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: www.ptreviewer.com 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. Learn more about us here. 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. Learn more about us here. 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: Learn more about us here. - 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!   You can find out more about Dr. Walton here and on Twitter.

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. Learn more about us here. 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. Learn more about us here. 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 Learn more about us here. 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. Learn more about us here.   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 Learn more about us here.   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. Learn more about us here.   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?</