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When is shoulder pain from the C/sp? When a patient presents with shoulder pain and stiffness, how can C/Sp referral be identified? If a patient has full neck range of movement, and neck movements don’t reproduce shoulder pain, can their pain still be from the C/sp? Recent research shows that including treatment of the C/sp can improve results in up to ⅓ of shoulder pain patients. In this video with Jo Gibson (Clinical Physiotherapy Specialist) discover how to identify, assess and treat patients with cervical referral, including: What history and pain features will patients with cervical referred shoulder pain report? What assessment tests can be performed to diagnose or rule out the C/Sp involvement in shoulder pain? What information does palpation and repeated movements in the objective assessment provide? What does the research reveal about cervical referred shoulder pain? What biopsychosocial factors may be involved in cervical referred shoulder pain? How can manual therapy to the C/Sp improve shoulder range of movement? What education can be provided to patients with cervical spine referral? What exercises and exercise variations may be used to improve cervical referred shoulder pain? Are upper muscle fibres of trapezius “overactive” or are these muscles actually weak? What exercises can be used for upper traps in C/sp referred shoulder pain? What manual therapy can be used for C/sp referred shoulder pain? Does the thorax get “stiff”, and what exercises help improve thoracic range of movement? Get your access to free videos with Jo Gibson on acute shoulder pain & stiff shoulder assessment & diagnosis at clinicaledge.co/shoulder. Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter   Articles associated with this episode: CLICK HERE to download the articles associated with this podcast Alonso-Perez JL, Lopez-Lopez A, La Touche R, Lerma-Lara S, Suarez E, Rojas J, Bishop MD, Villafañe JH, Fernández-Carnero J. Hypoalgesic effects of three different manual therapy techniques on cervical spine and psychological interaction: A randomized clinical trial. Journal of Bodywork and Movement Therapies. 2017 Oct 1;21(4):798-803. Hauswirth J, Ernst MJ, Preusser ML, Meichtry A, Kool J, Crawford RJ. Immediate effects of cervical unilateral anterior-posterior mobilisation on shoulder pain and impairment in post-operative arthroscopy patients. Journal of back and musculoskeletal rehabilitation. 2017 Jan 1;30(3):615-23. Katsuura Y, Bruce J, Taylor S, Gullota L, Kim HJ. Overlapping, Masquerading, and Causative Cervical Spine and Shoulder Pathology: A Systematic Review. Global Spine Journal. 2020 Apr;10(2):195-208. Vicenzino B, Collins D, Benson H, Wright A. An investigation of the interrelationship between manipulative therapy-induced hypoalgesia and sympathoexcitation. Journal of manipulative and physiological therapeutics. 1998 Sep 1;21(7):448-53.

When your patient has neck and arm pain, or low back and leg pain from neural tissue pain disorders (NTPD) such as peripheral nerve sensitisation (PNS), how will you treat them? Pain associated with PNS can occasionally be mild and non-irritable, but more often than not, it’s severe, highly irritable, and easy to stir up. How can you provide treatment that settles their pain, without stirring them up? What advice, education, manual therapy and exercise will you provide to help improve symptoms and speed up recovery? What are the keys to success with PNS patients? In Physio Edge podcast 104, Dr Toby Hall and I discussed PNS, common symptoms, causes, questions to ask, and how to assess and diagnose PNS in your patients. In this followup podcast, the second in our two-part series, Dr Toby Hall and I take you through the next phase - how to treat PNS. You’ll discover: The 7 keys to success with PNS How to successfully treat PNS in the neck and upper limb, AND the low back and lower limb. What education and advice should you provide to your patient about activities to avoid or reduce, and which activities should they increase? What are the most effective exercises for patients with PNS? Should exercise be painful or painless? When is neural mobilisation an effective treatment? When should you avoid using neural mobilisation as a treatment? Is manual therapy effective in PNS? Which manual therapy techniques can you use to improve symptoms and range of movement (ROM) immediately? How to perform effective manual therapy techniques that reduce pain without stirring up your patients. How can you combine neural mobilisation with manual therapy? If you use manual therapy to improve symptoms, what home exercises should patients perform after each treatment session? Links associated with this episode: Physio Edge podcast 104 - Peripheral nerve sensitisation & neural tissue pain disorders with Dr Toby Hall Comprehensive, practical training to improve your skills, clinical reasoning, treatment results & confidence with a free trial Clinical Edge membership The new “Making sense of pain” module available with a free trial Clinical Edge membership Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Sherlock Holmes & the Sign of the Four Hypotheses case study with Nick Kendrick Comprehensive, practical training to improve your skills, clinical reasoning, treatment results & confidence with a free trial Clinical Edge membership Dr Toby Hall on Twitter Manual Concepts Dr Annina Schmid Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Join live Q&A podcasts on Facebook Infographics by Clinical Edge

Explore cervical radiculopathy, central sensitisation, achilles tendinopathy, hip & groin pain, & strength tests for athletes with Simon Olivotto, Dave Toomey, Paula Peralta & Nick Kendrick. In this Clinical Edge member Q&A, the Clinical Edge Senior Physio Education & Presentation team 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 Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify 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 Like the podcast on Facebook Infographics by Clinical Edge Clinical Edge Education & presentation team Simon Olivotto Paula Peralta David Toomey Nick Kendrick   Articles associated with this episode: Maxwell S, Sterling M. An investigation of the use of a numeric pain rating scale with ice application to the neck to determine cold hyperalgesia. Manual therapy. 2013 Apr 1;18(2):172-4. Machado GC, Maher CG, Ferreira PH, Day RO, Pinheiro MB, Ferreira ML. Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis. Annals of the rheumatic diseases. 2017 Jul 1;76(7):1269-78. Zhu S, Zhu J, Zhen G, Hu Y, An S, Li Y, Zheng Q, Chen Z, Yang Y, Wan M, Skolasky RL. Subchondral bone osteoclasts induce sensory innervation and osteoarthritis pain. The Journal of clinical investigation. 2019 Mar 1;129(3):1076-93.  

