Welcome to episode number 10 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the topic of Tendon Neuroplastic Training and the article "Tendon neuroplastic training: Changing the way we think about tendon rehabilitation: A narrative review." Tendon rehabilitation has primarily consisted of exercise based interventions, with a focus on isometrics, eccentrics, or heavy slow resistance training with the goal to strengthen the musculotendinous structure. Little has been done to address the cortical excitation and inhibition changes that occur with tendinopathy. Utilization of externally paced exercises/movements can help address some of the motor control changes. Lastly, we address application of externally paced exercises to other conditions/pathologies to address cortical changes.

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Rio E, Kidgell D, Moseley G, et al. (2016). Tendon neuroplastic training: Changing the way we think about tendon rehabilitation: A narrative review. British Journal of Sports Medicine.

Welcome to episode number 9 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the topic of UCL rehabilitation and the article "Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction." There is a lot of variability among various UCL reconstruction rehabilitation protocols. Protocols can range from 12 months up to 18 months. Regardless of the protocol, the foundation and principles of the protocol remain the same. We discuss implementation of the protocol and why delaying plyometrics to continue to focus on strength/hypertrophy a little longer might yield better results. Lastly, we cannot neglect that the individual to focus solely on the sight of repair. We can continue to work on thoracic rotation, hip rotation, contralateral upper limb strength, lower body strength to allow the individual to better maintain pertinent biomotor qualities to sport. 

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Wilk K, Arrigo C, Dugas J, et al. (2017). Rehabilitation and Return-to-Play Criteria Following Ulnar Collateral Ligament Reconstruction. Operative Techniques in Sports Medicine.

Welcome to episode number 8 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the topic of posterior shoulder instability and the article "Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and Inform Return-to-Play Decision Making." Many therapists and healthcare professionals will utilize time and a simple clinical examination to determine whether an individual is ready to return to sport. Athletes who do not undergo a criteria-based return to sport test battery had a 22% greater rate of recurrence compared to those who undergo and pass. Similar to ACL-R, although objective performance tests such as the CKCUEST and UQ-YBT may be within 90% symmetry, strength deficits in the rotator cuff/shoulder girdle may continue to persist; which highlights the value of true objective strength measurements with dynamometry. Moreover, testing criteria should best approximate the demands of the sport/activity the individual desires to get back to. An eclectic approach incorporating both open chain and closed chain tests will likely serve as the most useful versus putting all of our eggs in one basket. Remember, not only does the testing demands need to approximate sport, but also training as well.

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Otley T, Balster S, Myers H, et al. (2022). Return to Sport After Shoulder Stabilization Procedures: A Criteria-Based Testing Continuum to Guide Rehabilitation and Inform Return-to-Play Decision Making. Arthroscopy, Sports Medicine, and Rehabilitation.

Welcome to episode number 7 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the topic of posterior shoulder instability and the article "A Comprehensive Rehabilitation Program for Posterior Instability of the Shoulder." There are 3 main subcategories of posterior shoulder instability: traumatic, atraumatic, and repetitive microtrauma. Prognosis with conservative and non-conservative management will depend on the mechanism of injury along with other factors. A treatment framework can be used to guide exercise prescription for posterior shoulder instability. The entry point for each individual will be determined by their training age/history, subcategory classification, number of episodes of recurrence, and symptom severity/irritability.

1) Scapular Phase

2) Phase 1: 0 degrees of shoulder elevation

3) Phase 2: 0-45 degrees of shoulder elevation

4) Phase 3: 0-90 degrees of shoulder elevation

5) Phase 4: 0-180 degrees of shoulder elevation

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Watson L, Balster S, Warby S, et al. (2017). A comprehensive rehabilitation program for posterior instability of the shoulder. Journal of Hand Therapy.

Welcome to episode number 6 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the topic of arthrogenic muscle inhibition (AMI) and the article "Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions." Typical physical therapy interventions to address AMI have included NMES and exercises such as quad sets to improve quadriceps activation. However, there are many underpinnings of AMI and traditional interventions have only addressed part of the problem. We discuss other interventions, modalities, and exercise strategies to resolve AMI to improve quadriceps activation. With the potential for AMI to last for many months following surgery, it is crucial to resolve AMI with a multimodal approach.

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Sonnery-Cottet B, Saithna A, Quelard B, et al. (2019). Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. British Journal of Sports Medicine.

Welcome to episode number 5 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the article "The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process." Traditional physical therapy has largely emphasized improving range of motion, strength, endurance, and motor control, while neglecting power and rate of force development. We discuss strategies to measure rate of force development in both a typical orthopedic clinical setting as well as a sports performance rehabilitation setting. Similarly, we dive into exercise structure, programming, and implementing variability into the periodization of the rehabilitation process. 

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Buckthorpe M & Roi G. (2017). The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscles, Ligaments and Tendons Journal.

Welcome to episode number 4 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the article "Movement Competency Screens Can Be Reliable in Clinical Practice by a Single Rater Using the Composite Score." Movement screens have been the rage the past 10 years in a hope to decrease injury risk by limiting aberrant movement patterns and asymmetries. Although initial studies may have shown promise, more evidence is mounting against the use of movement screens as a tool to predict injury risk. We discuss utilization of screens such as the Functional Movement Screen (FMS), the Landing Error Scoring System (LESS), and the single leg squat, and re-purposing movement screens for tools other than risk screening. 

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Mann K, O'Dweyer N, Bruton M, Bird S, & Edwards S. (2022). Movement Competency Screens Can Be Reliable in Clinical Practice by a Single Rater Using the Composite Score. International Journal of Sports Physical Therapy.

Welcome to episode number 3 of The Residents of the Roundtable Podcast. Join Joey, Rayce, and Robert, as they discuss the article "Exercise Progression to Incrementally Load the Achilles Tendon." The achilles tendon has to handle stressors/forces that are multiple times an individual's body weight. Many trainers and movement professionals will progress clients/patients based off intuition and symptom response; however, this article provides a tiered approach to incrementally load the achilles tendon in the hope to not under-load or overload. We also discuss the utilization of a concurrent training model in the various stages of the rehabilitation process.

Tier 1 (0.0-0.249):

• Seated heel raise (2-leg)
• Seated heel raise (1-leg)
• Squat
• Low step up (leading leg)
• High step up (leading leg)
• Standing heel raise (2-leg)

Tier 2 (0.25-0.49):

• Rebounding heel raise (2-leg)
• Lunge (leading leg)
• Low step down (leading leg)
• Low step up (trailing leg)
• High step down (trailing leg)
• Walk (stance)
• Low step down (trailing leg)
• Forward jump (2-leg)
• High step down (leading leg)
• High step up (trailing leg)
• Lunge (trailing leg)
• Counter movement jump (2-leg)
• Rebounding heel raise (1-leg)
• Standing heel raise (1-leg)

Tier 3 (0.50-0.74):

• Drop jump (2-leg)
• Hopping (2-leg)
• Run (stance)
• Forward hopping (2-leg)
• Counter movement jump (1-leg)
• Forward jump (1-leg)

Tier 4 (0.75-1.00):

• Hopping (1-leg)
• Drop jump (1-leg)
• Lateral hopping (1-leg)
• Forward hopping (1-leg)

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Baxter R, Corrigan P, Hullfish T, O'Rourke P, & Silbernagel K. (2020). Exercise Progression to Incrementally Load the Achilles Tendon. Medicine & Science in Sports & Exercise.