Ep. 062 | Poking into Pain: A Deep Dive into Dry Needling | Barbara Cagnie

In this episode of the Physiotutors podcast, Kai interviews Serena Simmons, a seasoned psychologist with over 30 years of experience, about behavioral change and patient buy-in in healthcare. Serena highlights the challenges that healthcare providers face due to the lack of psychological training in their initial education, which often leaves them unequipped to effectively promote behavioral change in patients. She emphasizes the importance of understanding both the practitioner's and the patient's psychology to foster meaningful interactions and facilitate change. Serena discusses the significance of the patient-provider relationship, suggesting that building trust and rapport is crucial, and that understanding and addressing the patient's intrinsic motivations can lead to better adherence to treatment plans. Additionally, Serena offers practical advice for healthcare providers, such as spending more time understanding the patient's emotional reasons for seeking treatment and creating small, achievable milestones to reinforce progress. She also stresses the importance of self-awareness and communication skills for practitioners, recommending further education in human psychology and decision-making processes. Serena's insights underscore the need for a holistic approach that combines psychological understanding with clinical expertise to improve patient outcomes. The episode is rich with strategies for enhancing patient engagement, compliance, and overall effectiveness in physiotherapy and other healthcare practices.   Content 00:00 Intro 02:00 Barriers to behavior change 05:19 How to identify psychological factors impeding recovery 08:15 How to create rapport 14:27 Everything starts with you 18:30 How to strengthen your bond with a patient 24:24 How to uncover a patient's "why" 33:40 The benefit of hands-on treatment 35:13 Motivational Interviewing 39:10 My patient doesn't do exercises 46:06 How to secure buy-in 51:09 Recommended reading 53:30 Serena's closing thoughts 54:10 Contact info 54:35 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this episode of the Physiotutors podcast, Kai interviews Niek Vink, a physiotherapist and manager at the National Training Center for Ultrasound (NT-E) in Utrecht, Netherlands. They discuss the role and benefits of ultrasound in physiotherapy. Niek explains the basics of ultrasound imaging, comparing it to other imaging techniques like MRI and X-ray. He emphasizes that while ultrasound offers high spatial resolution and is useful for assessing soft tissues, it cannot see inside bones. The conversation also highlights the importance of dynamic scanning and sono-palpation in physiotherapy, as well as the advantages and disadvantages of ultrasound. The discussion covers the adoption and application of ultrasound in physiotherapy practices, noting varying levels of usage in different countries. Niek shares success stories and potential pitfalls, stressing the importance of proper training, practice, and patient communication to avoid nocebo effects. He also touches on new developments in ultrasound technology, such as AI and elastography, and offers advice for physiotherapists considering adopting ultrasound in their practice.    Guest Niek is a Physiotherapist from Utrecht, Netherlands  and the manager and teacher at NT-e, an educational company focused on teaching ultrasound imaging to doctors, and physiotherapists. He’s been a public speaker on countless international events and today we will talk to him about the role of ultrasound in physiotherapy.   Content   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this episode of the Physiotutors podcast, host Kai speaks with Edel Fanning, a lead upper limb physiotherapist from Ireland, about various shoulder pathologies in athletes and effective rehabilitation strategies. Edel discusses common shoulder injuries in different sports, such as dislocations in contact sports like rugby and rotator cuff issues in overhead sports like swimming and tennis. She emphasizes the importance of considering the kinetic chain in rehabilitation, focusing on both local shoulder control and the role of other body parts to optimize recovery and performance. Edel also highlights the significance of proper scapular function and offers insights into the nuances of treating shoulder injuries, including specific exercises and positions to support recovery. Edel also delves into the challenges of returning athletes to sport post-injury, discussing the importance of objective testing, psychological readiness, and sport-specific considerations. She outlines the differences in rehabilitation approaches for contact vs. non-contact sports, noting the unique demands and injury mechanisms of each. The conversation touches on screening tests, injury prevention strategies, and the development of an online course on athletic shoulder rehabilitation. Edel's expertise and practical advice provide valuable insights for physiotherapists and sports professionals aiming to enhance shoulder health and performance in athletes.   