Princeton, New Jersey, USA
Saturday 18th April 2015

A Problem Identified…

Many years ago, when I started upon my path into physiotherapy, fresh out of university & confident that I knew all there was to know about treating injuries, I was stopped in my path.  

I think it was around week 1, maybe the first day or the second & I realised, in fact, that my knowledge was somewhat foundational, as I ran headlong into an assessment of a patient complaining of a painful Achilles.  

The patient’s subjective history reported failed attempts at management, many of which were what you could describe as “textbook”, those that I had been taught to apply & yet the symptoms were getting worse.

Keen to plug the chink in my armour, I asked advice from my senior physiotherapist & started reading through relevant journal articles for further guidance.

Over the following years, tendon problems proved to be one of those kryptonite conditions.  The presentations that sometimes got better but often didn’t, instead persisting in the face of treatment & not too uncommonly flaring up again, just as you thought you’d made a break through.

Football players, rugby players, tennis players, skiers, basketball players & track athletes, they all hobbled in.  Each time, the Achilles, patellar, hamstring or other tendon, hampering not just sports performance but the routine activities of daily living.  The more I saw, the more I became concerted in my efforts to learn more, to be more effective & achieve more successful results.

A Passion Discovered…

I went on courses aimed at manual therapy techniques, biomechanical analysis & taping techniques, each time learning a little more & a little more.  I read about Alfredson’s heavy-load eccentric calf training protocols & introduced the same techniques. 

Yet my frustration continued as results improved but were never predictable & I still encountered those presentations that refused to get better.

To compound my frustrations, I started to present with bilateral Achilles tendon pain & my lacrosse season started to suffer during the build up to the European Championships, which were an integral part of my preparations for the 2006 World Championships.

I upped my game.  In 2005, whilst working at Hearts FC, we had a foreign player that had a long term history of Achilles tendon problems.  He confronted me almost as soon as I walked in the door, desperate for an answer.  So, I got on the phone & started calling some guys that were publishing new research at the time.

I started talking to Otto Chan & Tom Crisp in London before taking the player down to see them for a consultation & intervention.  I spent a couple of days in their company.  I continued my reading & my ideas on eccentric exercises were reinforced by the work that Roos et al published a year earlier.  We made a bit more headway.

Still, the picture was muddled.  Terminology was inconsistent, used by different people to mean different things or changed with the fashion of the season.  Whilst results, undoubtedly better, were far from ideal.

Then around 2006, whilst working with my good friend & at the time, new colleague, Stephen Mutch, I was introduced to Henning Langberg.  Now a good friend & collaborator, then Henning was working hard with Kjaer’s group in Copenhagen & they were starting to change the paradigm.  

An Obsession Developed…

I learnt a lot from “H”, which just fed my passion & further fuelled what was becoming an obsession to know more about tendon issues.

Over the last 9 years, the research done by the teams led by Henning, Khan, Kjaer, Alfredson, Cook, Purdam, Vincenzino, Scott & others have changed the game.  The terminology has evolved as diagnoses & physiological understanding of what happens within the tendons in response to external load or biochemical fluctuations have improved.

I’ve been to master classes with Jill (Cook), Craig (Purdam) & Bill (Vincenzino), workshops, round-table symposia with the likes of Håkan (Alfredson), Karim (Khan) & Martin (Kjaer), international conferences, consensus meetings, informal chats & worked alongside the likes of James Moore, Raph Brandon, Gerry Ramogida, Paul Dijkstra, John Rogers & Noel Pollock at British Athletics.  

I have learned on the ground from the international athletes & players I have treated, their track coaches I worked alongside, like Lloyd Cowan, Dan Pfaff & Tony Lester.  I spent time in consultations or theatre with James Calder.  I have visited Richard Steadman in Vail, Hans-Wilhelm Müller-Wohlfahrt in Munich & Freddie Fu in Pittsburgh.  

I have spoken to Hans van Schie, the veterinarian who developed the UTC machine & had long discussions with Sam Rosenburg, until last year the injury prevention physiotherapist for Carlton AFL team, who has recently published the findings of a longitudinal study looking at how tendons respond to training load.

The research is still evolving but a couple of seminal papers from Jill Cook’s group & Karim Khan have helped make the leap in understanding as to why all tendons don’t respond in similar fashion.  Their work has underlined the importance of obtaining the correct diagnosis of the pathological structure, along with the recognition of which physiological changes accompany which symptoms & that these factors are critical in directing the most appropriate management strategies.

Yet, for some reason, the research does not seem to translate into the overall picture of what you see happening in much of the tendinopathy treatment I see around the world.  There is a major disconnect between the academic evidence & the approaches many clinicians I meet are using.

As such, after a conversation with my friend & colleague, Andrew Small in New York at the end of last year, I decided that the lessons I had learnt would be wasted if I kept them to myself.  Andrew, a physiotherapist from Australia, who works with the Aussie national diving & volleyball teams as well as with NFL, NBA & tennis players in his clinic in Manhattan, agreed & so we decided to write a course.

…Have Led to A Course Being Written

After 4 months of trawling through journal articles, course handouts, lecture notes, meeting/visit summaries & near 30 years of clinical experiential learning, the course is nigh on complete.  

As we undertake the final polishing of slides & slight tweaks, I am happy that our passion & obsession has given rise to a course that marries both the research-based findings with the clinical lessons we have gleaned from our years in elite sporting practice.

I believe we have developed a course that addresses the differential diagnosis, acute treatment, rehabilitation, long term management & prevention of tendinopathies, as we understand them today, presented in a digestible & accessible format.  

…That Will Help You Manage Tendon Problems With Confidence & Success

The course underlines the importance each member of the multi-disciplinary team has to play in each part of the process.  As such it is aimed at those clinicians (doctors, physiotherapists, chiropractors, osteopaths & athletic trainers) & coaches (strength & conditioning, personal trainers, fitness & sport specific) working with either elite professional athletes, full-time amateur athletes or passionate weekend warriors or youth athletes.

Attendees will be able to claim 9 hours of CPD, consisting of 7 hours theoretical & practical teaching, in addition to 2 hours of theoretical pre-course material.

We are limiting the courses to 16 attendees, to ensure adequate supervision & quality of teaching, particularly in the practical sessions.  However, we are open to holding more than one course in the same venue, should the interest be sufficient.

Given that the research continues to provide further light on the issues surrounding tendinopathy, the course will continue to evolve, enabling us to incorporate the latest research & both the learning experiences we gain from our clinical practice, in addition to those we learn from the attendees we meet around the world.  

Our dream is simple…we aim to provide an educational experience that will present you, the practitioner, when confronted with tendinopathic pathology, the best available tools to achieve successful results for your athletes & patients.


For more information, click on the links below:

Course Flyer Detailing an Overview of the Curriculum

Learning Objectives

Presenter Profiles


If you are interested in hosting a course in your locale, please contact me through:

Linked In:  LinkedIn


Email at: 

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