Explorez tous les épisodes du podcast Fit As A Physio

PHYSIO MOSMAN: https://www.fitasaphysio.com/

REF: Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture (Myhrvold et al., 2022)

This study investigated the effectiveness of nonoperative treatment compared to open-repair and minimally invasive surgery for patients with acute Achilles’ tendon ruptures. Researchers conducted a large randomized, controlled trial in Norway, tracking 526 patients to measure physical performance and quality-of-life scores over 12 months. The results indicated that surgical intervention provided no significant advantage over nonsurgical care regarding long-term functional recovery or patient-reported health status. While patients treated without surgery faced a higher risk of tendon rerupture, those who underwent minimally invasive procedures experienced more frequent nerve injuries. Ultimately, the findings suggest that the choice of treatment does not substantially alter a patient's physical outcome after one year.

READ MORE: https://www.fitasaphysio.com/blog/surgical-vs-nonoperative-treatment-of-achilles-tendon-rupture

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A mixed methods study exploring anterior cruciate ligament (ACL) injury treatment decisions from the perspective of 734 patients. (Filbay et al., 2025)

This mixed-methods study investigates how Australians with anterior cruciate ligament (ACL) injuries make treatment decisions and the specific advice they receive from healthcare professionals. The research reveals that a vast majority of clinicians, particularly orthopaedic surgeons, promote reconstruction surgery as the superior or only path to recovery, often downplaying risks and disregarding evidence that rehabilitation alone can yield similar results. Patients frequently reported feeling pressured or poorly informed due to rushed consultations and a lack of balanced, evidence-based information regarding non-surgical alternatives. While physiotherapists provided the most varied advice, general practitioners were viewed primarily as conduits for referrals rather than sources of management expertise. Ultimately, the study highlights a significant gap in shared decision-making, suggesting that current clinical practices often fail to provide the objective overview necessary for informed patient consent. These findings underscore the urgent need for patient decision aids and updated clinical training to align treatment recommendations with the latest research evidence.

READ MORE: https://www.fitasaphysio.com/blog/decision-making-experiences-and-treatment-advice-for-acl-injuries

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Insufficient Evidence for Load as the Primary Cause of Nonspecific (Chronic) Low Back Pain. A Scoping Review (De Bruin et al., 2024)

This scoping review evaluates whether physical loading of the spine is the primary cause of nonspecific low back pain. By applying the Bradford-Hill criteria for causality to a wide range of medical literature, the researchers sought to determine if activities like lifting or specific postures directly lead to the onset or persistence of pain. Their analysis revealed insufficient evidence to support a definitive causal relationship, noting that structural spinal changes are often found in individuals without any symptoms. The findings suggest that the traditional biomedical model, which focuses on unloading the spine to prevent injury, may be overly simplistic for such a multifactorial condition. Instead, the authors advocate for a biopsychosocial approach that considers individual experience, nervous system adaptations, and social factors. Ultimately, the source concludes that load management should not be the sole strategy for treatment, as the impact of physical strain on back pain has likely been overestimated.

READ MORE: https://www.fitasaphysio.com/blog/the-myth-of-spinal-load-as-a-cause-of-pain

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Physiotherapy management of plantar heel pain (Cotchett M, Morrissey D, 2026)

The article presents a comprehensive clinical guide for the diagnosis and treatment of plantar heel pain (PHP), integrating research data with expert and patient perspectives. It advocates for a stepped-care approach, beginning with a core treatment phase of stretching, taping, and tailored education. If symptoms persist beyond six weeks, the sources suggest advancing to secondary interventions such as extracorporeal shockwave therapy and custom foot orthoses. The documents emphasise the importance of individualised assessment, considering factors like footwear, physical load, and systemic health. Furthermore, the text highlights the value of co-designing education strategies with patients to ensure clarity and adherence. By synthesising high-quality trial data with clinical reasoning, the guide offers a practical framework for evidence-based management of this common condition.