When you assess your patients shoulder movements, and notice a winging scapula, altered resting position or timing of scapula movement, do you need to treat it? Can we diagnose “Scapular dyskinesis”, and does it matter? How can you simplify your scapular assessment? In this podcast, Jo Gibson (Clinical Physiotherapy Specialist) explores common beliefs and myths around the scapula, including: Abnormal scapular kinematics cause pain We can predict patients that are going to get shoulder pain Upper traps should be retrained to decrease their activation Scapular-based interventions are superior to rotator cuff based treatment There are reliable and valid ways to assess scapular movement Alongside this mythbusting, you’ll explore: Is there any point assessing the scapula? Is scapular asymmetry normal or abnormal? Is scapular dyskinesis a normal response to exercise or loading? How accurate are we at identifying scapular dyskinesis compared to findings in laboratory studies of scapula movement? What scapular findings will you commonly observe in patients with massive rotator cuff tears, nerve injuries & stiffness? How does rotator cuff fatigue impact scapular movement? How does fear avoidance and worry about particular movements impact muscle activity and movement? When is increased upper traps activity helpful and beneficial? Should we try to decrease upper traps activity in patients with C/Sp driven shoulder pain? Can we preferentially target the scapular or rotator cuff with our exercises? Do improvements in shoulder pain correlate with changes or “improvements” in scapular movement? How do scapular assessment test (SAT) results impact your treatment and exercise prescription? If the SAT improves pain, does that mean we should perform scapular based exercises? Can we use scapular dyskinesia classification to stratify patients or guide our treatment? Is there any reliability in scapular assessment? Does the SAT simply identify those that have a favourable natural history ie are going to get better on their own regardless? Do scapular treatments increase the subacromial space, and does this matter? Is winging post-surgery (posterior stabilisation + labral repair) a product of surgery or does this need to be addressed? How does incorporating the kinetic chain into rehab impact patient movement strategies, scapular and rotator cuff recruitment? Are scapulothoracic bursae relevant to shoulder pain? How can you address patient beliefs and fear avoidance around their shoulder pain? Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast Andersson SH, Bahr R, Clarsen B, Myklebust G. Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed. British journal of sports medicine. 2018 Sep 1;52(18):1191-8. Asker M, Brooke HL, Waldén M, Tranaeus U, Johansson F, Skillgate E, Holm LW. Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis. British journal of sports medicine. 2018 Oct 1;52(20):1312-9. Christiansen DH, Møller AD, Vestergaard JM, Mose S, Maribo T. The scapular dyskinesis test: Reliability, agreement, and predictive value in patients with subacromial impingement syndrome. Journal of Hand Therapy. 2017 Apr 1;30(2):208-13.

When your patient has leg, shoulder or arm pain, how can you identify if their pain is due to neural tissue compression, sensitisation or irritation? How can you differentiate whether pain is from neural tissue or local structures like nearby joints, tendons or muscles? What questions and objective tests will help you diagnose a neural tissue pain disorder (NTPD)? In this podcast with Dr Toby Hall (Specialist Musculoskeletal Physiotherapist, FACP, PhD), you’ll discover: Three types of neural tissue pain disorders, and how to identify each one What is Peripheral nerve sensitisation (PNS)? What clues in your subjective examination will help you identify PNS? Why do nerves become inflamed or irritated? How to identify & differentiate radiculopathy and radicular pain in patients with radiating limb pain. Do all patients with NTPD have obvious neuro symptoms such as pins and needles, numbness or weakness? Quick screening tests you can use in your assessment to identify PNS. How to identify if your patients shoulder and arm pain is from neural tissue or from local shoulder structures. How to diagnose a NTPD in patients with hip or leg pain. How to perform passive neurodynamic tests such as the straight leg raise (SLR), upper limb neurodynamic test (ULNT), slump test and femoral nerve slump test. What information does a positive or negative neurodynamic test provide? Can we identify the location of a nerve lesion or irritation with our passive neurodynamic tests or palpation? Initial PNS treatment options Is exercise helpful or harmful in patients with PNS? How can you palpate over neural tissue, and what information does this provide? Do opioids provide pain relief, or prolong recovery in patients with NTPD? This podcast is the first part in a two part series on neural tissue pain disorders with Dr Toby Hall. Part 1 (this podcast) guides you through the types of NTPD, and how to assess and diagnose NTPD. Part 2 (available soon) will take you through how to treat PNS. I highly recommend listening to this episode (part 1) prior to part 2, to have a thorough understanding of when and how to treat PNS. Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Sherlock Holmes & the Sign of the Four Hypotheses case study with Nick Kendrick Comprehensive, practical training to improve your skills, clinical reasoning, treatment results & confidence with a free trial Clinical Edge membership Dr Toby Hall on Twitter Manual Concepts Dr Annina Schmid Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Join live Q&A podcasts on Facebook Infographics by Clinical Edge

