We speak with physiotherapist, Rich Severin [DPT, PhD(c), CCS] about the importance of screening for cardiovascular risk factors during musculoskeletal assessments. Rich discusses a case study demonstrating the impact that screening can have, how you can screen in your practice, and the #VitalsareVital campaign.
Find out more about Rich:
Twitter: @ptreviewer
Instagram: @pt_reviewer
00:56 Can you introduce yourself?
02:32 What made you interested in doing two specialties?
04:29 What got you started with the vitals campaign?
08:44 What is the education like in schools for cardiovascular screening in MSK?
11:24 Can you take us through a case study?
15:24 Were you screening regularly at that point or was it the history that prompted you to take blood pressure?
16:52 Do you take blood pressure in younger populations?
18:49 Is there anything that you include in your screen beyond heart rate and blood pressure?
19:35 Is there any pushback from clinicians about implementing this in an assessment?
24:50 What cutoff values do you use for blood pressure? When would you refer someone on?
27:53 Do you have a standardized method of screening that you use in your clinic?
31:35 How is high blood pressure diagnosed?
33:15 Guidelines are to measure blood pressure in both arms, what accounts for differences between arms?
34:06 How immediate are changes in blood pressure with exercise?
38:13 How long would it take to see long term changes in hypertension?
39:18 What equipment do you use for testing? With exercise?
43:49 Does hypertension have an effect on orthopedic conditions?
47:32 More on the Vitals are Vital campaign
52:38 Where can people find out more about you?
We speak with physiotherapist, Dr. Daniel Harvie [B Physio (hons), M Musc & Sports Physio, PhD, Postdoctoral Research Fellow] about the use of virtual reality in the treatment of pain. Dan discusses the current uses of VR in acute pain, potential uses for persistent pain, and where he sees the future of VR heading.
You can learn more about Dr. Daniel Harvie on Twitter or LinkedIn
00:25 Can you introduce yourself?
01:29 Can you tell us about what you were doing for your PhD?
02:56 Can you tell us about your interest in virtual reality?
04:23 What is the history of using VR therapeutically in pain management?
09:18 Do you find that cost will be a barrier for using this type of technology?
10:02 Do you envision VR being used clinically?
10:41 What is it about the visual part of VR that leads to such a powerful effect?
13:24 Where would you like to see the future of VR going?
14:24 Can you tell us about the VR you use in the Brain Bus and how you use this to explain persistent pain?
16:14 Has there been any research with augmented reality?
18:10 How frequently would you have to use VR for pain for someone to have a therapeutic effect?
19:21 Do you have other areas of interest with research?
23:59 Are there normative values for two-point discrimination?
25:47 Are there biomarkers for pain that you think will show promise in the future?
We speak with Pharmacist, Pene Wood (PhD, BPharm, Lecturer in Clinical Pharmacy at La Trobe University), about the growing issue of opioid dependence, appropriate uses for opioids, and alternative solutions.
00:27 Can you introduce yourself?
00:56 Can you give us an overview of what opioids are, what opioid dependence is, and why this is a big issue lately?
03:54 What are the appropriate uses for opioids?
04:40 What are the stats on opioid addiction?
05:30 Why has it taken so long to find out the dangers of opioids?
06:44 What are other medications or non-medicinal options for people?
08:03 How can physiotherapists and other HCP’s help people who have been taking opioids long term?
10:36 How much interaction do you have with patients about alternatives to opioids?
12:32 Are there any signs of opioid dependence?
13:39 Are there certain medications that are over prescribed? Nerve pain medications?
15:24 What is the process like for someone to wean off opioids?
16:16 Can you tell us about your pain experience with your fall off your bike and dislocated elbow?
18:52 Any new insights from this injury?
19:34 Any advice you have for people who have gone through an injury and then developed chronic pain?
We speak with Prof Dave Walton, PhD, an associate professor at Western University School of Physical Therapy. Dr. Walton has been a strong advocate for incorporating technology into physiotherapy practice. In 2017, he traveled across Canada for the Physio Move Canada project to address the future of the profession. He speaks with us about a wide range of topics including:
- Artificial intelligence (AI) in rehabilitation
- Virtual reality (VR) in therapy
- Biomarkers for persistent pain
- Evolution of physiotherapy education
- The use of outcome measures in clinical practice
- And much more!
We speak with Canadian Men’s National Basketball Team Performance Coaches Charlie Weingroff and Karamvir Gill about their experiences working with the team, getting injured athletes back to playing, and how training = rehab.
Visit Basketball Canada or Charlie Weingroff's website for more info.
