JOSPT Insights

In episode 258, Drs Ruth Chang and JP Caneiro explain the results of trials testing cognitive functional therapy (CFT). They explored what CFT is and how it might help people in pain. In today's episode, Dr Caneiro (Curtin University; Evoolve Pain Care Academy) joins the JOSPT Insights community again to explain what is involved in learning the patient-centred CFT approach. ------------------------------ RESOURCES Evoolve Pain Care Academy: https://evoolvepaincare.academy/ Videos, infographics and written resources for clinicians: https://evoolvepaincare.academy/clinician-resources

All clinicians know the challenge and opportunity that comes with tailoring clinical decisions to the person in front of you. While it's helpful to have clinical practice guidelines to give you a starting point and to reduce unwarranted variation in practice, of course every patient is different! Today, Dr Trevor Lentz (Duke University) explains the concept of clinical phenotyping, which is another way of identifying patterns in your clinical practice, and guiding your clinical decisions. Clinical phenotyping has been suggested as a way of tailoring musculoskeletal care in practice, although its implementation in practice has been patchy - Dr Lentz explains some of the reasons why. ------------------------------ RESOURCES Psychological phenotyping in osteoarthritis: https://www.jospt.org/doi/10.2519/josptopen.2025.0177 OSPRO yellow flags tool: https://www.jospt.org/doi/10.2519/jospt.2016.6487 Clinical framework for screening yellow flags: https://www.jospt.org/doi/10.2519/jospt.2021.10570 STarT MSK research programme review: https://pubmed.ncbi.nlm.nih.gov/37490570/

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/