A young male patient woke with an acute onset of constant, shooting shoulder pain, is painful into abduction, reluctant to lift his arm, and feels like he’s losing shoulder strength. He has no recent history of injury.  Can you diagnose this unusual cause of shoulder pain, based on this patient's symptoms and physical tests? What are your differential diagnoses and red flags to keep in mind with this patient?  In this podcast, Jo Gibson puts your knowledge of shoulder pain and diagnostic skills to the test, and explores how you can treat patients with this diagnosis. Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast Clarke CJ, Torrance E, McIntosh J, Funk L. Neuralgic amyotrophy is not the most common neurologic disorder of the shoulder: a 78-month prospective study of 60 neurologic shoulder patients in a specialist shoulder clinic. Journal of shoulder and elbow surgery. 2016 Dec 1;25(12):1997-2004. Cup EH, Ijspeert J, Janssen RJ, Bussemaker-Beumer C, Jacobs J, Pieterse AJ, van der Linde H, van Alfen N. Residual complaints after neuralgic amyotrophy. Archives of physical medicine and rehabilitation. 2013 Jan 1;94(1):67-73. DO MAGDALIA PB. Neuralgic Amyotrophy. Challenging Neuropathic Pain Syndromes: Evaluation and Evidence-Based Treatment. 2017 Nov 12:197. Feinberg JH, Nguyen ET, Boachie‐Adjei K, Gribbin C, Lee SK, Daluiski A, Wolfe SW. The electrodiagnostic natural history of parsonage–turner syndrome. Muscle & nerve. 2017 Oct;56(4):737-43. Lustenhouwer R, Cameron IG, van Alfen N, Oorsprong TD, Toni I, van Engelen BG, Groothuis JT, Helmich RC. Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy. Cortex. 2020 Feb 28. Seror P. Neuralgic amyotrophy. An update. Joint Bone Spine. 2017 Mar 1;84(2):153-8. Get access to free videos with Jo Gibson on diagnosis of shoulder pain at clinicaledge.co/shoulder

Do you include stretches in your treatment of shoulder pain? Have you ever identified a glenohumeral internal rotation deficit (GIRD) and used the "Sleeper stretch" to help improve internal rotation? Do stretches have any value for shoulder pain, or are there better treatment options? In this podcast, Jo Gibson (Clinical Physiotherapy Specialist) discusses how to differentiate true capsular stiffness from muscle stiffness, what information GIRD provides, and whether sleeper stretches for shoulder pain are a useful treatment. Jo explores the current research and clinical implications on your treatment, including: What is the driver of decreased range of movement (ROM)? If we get immediate changes in ROM with a sleeper stretch, does that mean we should use this as a treatment? Is stretching an effective, efficient and evidence-based treatment? Can we use strengthening movements to improve range and cuff recruitment? What exercises can you use with patients with GIRD to improve ROM and cuff recruitment? Humeral retroversion and how torsional load from throwing sports at a young age impact your ROM assessment. If you have a patient with GIRD, what does this tell you? In patients with true capsular stiffness, does stretching in combination with damp heat have a role? Does eccentric strengthening have a role in improving GIRD in patients with true capsular stiffness or fibrosis? How can you use GIRD to monitor your athletes fatigue and recovery? Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast Hall K, Borstad JD. Posterior Shoulder Tightness: To Treat or Not to Treat?. journal of orthopaedic & sports physical therapy. 2018 Mar;48(3):133-6. Keller RA, De Giacomo AF, Neumann JA, Limpisvasti O, Tibone JE. Glenohumeral internal rotation deficit and risk of upper extremity injury in overhead athletes: a meta-analysis and systematic review. Sports health. 2018 Mar;10(2):125-32. Mine K, Nakayama T, Milanese S, Grimmer K. Effectiveness of stretching on posterior shoulder tightness and glenohumeral internal-rotation deficit: a systematic review of randomized controlled trials. Journal of sport rehabilitation. 2017 Jul 1;26(4):294-305.

Shoulder surgery in athletes is common following dislocation. Accelerated post-op shoulder stabilisation rehab protocols include early mobilisation to reduce movement, proprioceptive and strength deficits. This has allowed earlier return to play (RTP), however athletes often still have significant proprioceptive and strength deficits up to 2 years post surgery. Despite getting back to play, athletes may struggle to get back to performance. Following surgery, contact athletes such as rugby players, throwing athletes and young players have additional RTP challenges. Redislocation risks in contact sports such as rugby are high, leading to poor outcomes. Younger athletes are not skeletally mature, and with early RTP following stabilisation surgery may have higher failure rates. How can you identify and address these challenges? Which tests and features in a patients history help you determine whether a patient is suitable for an early RTP? In this podcast with Jo Gibson (Clinical Physiotherapy Specialist), you’ll explore: Which shoulder tests are most valuable with your patients? How has emerging evidence challenged our previous approach to RTP testing? What are the risks associated with early RTP following shoulder surgery? How can you help identify athletes at risk of redislocation? Which psychosocial factors impact RTP? How does fear of reinjury and levels of anxiety about their shoulder affect RTP? How does your patient’s sport of choice affects dislocation risks? How is RTP impacted by patients age? How do daily stressors impact RTP and predict outcomes? Which psychosocial factors impact RTP? What is the biggest factor in whether an athlete gets back to play? Which question are key to ask your patients? Which questionnaires can you use with your post-op shoulder patients? Which tests and combinations of tests have been validated and are evidence-based? How can you assess range of movement (ROM)? How can you measure patients strength? How is rate of force development (RFD) affected following shoulder injury? How can you assess RFD? How does fatigue impact strength testing eg testing at the start of training compared to the after training? How does the kinetic chain impact RTP testing for throwers? How can you assess shoulder endurance? RTP tests for swimmers What role does manual therapy have in shoulder rehab? Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast

100 Physio Edge podcast episodes since I discovered a love of podcasts, and created the Physio Edge podcast to help Physio’s, Physical Therapists and other health professionals in their clinical practice with practical information from the leaders in different musculoskeletal and sports injuries. I really enjoy recording each podcast, helping you with your clinical challenges and hearing how the podcast has helped you with your patients. While recording each of these podcasts, I’ve noticed that one area Physiotherapy experts & leaders have in common is their well developed clinical reasoning. They use effective & efficient clinical problem solving to assess and treat their patients. How can you improve your clinical reasoning to more effectively assess and treat your patients? In this podcast with the new Clinical Edge Senior Physio education & presentation team - David Toomey (NZ based Musculoskeletal Physio), Jordan Craig (APA Titled Musculoskeletal & Sports Physio) and Simon Olivotto (Specialist Musculoskeletal Physiotherapist, FACP), you’ll explore: Five practical strategies you can use immediately to improve your clinical reasoning and treatment results. Clinical reasoning - what is it and how will it help you with your patients? How to effectively & efficiently assess and treat in short treatment sessions How to create a rehabilitation or training plan for a patient to suit their individual needs. Low back pain patients - How to use clinical reasoning to target your questioning, objective assessment and treatment to your patients needs Download this podcast now to improve your clinical reasoning and treatment results with these five practical strategies. Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your clinical reasoning, assessment and treatment effectiveness, efficiency and results with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Clinical Edge Education & presentation team Simon Olivotto on Twitter Jordan Craig David Toomey on Twitter Articles associated with this episode: CLICK HERE to download your podcast handout

Patients with shoulder pain, rotator cuff tears and nerve injuries can often be seen shrugging their shoulder while they lift their arm, appearing to overuse their upper fibres of trapezius. Surface EMG research has shown increased activity in UFT in shoulder pain and whiplash patients. To add to this, patients get sore upper traps, and can be adamant that they need regular massage of their upper fibres of trapezius (UFT). We seem to have plenty of evidence that we need to decrease UFT muscle activity, and help this by providing exercises to target the middle and lower traps. Is this really the case? Are the upper traps really a bad guy, or a victim caught in the spotlight? Do we need to decrease upper traps muscle activity to help our patients shoulder or neck pain? Or perhaps counter-intuitively, do we need to strengthen upper traps and help them to work together with the surrounding muscles? In this podcast, Jo Gibson (Clinical Specialist Physio) explores the evidence around the upper fibres of trapezius, and implications on your clinical practice. You’ll discover: What are the myths around upper traps? Are upper fibres of trapezius a bad guy or a victim? Why do upper traps sometimes seem to be overactive? Should we aim to increase the activity in middle and lower traps? What information does surface EMG really provide? Can taping of the scapula change recruitment of the trapezius? Should we strengthen UFT? Why is initial activation of the UFT important in shoulder elevation movements? Why should patients with rotator cuff tears or stiff & painful shoulders use upper traps more with their movements? How can we incorporate UFT strengthening into our shoulder strengthening? What exercises can we use to strengthen UFT without increasing activity in levator scapulae? Why is UFT strengthening important in ACJ injury rehab? In gym goers, what scapula setting errors are commonly used? How do nerve injuries that affect the upper traps impact movement? Do trigger points or soreness indicate that our patients need massage or exercises to decrease UFT activity? Download this episode now to improve your treatment of shoulder and neck pain. Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast Lee JH, Cynn HS, Choi WJ, Jeong HJ, Yoon TL. Various shrug exercises can change scapular kinematics and scapular rotator muscle activities in subjects with scapular downward rotation syndrome. Human movement science. 2016 Feb 1;45:119-29. Pizzari T, Wickham J, Balster S, Ganderton C, Watson L. Modifying a shrug exercise can facilitate the upward rotator muscles of the scapula. Clinical Biomechanics. 2014 Feb 1;29(2):201-5.

Strength training can be used in your treatment and rehab programs to improve your patients strength, load capacity, function & pain, so they can get back into work and the activities they enjoy. In your athletic patients, strength training can be used to help restore power and speed, which are vital for sporting performance. Would you like to include more strength training in your treatment, but aren’t completely sure about the most effective ways to build strength? Which exercises can you use? How many sets and reps should your patients perform? Will 3 sets of 10 reps build strength effectively? What is power training, when should you focus on improving power, and how can you incorporate power training? In this podcast with David Joyce - Sports Physiotherapist, S&C expert and co-author of High performance training for sports, and Sports injury prevention and rehabilitation, you will discover: How to use strength training with your patients The most effective ways to help your patients develop strength Set and rep ranges for strength improvements Recent developments in S&C What is power & power training, and how does this compare to strength? When should your patients work on improving power vs strength How to improve power using different areas on the force/velocity curve Power development using bodyweight and barbell exercises Calf strengthening How to incorporate velocity/explosiveness training When are higher reps useful? Does endurance training with higher reps carryover to improved running or cycling When your patients are performing deadlifts or squats, what elements should you monitor? Do biomechanics in a deadlift or squat matter? What rest periods should be used to help develop strength, while maintaining an efficient training routine What is strength training vs conditioning? How can patients perform conditioning for improved fitness? Should conditioning be incorporated into strength training sessions for maximum improvements in strength? Should exercises and sets be performed to temporary muscular failure (when the bar is unable to be lifted for another repetition) Resources to help improve your strength & conditioning     CLICK HERE to download your podcast handout Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify S&C online courses with Dr Claire Minshull - available with a free trial S&C for youths and adolescents online course with Dr Jon Oliver Improve your confidence and clinical reasoning with a free trial Clinical Edge membership David Joyce on Twitter Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Join live Q&A podcasts on Facebook Infographics by Clinical Edge