00:28 Would you like to introduce yourselves?
01:02 Can you talk about your experience working for team Canada basketball and how you approach working together?
03:58 What’s your framework for developing a well-rounded strength and conditioning program?
06:17 At what level of sport or what age do you think it is important for kids to learn strength and conditioning?
08:22 There’s a lot of overlap between rehab programs and strength and conditioning programs. Do you look at those separately or together? How do you approach that?
10:08 What about if a player was recovering from an injury?
12:27 For physios or clinicians who aren’t working closely with a team but may be treating athletes, how would you suggest they communicate with the team coaches/strength coaches?
13:06 How can a physio at a clinic help to integrate their athlete back into their sports program?
16:34 How do you transition athletes back to playing? How do you determine when an athlete is ready to play again?
19:46 Do you use an athletes pain level as an outcome measure?
21:43 Do you incorporate pain science education into what you do with your athletes?
24:08 What are your opinions on biomechanics and how do you incorporate that into an athletes performance?
28:01 What are your thoughts on traditional physio equipment such as therabands?
28:56 Some physio clinics you go to, theres a treatment table, theraband, and weights up to 10 lbs. Do you think that is enough to get an athlete back to a high level of sport? Eg. A basketball player.
30:47 For clinicians who have not been taught a lot of strength and conditioning principles, do you have any recommendations on where they can learn that?
31:34 Do you think that strength training fundamentals should be taught in physio school?
33:02 Is there any technology that you see up and coming in this field?
33:31 Is there anything that you would like clinicians who don’t have a great idea of what you do to know?
37:19 Anything else you’d like to add in?
We speak with Johnny Owens, PT, from Owens Recovery Science. Johnny gives a great overview of blood flow restriction training and its use in the rehabilitation setting. This podcast covers a lot of ground, including:
- The basics and science behind blood flow restriction
- How to use it clinically
- What patient populations can benefit from BFR
- Risks and contraindications
- Future applications and research
- And more!
To find out more, you can listen to Owens Recovery Science podcast.
00:25 Can you introduce yourself?
00:58 How did you get started with Blood Flow Restriction (BFR) and what made you decide to start an educational company?
03:09 What is BFR and how does it work?
07:13 Is the research in this area new or has it been around a long time?
4.What is the theory behind BFR?
5.What is the current research on BFR and what is still unknown?
08:33 What are the main populations that can benefit from BFR?
11:20 Are there any contraindications to using BFR?
13:39 Do you have to have a certain occlusion pressure to get the effect?
16: 32 What are the risks with BFR?
18:52 Any neural or sensory issues from the compression?
21:20 What is your opinion on the cheaper pump up cuffs without Doppler ultrasound to determine limb occlusion pressure?
24:29 Is there are a minimum frequency that must be achieved with BFR to make clinically significant changes?
25:50 If the cuff has to be proximal to the area that is worked on, how can it be effective for something like shoulder rehab?
29:01 A few studies cite the 30-15-15-15 protocol. Is this just a generic approach to prescribing BFR based on current research or is there more flexibility in prescribing BFR?
33:24 Would you do multiple exercises in one session with the cuff on?
35:34 If someone can lift over 75% of their max, do you not use a cuff?
36:11 What about using BFR for non-injured athletes (for performance)?
39:01 What are your thoughts on non-health professionals using BFR?
40:59 Are there screening questionnaires for BFR?
42:18 When after an injury or surgery would you start using BFR?
45:33 What are some big unknowns you hope will be answered with future research?
48:04 What about use of BFR in hospitals?
48:55 Where can people find out more about you?
“Restricting activity in the hopes of saving your vagina is not holistic womens health”
We speak with Antony Lo (Musculoskeletal Physiotherapist based in Sydney, Australia) about pelvic health considerations in the female athlete and Crossfit training and injuries.
To find out more about Antony, visit: http://physiodetective.com
00:28 Can you introduce yourself?
00:55 What got you interested in women’s health?
03:05 How often do you treat males with pelvic floor dysfunction?
03:59 How do women perceive you as a male in this career path?
05:24 How do you explain what you do to women?
06:53 How do you assess what the pelvic floor is doing without an internal exam?
08:32 What are some of the biggest myths about pelvic floor dysfunction that you are hoping to dispel?
14:01 What are your thoughts on crunches and sit-ups?
17:20 How do you teach women to control their pressure system?
19:29 How did you get involved with crossfit?
22:10 Sometime crossfit gets a bad reputation because of injury and the structure of the workouts, what are your thoughts on that?