Content 00:00 Intro 00:45 Which pathologies to consider 08:34 The scapula and stability & performance 15:36 Which muscles to consider in rehab 19:08 The importance of strength in the kinetic chain 21:43 How to reduce injury risk 25:03 Shoulder warm-up routines 27:29 Screening tests useful? 33:11 Exercise dilemmas 38:47 AC Joint Injuries 45:50 What is assessed? 51:35 RTP & RTS markers are different 01:00:09 Edel's closing thoughts 01:01:00 Contact Details 01:02:50 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

Summary In this podcast episode, we talk with Jente Wachemans, a physiotherapist and researcher specializing in ankle sprains and chronic instability. We discuss the nature of lateral ankle sprains, differentiating them from other types of ankle injuries, and touch on chronic ankle instability, a condition that remains somewhat ambiguous and under-researched. Jente emphasizes that while ankle sprains are common, particularly in sports, the transition to chronic instability isn't always straightforward and requires more prospective data for a clearer understanding. We also explore the prevalence of ankle sprains across various sports and demographic groups, noting higher incidences in females and younger populations. Jente shares his approach to managing ankle sprains, from the acute phase to return to sport, advocating for exercise-based rehabilitation and the importance of patient education. He highlights the Peace and Love principles for immediate post-injury care and emphasizes the role of neurocognitive tasks in rehabilitation. We also discuss the use of orthopedic tests, ultrasound, and the significance of understanding which ligaments are involved in the injury for effective treatment. Jente stresses the importance of not underestimating ankle sprains, ensuring proper rehabilitation to prevent recurrence, and the potential role of surgery in persistent cases.    Guest Jente Wagemans is a physiotherapist and researcher at the University of Antwerp who is currently doing is PhD in collaboration with Ulster Universtity and Bern University of applied sciences. As part of his PhD he has published several papers about ankle sprains and chronic instability.   Timestamps 00:00 Intro 00:49 What is a lateral ankle sprain? 02:04 How is it different from other sprains? 03:12 At what point do we talk about chronic instability? 08:00 Prevalence 09:36 The typical patient 11:22 Risk factors 14:00 Ankle mobility & strength metrics 15:07 Chronic Instability risk factors 18:45 Red Flag Awareness 23:46 PEACE & LOVE 26:45 Orthopedic Testing 31:20 When is MRI valuable? 32:54 Functional Assessment 36:37 Management Approach  45:18 Taping & Braces 47:13 Recurrence & Prevention 49:00 When surgery is indicated 52:10 Return to Sport timeline 56:20 Jente's closing thoughts 57:53 Contact Info 59:40 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this podcast, Dr. Claire Minshull shares her insights on teaching strength and conditioning to physiotherapists, emphasizing the practical application of academic knowledge. She discusses common mistakes in S&C practices, the importance of muscular strength in rehabilitation, and the significance of individualized exercise prescription for optimal outcomes. Claire also explores topics like measuring strength, rate of force development, and emerging technologies in strength training, underlining the need for patient-centered approaches and effective rehabilitation strategies. Guest Dr. Claire Minshull is a sport scientist, researcher and visiting professor at Leeds Beckett University in the UK. She has published more than 30 papers mainly on strength and conditioning and runs an educational company called Get Back to Sport Content 00:00 Intro 01:01 Claire's Journey in S&C 04:58 The issue with S&C in Physio 07:38 S&C Mistakes Physios make 13:36 Hypertrophy & Strength is important 18:43 How to gauge Strength 24:03 Compound vs. Isolation Exercises 27:19 How far to push Patients to Fatigue 33:26 Failure to adapt Exercise Prescription in Clinic 36:04 Rate of Force Development explained 42:47 Cross Education Effect explained 