Sports Medicine Project

Stress fractures feel like they're everywhere lately but I don't think its changing disproportionately. I dig into why, what's really going on, and which bits of the "epidemic" narrative I think hold up.

Refs:
Bennell KL, Malcolm SA, Thomas SA, Reid SJ, Brukner PD, Ebeling PR, Wark JD. Risk factors for stress fractures in track and field athletes: a twelve-month prospective study. American Journal of Sports Medicine. 1996;24(6):810–818.
Knapik J, Montain SJ, McGraw S, Grier T, Ely M, Jones BH. Stress fracture risk factors in basic combat training. International Journal of Sports Medicine. 2012;33(11):940–946.
Changstrom BG, Brou L, Khodaee M, Braund C, Comstock RD. Epidemiology of stress fracture injuries among US high school athletes, 2005–2006 through 2012–2013. American Journal of Sports Medicine. 2015;43(1):26–33.
Rizzone KH, Ackerman KE, Roos KG, Dompier TP, Kerr ZY. The epidemiology of stress fractures in collegiate student-athletes, 2004–2005 through 2013–2014 academic years. Journal of Athletic Training. 2017;52(10):966–975.
Shi BY, Castaneda C, Sriram V, Yamasaki S, Wu SY, Kremen TJ. Changes in the incidence of stress reactions and fractures among intercollegiate athletes after the COVID-19 pandemic. Journal of Orthopaedic Surgery and Research. 2023;18(1):788.
Bergman AG, Fredericson M, Ho C, Matheson GO. Asymptomatic tibial stress reactions: MRI detection and clinical follow-up in distance runners. American Journal of Roentgenology. 2004;183(3):635–638.
Kiuru MJ, Niva M, Reponen A, Pihlajamäki HK. Bone stress injuries in asymptomatic elite recruits: a clinical and magnetic resonance imaging study. American Journal of Sports Medicine. 2005;33(2):272–276.
Hoenig T, Ackerman KE, Beck BR, Bouxsein ML, Burr DB, Hollander K, Popp KL, Rolvien T, Tenforde AS, Warden SJ. Bone stress injuries. Nature Reviews Disease Primers. 2022;8(1):26.
AusPlay (Australian Sports Commission). National participation data on running and jogging, 2015–present. https://www.clearinghouseforsport.gov.au/research/ausplay

In this episode, we explore questions such as:
Why does pain persist despite multiple high-quality treatments?
What does it actually mean to say pain is multifaceted, and how should that change clinical decision making?
How should clinicians communicate about pain in a way that is accurate, validating, and actionable?
What should clinics stop doing, start doing, and measure if they want to improve care?

In this episode, we speak with Dr Nardia-Rose Klem, a physiotherapist and research academic at Curtin University whose work focuses on young people living with persisting pain, particularly the relationship between pain, mental wellbeing, and access to appropriate care.

She is involved in several important clinical translation and public education initiatives, including young painHEALTH, painHEALTH, and the Musculoskeletal Clinical Translation Framework, all of which aim to improve the way pain and musculoskeletal conditions are understood, communicated, and managed. Her research spans young people with chronic musculoskeletal pain, co-existing mental health conditions, pain care experiences, and qualitative work exploring patient experiences across musculoskeletal healthcare contexts. 

Links mentioned
Profile and socials
Curtin University staff profile
Instagram: @physio_nardia
Websites and resources
young painHEALTH
painHEALTH
Musculoskeletal Clinical Translation Framework
Örebro Musculoskeletal Pain Screening Questionnaire, short form
Publications
Characterizing phenotypes and clinical and health utilization associations of young people with chronic pain: latent class analysis using the electronic Persistent Pain Outcomes Collaboration database 
“It’s kind of just like a never-ending cycle”: Young people’s experiences of co-existing chronic musculoskeletal pain and mental health conditions 
Lived and care experiences of young people with chronic musculoskeletal pain and mental health conditions: a systematic review with qualitative evidence synthesis 
A Prospective Qualitative Inquiry of Patient Experiences of Cognitive Functional Therapy for Chronic Low Back Pain During the RESTORE Trial 
What Influences Patient Satisfaction after TKA? A Qualitative Investigation

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.

Dr. Gerald Yeo emphasizes the complexity of foot and ankle surgeries compared to other orthopedic procedures.
The discussion highlights the importance of a multidisciplinary approach involving physiotherapists and podiatrists.
Dr. Yeo explains the traditional and modern approaches to treating Achilles tendonitis.
The episode explores the challenges of measuring surgical outcomes for foot and ankle procedures.
Dr. Yeo shares insights on the use of Richie braces in managing foot conditions.
The conversation covers the role of imaging in diagnosing and planning surgeries.
Dr. Yeo discusses the potential of minimally invasive techniques in foot and ankle surgery.
The episode addresses the common misconceptions about Haglund's deformity and its treatment.
Dr. Yeo talks about the importance of patient education in managing expectations post-surgery.
The discussion includes the future of orthopedic surgery and potential advancements in treatment options.
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