26:37 Are there any common injuries that you see with treating crossfit athletes?
28:49 How important is modifying load as a treatment intervention?
30:28 Do you find athletes have a hard time with being told what they can/cannot do when they are injured?
34:48 What cues do you use to teach pelvic floor contractions to an athlete vs. someone who’s not doing a high level of sports?
37:36 How do you explain to someone how much they should be squeezing?
38:44 How do you get people to the point where they can use that contraction in a functional movement?
40:14 Do you think that the pelvic floor should be discussed at the beginning for anyone in sports, or just if there is dysfunction present?
43:40 How do you get people back to a higher level of sport?
47:23 What are your thoughts on breathing and lifting?
50:28 What do you think about the use of weight lifting belts?
53:32 Anything else you’d like to touch on?
"'If you just hold your tummy tight you’ll be fine’…we’ve communicated, stiff equals strong, but really that dynamic quality is more like function and fitness, we move and so that system needs to move too to mimic that”
We speak with physical therapist Julie Wiebe about the role of breathing and the pelvic floor in the core system, and how this can be integrated into fitness. Julie also discusses common patterns she sees in assessments and how changing these patterns can improve someones function.
Visit JulieWiebePT for more info.
00:29 Can you introduce yourself?
01:53 What are your thoughts on pregnancy and exercise?
03:14 Can you explain the core system?
04:26 How does breathing and the pelvic floor work together?
05:57 Why do you call that piston science?
07:15 How can someone’s breathing pattern become altered?
09:40 What are some common breathing patterns you see?
11:09 Is belly breathing a good strategy to use?
12:52 When do you assess peoples breathing pattern?
15:20 How do you pick up a patients breathing pattern in an assessment? Do you tell them you’re looking at their breathing?
16:19 Do you think that someone’s posture has a big effect on breathing?
17:33 How do you get people back to sports/activities?
19:08 How long does it take people to change their breathing pattern without having to think about it?
21:09 How often do you get people to use these patterns to reinforce the strategy?
22:31 How do you help athletes going back to sports where they cannot use an optimal breathing strategy?
24:45 Are there good and bad ways of breath holding?
27:52 How do you know how someone is using their pelvic floor with sport specific movements?
29:38 Do cues for breath holding change if someone is wearing a weight lifting belt?
32:41 For non-pelvic health physios, when would you recommend they refer to a pelvic health physio?
35:07 How do you test core strength?
36:11 What are the basic movements you look at in a first assessment with someone?
36:49 What are your thoughts on knee valgus with single leg squat?
39:14 Is there any research that involves the pelvic floor and core/breathing system?
42:05 Where can people find out more about you?
"If you use a metronome to pace your strength training activity, what you get are the changes that you want at a muscle and tendon level, but you also get the changes to your motor cortex."
We speak with Dr. Ebonie Rio [Ba. App Sci, Ba Phys (hons), Masters Sports Phys, PhD] about tendon neuroplastic training, how the brain is involved in tendon pain and what the future holds for tendon rehabilitation.
To learn more about Dr. Ebonie Rio visit LaTrobe University
00:25 Can you introduce yourself?
00:39 What are your main areas of research?
01:05 Can you describe how the brain is involved in tendon pain and rehab?
03:12 As physiotherapist, how can we address this brain involvement?
04:36 Why use auditory cues? Why not visual cues?
05:52 How can you use a metronome clinically with patients?
06:52 With patients are you starting with slower speed and increasing speed as they are able to load their tendon more?
08:17 What rehab phases do you feel are necessary to restore a tendon to full function?
11:08 Why are isometrics so effective in reducing pain?
14:11 Does the exercise you are using to do an isomeric matter?
15:33 If someone has pain with heavy isometrics, does that mean they don’t have a tendon pathology?
17:23 What protocol works best? (Isometric vs. eccentric vs. heavy loading)
18:43 Is strength training important in rehab for someone returning to a sport like running where they don’t usually do strength training?
20:11 How do you monitor tendon load clinically?
21:32 How much pain are you are okay with patients experiencing with their exercises?
25:00 How often do you suggest people do quick loading during rehab?
26:05 What outcome measures do you use clinically?
27:23 Are there general time frames for recovery?
28:39 Why is there more research with tendons in lower extremity vs. upper extremity?
29:40 Are the major principles of treating tendon injuries the same across different tendons?
31:38 What are your thoughts on bracing for tendon injury
32:46 Do you think that virtual reality can have any use in tendon rehab?
36:11 What is still unknown in the treatment of tendinopathies? Do you think these unknowns can all be answered?
