Physio Edge podcast with David Pope

Should you prescribe isometric or isotonic exercises for your patient's lower limb tendinopathy?
When is it safe to add plyometric loading, and how do you progress running or jumping without flaring your patients tendon pain?
Why do some "tricky tendons" refuse to respond to your best loading programs?
Dr Ebonie Rio (Post-Doctoral Senior Research Fellow, La Trobe University) reveals the evidence-based answers as she guides you through the clinical reasoning and practical strategies for managing patellar, achilles, and other lower limb tendinopathies.
In this conversation, you'll follow clinical examples and unpack the latest research to help you feel confident with tendinopathy assessment and treatment.
Inside this podcast you'll explore:
Tendon pathology explained: What's happening inside tendinopathic tendons, how to explain tendinopathy and ultrasound scan results to patients
The role of isometrics: Whether isometrics actually change tendon structure, when to use isometrics to improve pain, optimal dosage, and whether isometrics are all your tendinopathy patients need
Safe loading from day one: When are both isometrics AND isotonics safe to start immediately, and how to choose isometric positions and loads.
The 24-hour emoji rule: How to teach patients to monitor their response after running or loading using the emoji system
What NOT to do: Exercises, manual therapy and supplements that won't help tendon pain and may stir it up
Differential diagnosis mastery: How to distinguish patellar tendinopathy from patellofemoral pain, mid-portion achilles tendinopathy from peritendinitis, and when you've got the diagnosis wrong
Stairs as a progression exercise: The quasi-isometric stair protocol that works for everyone from sedentary patients to elite sprinters—and how to use tempo to control tendon load
Criteria-based progressions: Moving beyond time-based rehab to functional milestones
When loading programs fail: What to do when your patient is worse with your exercises
You'll walk away with:
Clear clinical reasoning to differentiate true tendinopathy from other conditions
Practical loading frameworks that progress your isometrics, isotonics and plyometrics based on patient response
Patient education scripts that use imaging findings to build confidence rather than fear
Simple monitoring tools (the emoji system) to empower patients to self-manage their load progression
Dr Ebonie Rio is a post doc researcher at La Trobe University and has completed her PhD in tendon pain, Masters Sports Phys, B. Phys (Hons) and B. App Sci. Her clinical career has included the Australian Institute of Sport, Australian Ballet Company, Australian Ballet School, Melbourne Heart Football Club, Alphington Sports Medicine Centre, Victorian Institute of Sport, 2006 Commonwealth Games, 2010 Vancouver Winter Olympics, 2010 Singapore Youth Olympics, 2012 London Paralympics, 18 months travelling with Disney's The Lion King stage show (Melbourne and Shanghai tour).
 


Get free access to the "Tricky tendons" infographic series
Unlock the secrets of successful tendinopathy assessment and treatment with this free infographic series for therapists.
Links
Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership
Click here to register and receive immediate access to the Tricky tendons infographic series
Free Achilles tendinopathy video series with Tom Goom
David Pope at Clinical Edge
Download and subscribe to the podcast on iTunes
Download the podcast in Overcast
Listen to the podcast on Spotify
Dr Ebonie Rio
David Pope on Twitter
David Pope & why I started Clinical Edge
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Infographics by Clinical Edge
Chapters:
00:02:57 - How isometrics emerged as a tendinopathy treatment
00:07:01 - How loading helps a tendon
00:07:39 - Tendon structure & how to describe tendinopathy to patients
00:12:28 - When and why tendinopathy develops
00:15:18 - Tendon imaging
00:17:40 - Differential diagnosis - Achilles peritendinitis vs mid-portion tendinopathy
00:19:36 - Does treatment change tendon structure?
00:21:29 - Can we load disorganised areas of tendon?
00:22:48 - Do supplements help?
00:24:48 - Avoid these in your tendinopathy treatment
00:26:51 - Finding the right level of running or load
00:28:45 - What causes tendinopathy to develop
00:31:57 - When and how to include isometrics in treatment
00:36:47 - When isometrics are likely to help or not help
00:38:56 - Choosing the starting position for isometrics
00:39:43 - How to describe isometrics to patients
00:40:28 - How to choose the load for isometrics
00:42:59 - When to include isotonics in treatment
00:44:09 - Plyometric & Stair loading  
00:46:56 - How long should isometric holds be?
00:47:33 - Patient advice & discussion