Long head of biceps (LHB) tendinopathy and associated anterior shoulder pain can develop in patients that increase their lifting load eg moving house, overhead activities, activities that involve loaded shoulder extension and in throwing athletes. Patients may also develop long head of biceps tendon pain after a traumatic ACJ injury or SLAP tear. How can you identify and treat LHB tendinopathy? In this podcast with Jo Gibson, you’ll explore: What causes LHB tendinopathy? What mechanisms of injury commonly cause LHB pain, ACJ injury or SLAP tears? Key traumas you need to keep an eye out for that impact LHB Why do patients with ACJ injuries develop LHB pain? Why do patients with SLAP lesions develop LHB pain? What causes LHB reactive tendinopathy? LHB Anatomy & function What activities does LHB help with? Long head of biceps (LHB) anatomy Variance in proximal biceps attachment and how traumatic LHB injuries impact different structures How the LHB is stabilised anatomically in the bicipital groove Does the transverse ligament exist? Patient features that help your diagnosis Which patients are likely to present with LHB pain? Which structures are more likely to be affected with traumatic shoulder injuries in younger vs older patients? Why do young patients with LHB instability develop pain? Subjective history features that help your diagnosis Where do patients with LHB tendinopathy experience pain? Which movements are likely to be painful in LHB tendinopathy patients? Objective testing & diagnosis Which tests or combinations of tests help diagnose LHB pain? Which special tests help your diagnosis? Does palpation have any value in LHB diagnosis? How can you exclude intra-articular pathology with your testing? How can you rule in or rule out rotator cuff pathology? Rotator cuff tears & involvement in LHB How does LHB muscle activity vary in painful vs painfree massive rotator cuff tear patients? How do traumatic rotator cuff tears, particularly subscapularis, impact LHB? If patients have rotator cuff surgery, what details in the operation notes will help you identify if they are at risk of persistent post-op pain and stiffness? Why do subscapularis tears cause LHB pain? Imaging What information does imaging of LHB provide? What imaging can you use if your patient is not progressing? MRI vs MRA vs US for different pain & injuries How to treat LHB What is the best way to treat LHB tendon pain? Are isometrics helpful with LHB, and how do these help? What surgery is used for LHB pain? Additional questions covered How are results after rotator cuff tears impacted by the rotator interval? Links associated with this episode: Download and subscribe to the podcast on iTunes Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter

Patients with thoracic outlet syndrome (TOS) may have undiagnosed pain and symptoms into their shoulder, arm, hand, scapula, head, face, upper back, axilla, chest and anterior clavicle. With a number of potential sources of pain in these areas, TOS patients commonly have a delayed or incorrect diagnosis, followed by unnecessary and unsuccessful surgery. Further complicating matters, imaging and nerve conduction studies are often clear or inconclusive. Studies show that on average, patients with TOS have an average of 5 years of symptoms and see 6 doctors before receiving an accurate diagnosis. What tests and questionnaires will help guide your diagnosis and intervention? When are patients suitable for Physiotherapy and conservative management? When should you refer on for a surgical opinion? In this podcast with Jo Gibson (Clinical Physiotherapy Specialist), you will discover: What is Thoracic outlet syndrome (TOS)? Commonly reported symptoms of TOS Three different types of TOS The most common type of TOS with around 80% of all TOS patients Why imaging and investigations are often clear, and don’t match up with symptoms 3 key causes of TOS The relationship between TOS and hypermobility syndrome Criteria for diagnosis in the latest TOS diagnostic consensus statement Differential diagnosis (DDx) - Cervical NR compression, and peripheral nerve entrapment Common subjective findings that guide you towards a diagnosis of TOS A questionnaire you can use to assist cervicobrachial diagnosis What information is gained from imaging, including MRI and MR Neurography & nerve conduction studies What are the limitations of imaging? What is the difference between small nerve fibre and large nerve fibres, and how this impacts diagnosis QST - Quantitative sensory testing - Pin prick (Neurotip) and Thermal testing - warm and cold Simple QST test using a coin Objective testing What tests do you need to perform in patients with suspected TOS? What is the elevated stress test (EST)? What information does an upper limb tension test (ULTT) provide? Does a negative ULTT test exclude TOS? How are nerve blocks used? What is the best way to perform a nerve block? How effective are nerve blocks in assisting diagnosis? Who should we refer on for early medical or surgical management? When should you get an early surgical opinion? Which patients are likely to benefit from conservative management? Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter Articles associated with this episode: CLICK HERE to download the articles associated with this podcast

The sternoclavicular joint (SCJ) can cause pain locally, or refer into the neck and shoulder. With a relatively high incidence of serious and potentially life-threatening pathology at the SCJ, it’s important to diagnose the source of SCJ pain. In this (Facebook live/video/podcast) with Jo Gibson (Clinical Physiotherapy Specialist ), you’ll discover: How to identify and diagnose the SCJ as the source of pain Where does the SCJ commonly refer pain to? What pathologies cause SCJ pain What activities & movements commonly reproduce pain in the SCJ? Who develops SCJ pain? Which differential diagnosis (DDx) are important to identify, including localised osteoarthritis (OA) rheumatoid arthritis septic arthritis atraumatic subluxation seronegative spondyloarthropathies gout, pseudogout SC hyperostosis condensing osteitis Friedrich’s disease/avascular necrosis condensing arthritis Friedrich’s disease and ‘SAPHO’ (Synovitis Acne Pustulosis Hyperostosis Osteitis) syndrome How does DDx impact prognosis? What role does imaging have with the SCJ? SCJ Imaging - MRI vs CT vs Xray. If pain refers down to the anterior chest, what other structures may be involved? Tietze syndrome at the costochondral junction. Costochondritis - who develops it, is there a mechanism of injury? Red flags you need to be aware of around the SCJ Case study of an SCJ patient where a potentially life-threatening illness was identified Other red flags - infection, HIV, septic arthritis, diabetes, ankylosing spondylitis, gout What investigations are important for SCJ pain patients? What are realistic expectations for prognosis and resolution of SCJ symptoms? How can you rehab patients with SCJ pain? Costochondral joint pain Rehab following clavicular ORIF When is arthroscopic release suitable in frozen shoulder patients Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using the best podcast app currently in existence - Overcast Listen to the podcast on Spotify Improve your diagnosis of acute shoulder pain with 3 free videos with Jo Gibson Improve your confidence and clinical reasoning with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Jo Gibson on Twitter