38:15 Where can people find out more about you?
“Pain and pathology aren’t necessarily related. So you can have profound pathology, profound degeneration in your tendon and have no pain”
We speak with professor Jill Cook [PhD, Grad Cert Higher Ed, PG Dip Manips, BAppSci (Phty)] about tendon pathology, pain, and rehabilitation.
Visit LaTrobe University to contact or find out more about Jill Cook.
00:25 Can you please introduce yourself?
00:54 Can you clarify the terminology for tendon pain? (tendinitis/tendinosis/tendinopathy)
02:01 Can you describe the structure of tendons and what makes them unique?
03:28 What happens with a tendon when there is injury?
04:28 If tendons do not recovery, how do people have success with physiotherapy and tendon loading?
05:15 Why are tendon injuries imaged?
06:39 How do you explain tendon pathology to a patient?
07:34 Are pathologic tendons more likely to rupture?
10:17 What are the differences in outcomes for surgery vs. non surgery with tendon ruptures?
11:25 Is surgery ever indicated for a tendinpathy?
12:31 In kids you don’t see many tendon ruptures, you usually see avulsion fractures first, why is this?
13:54 If there is tendon change with age, should older adults load their tendons less?
14:50 Is there anything that can be done to prevent age related changes in a tendon?
15:49 Are there any risk factors for tendon pathology?
16:46 How do you engage patients in a rehab program when research suggests exercise is the best treatment?
18:15 What are your thoughts on injectables? Do they change tendon structure at all?
19:54 What are your thoughts on shockwave therapy?
20:46 What about the role of manual therapy in tendon treatment?
22:16 Is there anything clinically that should not be done when treating a tendon injury?
23:56 How do you balance tendon load vs. pain with loading?
25:33 Is pain reduction a good indication of recovery?
26:51 What is the importance of the kinetic chain in tendon rehab?
28:26 Does all of the research for lower limb tendon injuries hold true for the upper limb as well?
29:40 If a tendon is overloaded, how can loading it change pain?
31:08 Is there a prognosis for tendon injuries in terms of how long it will take to improve?
32:28 For people with longstanding tendon pain, is it common for them to develop central sensitization?
32:28 What has been the evolution of tendon rehab and where do you see it going in the future?
35:25 Is there any inflammation with tendon pathology?
36:35 Why does rest not help with tendon recovery?
37:20 How comfortable are you pushing people into pain with loading?
38:18 How often do you suggest people load their tendons?Show more...
"Why are we trying to decrease inflammation? Inflammation, the last I checked, was an amazing thing, it's a good thing!"
We speak with physiotherapist, Dr. Bahram Jam [D.Sc.PT, M.PHTY, B.Sc.PT, FCAMT], about the evidence behind the use of ice post soft tissue injury. Bahram also discusses the effects of ice, heat, and anti-inflammatories on the body's healing process.
To read Bahram's article on Ice and for references to studies visit:
00:28 Can you introduce yourself?
01:03 Patients often ask if they should use ice or heat for an injury. How do you answer that?
02:10 Do you think that peoples preference (ice vs. heat) has an influence on their pain?
03:35 Can you explain how the inflammatory process works and how ice would influence that?
06:49 Is there any research that ice may have a negative effect after acute injury?
08:28 What are your thoughts on ice baths and whole body cryotherapy as a recovery tool?
10:41 What do you think is the best way to reduce swelling?
11:42 What are your thoughts on Rice vs Price vs Police post injury?
13:21 What would you suggest to help with recovery for people with mobility restrictions eg. Non-weight bearing or in a cast?
14:11 A common use of ice is post-surgery. What are your thoughts on ice machines post-op?
15:54 What about the use of heat post injury?
16:50 What are your thoughts on the use of anti-inflammatories post injury?
20:42 What about the use of topical anti-inflammatories?
21:31 Where can people find out more about you?
You asked, they answered!
Three top pain scientists - Prof Lorimer Moseley, Dr. Tasha Stanton, Dr. David Butler - answer your burning questions about pain science. This episode is live from the Pain Revolution event in Australia.
Thank you to all who contributed questions and special thanks to the online communities who collaborated with us to make this podcast possible: Trust Me I'm a Physiotherapist, PhysioTutors, Rethinking Physiotherapy, GetPT1st, InfoPhysiotherapy and Exploring Pain Science. Check them out on Instagram, Facebook, and Twitter.
00:30 What is pain?
01:24 What do you tell a patient who answers you "So it's just in my head?"