READ MORE: https://www.fitasaphysio.com/blog/plantar-fasciitis-heel-pain

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Biomechanical insights into Achilles tendinopathy risk and protection in runners: a large prospective study 4HAIE (Jandacka et al., 2025)

This research examines the biomechanical and behavioral factors that contribute to the development of Achilles tendinopathy in both runners and non-runners. By monitoring a large cohort of over 900 participants for one year, the study identified that higher weekly running distances and specific movement patterns significantly increase injury risk. Specifically, a reduced peak ankle external rotation and a lower peak ankle inversion moment during the stance phase were found to be primary predictors of the condition. Interestingly, the data suggests that footfall patterns, such as rearfoot or forefoot striking, do not play a significant role in the onset of this injury. These findings encourage clinicians to focus on training volume management and ankle stability rather than altering strike types for prevention. Ultimately, the study highlights how maintaining sufficient ankle control and energy absorption can act as a protective mechanism against tendon degradation.

READ MORE: https://www.fitasaphysio.com/blog/risk-factors-for-achilles-tendinopathy-in-runners

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Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers (Hulin et al., 2013)

This study examines how sudden increases in training intensity impact the injury rates of elite cricket fast bowlers. Researchers tracked both internal workloads, based on athlete perception of effort, and external workloads, measured by the number of balls delivered. The findings reveal that when short-term (acute) workloads significantly exceed long-term (chronic) averages, the risk of injury rises sharply in the following week. Specifically, bowlers whose weekly activity more than doubled their four-week average faced a three-to-fourfold increase in injury likelihood. Conversely, maintaining a high, consistent chronic workload appeared to provide a protective effect against physical breakdowns. Ultimately, the data suggests that careful monitoring of training-stress balance is essential for keeping athletes healthy and prepared for competition.

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If You Want to Prevent Hamstring Injuries in Soccer, Run Fast: A Narrative Review about Practical Considerations of Sprint Training (Gómez-Piqueras, P.; Alcaraz, P.E., 2024)

This academic review explores the critical role of sprint training as a preventative measure against hamstring strain injuries (HSIs) in professional soccer. It highlights that since most hamstring injuries occur during high-speed running, exposing players to maximal sprinting speedsacts as a protective "vaccine" by strengthening specific muscles like the biceps femoris. The authors propose a practical multidirectional speed model that integrates linear and curvilinear sprints into the weekly training microcycle using a control-chaos continuum. Effective implementation requires individualized monitoring through GPS technology, focusing on relative speed thresholds rather than just absolute values to ensure players reach at least 85-95% of their maximum velocity. By balancing optimal dosage and timing, coaches can enhance athletic performance while significantly reducing the economic and physical burden of muscle injuries. Overcoming the "sprint paradox" involves transitioning from analytical drills to game-specific transitions to prepare athletes for the chaotic demands of elite competition.

READ MORE: https://www.fitasaphysio.com/blog/the-sprint-vaccine-protecting-hamstrings-through-high-speed-exposure

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Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians (Agresta et al., 2022)

This review explores the evolution of running footwear design and its relationship to injury prevention and athletic performance. The authors examine four primary scientific paradigms—pronation control, impact force modification, habitual joint motion path, and the comfort filter—noting that historical methods like matching shoe type to arch height lack strong empirical support. While traditional features like midsole cushioning aim to reduce repetitive stress, modern innovations such as carbon fiber plates and high-resiliency foams focus on enhancing running economy and speed. The text highlights a significant gap between technical research and clinical practice, often leading to recommendations that are not scientifically grounded. Consequently, the authors suggest that clinicians prioritize lightweight and comfortable footwear while considering the specific biomechanical needs of each individual runner. Overall, the source serves as an evidence-based guide to help medical practitioners navigate the complex landscape of modern shoe construction and runner assessment.

