Sports Medicine Project

In this episode of the Sports Medicine Project, Blake Withers is joined by Dr. Gerald Yeo, a renowned foot and ankle orthopedic surgeon, to discuss the intricacies of foot and ankle surgeries, particularly focusing on Achilles tendon and navicular stress fractures. Dr. Yeo shares insights from his extensive experience, discussing the challenges and advancements in surgical techniques, and the importance of a multidisciplinary approach in treatment. Keywords: Achilles tendon, navicular stress fractures, orthopedic surgery, foot and ankle, multidisciplinary approachTakeaways: Dr Gerald Yeo is a Queensland trained orthopaedic surgeon (BMedSci, FRACS (Ortho), FAOrthA) with subspecialist fellowship training in foot and ankle surgery. His clinical interests include minimally invasive and arthroscopic techniques, total ankle replacement, and lower-limb trauma, with a focus on supporting recovery through early, functional rehabilitation and multidisciplinary care. He consults and operates in Brisbane, including at Brisbane Orthopaedic Specialist Services and St Vincent’s Private Hospital Northside, and also consults at North Lakes and operates at North West Private Hospital. (drgeraldyeo.com.au)

Confused by all the ASICS “Blast” shoes? In this video I break down the entire Blast family and help you match the right shoe to your running.Megablast – max stack, FF TURBO SQUARED, ultra-bouncy long run and easy day optionSonicblast – dual-foam midsole with Pebax plate, built for tempo and faster long runs Superblast 2 – the super trainer sweet spot for daily training, long runs and some workouts Novablast 5 – the classic bouncy daily trainer, 8 mm drop, big stack without feeling unstable  Dynablast – more affordable, lower stack, flexible Blast option that still feels fun underfoot Which models suit higher weekly mileage and long runsWhen I might lean towards Megablast or Superblast?Where Dynablast and Novablast fit for newer runners or those not used to very high stack shoes?

Summary In this conversation, Blake Withers interviews Aidan Rich, a sports and exercise physiotherapist, about his research on proximal hamstring tendinopathy and the recent randomized control trial comparing physiotherapy and shockwave therapy. Aidan shares his journey into the field, the challenges of designing the study, and the importance of education in treatment. They discuss the nuances of exercise rehabilitation, patient experiences, and the surprising results of the trial, which showed no significant difference between the two treatment methods. Aidan emphasizes the need for individualized care and the potential for future research in this area. Paper links: Main RCT: https://journals.sagepub.com/doi/10.1177/03635465251391134 https://pubmed.ncbi.nlm.nih.gov/41037932/ https://pubmed.ncbi.nlm.nih.gov/40469642/ https://www.jsams.org/article/S1440-2440(25)00275-0/pdf Aidan Rich: PhD Candidate | APA Titled Sports and Exercise Physiotherapist | State Manager A dedicated and passionate physiotherapy professional with extensive experience in both academic research and clinical management. Currently pursuing a PhD with the topic of 'Physiotherapy for Proximal Hamstring Tendinopathy,' where he has conducted two randomised trials. In addition to his academic pursuits, he oversee the clinical, financial, and cultural performance of a network of 20 physiotherapy and sports medicine clinics across Victoria. His role involves ensuring the highest standards of patient care, optimising financial performance, and fostering a positive and collaborative work environment. Chapters 00:00 Introduction and Background of Aidan Rich 03:48 The Evolution of Tendinopathy Treatment 08:30 Shockwave Therapy: Insights and Experiences 13:13 Designing the RCT: Methodology and Protocols 18:20 The Exercise Program: Structure and Rationale 23:07 Education in Rehabilitation: Importance and Implementation 28:39 The Benefits of Resistance Training 29:52 Qualitative Insights from RCT Participants 31:36 Surprising Strength Outcomes in Rehabilitation 33:42 Effect Modifiers in Treatment Response 35:20 Clinical Applications of Shockwave Therapy 37:01 Patient Preferences in Treatment Choices 38:00 Individualized Treatment Approaches 39:04 Evaluating Shockwave Therapy Effectiveness 41:22 Challenges in Designing Effective Trials 43:22 Comparative Outcomes in Tendinopathy Treatments 45:43 Acute Responses to Shockwave Therapy 48:36 Key Takeaways for Clinicians 50:59 Future Directions in Research

Ian is a sports podiatrist and educator who helps people stay active and reach their goals through evidence-based pain and injury management. A keen runner himself, he pairs lived experience with top-tier credentials—degrees in Podiatric Medicine and Sports Injury, postgraduate training in Sports Podiatry and Academic Practice, and Fellowships of the Royal College of Podiatry, the Royal College of Physicians & Surgeons of Glasgow, and the Higher Education Academy—while lecturing at Queen Mary University of London and holding adjunct roles at Monash and Ziauddin Universities. He has presented internationally and supported elite teams including the PGA European Tour, England Rugby 7s, Surrey Cricket, GB Men’s Hockey and Arsenal (including London 2012), but takes greatest pride in helping everyday athletes stay healthy, resilient and able to enjoy their sport.