Have you ever wanted to improve your patients strength, but weren't sure about the best way to go about it? What exercises should you use? How many sets, reps and sessions per week should you ask your patients to complete? Strength levels often start to decline with pain or after an injury, from neuromuscular inhibition, swelling, inflammation or joint laxity (Hopkins & Ingersoll, 2000; Rice & McNair, 2010). Unfortunately strength doesn't always return as quickly as it disappears, and neuromuscular inhibition can carry on (Roy et al, 2017). In this podcast with Dr Claire Minshull, we dive into the role of strength and conditioning in rehab, and explore: Why building strength is an important part of rehab How can you build strength effectively and efficiently? Do 8-12 rep sets or 3-5 rep sets build greater strength? How many sets of an exercise should your patient perform? How frequently do patients need to perform their exercises? Is maximal loading necessary in rehab? Which patients should use lower load exercises? Will strength training make endurance athletes slow and muscular, or improve running economy? "Functional exercises" vs strength exercises When should exercises target strength, and when can you use "functional exercises"? What is power training, and what exercises help to develop power? When should power training be used? What lifting cues can you use with beginning lifters e.g. in deadlifts? Patients with knee osteoarthritis: What is an effective exercise strategy for patients with knee osteoarthritis (OA)? What important factors do you need to incorporate in your pain education? How can you start a strengthening program? What exercises can you use? What pain levels are acceptable during exercise? How can you know if your exercises are appropriate for each patient? What braces or supports can you use to make unicompartmental knee OA more comfortable and able to exercise?   CLICK HERE to download your podcast handout Dr Claire Minshull also presented two online courses for Clinical Edge members to further develop your strength & conditioning skills and confidence. You can get access to these online courses with your free trial membership. What is in Dr Claire Minshull's webinar? How to incorporate strength development in your rehab programs How to progress strength in rehab Exercise progressions and regressions to maintain a strength focus Case study examples taking you through how to apply S&C principles with your patients Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify Improve your confidence and clinical reasoning with a free trial Clinical Edge membership, and get access to the online courses on S&C with Dr Claire Minshull Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Dr Claire Minshull on Twitter Website - Get Back to Sport Instagram - Get Back to Sport Versus Arthritis Articles associated with this episode: Campos et al. 2002. Muscular adaptations in response to three different resistance-training regimens: specificity of repetition maximum training zones. Hall et al. 2018. Knee extensor strength gains mediate symptom improvement in knee osteoarthritis: secondary analysis of a randomised controlled trial. Jorge et al. 2015. Progressive resistance exercise in women with osteoarthritis of the knee: a randomized controlled trial. Latham et al. 2010. Strength training in older adults: the benefits for osteoarthritis. Teixeira et al. 2018. Effect of resistance training set volume on upper body muscle hypertrophy: are more sets really better than less? Uusi-Rasi et al. 2017. Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial.

Manual therapy (MT) comes in all shapes and sizes - mobilisation, manipulation, mobilisation with movement, soft tissue massage, instrument assisted massage, muscle energy techniques, pointy elbows pressed into flesh and more. Patients (often) love it, and it's a popular treatment modality with therapists. Debate rages, and myths and misconceptions surround MT. Could the time we spend performing MT be better spent elsewhere? How does MT work? Is it worth using if treatment effects are short lived? Is it just used as revenue raising by therapists, while creating reliance on passive therapies? Is MT evidence-based? Is it worth including in our treatment? Which patients may benefit from MT, and which patients you should steer away from MT? In this podcast, clinical researcher, physical therapist and Professor at Duke University, Dr Chad Cook, we discuss the evidence around MT, myths and misconceptions, how MT works, and using your clinical reasoning to decide when and how to utilise MT. You'll discover: What are the arguments against manual therapy? Do the arguments against MT have merit? Does MT break up scar tissue or adhesions, correct alignment of joints, or put them back into place? Do we have evidence that MT creates reliance on passive therapies? Evidence for and against MT How to use clinical reasoning with MT How MT works - potential mechanisms What MT is NOT doing How to explain MT to your patients Clinical reasoning Identifying pain adaptive and non pain adaptive patients How MT can help identify patients with a better or worse prognosis How many sessions of MT should patients receive? How to select MT techniques Does MT cause harm and patient reliance? How to identify patient treatment expectations How to help change patient expectations Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify Improve your confidence and plantar fasciopathy results with a free trial Clinical Edge membership, and get access to the 3 part webinar series on PHP with Henrik Riel Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Dr Chad Cook at Duke University Twitter - @ChadCookPT Book - Orthopaedic Manual Therapy Articles associated with this episode: Bialosky et al. 2009. The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model. Bialosky JE, Bishop MD, Penza CW. Placebo mechanisms of manual therapy: a sheep in wolf's clothing?. journal of orthopaedic & sports physical therapy. 2017 May;47(5):301-4. Cook et al. 2014. Is there preliminary value to a within- and/or between-session change for determining short-term outcomes of manual therapy on mechanical neck pain? Cook et al. 2013. Early use of thrust manipulation versus non-thrust manipulation: a randomized clinical trial. Cook et al. 2012. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain? Cook. 2011. Immediate effects from manual therapy: much ado about nothing? Deyle et al. 2005. Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program. Goss et al. 2004. A Cochrane review of manipulation and mobilization for mechanical neck disorders. Learmann et al. 2014. No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator. Rubinstein et al. 2011. Spinal manipulation therapy for chronic low back pain. Schneider et al. 2014. Derivation of a clinical decision guide in the diagnosis of cervical facet joint pain. Traeger et al. 2018. Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain.

