JOSPT Insights

Last week we explored how people with pain move. Drs Ruth Chang and JP Caneiro explained cognitive functional therapy, or CFT, as an approach to helping people in pain explore their beliefs with curiosity. Today, we take the discussion further, exploring what CFT could do for your practice. Dr Chang is a postdoctoral research fellow at Curtin University in Perth, Australia, and a specialist musculoskeletal physiotherapist. Dr Caneiro is a specialist physiotherapist, Adjunct Senior Clinical Researcher at Curtin University, and Director and Educator at Evoolve Pain Care Academy. ------------------------------ RESOURCES RESTORE trial: https://pubmed.ncbi.nlm.nih.gov/37146623/ Patterns of change in forward bending, and pain self-efficacy during CFT: https://www.jospt.org/doi/10.2519/jospt.2025.13114 Relationship between forward bending and improvement in pain and disability during CFT: https://www.jospt.org/doi/10.2519/jospt.2024.12727 Network meta-analysis of tailored exercise therapies with or without psychological interventions: https://www.jospt.org/doi/10.2519/jospt.2025.13281

If cognitive functional therapy hasn't been on your radar, it's likely only a matter of time. There's an increasing number of trials studying the effects of cognitive functional therapy. In a network meta-analysis published in January 2026 in JOSPT, the authors found that cognitive functional therapy topped a list of 27 different interventions for reducing disability in people with chronic non-specific low back pain. Today, Dr Ruth Chang (Curtin University, Australia) and Dr JP Caneiro (Curtin University; Evoolve Pain Care Academy) explain how cognitive functional therapy works and how to incorporate it into your practice. ------------------------------ RESOURCES RESTORE trial: https://pubmed.ncbi.nlm.nih.gov/37146623/ Patterns of change in forward bending, and pain self-efficacy during CFT: https://www.jospt.org/doi/10.2519/jospt.2025.13114 Relationship between forward bending and improvement in pain and disability during CFT: https://www.jospt.org/doi/10.2519/jospt.2024.12727 Network meta-analysis of tailored exercise therapies with or without psychological interventions: https://www.jospt.org/doi/10.2519/jospt.2025.13281

Manual therapy is one of those topics that seems to quickly descend to polarised debates in musculoskeletal rehabilitation. Today, we're talking about what manual therapy looks like and does in the 2020s. Dr Jodi Young explains the mechanisms of manual therapy, the typical effects and why you might think about adding manual therapy as another tool in your physical therapy toolkit. Dr Young is the Director of Research for the Doctor of Science in Physical Therapy program at Bellin College in Green Bay, Wisconsin, where she mentors doctoral clinicians and helps turn clinical and educational research questions into meaningful, publishable research. She is also a fellow of the American Academy of Orthopaedic Manual Physical Therapists. ------------------------------ RESOURCES Modern definition and description of manual therapy: https://pubmed.ncbi.nlm.nih.gov/38457654/ Modern way to teach and practice manual therapy: https://pubmed.ncbi.nlm.nih.gov/38773515/ Living review of manual therapy mechanisms: https://pubmed.ncbi.nlm.nih.gov/40100908/ Unravelling the mechanisms of manual therapy: https://www.jospt.org/doi/10.2519/jospt.2018.7476 Developing manual therapy frameworks: https://www.jospt.org/doi/10.2519/josptopen.2023.0002 Integrating person-centred concepts and modern manual therapy: https://www.jospt.org/doi/full/10.2519/josptopen.2023.0812 How do patients believe manual therapy works? https://www.jospt.org/doi/10.2519/josptopen.2025.0149 Does it matter how you apply spinal manipulation? JOSPT Insights ep 221: https://pod.link/1522929437/episode/NmM0MTg4OGMtODMwMi00ZTA3LTg1NzUtYjY2ZjBiMThiZGUy