Breakdown of Relative Energy Deficiency in Sport (RED-S), what it is, why clinicians and athletes should care, key stats/facts that often get missed, and practical screening you can use tomorrow in clinic or with your squad. What you’ll learn What RED-S actually is (beyond “under-fuelling”) Why it matters for health, performance, and injury risk Prevalence, red flags, and common pitfalls How to screen in real life: which tools, when to use them, and how to interpret results When to refer and build a multidisciplinary plan LEAF-Q (Low Energy Availability in Females Questionnaire) https://bjsm.bmj.com/content/bjsports/suppl/2014/02/21/ bjsports-2013-093240.DC1/bjsports-2013-093240supp1.pdf LEAF-Q Scoring Guide: https://bjsm.bmj.com/content/bjsports/suppl/2014/02/21/ bjsports-2013-093240.DC1/bjsports-2013-093240supp2.pdf • LEAM-Q (Low Energy Availability in Males Questionnaire) 6 https://www.mdpi.com/2072-6643/14/9/1873 (see supplementary material) • RST (RED-S Specific Screening Tool) 7 https://assets.cureus.com/uploads/original_article/ pdf/30734/1612430181-1612430175-20210204-18268-i9k6n7.pdf (Questionnaire in appendix C, scoring guide in appendix B) • SEAQ-I (Sport-Specific Energy Availability Questionnaire and Interview) 8 https://bmjopensem.bmj.com/content/4/1/e000424 (see supplementary material) • EDE-Q (Eating Disorder Examination Questionnaire) 9 https://socialwork.buffalo.edu/content/dam/socialwork/continuing- education/documents/Eating-Questionairre-EDE-Q.pdf • SCOFF (Sick, Control, One (stone), Fat, and Food Questionnaire) 10 https://www.nutritionhealth.com.au/site/assets/files/1064/scoff- questionnaire.pdf • EAI (Exercise Addiction Inventory) 11 https://doi.org/10.1080/16066350310001637363 (see appendix 1) • EDS (Exercise Dependence Scale) 12 https://www.personal.psu.edu/dsd11/EDS/EDS21Manual.pdf

Stress fractures are one of the most common running injuries (up to 20% of them), but what actually are they, why do they happen, and why do some take longer to recover than others?In this video, I explain: • What a stress fracture is and how it develops • Why taking time off running is often essential for healing • Why not all stress fractures are the same (location and severity matter) • What runners should know about recovery and reducing riskI’m a Sports Podiatrist and PhD researcher candidate in running injuries, and my goal is to give runners clear, evidence-based information to help them train smarter and stay injury free.

Find Gabriel: https://www.researchgate.net/profile/Gabriel-Moisan https://www.linkedin.com/in/gabriel-moisan-a382aaa7/ In this conversation, Blake Withers interviews Gabriel Moisan, a podiatrist and researcher, about his journey in the field of podiatry, the evolution of foot orthoses, and the ongoing debates surrounding their use. They discuss the challenges of research in podiatry, the mechanisms of foot orthoses, and the differences between custom and prefabricated devices. Moisan shares insights on how to determine the appropriate dosage of foot orthoses for patients and critiques the terminology used in describing conditions like adult acquired flatfoot. The conversation emphasizes the importance of understanding both the mechanical and psychosocial effects of foot orthoses in patient care. In this conversation, Blake Withers and Gabriel Moisan delve into the advancements in podiatry, particularly focusing on foot orthosis, 3D printing technology, and the importance of clinical outcomes. They discuss the role of footwear in treatment, the evolution of materials used in orthotics, and the integration of technology to enhance patient care. The conversation also highlights the significance of teaching and learning in podiatry, the challenges of research, and the future directions of the field, including the potential of AI in predicting treatment outcomes.takeaways titlesSound BitesChapters00:00Introduction and Name Pronunciation00:32Gabriel Moisan's Journey in Podiatry04:33The Evolution of Foot Orthosis Understanding10:33Research Challenges in Foot Orthosis16:40The Mechanisms of Foot Orthosis20:15Clinical Applications and Effectiveness of Foot Orthosis32:49Understanding Foot Orthosis for Adult Acquired Flatfoot39:44The Debate on Terminology in Podiatry46:54Long-Term Use of Foot Orthosis: A Patient-Centric Approach51:35Advancements in Foot Orthosis Manufacturing56:15Customizing Foot Orthosis for Specific Conditions01:04:08The Future of Foot Orthosis: Technology and Innovation01:09:29The Role of Technology in Podiatry01:12:25Understanding Foot Orthosis and Patient Outcomes01:15:29Predicting Biomechanical Effects of Orthoses01:18:26The Impact of 3D Printing on Orthotic Modifications01:22:36Future of Foot Orthosis: Research and Innovations01:26:05The Need for Comprehensive Resources in Podiatry01:26:41Influential Figures in Podiatry and Research Aspirations

