164. Case study: Rotator cuff tear + arm symptoms. Physio Edge Shoulder Success podcast with Jo Gibson

Your patellar tendinopathy patients are performing a solid, progressive loading program, but their quadriceps still test weaker, with lower maximal force output. Are their quads actually weak, or is muscle inhibition limiting the strength they can access? And how does this change your rehab? In this episode, Dr Patrick Vallance (Ph.D, Physiotherapist, Tendinopathy neuroscientist, Lecturer in Physiotherapy at Monash University) and David Pope explore why force output can be reduced in tendinopathy, and how understanding the mechanisms involved can help you tailor your treatment. You'll also discover: Clinical clues that inhibition may be contributing to your patient's reduced force output How inhibition at the brain and spinal cord differs, and why this matters for rehab The reticulospinal pathway and its role in producing strength and power How metronome-paced and self-paced exercises may target different neural pathways, and what this could mean for your exercise choices Why Achilles and patellar tendinopathy may need different treatment approaches, including when to target muscular endurance How assessing strength, power and endurance helps you identify what each patient's rehab needs to address Why researchers are reconsidering TENS and ice as possible adjuncts to exercise for patellar tendinopathy Where isometrics fit when they don't relieve pain, and how their role in tendon stiffness could influence your exercise prescription Throughout the episode, Patrick uses simple analogies and practical exercise examples to make the science easier to understand and apply. He explores what the research can currently tell us, which treatment ideas are still being tested, and how to use this understanding to tailor your rehab to your patients' needs and goals. Chapters 0:00 - Introduction 2:28 - Tendinopathy, inhibition and force output 3:10 - Measuring inhibition 8:47 - Why look beyond the tendon? 10:24 - Corticospinal vs reticulospinal pathways 16:01 - Pain and spinal inhibition 22:09 - Power vs control 26:20 - Metronome-paced vs self-paced training 30:50 - What is self-paced training? 36:08 - How to reduce nociceptive drive 39:26 - How to target the reticulospinal pathway 41:16 - How to target the corticospinal pathway 43:19 - Achilles vs patellar tendinopathy 46:08 - Endurance targets 47:36 - Isometrics and tendon stiffness 50:05 - Where the research is heading Free resources Podcast handout: your key takeaways from the podcast, plus the full transcript, so you can remember it and apply it with your patients. Clinical Edge membership: improve your assessment and treatment results, including the new taping video series with Zoe Russell (Specialist Sports Physiotherapist). Free running injury resources: for the runners and running injuries you treat. Links associated with this episode Click here to download your podcast handout Improve your assessment and treatment results with a Clinical Edge membership Free running injury resources 175. Tendinopathy treatment: Your guide to isometrics, isotonics & plyometrics with Dr Ebonie Rio Dr Patrick Vallance - Instagram (Tendinopathy Circuit Breaker) David Pope - X David Pope - Instagram

Patellofemoral pain (PFP) rehabilitation doesn't end when your patient gets stronger. The real challenge is getting them back to running, training and racing without triggering another flare-up. In this final episode of the four-part series, Tom Goom (Running Physio) and David Pope explore the fourth pillar of successful PFP rehabilitation: a planned return to running. Continuing Alice's journey from the previous episodes, a HYROX athlete preparing for competition, Tom and David break down exactly how to rebuild running volume, progress training safely, and help runners hit their goals, or return to racing or competition, with confidence while minimising the risk of recurrence. You'll discover: How to structure a return-to-running program that steadily rebuilds running capacity without overloading the knee A simple progression strategy that makes increasing running volume practical and easy to implement Why recovery weeks are just as important as progression weeks, and how to use them effectively How to use a simple "traffic light" system to decide when to progress, maintain or reduce training When gait analysis and running retraining should (and shouldn't) be introduced during rehabilitation Why sleep, recovery and anxiety can have a major influence on running injury recovery, and practical ways to address them How to manage the inevitable flare-ups that occur during rehabilitation without losing progress or confidence How the same four-pillar framework can be applied to virtually every running injury, from tendinopathy to bone stress injuries Throughout the episode, Tom shares the practical clinical reasoning behind every decision, from mapping out a patient's weekly training schedule through to progressing running distance, introducing recovery weeks, and eventually returning to continuous long-distance running. Whether you're treating recreational runners, competitive athletes or patients training for events like HYROX, you'll come away with a clear framework you can immediately apply to help your patients return to running safely, confidently and with a much lower risk of recurrence. This is the fourth and final episode in Tom Goom's four-part podcast series on patellofemoral pain. Together, the series provides a complete framework for assessing, educating, rehabilitating and returning runners with PFP back to the sport they love. Timeline: 0:00 - Introduction 3:07 - Introduction and case recap 6:03 - Weekly training structure 8:10 - Progress and recovery 11:03 - Gait analysis and the four pillars 12:13 - Recovery, sleep and anxiety 14:40 - Alice's progress and flare-ups 18:32 - Four pillars for all running injuries 20:52 - Free assessment form and webinar Free resources Running injury assessment sheet — Tom's go-to assessment sheet for every runner, giving you the structure to gather all the key information you need. It includes his screening questions for past medical history, a weekly training structure block, the key physical tests he performs, and a QR code to an energy availability questionnaire.