Have any of your shoulder patients improved and then plateaued, unable to regain their full range of movement, or get rid of their painful arc?
Sometimes it's not the cuff, capsule, nerves or neck—it's the acromioclavicular joint (ACJ) holding things back.
In this episode, Jo Gibson sheds light on this often-overlooked contributor to persistent shoulder pain.
From real patient case studies to the latest research and simple clinic-ready symptom modification tests, Jo shares practical strategies you can use immediately.
Learn how to identify ACJ involvement, and use targeted rehab exercises, symptom modification and treatment strategies to help patients break through their plateau and regain their confidence and range.
Chapters:
00:00 - Intro

02:59 - Case study: Patient with shoulder pain

03:29 - Recent research around the ACJ

06:37 - Psychosocial or biomedical factors influencing the ACJ and shoulder pain

06:53 - Role of the ACJ

07:06 - Pain and movement patterns indicating ACJ involvement

08:34 - Protective movement strategies that may affect the ACJ

09:18 - Symptom modification tests

10:08 - Exercises for the ACJ

12:43 - Manual therapy for a stiff ACJ?

15:40 - Summary: When to look at the ACJ


Join the free 7-day Shoulder assessment bootcamp with Jo Gibson and Clinical Edge
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The handout for this podcast consists of a transcript associated with this podcast.




Shoulder: Steps to Success online course with Jo Gibson
Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Free trial Clinical Edge membership
Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial
Links associated with this episode:
Join the free 7-day Shoulder assessment bootcamp with Jo Gibson and Clinical Edge
Free video series - How to be a shoulder detective: Solving acute shoulder pain with Jo Gibson
Get your access to the free video series "Frozen shoulder assessment & treatment" with Jo Gibson
Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson
Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday
Download and subscribe to the podcast on iTunes
Download the podcast now using the best podcast app currently in existence - Overcast
Listen to the podcast on Spotify
Jo Gibson on Twitter
Let David know what you liked about this podcast on Twitter
Review the podcast on iTunes
Infographics by Clinical Edge

Anterior hip pain is often blamed on the hip flexors, but in runners, that's rarely the diagnosis. So how can you identify the real cause and guide patients to a safe, effective recovery?
In this episode, Tom Goom (Running Physio) explores the function of the hip flexors in running, key differentials for anterior hip or groin pain, and practical rehab strategies you can use right away.
You'll discover:
Why true hip flexor tendinopathy is uncommon in endurance runners
Red flags and key tests to identify bone stress fractures and intra‑articular pathology
Early‑stage loading strategies that protect the tendon from aggravation
The role of the adductors, trunk, and synergistic muscles in successful rehab
Common myths and misconceptions around hip flexors
How to progress rehab to sport‑specific drills and return to running
If you're a physiotherapist or health professional treating runners, this episode gives you research‑backed, clinically reasoned strategies to assess and manage hip flexor pain with confidence.
Timestamps:
00:00 - Intro
03:35 - Hip flexor function
06:56 - Tip 1 - Is it a hip flexor tendinopathy?
09:48 - Tip 2 - Rehab of hip flexors
11:35 - Tip 3 - Other muscle groups to include in rehab
13:08 - Common misconceptions
13:37 - 1. Pronation
14:49 - 2. Firing order
16:13 - 3. Weak transversus abdominis
17:12 - 4. Rib alignment and breathing patterns
🔗 Free Webinar Alert! Don't miss out on our free webinars for therapists on shin pain and Achilles tendinopathy in runners. Check the link in the description for more information.
Free running injury assessment & treatment video series available now

 

 

 

 

Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs.