After Lindsey Vonn's sad early exit due to injury from the Milano-Cortina 2026 Winter Olympics, it feels like an apt time to revisit the latest consensus on managing knee injury, and supporting return to sport after complex meniscus injury and surgery. Today, we continue the conversation on the latest consensus for managing acute and degenerative meniscus tears. We jump into non-surgical treatment, and all the return to sport considerations for athletes and active people with meniscus injury. Dr Arielle Giordano (University of Delaware) shares the results of the EU-US Meniscus Rehabilitation Consensus. ------------------------------ RESOURCES EU-US Meniscus Rehabilitation Consensus on prevention, non-operative treatment and return to sport: https://www.jospt.org/doi/10.2519/josptopen.2025.13539 DREAM trial primary report: https://pubmed.ncbi.nlm.nih.gov/38319181/ Should symptoms guide treatment choice in young patients? https://www.jospt.org/do/10.2519/jospt.blog.20240415/full/ Early surgery vs exercise therapy + education for traumatic and non-traumatic meniscus tears: https://www.jospt.org/doi/10.2519/jospt.2024.12245 Ep 224: Saving the meniscus: https://pod.link/1522929437/episode/NTg3YTgzZWUtYTZjZC00ZDYwLWI2OTAtYTczMzAzNTEyNzgz Ep 192: DREAMing of better care for meniscus tears: https://pod.link/1522929437/episode/Yzk2YzkyOWItMDk1MS00YWZkLWI2MjQtNmRlYjIwZGJmOTg0

Trust is integral to the therapeutic relationship between patients and clinicians in musculoskeletal rehabilitation. But does that trust go both ways? If you do a deep dive into the literature on trust, you'll find that it almost always talks about whether patients trust clinicians, not if clinicians trust patients. There's also an inherent bias built into the biomedical environment where so called 'objective' tests - the imaging, the bloodwork, the physical performance tests that clinicians administer - are prioritised over patients' lived experience and expertise, which is derided as 'subjective' and somehow less trustworthy. Today's guests today invite you to join a revolution of starting from a place of trusting people with pain, and acknowledging the patient's expertise. Joletta Belton is an author, advocate and patient engagement in research specialist, who makes sense of pain through science and stories. Dr Ben Darlow is a physiotherapy specialist and Professor of Primary Health Care at The University of Otago in Aotearoa/New Zealand. ------------------------------ RESOURCES Do we trust patients in pain viewpoint: https://www.jospt.org/doi/10.2519/jospt.2025.13725 Jo's substack (MyCuppaJo): https://mycuppajo.substack.com/ Framework for establishing connections in physiotherapy practice: https://pubmed.ncbi.nlm.nih.gov/29432058/

Need a refresher on youth sport-related concussion? Today's episode is a rapid review of the epidemiology and best practice for managing youth concussion. Lisbeth Lund Pedersen (University of Southern Denmark & Danish Society for Sports Physiotherapy) shares the results of the HAAPY study, which involved more than 900 young Danish handball players prospectively recording handball exposure and injuries. We discuss why female athletes might have a greater concussion risk, and what clinicians can do to promote you athletes' brain health. ------------------------------ RESOURCES Health And Performance Promotion in Youth Sport (HAPPY) study of concussion: https://www.jospt.org/doi/10.2519/jospt.2025.13399 Female, woman and/or girl Athlete Injury pRevention (FAIR) practical recommendations: https://pubmed.ncbi.nlm.nih.gov/41330629/ Consensus statement on concussion in sport: https://pubmed.ncbi.nlm.nih.gov/37316210/

The updated clinical practice guideline for managing hip osteoarthritis landed in late 2025. Today, Dan and Marquis speak with lead author Dr Thomas Koc Jr. to highlight what's new, what's changed and what’s currently considered best practice for hip osteoarthritis. Dr Koc shares the upgraded evidence for dry needling, downgraded evidence for ultrasound, and everything in between. ------------------------------ RESOURCES Read the CPG yourself here: https://www.jospt.org/doi/10.2519/jospt.2025.0301