Strengthening exercises are a key part of successful patellofemoral pain (PFP) rehabilitation. Squats, lunges and single leg squats are often painful early on and can aggravate your patients pain, but on the flip side, we want to build up their tolerance and confidence with these movements. If you introduce an exercise your patient isn't ready for, progress too quickly, or overload the knee too early, you'll often flare your patients pain and set their rehabilitation back. In this episode, Tom Goom (Running Physio) and David Pope explore the third pillar of successful PFP treatment: progressive rehab. Continuing the case of Alice from the previous two podcasts, a HYROX athlete preparing for competition, Tom and I walk through exactly how to choose, modify and progress exercises that build strength, restore confidence and prepare patients for the demands of running and sport, without flaring their symptoms. You'll discover: How to decide when to prioritise load management before introducing strengthening exercises Why rehabilitation should be tailored to the individual rather than using a "cookie-cutter" exercise program The key strength deficits Tom commonly looks for in runners with PFP, and how to assess them How to select exercises that improve strength while minimising stress on the patellofemoral joint Practical ways to modify squats, lunges and other knee-loading exercises to reduce pain while rebuilding movement tolerance A simple four-stage progression from low-irritability exercises through to sport-specific strength and power training How to integrate rehabilitation into a patient's existing training so they are more likely to stick with the program Throughout the episode, Tom shares the clinical reasoning behind each exercise choice, showing how to progress patients from simple strengthening exercises to the powerful, sport-specific movements required for running and HYROX competition, without provoking unnecessary flare-ups. This is part three of a four-part podcast series with Tom Goom on PFP. In the final episode, available later this week, Tom and David explore the fourth pillar of rehabilitation: how to safely progress running volume, speed and training so patients can confidently return to racing and competition while minimising the risk of recurrence. Timeline: 2:45 Introduction & Recap 5:20 When to Start Rehab 7:40 Assessment Findings 9:37 Squats to Rebuild Tolerance 12:03 Psychosocial Screening & Gait 13:11 Matching Rehab to HYROX 14:57 Stage 1: Low Knee-Stress Work 17:11 Stage 2: Loaded Knee Flexion 18:53 Review Frequency & Goals 21:49 Stage 3: Knee-Focused Loading 24:09 Stage 4: Power Work 27:43 Keys to Avoid Flare-Ups 28:58 Webinar & Resources Free resources Running injury assessment sheet — Tom's go-to assessment sheet for every runner, giving you the structure to gather all the key information you need. It includes his screening questions for past medical history, a weekly training structure block, the key physical tests he performs, and a QR code to an energy availability questionnaire.