When your patient has heel pain with their first few steps in the morning, after sitting for a while or at the start of a run, a diagnosis of plantar heel pain (PHP) or plantar fasciopathy might jump straight to the top of your list. How will you treat your patients with PHP? How long will it take? How can you explain PHP, the rehab and recovery to your patients? In this podcast with Henrik Riel (Physiotherapist, researcher and PhD candidate at Aalborg University) we take a deep dive into PHP, and how you can treat it, including: How to describe plantar heel pain to your patients How to explain to your patient why they developed PHP, recovery timeframes and rehab Plantar fasciitis, plantar fasciopathy, plantar heel pain? What's the most appropriate terminology? Differential diagnosis for PHP including Neuropathic pain Fat pad irritation, contusion or atrophy Calcaneal stress fracture Other diagnoses How to systematically perform an objective assessment and diagnose PHP Assessment tests to identify factors contributing to your patients pain Whether your patients require imaging How long PHP takes to recover What factors affect your patients prognosis and recovery times How to differentiate your treatment for active or sedentary patients Whether your patients can continue to run with PHP Factors that may hinder the recovery of your sedentary patients, and how to address these Whether your patients should include stretching in their rehab Types of strengthening to include in your rehab - isometric, isotonic or otherwise How many sets and reps should your patients perform of their strengthening exercises Whether orthotics are useful Corticosteroid injections - do they help or increase the risk of plantar fascia rupture? Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using my favourite podcast app - Overcast Improve your confidence and plantar fasciopathy results with a free trial Clinical Edge membership, and get access to the 3 part webinar series on PHP with Henrik Riel Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Twitter - @Henrik_Riel Research Gate - Henrik Riel Articles associated with this episode: Alshami et al. 2008. A review of plantar heel pain of neural origin: differential diagnosis and management. Chimutengwende-Gordon et al. 2010. Magnetic resonance imaging in plantar heel pain. Dakin et al. 2018. Chronic inflammation is a feature of Achilles tendinopathy and rupture. David et al. 2017. Injected corticosteroids for treating plantar heel pain in adults. Digiovanni et al. 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. Hansen et al. 2018. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination. Lemont et al. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Rathleff et al. 2015. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Riel et al. 2017. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on. Riel et al. 2018. The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial. Riel et al. 2019. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial. Other Episodes of Interest: PE 062 - How to treat plantar fasciopathy in runners with Tom Goom PE 061 - How to assess and diagnose plantar fasciopathy in runners with Tom Goom PE 060 - Plantar fasciopathy in runners with Tom Goom PE 038 - Plantar fasciopathy loading programs with Michael Rathleff PE 012 - Plantar Fascia, Achilles Tendinopathy And Nerve Entrapments With Russell Wright

When you love running or any other sport or activity, having to take time off with an injury is really frustrating. Your patients with an injury limiting their running will feel frustrated and be keen to keep running or get back to running as quickly as possible. We can make a huge difference in helping them return to running, but how do we do it? It would be pretty simple if we could hand all of our running injury patients a standard return to running table with a list of set running distances, and send them on their way to just follow the program. The trouble is, it doesn’t work that way in real life. Each of your patients will have different goals, and respond differently to rehab and increases in running, depending on their injury, irritability of their symptoms, their load tolerance, and a lot of factors. Since recipe-based approaches won’t work for a lot of patients, how can you tailor your rehab and guide your running injury patients through their return to running? In this podcast with Tom Goom, we’re going to help you return your patients to running as quickly as possible, know which factors you need to address in your rehab, and how to tailor your rehab to each of your patients. You will explore how to: Test whether your patient is ready to run Find your patients ‘run tolerance’ Incorporate your athlete’s goals into their rehab Use their pathology to guide return to running eg stress fractures or plantar fasciopathy Use irritability to guide your load progression Vary your treatment depending on the stage of their competitive season Address strength, range of movement, control, muscle mass, power and plyometric impairments in their rehab program Choose the number of exercises you use Balance risk and reward to meet patients goals Four key steps to return your patient to running Use impact tests when assessing whether your patient is ready to run Plan training structure and progression Monitor return to running Identify acceptable pain levels while increasing running We will take you through four real patient case study examples so you can apply the podcast in your clinical practice, including: Achilles tendon pain Medial tibial stress syndrome (MTSS)/Shin splints Calf pain High risk tibial stress fracture CLICK HERE to download your podcast handout   Links associated with this episode: Free lateral hip pain video series with Tom Goom Download and subscribe to the podcast on iTunes Twitter - @tomgoom Let David Pope know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Other episodes of interest: Physio Edge 084 Running injury treatment - tendinopathy, MTSS, total hip replacement & high BMI patients. Q&A with Tom Goom Physio Edge 083 Running gait retraining, strengthening, glutes & ITB syndrome. Q&A with Tom Goom Physio Edge 082 Achilles tendinopathy treatment - the latest research with Dr Seth O'Neill Physio Edge 076 Footwear advice for running injuries with Tom Goom Physio Edge 075 Tendinopathy, imaging and diagnosis with Dr Sean Docking Physio Edge 068 Lower limb tendinopathy loading, running and rehab with Dr Peter Malliaras Physio Edge 042 Treatment of Plantaris & Achilles Tendinopathy with Dr Seth O'Neill Physio Edge 041 Plantaris Involvement In Achilles Tendinopathy With Dr Christoph Spang