50:41 Tips to create Patient Buy-In to Exercise 55:06 Emerging Technology Highlights in S&C 01:01:56 Claire's closing thoughts 01:03:48 Contact Info 01:04:48 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this podcast episode, Dr. Kerstin Luedtkee discusses the topic of migraine headaches, providing insights into the definition, classification, and pathophysiological theories behind migraines. She explains the criteria for diagnosing migraine headaches, including the presence of associated symptoms such as nausea and sensitivity to light or sound. Dr. Luedtkee delves into the role of the hypothalamus as a key structure in triggering migraine attacks and highlights the importance of understanding the central nervous system changes that occur in individuals with migraines. Moreover, she emphasizes the need for a holistic approach in managing migraines, incorporating physiotherapy interventions alongside pharmacological treatments. Dr. Luedtkee suggests addressing musculoskeletal dysfunctions in the neck, providing education on migraine triggers and symptoms, promoting relaxation techniques, and encouraging aerobic exercise. She also mentions ongoing research areas focused on patient perspectives, the effectiveness of physiotherapy in migraine treatment, and the importance of incorporating patient feedback into future studies to enhance the overall management of migraines. Content 00:00 Introduction 00:37 Definition of Migraine Headaches 01:40 Migraine with Aura 03:30 Pathophysiology 05:30 The role of the Hypothalamus 07:36 Risk Factors for Migraine 13:25 Prevalence 16:44 The typical patient 18:29 Migraine and Chronic Pain 21:30 Red Flags 23:13 Other Diagnostic Measures 29:00 MSK Dysfunctions in Headache 31:18 The role of Vestibular Assessment 33:25 Subtype Vestibular Migraine 34:34 Physical Therapy Effectiveness 40:11 Guideline Management Approach 45:15 Added benefit of moving more? 46:16 Hot topics in Migraine Research 48:30 The Importance of the Patient’s perspective 49:56 Contact Info 51:15 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this podcast episode, Dr. Leanne Bisset, a musculoskeletal physiotherapist and associate professor at Griffith University, shares valuable insights on lateral epicondylalgia, also known as lateral elbow tendinopathy. She discusses the anatomy and function of the affected muscles, highlighting the importance of stability in wrist movements and the role of the extensor carpi radialis brevis. Dr. Bisset emphasizes the shift in terminology from epicondylitis to tendinopathy, debunking misconceptions around inflammation in the condition and providing a comprehensive overview of diagnostic considerations, risk factors, and red flags to look for during assessment. Furthermore, Dr. Bisset delves into the management of lateral elbow tendinopathy, emphasizing the significance of tailored exercise programs focusing on isometric loading initially, progressing to incorporate global upper limb strengthening for comprehensive rehabilitation. She also addresses the limited efficacy of modalities like shockwave therapy and the potential benefits of orthoses in pain management. Dr. Bisset's evidence-based approach underscores the importance of patient education, individualized treatment plans, and monitoring pain responses to optimize outcomes in the management of lateral epicondylalgia.   Guest Dr. Leanne Bisset is a musculoskeletal physiotherapist and an associate professor at Griffith University at the gold coast, Australia. She has published over 100 papers on a variety of topics and has done extensive research on lateral epicondylalgia.   Chapters 00:00 Intro 00:44 Definition of lateral elbow tendinopathy 05:39 Why Inflammation is inaccurate 11:49 Risk factors 13:46 The typical patient 17:34 Red Flags 27:30 Diagnostic tests 29:49 Leanne's Diagnostic Approach 32:27 Treatment 38:15 Details on Isometric Loading 49:29 Other treatments 54:02 Treatment Progressions 58:45 How much pain to allow 01:01:28 Shockwave and Dry Needling 01:03:56 Elbow Braces 01:05:50 Contact Info 01:06:58 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this episode of the Physiotutors podcast, Tom Goom, also known as the Running Physio, provides valuable insights into medial tibial stress syndrome (MTSS) and its management. He discusses the pathophysiology of MTSS, Risk factors, and emphasizes the importance of gradual training progression and proper footwear selection to prevent MTSS. Tom also shares his approach to assessing and treating MTSS, focusing on finding a pain-free level of loading, incorporating strength training, and carefully guiding patients through a structured return to running program. It's a value-packed episode so tune in to master your approach to treating shin splints. This episode is sponsored by Lindy.ai - your A.I. medical scribe. Try Lindy for free by going to lindy.ai/physiotutors and receive 1 week of unlimited patient notes.   