Get free access to the "Tricky tendons" infographic series
Unlock the secrets of successful tendinopathy assessment and treatment with this free infographic series for therapists.

Article associated with this episode:
Click here to download your podcast handout
Lenhart R, Thelen D, Heiderscheit B. Hip muscle loads during running at various step rates. journal of orthopaedic & sports physical therapy. 2014 Oct;44(10):766-A4.
 
Links associated with this episode:
Free Achilles tendinopathy videos
Discover the simple secrets to successfully treat tendon pain in this free three part video series with Tom Goom
Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
Join Tom live on Facebook & ask your shoulder related questions every Friday
Download and subscribe to the podcast on iTunes
Download the podcast now using the best podcast app currently in existence - Overcast
Listen to the podcast on Spotify
Tom Goom on Twitter
Tom Goom's website
David Pope - Twitter
David Pope & why I started Clinical Edge
Review the podcast on iTunes
Infographics by Clinical Edge

Your patient presents with shoulder pain, and straight away you need to identify:
Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely?
Is it rotator cuff related shoulder pain, frozen shoulder, instability, or something else entirely?
Is the pain actually coming from the shoulder?
Could it be the cervical spine?
Is there a tear that needs urgent referral?
Should you order imaging? Refer to a surgeon? Or confidently continue with rehab?
In this podcast, Jo Gibson (Upper Limb Rehabilitation Specialist Physio) guides you through a simple, evidence-informed clinical reasoning framework to help you confidently assess and treat patients with shoulder pain.
Drawing on decades of clinical experience and the latest research, Jo breaks down four essential questions you need to ask in every shoulder assessment—helping you identify red flags, tailor your treatment plan, and avoid common diagnostic pitfalls.
In this episode, you'll discover:
How to distinguish shoulder pain from cervical spine referral
Key subjective clues that guide your diagnosis and treatment decisions
Whether it's "torn"—and how to know if a surgical referral is appropriate
Clinical signs that help differentiate frozen shoulder from other causes of stiffness
Why pain irritability matters—and how it impacts your rehab approach
When to use (and when to avoid) imaging
How to identify instability and assess the likelihood of recurrence
What assessment tests to perform in your objective examination
The real value—and limitations—of special tests like the Hawkins-Kennedy, drop arm, Hornblower's, and more.
How to modify testing to better isolate rotator cuff contributions
Why symptom modification tests are useful—and what they tell you
How to help your patient overcome fear, regain confidence, and move again
What research says about exercise prescription, and how many exercises you should give patients
Listen in to strengthen your clinical reasoning and give your shoulder assessments a clear structure that helps you feel more confident—and gets better outcomes for your patients.
Chapters:
00:00 - Intro
03:12 - Subjective clues that guide diagnosis
04:33 - What to call shoulder pain? RCRSP or SAP?
06:04 - 4 key questions to ask
06:29 - Cervical spine driven shoulder pain
10:03 - Is it torn and does it matter?
11:29 - Traumatic dislocations
12:37 - Special tests in the "Is it torn" group
15:56 - Is it stiff?
17:36 - Is it irritable?
20:38 - Can I change it?
23:05 - Summary
Click on an image below to access these free resources from Jo Gibson and Clinical Edge


The handout for this podcast consists of a transcript associated with this podcast.