READ MORE: https://www.fitasaphysio.com/blog/the-great-running-shoe-myth-5-science-backed-truths-that-will-change-how-you-shop

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Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial (Rangan et al., 2020)

The UK FROST study was a multicentre randomised clinical trial conducted to determine the most effective treatment for adults suffering from primary frozen shoulder. Researchers compared three common interventions: early structured physiotherapy with a steroid injection, manipulation under anaesthesia, and arthroscopic capsular release. The trial findings revealed that none of the treatments were clinically superior to the others regarding long-term pain relief and improved shoulder function at the one-year mark. While capsular release surgery carried the highest risks and costs, manipulation under anaesthesia was identified as the most cost-effective option within the UK healthcare system. Consequently, the authors suggest that doctors should prioritise less invasive treatments and reserve surgery for cases where initial therapies fail.

READ MORE: https://www.fitasaphysio.com/blog/frozen-shoulder-what-the-worlds-largest-clinical-trial-reveals-about-surgery-vs-therapy

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Effectiveness of Recovery Strategies After Training and Competition in Endurance Athletes: An Umbrella Review (Shuting et al., 2024)

This umbrella review by Li et al. (2024) evaluates the effectiveness of various recovery strategies specifically for endurance athletes, such as cyclists and runners. The researchers analyzed twenty-two systematic reviews and meta-analyses to determine if methods like compression garments, cryotherapy, massage, and nutritional supplements actually improve performance or physiological markers. Their findings indicate that no single strategy provides consistent, universal benefits across all recovery parameters for this specific population. However, individual data suggests that compression garments and cold-water immersion show the most promise for enhancing recovery between intense training sessions. The authors conclude that while these passive techniques may reduce muscle soreness, more high-quality research is needed to establish definitive guidelines. Overall, the study emphasizes that endurance athletes may respond differently to these interventions compared to team-sport athletes.

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Is it time for evidence-­ based protective strategies for heading in youth football? (Sutehall et al., 2026)

Current medical research is investigating the long-term neurological risks associated with purposeful heading in youth and professional football. While football offers significant physical and mental health benefits, concerns persist regarding how repeated subconcussive impacts might affect the developing brain. In response, governing bodies have implemented safety guidelines to restrict heading frequency during training, yet scientific evidence remains limited and primarily focused on adults. Experts emphasize the need for comprehensive studies to establish a safe dosage of head impacts without discouraging participation in the sport. Ultimately, higher-quality data is required to balance the social advantages of play with the preservation of player safety.

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It is not all about strength: rethinking mechanistic assumptions in exercise-based
rehabilitation for musculoskeletal pain relief (Powell et al., 2026)

This editorial challenges the traditional belief that muscle strength gains are the primary reason exercise relieves musculoskeletal pain. While physical activity is highly effective for recovery, current research suggests that biomechanical changes often fail to explain why patients feel better. Instead, the authors highlight biopsychosocial factors, such as increased confidence, reduced fear of movement, and improved biochemical balance, as more likely drivers of improvement. They urge clinicians to move beyond simplistic strength-based narratives to avoid demoralizing patients who do not see physical gains. Ultimately, while strength remains vital for general health, the sources emphasize that the mind-body connection and the therapeutic relationship are more central to pain rehabilitation.

READ MORE: https://www.fitasaphysio.com/blog/strength-in-musculoskeletal-pain-rehabilitation

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Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-­ analysis (Saueressig et al., 2022)

This living systematic review and meta-analysis evaluates whether early surgical reconstruction or primary rehabilitation—with the option of later surgery—offers better outcomes for anterior cruciate ligament (ACL) injuries. After analyzing data from multiple randomized controlled trials, the researchers found no clinically significant differencesbetween the two strategies regarding self-reported knee function, sports participation, or quality of life. The study highlights that rehabilitative management may trend toward a lower risk of radiological osteoarthritis, while surgery shows a slight potential benefit for meniscal health, though both findings carry low certainty. These results challenge the traditional medical paradigm that immediate surgery is necessary to ensure optimal long-term recovery. Consequently, the authors suggest that clinical guidelines should be updated to recommend a "stepped care approach" that prioritizes physical therapy as the first line of treatment. Continuous annual updates are planned for this review to incorporate emerging data from ongoing clinical trials.