Content 00:00 Intro 01:06 What is MTSS? 02:19 Risk Factors 03:34 Typical Patient 04:20 Specific Training Errors 05:40 Influence of Footwear 06:58 Forefoot Running 08:40 Red Flag Diagnoses 12:08 MTSS DIagnosis 13:06 Assessing the Patient 15:45 Muscle Testing 17:18 Sponsored Segment 18:55 Other Strength Parameters 21:05 Running Analysis/Technique 26:15 Treatment 29:29 Strengthening Exercises 31:58 What about Tibialis Anterior? 33:12 How to manage a flare-up? 35:25 Return to running 38:02 Different Mx for Different Sports 40:20 Duration of MTSS 41:35 Adjunct Treatments 43:30 Can MTSS become a Fracture? 44:25 Tom's closing remarks 46:25 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this podcast episode, Barbara Cagnie, a physiotherapist and manual therapist, discusses the topic of dry needling, providing valuable insights into its definition, physiological effects, and clinical applications. Dry needling is described as a technique used by physiotherapists to treat myofascial pain, with the insertion of thin filiform needles into specific trigger points aiming to reduce pain and restore muscle function. Barbara highlights the physiological basis of dry needling, emphasizing its effects on peripheral and central systems, as well as its potential impact on pain and inflammation. The discussion delves into the differences between active and latent trigger points, reliability in identifying trigger points, and the mechanism of referred pain. Barbara also addresses the evidence supporting the efficacy of dry needling in various musculoskeletal disorders, particularly in neck pain, highlighting the need for ongoing research to further explore its clinical applications. The conversation touches on the contraindications and potential risks of dry needling, emphasizing the importance of proper training and anatomical knowledge to minimize adverse events. The future of dry needling is also considered, with mentions of ultrasound-guided and electrical dry needling techniques. Barbara's expertise and comprehensive explanations serve to demystify dry needling and shed light on its clinical relevance. Her insights not only provide valuable information for physiotherapists but also instill curiosity about the potential of this technique in optimizing patient care.   Chapters 00:00 Intro 00:46 Defining Dry Needling 01:49 The Physiology 07:26 Difficulty of human studies 08:15 Active vs. Latent Trigger Points 10:05 Reliability Issues of TP Therapy 12:00 Referred pain in Trigger Points 15:40 The local twitch response 17:50 In-situ vs. winding technique 18:36 Research vs. Clinical Practice 20:22 Dry Needling for Tendinopathy? 23:58 Evidence for MSK Complaints 28:01 Contraindications and Risks 30:45 Needles vs. Hands 32:16 Kai's Dry Needling Anecdote 33:06 Are we chasing short-term effects? 35:26 Top 3 Reasons to learn Dry Needling 40:01 Closing thoughts 41:06 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

In this episode, Dutch researcher Corinne Visscher discusses temporomandibular disorders (TMD) with a focus on prevalence, risk factors, diagnosis, and treatment. She provides insights on the research she is currently focused on, particularly in understanding the journey of patients with chronic complaints related to TMD. Corinne also emphasizes the importance of screening for TMD, providing counseling and advice on habits, and referring patients to oral facial physical therapists or dentists when necessary. She also highlights the link between TMD and secondary headaches, and offers ways to reach out to her for further information.   Content 00:00 Intro 00:35 What is TMD? 01:18 TMD Prevalence/Incidence 02:20 The typical TMD Patient 03:23 Risk Factors 06:38 Red Flag Screening 09:20 The Diagnostic Process 14:05 Special Tests 15:25 Questionnaires 17:47 TMD & Headaches 19:30 Am I clenching my teeth? 20:40 Is posture a factor for TMD? 22:50 The course of TMD 27:09 A place for Dry Needling? 28:29 Other Manual Therapies? 31:50 Current TMD Research 35:05 Top 3 Takeaways 40:20 Tension-Type or TMD Headache 42:28 How to get in touch 43:08 Outro   Bonus Material To view and download the bonus content such as transcripts of this episode become a Physiotutors Member. All episodes and bonus content can be found here   Follow our Podcast on: Spotify | Apple Podcasts