Sleep: we all know it's essential for function in everyday life, and plays an important role in recovery and managing musculoskeletal pain. How much did you learn about assessing and managing sleep dysfunction in your musculoskeletal degree program? Today, Dr Mark Shepherd (Bellin College) shares practical tips to help you assess sleep, identify common sleep disorders, and incorporate behavioural strategies into your musculoskeletal rehabilitation practice. ------------------------------ RESOURCES Clinician's guide to assessing and addressing sleep dysfunction in people with musculoskeletal pain: https://www.jospt.org/doi/10.2519/josptopen.2025.0198 Spine pain and sleep study: https://pubmed.ncbi.nlm.nih.gov/35642567/ UK Biobank study on predictors of persistent pain: https://pubmed.ncbi.nlm.nih.gov/37414898/ Systematic review on lack of sleep measures: https://pubmed.ncbi.nlm.nih.gov/37259893/ APTA position paper on the PT’s role in sleep health: https://www.apta.org/apta-and-you/leadership-and-governance/policies/role-pt-apta-sleep-health DPT students and sleep behaviours: https://pubmed.ncbi.nlm.nih.gov/39425093/

The JOSPT Insights team has been on a hiatus in December. We're very pleased to say we're back and recording new episodes to share with you in 2026. We're back in your feed with new episodes from mid-January. Until then, we're sharing a couple of our most impactful episodes of 2025. Enjoy! ------------------------------ Patellofemoral pain can affect anyone at any age, which mean you're likely to come across it in your clinical career. What is best practice in managing patellofemoral pain? Today, Dr Brad Neal (Queen Mary University of London) walks us through how to apply the best research to your practice. Dr Neal has worked for over a decade in elite sport, private and public health care settings as a specialist musculoskeletal physiotherapist. His PhD work in biomechanics has helped guide understanding of how to manage patellofemoral pain. ------------------------------ RESOURCES Best practice guide for patellofemoral pain: https://pubmed.ncbi.nlm.nih.gov/39401870/ Effects of treatment for patellofemoral pain - systematic review with meta-analysis: https://www.jospt.org/doi/full/10.2519/jospt.2022.11359 Patellofemoral pain 2019 clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2019.0302

The JOSPT Insights team has been on a hiatus in December. We're very pleased to say we're back and recording new episodes to share with you in 2026. We're back in your feed with new episodes from mid-January. Until then, we're sharing a couple of our most impactful episodes of 2025. Enjoy! ------------------------------ Tune in today for the latest consensus on rehabilitation approaches for people who have had meniscus surgery. Orthopaedic surgeons and physical therapists from Europe and the US debated the best research evidence, and brought extensive clinical experience to the table, ultimately producing a 2-part series of summary papers. Dr Arielle Giordano (University of Delaware) was one of the physical therapy leads on the project, and today she shares the most important messages from the consensus. ------------------------------ RESOURCES EU‐US Meniscus Rehabilitation 2024 Consensus - Rehabilitation after meniscus surgery: https://www.jospt.org/doi/10.2519/josptopen.2025.0162 EU-US Meniscus Rehabilitation 2024 Consensus - Prevention, non‐operative treatment and return to sport: https://www.jospt.org/doi/10.2519/josptopen.2025.13539

Calf strains are challenging for athletes and clinicians to manage—with uncertain return to play times and risks for reinjury if they're not managed well. Dr Brady Green (University of Notre Dame, Perth, Australia) shares his research and clinical expertise on muscle strains in elite and subelite athletes, including from his previous work in elite Australian football at the Essendon Football Club. Today's episode launches from Dr Green's latest study of the epidemiology of calf strains, and discusses how musculoskeletal rehabilitation specialists, including sports physical therapists, can use this information to guide their practice. ------------------------------ RESOURCES Gastrocnemius muscle strain injury epidemiology: https://www.jospt.org/doi/10.2519/jospt.2025.13526