Find Luke: https://www.instagram.com/sportschiroluke/ Luke is a titled Sports & Exercise Chiropractor, Running Coach, and Strength Coach with over 20 years of experience in private practice in Melbourne. He has lectured extensively across Australia and internationally on sports injuries, with a focus on running-related topics. As an avid fitness enthusiast, Luke has completed 11 marathons, an ultra-marathon, and two Ironman triathlons. In recognition of his expertise, Luke was awarded Fellowship status by the Australasian Institute of Chiropractic Education in 2019, inducted as a Fellow of the Australian Sports Medicine Federation in 2024, and honoured as the 2022 ACA Chiropractor of the Year for his contributions to the profession.Luke Nelson Sports & Exercise Chiropractor Director Health & High PerformanceB App Sci (Clin Sci.)/B Chiro Sci, ICCSP, Postgrad.Dip.Sport Chiro, M.Sport.Sci, ASCA Lev 1, FAICE, FASMF w. https://www.healthhp.com.au/ Chapters 00:00 Introduction to Podiatry and Chiropractic Practices 00:58 Evolving Perspectives in Healthcare 03:36 The Journey of a Chiropractor 06:47 The Role of Social Media in Healthcare 09:32 Strength Training and Injury Prevention 12:37 Plyometrics in Running Training 15:24 Individualized Training Approaches 18:34 Managing Tendon Injuries 21:11 Patient Education and Communication 29:06 Effective Communication in Consultations 33:14 Understanding Running Programming 40:23 Assessment Techniques for Runners 47:14 The Importance of Strength Assessment 53:47 Managing Bone Stress Injuries 01:01:24 Reflecting on Gratitude and Perspective 01:01:48 Foot Strike Patterns and Gait Interventions 01:04:59 Sustaining Changes in Running Technique 01:06:35 Programming for Return to Running 01:10:57 Adding Intensity to Training 01:11:59 Managing Pain and Progressing Training 01:16:52 Mechanical Interventions in Running 01:20:03 Favorite Running Shoes and Recommendations 01:23:09 Interviewing the Greats and Research Aspirations 01:27:06 Future Endeavors and Closing Thoughts Takeaways The breakdown of traditional silos in healthcare is beneficial for patient care. Interdisciplinary collaboration leads to better treatment outcomes. Social media can enhance the dissemination of healthcare knowledge. Strength training is crucial for injury prevention in runners. Plyometrics can improve performance and aid in rehabilitation. Patient education is essential for effective treatment. Understanding patient goals helps tailor treatment plans. Assessment techniques are vital for identifying issues in runners. Research translation is important for evidence-based practice. Healthcare professionals should continuously evolve their practices. Strength parameters should be assessed in context, not isolation. The act of doing training is more important than just numbers. Weakness can be a precursor to injuries, but it's not the only factor. Criteria-based rehabilitation is often more effective than time-based. Managing bone stress injuries requires careful progression and monitoring. Runners often need mental support when facing injuries. Foot strike patterns should be assessed but not always changed. Easy running builds the foundation; speed work enhances performance. Individualized programming is crucial for effective rehabilitation. The future of injury prevention research is multifactorial and complex.