02:07 How can we change people's general knowledge (before they become "patients") about pain and pain management?
03:09 What metaphors and analogies do you use with your patients?
04:38 How much is it possible to deliver in a 20-minute clinical education setting? What would you focus on?
05:37 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?
06:22 What is one piece of advice you would give to someone suffering from persistent pain?
07:11 Those of us in the profession like to dig deep in the science and research, but what the overall public is interested in is far more practical - what can we do? Data alone hasn't convinced many, how can we better explain what's going on in a simple, understandable way?
09:24 What are some exciting new advances in pain science that you think will impact clinical practice in the near future?
10:43 What are the biggest barriers in making physio and pain management move forward?
11:56 How do you see the role of manual therapy in both acute and persistent pain - assuming an ethical and accurate explanation (as opposed to a PSB model approach)
13:35 What is the most effective way to implement a pain science approach in chronic regional pain syndrome (CRPS), and how should medications be used during implementation?
16:44 What can you tell us about pain thresholds? Could a pain threshold be more about coping/ pain tolerance or is there an actual inter-individual difference on a neurological level, such as our perception, or even a nociceptor level?
18:45 Does the health industry need to change the way it understands and treats pain? if yes - what are your suggestions?
21:18 With the biopsychosocial model, there is often a focus on the psychosocial factors, where does the bio fit into all of this? Where does it come into play or are they thought of very separately?
23:09 How do you explain pain to an uneducated patient who thinks treatment is a quick fix? My challenge is breaking down the information simply enough for such patients to understand.
24:48 What changes do you think healthcare professionals need to institute in the treatment of acute pain, in order to help prevent transition to chronic pain states?
26:29 What is your go-to one liner to explain Central sensitization to your chronic pain patient? How do you explain this on day one without loosing the patient?
29:37 Please explain fibromyalgia.
31:10 How does stress and emotion contribute to pain manifestation at different sites?
34:14 Mindfulness, how can it be used to work with people’s pain management/ perception?
36:32 I want to hear their answer on a question asked by Mick Thacker: If pain is a perception, then how does the neuro-physiology involved go on to be become a higher centre cognitive function?
40:13 Children who fall over in the playground experience a broad range of responses from their parents ranging from a "toughen up" type of indifference right through to overt and excessive concern. How might these paren
"Some of the biggest manufacturers in Canada and the US often claim to make custom product when they’re actually using stock item shells and creating orthotics that are not actually unique to the patients feet."
We speak with Aaron Tran, pedorthist and founder of Orthogenic Laboratories, about custom foot orthotics - what they are, what conditions they help treat, how they're made, and how to tell if they are truly custom.
To find out more visit http://orthogeniclab.com
00:25 Can we start by having you introduce yourself?
01:06 Can you give us an overview of what Orthogenic Lab does?
01:42 What are the differences between the types of foot specialists?
03:28 What are orthotics and why are they important?
04:35 What types of conditions can orthotics help with?
05:22 Can orthotics help conditions that are not foot related, such as low back pain?
06:25 Are orthotics a temporary or long term solution?
08:12 Do you recommend that if someone has orthotics they use them all of the time?
09:43 What are the components of an orthotic? What are the purposes of the different layers?
10:16 What are the common materials used in orthotics?
10:57 Can you tell us the purpose of the different parts of orthotics?
12:21 Is there a difference between hard and soft orhtoics?
15:00 Do orthotics make your feet lazy?
16:03 What are the different methods of casting orthotics? How accurate are they?
18:50 What is the difference between a weight bearing vs. non weight bearing casting?
20:02 Once someone is casted, what is the process of making the orthotics?
22:46 What type of process do you use at Orthogenic Lab?
24:35 Do you think technology will keep changing your profession?
25:33 Do insurance companies cover the cost of orthotics made using a 3D scanner?
26:44 What is the difference between custom and off the shelf orthotics?
28:26 There have been a few articles about off the shelf orthotics being advertised as custom made. What are your thoughts on that?
30:50 Is there a cost difference between off the shelf vs. custom?
31:28 What should patients look for when purchasing orthotics?
33:01 Are there any regulations for selling orthotics?
34:40 What healthcare providers can prescribe orthotics?
35:55 How can healthcare providers who don’t prescribe orthotics screen a patient to see if they may be appropriate for them?
37:16 Are there any online resources for healthcare providers to learn more about different conditions orthotics may help?
38:10 Where can people find out more about you?
