We're often asking or answering the question "why?" in clinical practice. Why does it hurt? Why does this treatment give me relief? Why is the problem not getting better? Sometimes it's easy to answer why, and sometimes it's not. In today's episode, Dr Damian Keter (US Department of Veterans Affairs) explores and explains musculoskeletal treatment mechanisms. Dr Keter suggests some ways to approach responding to the why question, even when the treatment mechanism isn't clear. He shares his perspectives on person-centered care and precision medicine. ------------------------------ RESOURCES Understanding musculoskeletal treatment mechanisms: https://www.jospt.org/doi/10.2519/jospt.2026.14486 Person-centered care and modern manual therapy: https://www.jospt.org/doi/10.2519/josptopen.2023.0812 The case for treatment pluralism: https://www.jospt.org/doi/10.2519/jospt.2026.13992 Sequenced care pathway vs. pain navigator pathway for veterans with low back pain: https://pubmed.ncbi.nlm.nih.gov/41926124/

Returning to sport after an ACL injury is often framed around a single construct: fear of reinjury. But what if fear doesn't tell the whole story? In today's episode, Chelsea and Marquis speak with Cobie Starcevich about her team's qualitative evidence synthesis exploring how athletes experience and interpret reinjury concerns after ACL injury. The team's findings suggest that what clinicians commonly label as "fear of reinjury" is actually a much broader, nuanced experience encompassing altered beliefs, assessments of threat, behavioral and cognitive coping strategies, physiological sensations, and concerns about the future. Cobie explains what the findings mean for clinicians, and how clinicians can move beyond fear and into exploring the multidimensional experiences of injury with patients. ------------------------------ RESOURCES Qualitative evidence synthesis of athletes' experience and interpretation of reinjury concerns after ACL injury: https://www.jospt.org/doi/10.2519/jospt.2026.13852

A patient might ask the clinician: "How long will it take me to get back to sport?" or "How long until I'm feeling back to myself again?". These questions ask the clinician to make a prognosis - to predict the future. Often we rely on our clinical experience or intuition to answer with a prognosis. Sometimes we might know some prognostic factors, which can give us some big-picture ideas, but they're rarely enough to give the full picture. Today physiotherapists and researchers Daniel Feller and Dr Alessandro Chiarotto (Erasmus Medical Centre, Rotterdam, The Netherlands) explain prognostic prediction models: what they are, how they might help in practice, and what to look for when you're deciding whether a tool like the STarT Back is suitable for your practice. ------------------------------ RESOURCES When is a prognostic prediction model ready for clinical use?: https://www.jospt.org/doi/10.2519/jospt.2026.13868

Today we're talking about one very important milestone in rehabilitation after an ACL reconstruction: return to running. It's a milestone that sometimes gets overshadowed by its more flamboyant sibling, return to sport. Brendan Butler joins JOSPT Insights to explore best practice in return to running. Brendan an Irish sports physiotherapist, who is currently working at the Aspetar Orthopaedic & Sports Medicine Hospital in Doha, Qatar. He's a member of the Aspetar ACL team, where he applies skills honed in Gaelic football, rugby, soccer and athletics. ------------------------------ RESOURCES Simple clinical measures that quantify knee loading symmetry during running: https://pubmed.ncbi.nlm.nih.gov/41110241/ Clinician choices for return to running criteria: https://www.jospt.org/doi/10.2519/josptopen.2026.0195 Lower medial hamstring activity during running: https://pubmed.ncbi.nlm.nih.gov/33782638/

All the data point to a growing burden of chronic musculoskeletal pain for populations around the world. Clearly, there is a need to innovate in the way that musculoskeletal care is delivered. In today's episode, Dr Luc Hébert shares his wealth of experience in musculoskeletal rehabilitation care - as a clinician and as a researcher leading clinical trials of different care models. We explore new models of care and the data supporting them. Dr Hébert is Professor at Laval University in Quebec City, Canada, and researcher at the Interdisciplinary Research Centre on Rehabilitation and Social Integration. ------------------------------ RESOURCES Group-based rehabilitation vs. individual programs: https://www.jospt.org/doi/10.2519/jospt.2024.12342 Benefits of primary contact emergency department physical therapy: https://www.jospt.org/doi/10.2519/jospt.2025.13429

