Ep. 060 | Pain and Disability Drivers Management (PDDM) Model | Yannick Tousignant-Laflamme

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  

In this Physiotutors podcast episode, Canadian researcher Yannick Tousignant-Laflamme introduces the Pain and Disability Drivers Management Model, a groundbreaking approach to understanding and managing chronic musculoskeletal pain, particularly low back pain. This model identifies five key domains across three dimensions, going beyond biomechanics to reveal the root causes of pain and disability. It underscores the significance of interdisciplinary collaboration and effective communication among healthcare professionals. By integrating classification systems and prognostic tools, this model optimizes its effectiveness. Classification systems pinpoint patient subgroups, while prognostic tools screen for psychological factors affecting pain outcomes. Clinicians are encouraged to utilize these tools for screening, delving deeper for medium or high-risk patients. The incorporation of questionnaires and patient-reported outcome measures informs evidence-based decision-making. The ultimate aim? Personalized, evidence-based care for musculoskeletal conditions, addressing both physical and psychosocial factors. Curious to learn more about this innovative approach? Tune in to the full episode for a comprehensive exploration.   Guest Canadian researcher Yannick Tousignant-Laflamme is a professor at the School of Rehabilitation at the University of Sherbrooke. His research activities target the management of chronic pain associated with musculoskeletal disorders, particularly low back pain.   Content 00:00 Intro 00:40 What is the PDDM? 03:19 The 5 Drivers of Pain & Disability 07:56 The struggle with interdisciplinary care 11:15 Lifestyle within the PDDM 13:28 Why is PDDM more than a classification system? 17:23 Patient History within the PDDM 30:57 Why so many PROMs? 32:45 NSLBP - is it a helpful diagnosis? 39:37 Can Physiotherapists cover all 5 domains? 43:18 Is it all talking? 45:42 What has changed since 2017 49:28 How can we apply the PDDM? 3 Tips 51:26 Yannicks closing thoughts 53:15 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  

In this podcast, we explore scapular dyskinesis, the abnormal movement of the shoulder blade. We discuss related terms like scapular misalignment and sick scapula, questioning the practicality of assessing it through visual observation. We highlight that identifying it as normal or abnormal may not guide treatment decisions or pinpoint the cause of shoulder pain. We also address its prevalence in athletes and non-athletes and suggest using various tests to assess scapular dyskinesis. Intriguingly, we'll reveal a surprising connection between scapular dyskinesis and an unexpected aspect of training, which might change the way you think about shoulder issues. So, join us for the full episode to uncover this fascinating insight.   Guest Filip Struyf is a sportsphysiotherapist and professor at the Department of Rehabilitation Sciences and Physiotherapy at the University of Antwerp, Belgium. According to Expertscape, he is the #1 shoulder researcher world-wide. He teaches shoulder courses nationally and internationally and has created an online course together with us called “Rotator Cuff Related Shoulder Pain: Separating Facts from Fiction”.   Content 00:00 Intro 01:15 The "correct" definition  04:05 What is "normal" 12:05 Prevalence 14:21 Is it a functional adaptation? 16:46 Scapula Dyskinesia as a risk factor? 26:09 How do we assess it? 28:51 How reliable or valid is assessment? 32:39 Can we improve scapula movement? 39:09 What's up with focussing on the lower trapezius? 42:26 What about Rhomboid Pain? 46:21 Is there a place for scapula mobilization techniques? 49:42 Filip's closing thoughts 52:15 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  

In this podcast episode, sports physiotherapist and lifestyle expert Jaap Wonders discusses the several aspects of successful lifestyle interventions as part of the treatment plans in physiotherapy practice. He outlines the guidelines on proper sleep hygiene, diet and other important factors to take into account when prescribing a healthy lifestyle. We discuss the challenges of adopting healthy habits and what we can do about this. Content00:00 intro  00:45 Why the interest in Lifestyle? 02:50 How to deal with unhealthy lifestyles 05:52 Failing to meet movement goals 10:43 Movement snacks 12:28 10K Steps a Day. What's the deal? 17:55 Recommendations on Nutrition 20:55 Healthy vs unhealthy Protein 24:55 The importance of sleep 31:16 How we address stress 36:09 Positive Stress 38:15 Mindfullness 39:05 Cold Showers 42:10 What doesn't kill you makes you stronger? 47:22 Lifestyle interventions in chronic conditions 58:00 3 steps to a healthier lifestyle 01:03:20 Closing thoughts 01:05:08 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  