Get some help with Jack: https://www.clinicmastery.com Find Jack: https://www.instagram.com/jackdobrien/ Summary In this episode, Blake Withers and Jack O'Brien discuss the often-overlooked aspects of business and finance in healthcare. They explore the importance of sustainability, negotiation strategies for new graduates, and the realities of income potential in allied health professions. Jack shares his journey from clinician to business owner and emphasizes the need for effective communication and understanding of financial literacy in the healthcare field. The conversation also touches on the challenges of starting a private practice, the significance of KPIs, and the value of patient-centered care. Chapters 00:00 Introduction to the Conversation 00:29 The Importance of Business in Allied Health 01:41 Jack O'Brien's Journey in Healthcare 03:36 Sustainability in Healthcare Practices 07:42 Negotiating Your First Job 10:48 Work-Life Balance vs. Work-Life Tension 12:49 Understanding Income Potential in Healthcare 16:06 The Reality of Business Expenses 19:47 Profit Sharing and Employee Satisfaction 20:55 Effective Communication in Negotiations 25:00 Increasing Your Income Potential 27:51 Ethical Revenue Generation in Healthcare 32:55 The Challenges of Starting Your Own Practice 33:46 The Reality of Starting a Clinic 37:29 Exploring Career Progression in Healthcare 41:24 Financial Strategies for Clinicians 41:58 Contractor vs Employee: Weighing the Risks 45:18 Creating a Reward Structure in Clinics 48:20 The Value of Patient Care and Communication 58:12 Believing in the Value of Every Patient Interaction

study link :https://pmc.ncbi.nlm.nih.gov/articles/PMC9884822/pdf/fspor-04-1048655.pdf Key takeaways: Gait modifications can immediately reduce patellofemoral pain in some runners. The most effective strategies were increasing step rate by 10% and adopting a forefoot strike pattern. Runners with a rearfoot strike benefitted more from forefoot strike and “running softer,” while non-RFS mainly improved with a higher step rate. Reductions in patellofemoral joint force were linked to pain decreases, but not always — suggesting other mechanisms (psychological/central factors) may also contribute. Increasing step rate is likely the safest first option; forefoot strike may work but carries higher Achilles tendon load, so requires caution.

Issac instagram: https://www.instagram.com/isaacheyne/ Substack: https://substack.com/@isaacheyne?r=jxf68&utm_medium=ios&utm_source=profile&fbclid=PAZXh0bgNhZW0CMTEAAadhAnzfZo7PbmOOABf-9MoarClQRKfYUPEdbOD-PgKY6y7d1bBdYhSKAcUV1A_aem_2VWcJabI4cL4gvFebIjang keywords: running, influencers, training load, misinformation, social media, sports medicine, physiotherapy, nutrition, community, injury prevention, running culture, injury prevention, running community, evidence-based practice, footwear innovation, personal experience, inclusivity, social media, athlete support, training methodssummaryIn this conversation, Blake Withers and Isaac Hain discuss the influence of running influencers on the sport, the importance of understanding training load, and the challenges of navigating misinformation in the running community. They explore the evolution of running knowledge, the impact of social media, and the necessity of critique in professional development. The discussion also touches on the role of nutrition in injury prevention and the positive aspects of running communities. In this conversation, the speakers explore the evolution of running culture, the impact of increased participation in the sport, and the importance of inclusivity within the running community. They discuss the challenges of traditional running paths and the role of evidence in running practices, emphasizing the need for individualized approaches to running injuries. The conversation also touches on the balance between tradition and innovation in running, the emotional connection to the sport, and the significance of engaging with the running community online. Ultimately, the speakers reflect on their personal experiences and the purpose they find in helping others navigate their running journeys. Chapters 00:00 Introduction to Running and Physiotherapy 10:18 Isaac's Journey: Runner and Clinician 13:34 The Evolution of Running Knowledge 16:15 The Impact of Misinformation in Running 19:25 Navigating Social Media and Running Advice 22:30 The Role of Critique in Professional Growth 25:33 Finding Truth in Running Information 28:22 The Balance of Sharing Knowledge 31:25 Conclusion: The Future of Running and Health Information 37:54 Understanding Knowledge Gaps in Physiotherapy 41:34 Navigating Scope of Practice and Online Influence 43:45 The Role of Nutrition in Physiotherapy 46:58 The Impact of Social Media on Running Culture 52:34 The Evolution of Running and Its Community 58:36 Challenging Traditional Paths in Running 01:03:27 Balancing Old and New Practices in Training 01:08:25 Understanding Individualized Treatment in Healthcare 01:11:28 The Complexity of Physiotherapy and Patient Care 01:14:22 The Role of Social Media in Running and Community Engagement 01:17:21 Personal Experiences Shaping Professional Passion 01:20:36 Navigating Online Presence and Telehealth in Physiotherapy 01:22:38 The Evolution of Running Footwear and Personal Preferences

Foot orthoses are more than just plastic shells and we need to evaluate them appropriately if we want to better help patients. Here is how I think about foot orthoses—covering assessment, materials, and the clinical reasoning that underpins effective prescription. Whether you’re a podiatrist, physiotherapist, or other allied health professional, this 30-minute discussion will help you understand how to approach orthoses with clarity and confidence in practice.