“If there’s no bio (in biopsychosocial), why are there physios?...For a long time we said every body has a brain, meaning don’t forget there’s a brain attached, but we have to also go backwards and remember that the brain has a body”
We speak with physiotherapist Adriaan Louw (PT, PhD, CSMT) about pain neuroscience education, including layman's explanations and metaphors to help patients better understand their pain. Adriaan discusses the science behind pain education and current research in this area. He also addresses the biosychosocial model, and the importance of including the bio in a pain science approach.
For more information visit www.ispinstitute.com
00:24 Can you introduce yourself?
00:42 What was your PhD in?
01:21 How did you get involved with pain neuroscience education?
02:18 Can you define Pain Neuroscience Education?
03:14 Can you give us a 5 minute layman’s explanation to describe pain?
06:47 What metaphors do you use to help patients understand their pain?
07:43 How does neuroscience education actually work to change someone’s pain?
09:24 What is the latest evidence to support this as a treatment intervention? How strong is this evidence?
11:04 What are some common pitfalls when explaining pain neuroscience to patients?
12:24 How do you change your explanations to suit the patient in front of you?
14:10 How do you explain the difference between acute and chronic pain?
16:10 How do psychosocial and lifestyle factors influence pain?
17:26 How do you like to address Pain Neuroscience Education when working with patients who are highly invested in the belief that structural pathology/biomechanical flaws are the source of their pain?
20:44 If a patient is seeing other health professionals who have been given other explanations about their pain, how do educate them without undermining the other HCP’s?
23:20 Depending on where you practice, there is very limited time during a treatment session. Do you have any strategies for therapists to incorporate pain neuroscience in that kind of setting?
25:44 It seems that the pendulum has swung heavily in favor of addressing the psychosocial aspects of chronic pain. How important is the bio aspect in chronic pain?
28:44 How do you explain why you are doing manual therapy to a patient?
31:26 Are there any specific words that you feel should never be used when educating someone about their pain?
32:53 What treatment approaches do you find work best for patients with allodynia and/or strong central sensitization?
33:50 How important do you think movement and exercise is in treatment?
34:25 What research questions are you hoping that get answered in the future?
37:21 Where can people find out more about you or your work?
In this episode, physiotherapist Darryl Yardley (FCAMPT, B.Kin (Hons), M.Sc.(PT), M.Cl.Sc.(Manip), Chair Private Practice Division – Canadian Physiotherapy Association, Founder - Mentorship Bootcamp) answers questions from students and new grads. Topics include job hunting and applying for jobs, contract negotiations, salary, building a caseload, and mentorship for both private and public sectors.
To find our more visit http://cpaprivatepractice.ca
00:37 Can you introduce yourself and your background?
02:38 Today we are getting your answers to some student and new grad questions that were collected from physiotherapy schools across Canada.
02:50 The first question is: What is the best way to build a caseload when first starting out?
06:01 Do you have any suggestions on how new grad can market themselves when they don’t have much experience?
08:00 One of the biggest questions that was asked is: What is the difference between an independent contractor and an employee.
12:08 As an independent contractor, when should you incorporate?
13:35 How do you make sure your billing number is being used appropriately?
16:35 How do you know if there is someone else using your billing number if it is public information?
18:55 For physios starting out, is it better to learn through experience or take a lot of courses?
23:42 Do you have any tips for physios starting in a clinic where there are already established PTA’s?
26:02 For those working in publically funded settings, how do you maintain quality care given restraints?
29:25 It seems like every hospital job wants 1-2 years of experience in the field. Seeing as new grads have limited experience through placements, how can they possibly demonstrate that they have the skills and experience to be employable?
32:24 If a hospital or clinic does not offer mentorship, how do you suggest that students or new grads seek out that external mentorship on their own?
36:08 In a hospital setting, how can new grads get full time employment?
39:04 How difficult is it to transition from hospital to private practice and vice versa?
41:10 There seems to be a perception that private clinics lead to a bigger income compared to hospitals? Does this hold true in the long run (5-10 years) with benefits and pension factored in?
44:05 Where should new grads start when looking for a job?
47:11 Do you recommend applying for jobs even if you don’t have the required experience?
48:53 What is negotiable in a contract?
49:52 Are there any questions you feel new grads should ask in an interview?
53:27 What starting salary should a new grad expect?
55:55 How often should you renegotiate your contract?
58:24 Are there any ethical issues/business red flags that new grads should be aware of when job hunting or starting out at a new clinic?
1:02:56 How long should you practice before opening your own clinic?
1:07:15 What are some benefits of being a CPA member?
1:09:33 Where can people find out more about you?