Over the past decade, the term rotator cuff–related shoulder pain (RCRSP) has gained traction as a more accurate, patient-centered way to describe shoulder pain. In this episode, Dr Amy McDevitt (Physical Medicine and Rehabilitation Department, University of Colorado) joins Dan Chapman and Marquis Sanabrais to unpack why shifting from structural labels like impingement or tendinopathy toward RCRSP can improve both communication and care. They discuss how imaging often fails to match symptoms, why language matters for patient engagement, and how clinicians can explain shoulder pain without over-pathologizing. Take home messages: 1. RCRSP reflects the multifactorial nature of shoulder pain, biological, mechanical, and psychosocial. 2. Clear and non-anatomic terminology helps patients understand and buy into treatment. 3. Future research should clarify mechanisms behind exercise and refine subgroups within RCRSP. ------------------------------ RESOURCES The case for using "rotator cuff-related shoulder pain" in practice: https://www.jospt.org/doi/10.2519/jospt.2025.13405

Some of the most powerful drivers of change in musculoskeletal rehabilitation aren’t researchers or administrators—but clinicians working shoulder-to-shoulder with their peers. These so-called "local opinion leaders" often shape practice more effectively than top-down mandates or distant guidelines. And they're more than simply influencers or savvy social media marketers. In today's episode, Dr Seth Peterson explores how local opinion leaders—those trusted voices within clinical settings—can play a pivotal role in translating research into practice. Dr Peterson shares practical strategies for fostering cultures of learning and supporting clinicians to lead. Dr Peterson is a clinician-researcher based in Tucson, Arizona. He leads care at his clinic, The Motive, and teaches nationally with The Movement Brainery. ------------------------------ RESOURCES Empowering local opinion leaders in physical therapy systems: https://www.jospt.org/doi/10.2519/jospt.2025.13508 Why higher standards are needed in physical therapist professional development: https://www.jospt.org/doi/10.2519/jospt.2022.11377 2025 hip osteoarthritis clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2025.0301

Pain near the posteromedial tibia is common in running and jumping athletes. Laura Anderson, physiotherapist and PhD candidate, is challenging the diagnostic labels "shin splits" and "medial tibial stress syndrome", and suggesting a new term: "load-induced medial leg pain" (LIMP). In today's episode, Laura explores ways to improve how you diagnose and manage shin pain in athletes, including how you talk with athletes about their condition. She discusses loading, red flags and the role of running retraining. ------------------------------ RESOURCES Diagnosing medial tibial stress syndrome (including flow diagram): https://pubmed.ncbi.nlm.nih.gov/28179260/ Re-naming MTSS as Load Induced Medial Leg Pain (LIMP): https://www.jospt.org/doi/10.2519/jospt.2025.13411 Effectiveness of running gait retraining - systematic review: https://www.jospt.org/doi/10.2519/jospt.2022.10585

Over half of performing artists and artistic athletes report pelvic floor symptoms. Up to 80% of female artistic athletes report pelvic floor symptoms, yet many believe these issues—like urinary leakage during performance—are par for the course, part of the job. Today, Jessica Frydenberg explains who performing artists are, why they are particularly susceptible to pelvic floor symptoms, and what this means for your clinical practice. Jess is an experienced pelvic health physiotherapist and PhD candidate at La Trobe University in Melbourne, Australia. She has extensive experience working with performing artists, and recently led a systematic review investigating the epidemiology of pelvic floor symptoms in performing artists. ------------------------------ RESOURCES Prevalence and impact of pelvic floor symptoms systematic review: https://www.jospt.org/doi/10.2519/jospt.2025.13452

Who pays you, and how, for your work as a physical therapist? How health care is funded has implications for the way you work, and for the care that you can provide for patients. Societies all around the world are grappling with complex decisions about health care and how it is funded. Even more so as changing populations place different demands on health care systems, and as the health work force changes. Today, Dr Chris Bise (Assistant Professor, University of Pittsburgh) explains the changing face of health care funding, and what it means for the physical therapist. Chris has 25 years of experience as a physical therapist and health system analyst who studies value-based health care and physical therapy practice - trying to find better ways of funding health care to deliver outcomes that satisfy patients, clinicians and payers. ------------------------------ RESOURCES Building the foundation for value-based physical therapy: https://www.jospt.org/doi/10.2519/jospt.2025.13586 Perspectives for Payers - Heel pain/plantarfasciopathy: https://www.jospt.org/doi/10.2519/jospt.2025.0502 Perspectives for Payers - Achilles tendinopathy: https://www.jospt.org/doi/10.2519/jospt.2025.0503