Blake Withers and Jack Craigo discuss the nuances of running shoes, particularly focusing on super shoes and their suitability for different runners. They explore the importance of shoe fit, the role of retail in guiding shoe selection, and the potential injury risks associated with performance footwear. The discussion also highlights the significance of comfort and the impact of shoe technology on running performance, concluding with recommendations for runners on choosing the right shoes for their needs. Jack Crago youtube and instagram: @jog.on.crago super shoes, running shoes, injury prevention, shoe fit, marathon training, footwear technology, running performance, retail experience, shoe selection, running community Super shoes, also known as advanced footwear technology (AFT), are designed to enhance running performance by incorporating features like aggressive rocker geometry, high stack heights (often ≥35–50 mm), lightweight and compliant foams, carbon or composite plates, and minimal weight. These features aim to improve running economy and propulsion. However, their widespread use has prompted questions about whether they are the best option for all runners—especially when it comes to injury risk and biomechanical stability. Running participation continues to grow, with events like marathons selling out rapidly (Barrons et al., 2023). Many runners get their footwear advice from online sources or retail staff. Research suggests that both runners and retailers prioritise comfort, with super shoes often perceived as more comfortable than generic alternatives (Malisoux et al., 2020). While footwear is known to influence both performance and injury risk (Nigg et al., 2023), the assumption that super shoes are universally superior oversimplifies a complex trade-off. One of the major proposed performance benefits of high stack height is an increase in effective leg length, which may lengthen stride and improve running economy (Burns & Tam, 2020). However, these gains may come at the cost of reduced frontal plane ankle stability, particularly at higher speeds (Hoogkamer, 2020; Barrons et al., 2023). This potential drawback becomes even more important in longer races when fatigue sets in and motor control becomes more challenged. Recent studies have begun to test these assumptions more rigorously. Garofolini et al. (2024) and Möhler et al. (2022) hypothesised that high-stack shoes increase instability in the control of the centre of mass (CoM), and that these effects are exacerbated at higher speeds due to the added demands on motor coordination. Their findings suggest that super shoes may impose additional coordination demands that not all runners can accommodate. In one of the most comprehensive studies to date, Kettner et al. (2025) tested runners using shoes with low (27 mm), medium (35 mm), and high (50 mm) stack heights. The high stack shoes caused measurable changes in running style: increased vertical oscillation of the centre of mass (COMosc), lower step frequency, and higher duty factor (i.e., more time spent on the ground). These shoes also altered ankle mechanics, especially increasing time in eversion and eversion angles. Critically, they found lower local dynamic stability at the hip—measured using Maximum Lyapunov Exponent (MLE)—with the high stack shoes, suggesting impaired control of the centre of mass. These changes were largely independent of running speed, appearing consistently at both 10 and 15 km/h. From a clinical perspective, this evidence indicates that super shoes are not one-size-fits-all. Runners with a history of injury, reduced neuromuscular coordination, or poor fatigue resistance may be better served by lower stack, more stable footwear. Coordination and stability may be just as critical as cushioning and propulsion—especially in long races or for less experienced runners.

Dr Myles Murphy is a clinical physiotherapist and early-career clinician researcher from the Nutrition and Health Innovation Research Institute at Edith Cowan University. Myles’ works clinically at SportsMed Subiaco and has worked with or consulted for a variety of elite sporting teams. While working clinically, Myles’ completed his PhD part-time at The University of Notre Dame Australia investigating the different mechanisms related to pain and dysfunction in people with lower-limb tendinopathy. Myles’ research involves investigating the drivers of pain and impairment in people with lower-limb musculoskeletal injury and disa