Shoulder: Steps to Success online course with Jo Gibson
Improve your assessment and treatment of shoulder pain with the Shoulder: Steps to Success online course with Jo Gibson, now available for enrolment at clinicaledge.co/shouldersuccess

Free trial Clinical Edge membership
Use a fresh approach to your musculoskeletal and sports injury treatment with a free trial Clinical Edge membership at clinicaledge.co/freetrial
Links associated with this episode:
Free video series - How to be a shoulder detective: Solving acute shoulder pain with Jo Gibson
Get your access to the free video series "Frozen shoulder assessment & treatment" with Jo Gibson
Improve your shoulder assessment & treatment with the Shoulder: Steps to Success online course with Jo Gibson
Improve your confidence and clinical reasoning with a free trial Clinical Edge membership
Join Jo Gibson live on Facebook & ask your shoulder related questions every Monday
Download and subscribe to the podcast on iTunes
Download the podcast now using the best podcast app currently in existence - Overcast
Listen to the podcast on Spotify
Jo Gibson on Twitter
Let David know what you liked about this podcast on Twitter
Review the podcast on iTunes
Infographics by Clinical Edge
Chapters:
00:00:00 - Intro
00:03:12 - Subjective clues that guide diagnosis
00:04:33 - What to call shoulder pain? RCRSP or SAP?
00:06:04 - 4 key questions to ask
00:06:29 - Cervical spine driven shoulder pain
00:10:03 - Is it torn and does it matter?
00:11:29 - Traumatic dislocations
00:12:37 - Special tests in the "Is it torn" group
00:15:56 - Is it stiff?
00:17:36 - Is it irritable?
00:20:38 - Can I change it?
00:23:05 - Summary

Your patient is running, playing sport, or jumping or lunging forward - an activity with fast eccentric or concentric activity in dorsiflexion,and suddenly they feel like they've been kicked in the back of the leg.
They might hear a snap and have difficulty weightbearing, walking and pushing off.
What's your likely diagnosis?
You picked it - an Achilles tendon (AT) rupture.
AT ruptures are a devastating injury that can drastically impact a patient's ability to walk, run, or return to sport.
Despite their frequency, there's a lot of uncertainty among clinicians, patients, and even surgeons around how to best assess, treat, and rehabilitate Achilles tendon ruptures.
Patients are often fearful of doing the wrong thing and re-rupturing the tendon.
Therapists often follow a non-surgical protocol of putting people in a boot, but are unsure how to progress, how fast to progress and what to do during and after they're in the boot.
An even bigger problem than AT re-rupture is the very common issue of an elongated tendon where patients have long-term difficulty with calf weakness and inefficiency, walking long distances, hopping, jumping, and returning to sport.
In this podcast, David Pope (APA Titled Musculoskeletal and Sports & Exercise Physiotherapist) is joined by Prof. Peter Malliaras (Specialist Physiotherapist FACP, clinician and researcher with a PhD in tendinopathy) to explore the latest evidence, clinical insights, and rehab strategies for Achilles tendon ruptures.
Peter draws on his extensive clinical experience, recent research, and the development of a specialist Achilles rupture service at OrthoSport Victoria to help guide your decision-making and treatment approach.
In this podcast, you'll discover:
The mechanism of injury and clinical presentation of Achilles tendon ruptures.
Key diagnostic tests and how to avoid missed or delayed diagnoses.
Common pitfalls that lead to tendon elongation—and how to prevent them.
When to recommend surgical vs non-surgical management.
A new, innovative approach to strengthening the Achilles tendon while the patient is in the boot.
How to safely begin loading the Achilles in the early phase of rehab.
Strategies to protect against tendon elongation during and after boot use.
Whether we should be stretching or trying to improve dorsiflexion.
Objective strength criteria to guide progression through rehab stages.
Return-to-walking and return-to-sport timeframes—and how to individualise them.
What to do when patients present late or have already developed elongation.
Complications to watch for post-injury or post-surgery.
How to help patients navigate the psychological and motivational challenges of recovery.
Listen to this episode to gain clarity on Achilles tendon rupture assessment and rehab, and develop a structured, evidence-based approach you can apply immediately in your clinical practice.
Timeline
00:06:23 Problems Physios and patients face with AT ruptures?
00:09:29 Subjective - How to identify a likely AT
00:12:03 Who gets an AT rupture?
00:18:45 Why do AT's rupture?
00:20:06 Misdiagnosis
00:24:14 Surgical or non-surgical management?
00:30:25 Elongation - Improve dorsiflexion or make the AT stiffer?
00:36:53 Safe loading in the boot & progressions
00:42:49 When to start exercising in the boot
00:46:08 Elongation - why is it a problem?
00:54:00 Bent or straight knee calf exercises?
00:59:55 RTP - How long does it take?
01:03:32 Surgical vs non-surgical timeframes
01:04:25 Assessment and diagnosis of AT ruptures
01:08:40 Initial management of an AT rupture
01:11:26 Education - What to tell patients
01:12:54 Imaging
01:14:57 Delayed presentation - How to manage
01:16:10 Red flags & complications
01:19:10 Walking - How to guide patients as they come out of the boot
01:21:27 Exercise progressions after the boot
01:23:48 Key takehome messages
   