There are many outstanding leaders in the sports medicine and musculoskeletal rehabilitation world. How did they get there? What decisions did they make that have got them to where they are today? In today's episode, Dr Amber Donaldson shares what she is looking for in the next generation of sports medicine leaders, how she has approached developing her own career, and her advice for early-career clinicians looking to establish themselves in elite sports medicine. Dr Donaldson is the Vice President - Sports Medicine at the United States Olympic and Paralympic Committee.

How often do you think about the air quality in the clinic or outside when you're exercising? Perhaps you live and work in a part of the world where you're fortunate to have good air quality most of the time. For many people though, that's not the case. Air pollution from wildfires in increasing, and it has serious implications for everyone's health. Today, Dr Débora Petry Moecke (Centre for Heart Lung Innovation, University of British Columbia) explains how to support clean air in the clinic to protect patients' health. ------------------------------ RESOURCES Wildfire smoke and its impact on physical therapy practice: https://www.jospt.org/doi/10.2519/jospt.2025.13546 IQAir (real-time air quality data from around the world): www.iqair.com

Today, Dr Federico Pozzi (University of Florida), walks Dan and Marquis through his recent paper titled “Addressing Shoulder Weakness in Individuals With Rotator Cuff–Related Shoulder Pain: A Systematic Review With Meta-analysis” In this discussion, Dr Pozzi, Dan & Marquis look at the research regarding rotator cuff-related shoulder pain, asking the question: what type of strengthening interventions help best? Dr Pozzi shares his advice for clinicians on how to design and implement effective shoulder rehabilitation programs. ------------------------------ RESOURCES Addressing shoulder weakness systematic review: https://www.jospt.org/doi/10.2519/jospt.2025.13445

Rugby is seeing consistent growth in popularity and participation. It's also no secret that women's sport is also growing rapidly. Put those together and you enter the exciting and rapidly developing area of women's and girl's rugby. Today, Dr Isla Shill (University of Victoria) discusses her research work in preventing injuries (including concussion) in girl's rugby. She shares the key components, and what it takes to implement an effective injury prevention program. ------------------------------ RESOURCES Effects of neuromuscular training warm-up for preventing injury and concussion in girl's rugby: https://www.jospt.org/doi/10.2519/jospt.2026.13373 SHRED injuries neuromuscular training warm-up programs: https://www.ucalgary.ca/shred-injuries Tips for supporting athletes to return to sport after concussion, with Dr Kathryn Schneider: https://pod.link/1522929437/episode/YTA0ZWY0NDgtYzNmZi00ODlmLTg5ZWQtMTAyMDE3ZTUxNjhk Female, woman, and/or girl Athlete Injury pRevention: https://fairconsensus.com/ FAIR practical recommendations: https://pubmed.ncbi.nlm.nih.gov/41330629/

Today’s guest—Dr Thomas Ibounig—who led the paper, “Rotator Cuff Imaging Abnormalities in Asymptomatic Shoulders: A systematic review” explores how prevalent abnormal MRI findings are in asymptomatic shoulders, and how the prevalence changes by population. The systematic review is an exemplar of what musculoskeletal rehabilitation clinicians can learn from accepting what we don’t know! Chelsea and Marquis wrap up the chat by thinking about how physical therapists can take the systematic review findings into account when educating and referring patients with shoulder pain. ------------------------------ RESOURCES Rotator cuff imaging abnormalities in asymptomatic shoulders systematic review: https://www.jospt.org/doi/10.2519/jospt.2025.13611 More on the SCRUTINY (Systematic Review of Shoulder Imaging Abnormalities in Asymptomatic Adults) project: https://www.ficebo.com/project/scrutiny