Ep. 055 | Cervicogenic Dizziness | Julia Treleaven

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

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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

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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

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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

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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.

Content
00:00 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 

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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

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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

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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

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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

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Welcome to episode 53!

In this episode we are joined by Adam Dobson who is working as a specialist triage & treat spinal physiotherapist for South Tees Hospitals NHS Foundation Trust. He is the author of "Lumbar Radicular Syndromes - At a Glance" and actively shares his knowledge around radicular syndromes on his Twitter (@adamdobson123) and as guest on various podcasts. We are very happy to have him on the microphone for this episode. Enjoy!

Content

00:00 Intro 
00:40 Definition of Lumbar Radicular Syndrome
02:57 Signs & Symptoms of Sciatica
06:12 Red Flags
14:14 Cauda Equina Pathway
19:20 Facet Joint Stenosis Differentiation
21:54 K.I.S.S.
22:30 Motor Control Exercises
24:45 Opinion on Piriformis Syndrome
30:20 Minor Neurogenic Dysfunctions
35:17 Treatment for LRS
38:55 Advice. Anything Else?
44:16 Clinical Decisionmaking
45:52 Adam's closing thoughts
50:47 Encore - Stenosis
53:05 Outro

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