informed care with Dan Rothenberg | Episode 2 01/03/2023

Tips & takeaways from private practice with Physio Andrew Wild | Episode 1 12/22/2022

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