In this podcast episode, physiotherapist Sarah Michiels discusses somatic tinnitus, a type of tinnitus that is often caused by dysfunctions in the upper cervical spine and jaw. She highlights the prevalence of somatic tinnitus and the importance of a comprehensive diagnosis to rule out other causes. The talk provides insights into her evaluation and treatment approach, emphasizes the role of physiotherapy in improving muscle function and coordination to manage this debilitating condition. Content 00:00 Intro 00:46 Definition of Somatic Tinnitus 01:35 Tinnitus and the Cervical Spine 04:47 Prevalence of Tinnitus 06:22 Epidemiology of Tinnitus 08:15 Physiotherapy Diagnosis Possible? 10:30 ENT Diagnosis of Somatosensory Tinnitus 14:27 Special Testing for Tinnitus 16:00 Cervical Spine Assessments 17:35 Tinnitus and the Jaw 18:51 Red Flags 20:53 Physiotherapy Effectiveness for Somatosensory Tinnitus 22:00 Typical Treatment Course 23:20 What causes Improvements in Symptoms? 25:18 Tinnitus Relapse 27:10 Prognostic Factors 29:30 Sarah's Treatment Approach 31:48 Why Patients get worse 34:15 How to learn more about Tinnitus 35:10 Is MT knowledge required? 36:20 Sarah's Closing Thoughts 37:30 Could Van Gogh have been saved? 38:10 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  

Welcome to Physiotutors podcast episode 56 with Thomas Mitchell. Thomas is a wrist and hand specialist physiotherapist, and working toward his PhD at Sheffield Hallam. He is a physiotherapist of 25 years standing in primary care, private practice and sports. He is a First-contact Practitioner clinical supervisor and member of the British Association of Hand Therapists. He is also a Member of the Mulligan Concept Teachers Association, so the perfect person to talk to about the Mobilizations with Movement abbreviated as MWM. He is also an instructor for our online courses and has developed the complete upper limb focus together with Andrew Cuff. Content 00:00 Introduction  00:48 Definition of mobilizations with movement 02:42 Discussion on Mulligan's positional fault concept 04:14 Importance of symptom modification 06:39 Principles of mobilizations with movement 08:20 The concept of "Pill" in mobilizations with movement 10:36 The "Crocks" principle in mobilizations with movement 12:17 Empowering patients through functional positions 13:41 Personal adjustments in practice based on Mulligan's concept 15:33 Importance of Self-Treatment and Patient Expectations 17:03 Discussion on Plausible Fallacies and Patient Beliefs 18:40 Understanding Mulligan Concept and Pragmatic Approach 19:24 Explaining Treatment to Patients 20:40 Thomas Online Course 21:18 Differentiating MWM from Other Manual Therapy Techniques 23:16 Patient Control and Bottom-Up Approach in MWM 27:51 Evidence and Systematic Reviews on MWM 33:23 Importance of self-treatment and clinical expertise 35:57 Application of MWMS in chronic pain patients 37:40 Challenges with musculoskeletal rehab in the UK 40:13 Effectiveness of MWMS for lateral epicondylalgia and De Quervain's disease 44:34 Benefits of mobilizations with movement 47:36 Learning resources for Mulligan concept and MWMs 49:17 Thomas closing thoughts 51:08 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  

This episode of the Physiotutors podcast features Julia Treleaven, a researcher and physiotherapist, who discusses cervicogenic dizziness and its diagnosis. We delve into the condition's pathophysiology and prevalence in patients with chronic neck pain. We also discuss red flags to watch for during patient history taking and differentiating cervicogenic dizziness from other forms of dizziness. The episode covers functional tests used to assess balance and motor control and treatment options, including sensory-motor exercises, manual therapy, and posture correction. The discussion emphasizes the importance of focusing on the neck's role in such cases rather than just diagnosing the condition.   Content 00:00 Introduction 01:20 Definition 06:36 Characteristics of Cervicogenic Dizziness 12:08 Physical and Orthopedic Tests for Cervicogenic Dizziness 15:03 Functional Assessment for Cervicogenic Dizziness 18:25 Treatment for Cervicogenic Dizziness 26:10 Progressing Sensory Motor Control Exercises for Cervicogenic Dizziness 29:46 Role of the neck in dizziness 32:08 Research endeavors in neck-related dizziness 34:58 Determining the role of the neck in dizziness and the controversy of cervicogenic dizziness   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  

Nicol van Dyk is a physiotherapist and clinical researcher currently occupying the role of Injury Surveillance and Medical Research Officer with the Irish Rugby Football Union in Dublin, Ireland. In 2018 Nicol completed his PhD in Health Sciences at Ghent University, Belgium titled “Risk factors for hamstring injuries in professional football players.” During this time Nicol was a physiotherapist at the Aspetar Orthopaedic and Sports Medicine Hospital. In this episode we are joined by Nicol van Dyk. We discuss injury prediction and screening tests, individual risk factors for athletes at risk of injury, the importance of clinical reasoning and individualized approaches as well as why it rains so much in the Netherlands.... This was a great episode to record and we hope you enjoy it.   Content 00:00:00 Introduction 00:01:00 Screening tests and injury prediction 00:05:10 Importance of screening tests in injury prevention and building athlete trust 00:13:14 Importance of Previous Injuries 00:17:47 Role of Technology and Social Support in Rehab 00:21:35 The Significance of Sleep in Injury Prevention 00:26:41 Understanding individual athlete risk factors 00:30:10 Importance of clinical reasoning and individualized treatment 00:38:08 Using mixed methods approach for injury prediction 00:41:09 Injury prediction vs risk estimation 00:44:32 Focus on performance and robustness 00:46:24 Importance of communication and empathy in physiotherapy   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