READ MORE: https://www.fitasaphysio.com/blog/surgery-versus-rehabilitation-for-acl-rupture

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Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts (Warneke et al., 2025) 

This consensus statement provides evidence-based practical recommendations and standardized definitions regarding the diverse effects of stretching on human health and performance. Developed by a panel of twenty international experts using the Delphi method, the document clarifies that stretching effectively improves range of motion and reduces muscle stiffness in both acute and chronic contexts. Conversely, the researchers conclude that stretching is ineffective as a primary tool for increasing muscle mass or strength, correcting posture, or accelerating post-exercise recovery. While the panel notes potential benefits for vascular health, they categorize the evidence for general injury prevention as inconsistent or unsupportive. Ultimately, this source serves to bridge the gap between scientific evidence and athletic or clinical practice by addressing long-standing misconceptions in exercise science.

READ MORE: https://www.fitasaphysio.com/blog/everything-you-knew-about-stretching-might-be-wrong

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Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-­analysis (Munro et al., 2025)

This meta-analysis synthesises evidence from numerous studies to evaluate how structured physical activity alleviates symptoms of depression and anxiety across various demographics. The research concludes that exercise is a highly effective intervention, often matching or surpassing the results of traditional medication and psychotherapy. While all forms of movement are beneficial, aerobic activities and supervised group settings offer the most significant relief for depressive symptoms. Conversely, shorter, low-intensity routines appear particularly efficacious for managing anxiety. The authors specifically highlight emerging adults and postnatal women as groups that experience the greatest mental health improvements from these interventions. Ultimately, the study advocates for health professionals to prescribe tailored exercise programs as a primary, cost-effective treatment for psychological distress.

READ MORE: https://www.fitasaphysio.com/blog/exercise-for-depression-and-anxiety

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Conservatively treated massive prolapsed discs: a 7-year follow-up (Benson et al., 2010)

This research investigates the natural history and recovery potential of massive lumbar disc herniations treated without surgery. By tracking patients over seven years, the study reveals that non-operative management is highly effective when early clinical progress is noted. Findings indicate that extruded disc material often shrinks significantly over time, with an average volume reduction of 64% seen on follow-up imaging. Most participants achieved a complete and sustained recovery, reporting high levels of long-term satisfaction and minimal recurrences. Ultimately, the authors conclude that conservative treatment is a safe and viable alternative to surgery, even for the largest spinal protrusions.

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Recent highlights in low back pain research, Part I: Diagnosis and Prognosis (Pinto et al., 2025)

This narrative review synthesizes recent research on the diagnosis and prognosis of low back pain, highlighting five core themes to assist clinical decision-making. The authors emphasize that serious spinal pathologies are extremely rare, suggesting that clinicians should evaluate overall patient risk rather than relying on isolated red flags. The text criticizes the continued overuse of diagnostic imaging, noting that most findings are common in healthy individuals and lack significant predictive value. Furthermore, the review suggests that embracing diagnostic uncertainty and focusing on modifiable lifestyle factors is more effective than providing potentially harmful structural labels. Findings indicate that while many patients recover quickly, recurrences are frequent, and traditional terms like "acute" or "chronic" often fail to reflect actual pain trajectories. Finally, the researchers identify psychological and physical prognostic factors for delayed recovery but conclude that current prediction models are not yet ready for practical implementation.

READ MORE: https://www.fitasaphysio.com/blog/beyond-the-mri-5-truths-about-back-pain-that-might-change-how-you-heal

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Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial (Pocovi et al., 2024)

The WalkBack trial investigated the effectiveness of a walking and education program in preventing the return of low back pain. Researchers conducted a randomized controlled trial in Australia, comparing participants who received physiotherapy-led health coaching to a group receiving no treatment. Results demonstrated that this low-cost, accessible intervention nearly doubled the median time between pain recurrences while significantly reducing pain-related disability. Beyond clinical benefits, the study found the program to be highly cost-effective from a societal perspective. Although the walking group reported more minor lower extremity injuries, the overall strategy offers a scalable, safe solution for managing a high-burden health condition.