In this conversation, Blake Withers and Kelly Kortick host Esther Keown and Dr Claire Badenhorst to discuss the importance of understanding female physiology in sport, particularly running. They explore the challenges young female athletes face regarding body image and performance, the significance of individualised training programs, and the role of communication in supporting female athletes. The discussion also highlights the launch of Femmi's membership, which aims to empower women through education, community support, and personalised training that considers the unique physiological needs of women. Femmi: https://tinyurl.com/c7r732bs Esther: https://www.instagram.com/estherkeown/?hl=en Claire: https://www.instagram.com/claire_bades/?hl=en Takeaways Takeaways Understanding female physiology is crucial for optimizing training and performance. Communication about body image and performance is essential for young female athletes. Individualized training programs are necessary to accommodate the unique needs of female runners. FEMI provides resources and support for women to understand their bodies better. The menstrual cycle significantly impacts training and performance for women. Empowerment through education can enhance confidence in female athletes. Community support plays a vital role in encouraging women to participate in running. Research on female physiology is still evolving and needs to be more inclusive. FEMI's membership offers personalized training and expert guidance for women runners. Tracking menstrual cycles can help women understand their bodies and improve performance. Chapters 00:00 Introduction to FEMMI and Its Mission 01:29 Understanding Female Physiology in Training 02:17 Optimizing Communication and Support for Female Athletes 02:44 The Impact of Societal Norms on Female Athletes 04:21 New Chapter 04:36 The Role of Coaches and Clinicians in Body Positivity 07:24 Understanding Female Physiology and Injury Prevention 10:04 Research Insights on Female Athlete Well-being 13:08 The Importance of Open Conversations in Sports Medicine 15:45 Celebrating Progress in Female Sports Education 24:24 Understanding Menstrual Cycle Research Limitations 30:16 Individual Variability in Menstrual Cycle Symptoms 33:13 FEMI: Tailoring Training to Female Physiology 37:24 The Complexity of Hormonal Impact on Performance 42:52 Recognizing Luteal Phase Defects and Their Implications 51:31 Empowering Women Through Cycle Tracking 56:12 Understanding Your Body and Hormones 57:12 The Importance of Iron for Female Athletes 01:06:43 Debunking Foot Strike Hemolysis 01:11:30 The Dangers of Generic Training Programs 01:14:35 Maximizing Performance for Female Athletes 01:17:54 Introducing the Femi Membership Keywords FEMMI, female physiology, running, training programs, women's health, empowerment, communication, performance, menstrual cycle, community support

Takeaways Metatarsal stress fractures are common injuries in athletes. Understanding the remodeling process of bones is crucial for recovery. Subjective questioning can reveal important clues about the injury. Palpation techniques are essential for accurate diagnosis. Systemic factors like energy availability can influence bone health. Imaging, particularly MRI, is vital for diagnosing bone stress injuries. Treatment should focus on offloading the affected area. Recovery time varies significantly between individuals and injuries. Communication with patients about their condition is key to effective treatment. Injury prevention strategies should include monitoring training loads. ** You should always see a medical professional for diagnoses and assessment. This is not medical advice and is for educational purposes only. Summary In this episode of the Sports Medicine Project, hosts Blake and Kelly delve into the complexities of diagnosing metatarsal stress fractures and bone stress injuries. They discuss the importance of understanding the clinical assessment process, including subjective questioning, palpation techniques, and the role of imaging in diagnosis. The conversation emphasizes the significance of systemic factors and adequate recovery in preventing these injuries, as well as the need for effective treatment strategies. The hosts share insights from their clinical experiences, making the discussion both informative and engaging for listeners interested in sports medicine and injury management. Chapters 00:00 Introduction and Overview of Metatarsal Injuries 03:01 Understanding Bone Stress Injuries 05:46 Diagnosis and Clinical Assessment 09:04 The Role of Training Load and Recovery 12:06 Systemic Factors Influencing Bone Health 14:49 Imaging and Diagnostics for Metatarsal Injuries 18:01 Palpation Techniques and Patient History 20:53 Conclusion and Key Takeaways 25:35 Palpation Techniques for Metatarsal Assessment 32:06 Clinical Decision-Making in Bone Stress Injuries 37:54 Differentiating Between Tendon and Bone Injuries 48:02 Imaging and Diagnosis of Bone Stress Injuries Keywords metatarsal stress fracture, bone stress injury, diagnosis, clinical assessment, imaging, treatment, sports medicine, recovery, palpation techniques, systemic factors