Squeezing a stress ball and strengthening with 0.5kg dumbells will only get you so far with your treatment of hand and wrist injuries, and soon enough you'll hit a wall with treatment results. How are you going to smash through that wall, and help your patients keep working or playing, or get back to it? If you've felt limited with your hand and wrist treatment and exercises, you'll love the treatment approach and strengthening exercises from the third and final podcast in this series with Ian Gatt. In the previous two podcasts with Ian we explored how you can take a great history, assess and diagnose wrist and hand injuries. You discovered types of grip strength and how to perform low and high tech grip strength assessment. In this new podcast with Ian Gatt you will discover how to use your assessment findings to develop a treatment plan, and how to develop your patients hand and wrist strength, plus: Strength exercises can you use in your rehab of hand and wrist injuries What pain level is acceptable during rehab exercises? How many sets and reps should your patients perform of each exercise? How can you reduce the pain your athlete experiences so they can perform their rehab exercises? What finger strengthening exercises can you use? Why is the proximal radio-ulnar joint (PRUJ) so important to treat with wrist and elbow injuries? How can you treat the PRUJ? How can you incorporate the kinetic chain into your hand and wrist rehab? How and why would you want to use vibration as part of rehab, even if you don't have a vibration plate? What manual therapy can you use with your hand patients? How can you maintain your athletes skill and performance while taking them through a rehab program? How should you adjust training volume or intensity with knuckle or Carpometacarpal joint (CMCJ) injuries? Can boxers with CMCJ injuries continue to hit the bag? What wrist positions and movements need to be limited during rehab and to prevent injury? Why is wrapping your boxers hands properly so important? How can you wrap your boxers hands? What gloves are recommended for boxers? Ian works with GB Boxing, which involves helping boxers recover from hand, wrist and other injuries. This podcast is therefore boxer-centric, however there are a lot of specifics, exercises & principles in this podcast that you can use with your hand & wrist patients. Dive into this podcast, and pick up a lot of great ideas for your hand & wrist injury treatment. Links associated with this episode: Download and subscribe to the podcast on iTunes Listen to the podcast on Spotify Improve your confidence and patient results with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge LinkedIn - Ian Gatt Twitter - @IanGattPhysio Instagram - @IanGattman Sheffield Hallam University - Ian Gatt Courses - HE Seminars   CLICK HERE for your spot on a free shoulder assessment webinar with Jo Gibson, available soon. Resources associated with this episode: Video - How to wrap a boxer's hands with Ian Gatt Loosemore et al. 2016. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad. Other Episodes of Interest: PE089 - Combating hand & wrist injuries part 2 - Objective assessment with Ian Gatt PE 088 - Combating hand and wrist injuries part 1 with Ian Gatt PE 043 - Sporting Shoulder with Jo Gibson PE 027 - Sports Injury Management with Dr Nathan Gibbs

Your knuckles getting crushed in an overenthusiastic handshake by hands the size of watermelons isn't a fun experience. Do these knuckle-crushers know they're squeezing that hard, or do they just regularly snap pencils while taking notes, and wonder why pens and pencils are so fragile nowadays? How much grip strength do you actually need, even if you're not planning on crushing any knuckles the next time you meet someone? How much grip strength do your patients need when recovering from a hand, wrist or upper limb injury? Testing and building grip strength is a really important part of helping your hand, wrist, elbow pain and injury patients get back to work and day to day life. Gripping also pre-activates the rotator cuff, so you can use gripping as part of your patients shoulder rehab exercises. Grip strength tests using handheld dynamometers (HHD)* test your "Power Grip", but this test doesn't assess thumb or pinch grip strength. There are two other grip strength tests that are pretty easy to perform, that are going to be better suited to some of your patients. What are they, and how can you test the different types of grip strength in your patients? In this podcast with Physiotherapist (English Institute of Sport Boxing Technical Lead Physio) Ian Gatt, we discuss assessing and building grip strength, assessing hand and wrist injuries and more, including: 3 different types of grip strength you need to measure in your hand and wrist patients How grip strength measures help guide your assessment and prognosis What is the "Power grip" and how is it useful? How can you test thumb strength? Low-tech, simple grip strength tests you can use in your clinic The high-tech approach to grip strength testing How strong should wrist flexors and extensors be? How can you assess weight bearing tolerance of the hand and wrist? Why your patient can have a painfree grip and still be painful with weightbearing on the hand What exercises, weights and reps should you use following upper limb injury? How can you accurately measure wrist range of movement? How are the proximal radio-ulnar joint (PRUJ) and radio-humeral joint (RHJ) involved in hand and wrist injuries, and how can you assess these? Like the tests demonstrated in the Clinical Edge online courses on Assessment & treatment of the elbow Links associated with this episode: Download and subscribe to the podcast on iTunes Download the podcast now using my favourite podcast app - Overcast Listen to the podcast on Spotify Improve your confidence and patient results with a free trial Clinical Edge membership Let David know what you liked about this podcast on Twitter Review the podcast on iTunes Like the podcast on Facebook Infographics by Clinical Edge Linked In - Ian GattTwitter - @IanGattPhysio Instagram - @IanGattman Sheffield Hallam University - Ian Gatt Courses - HE Seminars   CLICK HERE for your spot on a free shoulder assessment webinar with Jo Gibson, available soon. Resources associated with this episode: Video - How to wrap a boxer's hands with Ian Gatt Loosemore et al. 2016. Hand and Wrist Injuries in Elite Boxing: A Longitudinal Prospective Study (2005-2012) of the Great Britain Olympic Boxing Squad. Other Episodes of Interest: PE 088 - Combating hand and wrist injuries part 1 with Ian Gatt PE 043 - Sporting Shoulder with Jo Gibson PE 027 - Sports Injury Management with Dr Nathan Gibbs