Get free access to the "Tricky tendons" infographic series
Unlock the secrets of successful tendinopathy assessment and treatment with this free infographic series for therapists.

Links associated with this episode:
Prof Peter Malliaras at OrthoSport Victoria
Prof Peter Malliaras
Online courses with Prof Peter Malliaras
Tendinopathy podcast with Prof Peter Malliaras
Summary handout
Adductor related groin pain rehab with Andrew Wallis
FAI assessment and treatment with Dr Adam Weir
Accelerated conservative management of medial knee injuries with Chris Morgan
Improve your musculoskeletal and sports injury assessment & treatment results with a free trial Clinical Edge membership
Click here to register and receive immediate access to the Tricky tendons infographic series
Free Achilles tendinopathy video series with Tom Goom
David Pope at Clinical Edge
Download and subscribe to the podcast on iTunes
Download the podcast in Overcast
Listen to the podcast on Spotify
Dr Lachlan Giles
David Pope on Twitter
David Pope & why I started Clinical Edge
Review the podcast on iTunes
Infographics by Clinical Edge
Research associated with this podcast
Barfod, K. W., Hansen, M. S., Sandholdt, H., Boesen, A., Hölmich, P., Troelsen, A., & Kristensen, M. T. (2022). The Copenhagen Achilles length measurement performed at time of acute Achilles tendon rupture is correlated to tendon elongation after 1 year. The Journal of Foot and Ankle Surgery, 61(5), 1098-1102.
Barfod, K. W., Overgård, A. B., Hansen, M. S., Haddouchi, I. E., Toft, M., & Hölmich, P. (2023). Effect of the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) on Calf Muscle Volume and Tendon Elongation After Acute Achilles Tendon Rupture: A Predefined Secondary Analysis of the First 60 Patients in a Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine, 11(11), 23259671231211282.
Hansen, M. S., Vestermark, M. T., Hölmich, P., Kristensen, M. T., & Barfod, K. W. (2020). Individualized treatment for acute Achilles tendon rupture based on the Copenhagen Achilles Rupture Treatment Algorithm (CARTA): a study protocol for a multicenter randomized controlled trial. Trials, 21, 1-14.
Hansen, M. S. (2022). Achilles tendon rupture: Tendon elongation, gait dynamics, and individualized treatment(Doctoral dissertation, School of Health and Medical Sciences, University of Copenhagen).
Hansen, M. S., Bencke, J., Kristensen, M. T., Kallemose, T., Hölmich, P., & Barfod, K. W. (2023). Achilles tendon gait dynamics after rupture: A three-armed randomized controlled trial comparing an individualized treatment algorithm vs. operative or non-operative treatment. Foot and Ankle Surgery, 29(2), 143-150.
Willits, K., Amendola, A., Bryant, D., Mohtadi, N. G., Giffin, J. R., Fowler, P., ... & Kirkley, A. (2010). Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation. JBJS, 92(17), 2767-2775.