Gregs social: https://www.instagram.com/greglehman/ Pro version Heidi AI Scribe (time saver) Link: ⁠https://scribe.heidihealth.com/?via=SMP⁠ Support the show: ⁠https://patreon.com/SportsMedicineProject?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink Gregs Website: https://www.greglehman.ca/ Chapters 00:00 Evaluating Shockwave Therapy in Tendinopathy 00:44 The Role of Exercise in Rehabilitation 03:43 Understanding Patient Ecosystems and Health 06:23 Case Studies: Practical Applications in Treatment 08:49 The Complexity of Pain Management 11:43 Research Critique: Shockwave Therapy and Evidence 14:10 Psychological Factors in Pain Perception 17:02 Clinical Decision-Making in Patient Care 26:00 Trusting Experts and Knowledge Translation 27:21 Challenging Established Beliefs 28:30 Comparing Treatment Philosophies 31:03 The Role of Patient Understanding 33:35 Exercise vs. Alternative Treatments 34:26 Load Management in Rehabilitation 35:54 Creative Approaches to Running Rehabilitation 37:06 Resistance Training for Runners 40:12 Skepticism Towards New Research 42:50 Understanding Bone Stress Injuries 54:53 Understanding Pain and Structural Changes 58:59 Navigating Risks in Running Injuries 01:04:20 The Role of Social Media in Health Information 01:09:39 Strength Training and Recovery Insights 01:12:24 Research Aspirations and Future Directions Keywords: shockwave therapy, tendon rehabilitation, exercise, pain management, sports medicine, patient education, metabolic health, case studies, research appraisal, individualized treatment, training protocols, bone health, stress fractures, plyometric training, rehabilitation, pain management, social media, health information, research ethics, performance. Summary: This conversation delves into the complexities of sports medicine, focusing on shockwave therapy, exercise rehabilitation, and the importance of understanding patient ecosystems. The speakers discuss recent research findings, the role of exercise in pain management, and the need for individualized treatment approaches. They also explore the psychological factors influencing pain and the critical appraisal of existing research in the field. In this conversation, Blake Withers and Greg delve into various aspects of training protocols, bone health, and the complexities of rehabilitation. They discuss the importance of flexibility in training, the role of frequency in plyometric exercises, and the nuances of managing pain in relation to structural changes. The dialogue also touches on the ethical considerations of pain in research, the impact of social media on health information, and future directions in rehabilitation research.takeaways

We discuss the latest review PMID: 39704142 with Prof Peter Malliaras ✅ Identifying early responders – Can we predict who will benefit? ✅ Effect – Does it work? ✅ Diminishing returns – When does adding SWT to exercise stop being beneficial? ✅ Types of shockwave therapy – Why radial shockwave was chosen in this study ✅ Sham treatments – Do they still have a therapeutic effect? ✅ Mechanisms of action – Neuromodulation, therapeutic alliance, and tendon adaptation ✅ The ‘Big Machine Effect’ – Is patient belief in SWT part of its effectiveness? ✅ Comparisons to exercise – Would fewer appointments with exercise yield similar outcomes? We also discuss clinical implications—will these findings change how shockwave therapy is used in practice? 🔗 References & Studies Discussed: • Alsulaimani et al. (2024) - Achilles tendinopathy & shockwave RCT • Benli et al. - SWT vs. exercise alone • Heide et al. - Shockwave therapy for plantar heel pain Find out about Peter and upcoming course: https://www.tendinopathyrehab.com/home Socials: https://www.instagram.com/tendinopathyrehab/ https://www.linkedin.com/posts/petermalliaras_my-new-tendinopathy-rehabilitation-framework-activity-7296743926009368576-GNRW/?utm_source=share&utm_medium=member_ios&rcm=ACoAAAexDmkBlV5e4jGTX2E4X9J6s8ZitO8yX0M&fbclid=PAZXh0bgNhZW0CMTEAAabnnAaDDYH_S3We7eJaZZbOHWHxrtGYC_5AiRO-rDUtmh29GdmHqrWh9fI_aem_FLbCehDnORljxK3cgMA8fQ