"Degenerative change is not something we really want to put cortisone in and around if we can avoid it, because the pathology in that situation is not inflammation...On top of that you've added a drug that can be degenerative to tissue that already is degenerative, and for that reason again I'm reluctant to use cortisone in most situations."
In this podcast, Dr. Douglas Stoddard (MD, Sports Medicine Physician and Founder of RegenerVate) gives an overview of therapeutic medical injections, including: Cortisone, Prolotherapy, Viscosupplementation, Platelet-rich plasma (PRP), and Stem cells.
These injections are used to treat a variety of musculoskeletal injuries and are considered if conservative treatment fails. Controversy still exists around regenerative and non-regenerative injections. Conflicting research shows either favourable or unfavourable results depending on the type of injection. Whether medical injections will be standard in musculoskeletal medicine remains to be seen.
00:28 Can we start by having you introduce yourself?
00:44 So what are the different types of injections used in sports medicine?
02:01 What are the differences between the injections? How do you determine which one to use?
03:33 What are the physiological mechanisms of how these injections work?
04:30 Can you explain the procedure of these types of injections?
06:27 Are all the injections done using ultrasound guidance or just the PRP and stem cell?
06:57 With stem cells, are there different types of stem cell procedures?
07:35 What are the criteria for someone to be eligible for these treatments?
09:04 So for healthcare practitioners who treat that level 1, at what point would you say that they should refer a patient on to discuss injections?
10:16 How long do the results of the injections normally last?
11:15 For someone who does get an injection, do they need to then continue with those level 1 interventions, like physiotherapy, after the injection?
12:19 Are there are specific protocols that therapists should be following for patients post injection?
12:54 What are the risks of the injections?
16:01 Are there any patients who you would not give an injection to, for example someone with a lot of comorbidities?
17:55 What are you noticing clinically with your outcomes of these injections?
19:15 How do you determine whether an injection is successful? Is that largely based off of the patients’ report of pain levels and function?
20:38 What is your opinion on the use of corticosteroids in sports medicine?
23:05 For a patient wanting a repeat cortisone injection, would you direct them more towards the regenerative injections?
24:04 With any of these injections do you do imaging before to find out the condition of the tissue?
26:04 I know there’s a bit of skepticism around PRP and stem cell injections because they’re still consider new and there’s not a ton of research on them and they haven't been proven in clinical trials. So what are your thoughts on this?
29:37 Are there any regulations around the field of regenerative injections?
32:19 Where do you see the future of these types of injections going?
33:45 What is the training like to be able to provide these services?
34:37 Where can people find out more about you?
"What I’ve learned is that when a muscle becomes wasted, its not just because of a lack of impulses from the nerve into the muscle, its not just a lack of activity, it’s being told by a trophic factor produced by the nerve to get wasted"
We speak with physiotherapist Michael Shacklock (DipPhysio, MAppSC, FACP, NDS Instructor and founding director) about neurodynamics, nerve dysfunction, the anatomy and physiology of the nervous system, diagnosis and treatment of peripheral nerve disorders, and patient education.
Check out the summary video we did with Michael on Why Do Nerves Become Hypersensitive?
To find out more about Michael, visit his website, Twitter, Facebook and Instagram.
Shownotes:
Neural Mobilization: Treating Nerve-Related Musculoskeletal Conditions
00:29 Can we have you introduce yourself?
02:05 Can you explain what neurodynamics are?
03:22 Are there any terms that are important to understand when discussing neurodynamics?
04:12 Can you provide a layman’s explanation of the function of nerves and how structure relates to its function?
05:17 What are the mechanical properties of nerves?
06:54 How much mechanical load can a nerve tolerate?
07:35 How do nerves become injured or sensitive? What is the physiological response in the nerve?
08:41 How about with ischemic injuries?
09:52 How does the nervous system respond to movement and why is movement effective?
12:13 Clinically can you determine elongation values?
13:14 Can you describe the difference between a sensitive nerve and a damaged nerve?
14:37 Do neurodynamic tests and medical tests if there’s a nerve condition look at the same thing?
15:37 What medical tests or subjective history may point to a nerve issue?
16:17 What constitutes a positive neurodynamic test?
18:40 Can neurodynamic tests selectively load or bias a specific nerve or nerve root?
19:45 What exactly is occurring in the body when you perform a sensitizing movement?
21:45 Can you explain what double crush syndrome is?
23:38 What has been the evolution in the treatment of nerve issues?
26:53 How important is treating the mechanical interface?
28:22 How long does it take a sensitive nerve to return to normal?
29:36 Can you discuss chemical irritation a bit more?