Many runners patellofemoral pain (PFP) is aggravated by the activity they love. They either stop running to let their pain settle, and then it returns as soon as they start back up again, or keep running despite the pain getting worse. They may know (and you may have told them) they should reduce their training….but what happens when they can't? Or won't? In this episode, Tom Goom (Running Physio) and David Pope explore the second pillar of successful PFP rehab: education and empowerment. Using the real case of Alice, a HYROX athlete preparing for competition, you'll discover how and when to help runners continue training safely while building long-term confidence and self-management. You'll discover: Why simply telling runners to "stop running" often leads to poor outcomes Practical communication strategies that improve patient buy-in and adherence How to uncover the real reasons patients resist reducing their training Ways to keep runners connected to the physical and social benefits of their sport during rehab How to explain PFP without creating fear around "maltracking," arthritis, or joint damage A simple framework that patients understand and can use to confidently self-manage flare-ups How to educate patients about the balance between training stress and recovery to improve both performance and rehabilitation Practical load management strategies for runners with symptoms so irritable they can't tolerate running yet Throughout the episode, Tom demonstrates how education isn't simply about explaining a diagnosis. It's about helping patients understand their pain, make better decisions independently, and confidently adjust their training as symptoms change. This is part two of a four-part podcast series with Tom Goom on PFP. In the next episode, Tom and David dive into the third pillar of rehabilitation: how to choose and progress strengthening exercises that build capacity without flaring symptoms, while avoiding the common rehab mistakes that slow recovery. Timeline 00:00 - Introduction 02:42 - Case study: Recurrent PFP and HYROX load 09:22 - Subjective clues 11:57 - Barriers to recovery 13:48 - Offloading when the knee can't tolerate running 17:12 - Helping patients understand and self-manage 23:48 - Self-management approach 27:11 - Stress, recovery and progress 28:47 - Key takeaways & free resources Free resources Running injury assessment sheet — Tom's go-to assessment sheet for every runner, giving you the structure to gather all the key information you need. It includes his screening questions for past medical history, a weekly training structure block, the key physical tests he performs, and a QR code to an energy availability questionnaire.

Patellofemoral pain (PFP) is one of the most common running injuries, and the high recurrence rate can make it a frustrating injury for patients to experience and clinicians to treat. In this episode, Tom Goom (Running Physio) and David Pope break down why PFP has such a high recurrence rate, and what most rehab plans miss. You'll also discover: The "Four pillars" framework Tom uses to treat PFP and other running injuries How and when to keep patients running or exercising when it is essential for their mental health and social life How to find a manageable starting point when a patient has a highly irritable pain presentation A step-by-step load management approach to find patients training and running "sweet spot" How to keep athletes connected to their sport during rehab (and why it matters for mental health) The "layering" approach to training and running that avoids pain flare-ups So you can easily apply the podcast with your patients, Tom walks through the real case of a runner and HYROX athlete who presented with recurrent PFP that flared up with each of her 3-4 weekly training sessions. This is part one in a four-part podcast series with Tom Goom on PFP. In the next episode, Tom and David continue this case study and dive into the second pillar in the framework that will help you tackle the problem of "What to do when your runners won't reduce their training?". Timestamps: 03:41 - Why PFP is tricky and recurs 04:45 - Meet Alice: HYROX athlete with recurrent PFP 05:32 - HYROX explained and its knee-load demands 08:47 - Presentation, irritability and moving beyond "stop running" advice 11:15 - Alice's goals 12:41 - The four pillars framework 15:29 - Pillar 1: Load management 23:39 - Testing tolerance 27:21 - Building Alice's weekly routine 30:06 - Key takeaways & free resources 34:10 - Free resources Free resources Running injury assessment sheet — Tom's go-to assessment sheet for every runner, giving you the structure to gather all the key information you need. It includes his screening questions for past medical history, a weekly training structure block, the key physical tests he performs, and a QR code to an energy availability questionnaire. Free "Patellofemoral pain masterclass: The four pillars of lasting recovery in runners with Tom Goom (Running Physio)" — Join Tom's free webinar to see his assessment and treatment in action, with visuals of the assessment tests, gait assessment and the traffic-light and sweet-spot approaches, plus the exercises, evidence and best-practice guidelines behind treating patellofemoral pain. Improve running injury assessment & treatment now with the Running Repairs Online course with Tom Goom at clinicaledge.co/runningrepairs.