Welcome back to this explainer on health economics analyses in musculoskeletal rehabilitation. In part 1, Dr Codie Primeau explained the things you're looking for when reading a health economics analysis, to decide whether it's a good quality analysis. That's important because a good quality analysis can help you make decisions about whether the intervention being studied is worth considering. Today in part 2, we take things a step further to explore how you decide what "worthwhile" really means. Worth it for whom? The patient, your clinic, the health system, or even society? ------------------------------ RESOURCES From whose perspective is cost-effectiveness judged?: https://pmc.ncbi.nlm.nih.gov/articles/PMC6351264/ Review of health economics evaluations in hip and knee orthopaedics: https://pubmed.ncbi.nlm.nih.gov/34262974/

Whether you work in a solo private practice, or a large health network, no doubt you're considering costs when it comes to deciding what to change and perhaps what to implement - or de-implement - in your practice. Perhaps you're in the position of making decisions on behalf of a health service or you are trying to quantify and communicate the costs and benefits of treatments you study in a research setting? Today is part 1 of a 2-part chat with Dr Codie Primeau about health economics in musculoskeletal rehabilitation, which has something for everyone working in health care. We're covering how to read a health economics analysis to decide whether the analysis can help you navigate the complex decisions you're grappling with. Dr Primeau is a physiotherapist and Assistant Professor in the School of Physical Therapy at Western University in London, Canada, and an Affiliate Scientist with Arthritis Research Canada. His research focuses on arthritis, chronic pain, and pelvic health, using a blend of qualitative and quantitative methods to improve patient care and outcomes, including health economics evaluation. ------------------------------ RESOURCES From whose perspective is cost-effectiveness judged?: https://pmc.ncbi.nlm.nih.gov/articles/PMC6351264/ Review of health economics evaluations in hip and knee orthopaedics: https://pubmed.ncbi.nlm.nih.gov/34262974/

Wondering about whether large language models (generative AI) like ChatGPT, Co-Pilot or Claude, to name just a few, could add value to your clinical practice? Drs Mark Vorensky and Daniel Peredo (Rutgers University; NYU Langone Health) discuss the field of 'prompt engineering' - the approach to structuring and crafting the instructions (a.k.a. prompt) given to a generative AI model, to describe the task that the AI should perform. The quality of the output from generative AI is highly dependent on how the model is prompted. So, if you're looking to get the best out of generative AI, tune in! ------------------------------ RESOURCES Improving ChatGPT's performance using the CRISPE framework: https://www.jospt.org/doi/10.2519/josptmethods.2025.0151 Neck pain clinical practice guideline: https://www.jospt.org/doi/10.2519/jospt.2017.0302

How do you think about supporting athletes to return to running after injury? Andrew Mitchell is someone who has thought about it a lot, and refined his approach over years of practice in top football/soccer. In today's episode, Andrew outlines the 5 elements of his criteria-based approach. Andrew is a sports physiotherapist and strength & conditioning practitioner with experience working in the hospital, private practice and professional sport arenas, including in the English Premier League, the German Bundesliga and the European Champions League. ------------------------------ RESOURCES Evidence-informed return-to-running framework: https://www.jospt.org/doi/10.2519/josptopen.2025.0115 Criteria-based return-to-performance pathway: https://www.jospt.org/doi/10.2519/josptopen.2024.1240 On the path to perfoming after injury (ep 193): https://pod.link/1522929437/episode/NmEzODliMjAtYmIyZi00YzkwLWIwMzctNjU3NzI4NTY3ZWUz