Patreon: ⁠https://patreon.com/SportsMedicineProject?utm_medium=unknown&utm_source=join_link&utm_campaign=creatorshare_creator&utm_content=copyLink 1. Keep Intensity the Same This is the biggest and easiest mistake. If your Achilles is sore, what will aggravate it most is higher rates of loading—formally, this happens more when you run faster. Yes, it might warm up during the run, but you’ll pay for it 24 hours later. You need to stress it just a little, see how it responds, and build from there. 2. Rest, Then Go Straight Back to Full Load You shouldn’t completely rest and then jump straight back to the same training load. If you usually do speed work on Tuesdays, and you’ve had a week or two off, that first run back shouldn’t be the same session. Don’t do that. Start gradually—try something like 6 x 1-minute efforts and progress from there. 3. Wear Flat Shoes Heel pitch helps Achilles tendon pain. A higher heel reduces both tensile and compressive forces by limiting dorsiflexion. Achilles pain isn’t just about the run—it’s about everything you do throughout the week. If you’re on your feet all day, even if it’s not sore at the time, that will contribute to your pain during training. 4. Not Question the Diagnosis Sometimes, it’s not Achilles tendinopathy. Yes, if you’ve had it before, you can get it again—but not always. Other things mimic Achilles pain. Be sure. 5. Keep Training Load the Same If you’re dealing with Achilles pain, take something away. Reduce intensity or volume—adjust something. If you’re not sure how, see someone who can help you make it graded. 6. Think the Adjuncts Are the Answer They can help, but they’re not the solution. Shockwave, massage, needling—useful, sure. But if you’re not loading appropriately, nothing else will fix it. 7. Not Load It Properly You have to load it. Strength, plyometrics, progressing appropriately—it all matters. 8. Smash the Anti-Inflammatories and Think That’s Enough Anti-inflammatories aren’t bad, but if that’s all you’re doing, you’re missing the point. This isn’t an inflammatory condition—it’s a load issue. 9. Think Injections Are the Quick Fix Too many people jump to injections too early. They can have a role in specific cases, but they’re not a cure. 10. Ignore the Psychology Behind Injury This is huge. Achilles pain isn’t just about the tendon—it’s about the mental load of not running, the frustration, the identity shift. Understanding this can change everything. Achilles tendinopathy, injury management, running injuries, health professionals, rehabilitation, load management, resistance training, anti-inflammatories, psychological impact, running performance

Mr. Ian Reilly qualified as a Podiatrist in 1988 and became a Podiatric Surgeon in 1996. Over his career, he has performed more than 11,000 surgical procedures under various anaesthesia types, showcasing his extensive expertise. You can out more below by clicking the link on his website. From 2001 to 2024, he led Podiatric Surgery at Northamptonshire Trust, significantly advancing podiatric care. Now retired from NHS practice, he focuses on private care, operating weekly at Three Shires Hospital in Northampton and treating patients across self-pay, insured, and NHS pathways. Mr. Reilly specializes in: Injection Therapy: • Cortisone Injections Podiatric Surgery: • Cyst and ganglion excision (soft tissue lumps and bumps) • Morton’s neuroma surgery (trapped nerves) • Subungual and other bony exostectomies (bony bumps) • Lesser toe correction (hammer toes) • Metatarsal surgery for forefoot pain • Surgery for hallux limitus (arthritis of the great toe) • Surgery for hallux valgus (bunions) • Haglund’s deformity (heel bumps) • Plantar fasciitis (heel pain) • Flatfoot surgery Minor Surgery: • Verrucae, corn, and skin surgery • Nail surgery Dr Ian Reilly website: https://podsurgeon.co.uk/ Youtube: https://youtube.com/@ianreillypodsurgeon?si=rDK6BHAwRGBu4L3F What it takes to become a Podiatric surgeon? file:///Users/blakewithers/Desktop/ian%20pod/The%20Royal%20College%20of%20Podiatry.html Mary PoppinsProbably Needed Orthotics article https://podiatrym.com/Highlights2.cfm?id=3286 00:00Introduction to Dr. Ian Riley02:07Career Progression in Podiatry05:53Surgical Experience and Case Studies07:24Injection Therapy in Podiatry13:55Managing Neuritis and Injection Guidelines18:43Understanding Osteoarthritis and Injection Therapy23:41Patient Case Study and Emotional Impact26:50The Role of Podiatry Post-Surgery32:22The Evolving Perspective on Orthotics35:12International Standards in Podiatry37:06The Importance of Imaging in Diagnosis39:42The Forefoot Examination Process42:28Understanding Morton's Neuroma46:02The Role of Imaging in Treatment Decisions48:31Surgical Indicators for Forefoot Conditions01:03:10Understanding Patient Concerns and Predictions01:05:14The Role of Orthotics in Treatment01:06:53The Importance of Communication in Healthcare01:08:57Navigating Conflicting Opinions Among Clinicians01:11:18Injection Therapy and Its Efficacy01:15:29Challenges in Treating Mid-Foot Osteoarthritis01:22:33Research Aspirations in Injection Therapy01:24:45Interviewing Historical Figures for Insight01:26:24Future Teaching and Learning Opportunities