30:46 What are some common misconceptions surrounding nerves and nerve pain?
There are some common explanations that you hear when clinicians explain nerves, and we’d like your opinion on them:
32:34 - a nerve is like a telephone wire.
33:07 - Your nerve is stuck?
35:46 - When you’re doing neurodynamic exercises you’re stretching nerves
36:37 Can you give an example of how you would explain a nerve issue?
37:24 When hearing the word swollen, do some patients think that they have a big inflammatory resp
Sanjeev Bhatia (CEO and co-founder of Clinic Space) returns as guest host to interview Charlotte Anderson (PhD(c), MScPT). Charlotte is a physiotherapist and owner of Alpha Health Services, a multi-disciplinary rehab clinic she started over 4 years ago. In this podcast, they explore the challenges of starting, managing and growing a private practice.
You can follow Sanjeev on Instagram @thesanjeevbhatia or find him on LinkedIn.
To find out more information about Charlotte visit https://www.alphahealthservices.ca
This Business Series is in partnership with the CPA Private Practice Division. Check out http://cpaprivatepractice.ca for more great business content and stay tuned for the next instalments of the business series.
"The real key with the Mulligan Concept and its effectiveness is that you know you're in the right place, doing the right technique, in the right direction, with the right grade while you're doing it, by symptom abolition."
We speak with physiotherapist Jack Miller [BSc(PT), DipMT(NZ), MClSc, DPT, FCAMPT] about the Mulligan Concept, including common terminology, techniques used, and current research. Jack also discusses the structure of the Mulligan Concept courses that he teaches.
To find out more about Jack Miller and the Mulligan Concept visit www.mulliganconcept.ca
00:24 Can you introduce yourself?
00:52 How did you get involved with the Mulligan Concept?
01:41 Can you explain what the Mulligan Concept is?
03:18 Can you explain the terminology used with the Mulligan Concept?
04:06 What body areas can this concept be used on?
05:16 What are the basic principles of the Mulligan technique?
07:15 How do you determine what technique to perform?
08:41 How do the techniques change when the condition is acute vs. chronic?
09:34 How do patients maintain any improvements that they get during treatment, are there specific Mulligan exercises they are given?
10:25 Is there any equipment needed?
10:42 What research has been done on the Mulligan Concept?
11:44 Why do you think the Mulligan techniques are effective?
13:33 When would you use a Mulligan technique vs. a passive manual therapy technique such as a joint mobilization?
14:35 What is your opinion on the relevance of manual therapy to patient outcomes?
15:46 What do you teach at your courses?
16:51 Where can people find out more about you?
“You can give someone all the tactics, all the strategies. You can even give them the processes, the training material, get team buy in. But if you can’t execute, and you can’t deliver, then you’ve dropped the ball. So what I’ve learned is execution is everything.”
We speak with Sanjeev Bhatia (CEO and Co-founder of Clinic Space) about how to efficiently run and automate your practice and how the patient experience is the common thread that ties it all together.
You can follow Sanjeev on Instagram @thesanjeevbhatia and LinkedIn
This Business Series is in partnership with the CPA Private Practice Division. Check out CPA Private Practice Division for more great business content and stay tuned for the next instalments of the business series.
00:42 Can you introduce yourself?
03:25 How do you define clinic operations?
04:41 Why is it important to have your operations in place?
05:51 How do you systematize different parts of the clinic? Can all parts of a clinic work in this way?
12:05 Employee training would be important to make sure things run smoothly and to get a great patient experience. How do you make sure that is executed from an organizational level?
16:54 Part of patient experience is the treatment they receive. With big clinics, how do you reduce inconsistency between providers?
20:23 In your opinion, what separates a bad clinic from a good clinic, or a good clinic from a great clinic?
22:13 What are some top mistakes you see business owners make?
23:22 Why is it important for the clinic owner to understand about all of the clinic operations?
25:11 How does a therapist wanting to branch out into owning a business transition to that business owner role?
26:25 What are the most important things that you believe you need to have in place when starting a clinic?
28:12 Do you think smaller companies will have a harder time attracting new business with all of the larger companies that are expanding?
30:05 What role do you think technology will play in the future?
31:58 From a business perspective, where do you see the future of the therapy professions going?
33:43 With all of the advances in technology, how can current clinic owners keep up with all of these changes?
35:06 Many business rely on patients having benefits and insurance coverage for treatment. Do you see any trends towards declining insurance coverage?
37:18 What challenges do you see for the rehab profession as a whole?
38:46 Where can people find out more about you?