READ MORE: https://www.fitasaphysio.com/blog/new-study-reveals-a-surprisingly-simple-way-to-stop-your-back-pain-from-coming-back

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Cryotherapy for treating soft tissue injuries in sport medicine: a critical review (Raciness et al., 2024)

A 2024 critical review titled "Cryotherapy for treating soft tissue injuries in sport medicine" challenges the common practice of using ice for injury treatment. The authors conducted a systematic literature search, finding a significant lack of human studies that demonstrate a positive effect of cryotherapy on tissue regeneration, contrasting with its established use for short-term pain relief. While acknowledging that cryotherapy is a basic principle in protocols like RICE, the review highlights that the bulk of evidence on tissue healing comes from animal studies, which often suggest that cryotherapy may delay or impair muscle and tendon regeneration post-injury, especially with prolonged use. Consequently, the authors conclude that cryotherapy should be recommended only in the first hours after an injury to manage pain and swelling, with caution advised for continued application until more conclusive human research is available.


READ MORE: https://www.fitasaphysio.com/blog/rethinking-ice-5-surprising-truths-about-using-cold-therapy-for-injuries

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Physiotherapy management of Achilles tendinopathy (Malliaras, 2022)

We discuss a comprehensive research review article from the Journal of Physiotherapy focused on the physiotherapy management of Achilles tendinopathy, covering both mid-portion and insertional types. The article provides an in-depth exploration of the condition's epidemiology, burden, and clinical course, advocating for a shift from a biomedical to a biopsychosocial view in diagnosis and care. The article details assessment methods, including load tolerance and identifying various physical and psychological impairments, and offers an extensive, evidence-based overview of management strategies, particularly focusing on education, activity modification, and graded exposure exercise as primary treatments, while also summarising the evidence for various adjunct therapies.

REFERENCE: https://www.fitasaphysio.com/blog/5-surprising-truths-about-achilles-pain-that-could-change-how-you-recover

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Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline (Desmeules et al., 2025)

A recent article provides an evidence-based Clinical Practice Guideline (CPG) developed by an international expert panel focusing on the non-surgical diagnosis and treatment of rotator cuff (RC) tendinopathy. The guidelines emphasize that initial assessment must rely on a comprehensive clinical evaluation and detailed patient history, rather than the costly and often unnecessary use of diagnostic imaging like MRI. For objective measurements, the CPG mandates the use of reliable tools such as a handheld dynamometer and validated patient-reported outcome measures. Treatment recommendations strongly support structured exercise programs and manual therapy as primary interventions, noting that pharmacological options like NSAIDs or corticosteroid injections are considered supplemental for short-term pain relief. Finally, the CPG covers the entire management continuum, including specific guidance on referral to a specialist if non-surgical treatment fails and criteria for an athlete’s safe return to function and sport.

READ MORE: https://www.fitasaphysio.com/blog/the-new-rules-for-fixing-shoulder-pain-why-exercise-beats-injections-and-surgery

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Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications (Navarro-Ledesma, 2025)

This academic review re-examines Frozen Shoulder (FS), traditionally seen as a localized orthopedic problem, by proposing an integrative systemic model linking the disorder to immunometabolic and endocrine dysfunctions. The central focus is on estrogen deficiency and resistance, noting the disproportionate effect of FS on perimenopausal and postmenopausal women. The article explores how factors such as thyroid dysfunction, endothelial damage, metabolic stress (high HbA1c, dyslipidemia, AGEs), and adverse lifestyle factors (poor sleep, stress, EDCs) converge to create a state of chronic low-grade inflammation and a profibrotic environment in the joint capsule. This new paradigm advocates for integrative, personalised treatments that target systemic hormonal and metabolic imbalances alongside traditional physiotherapy.

READ MORE: https://www.fitasaphysio.com/blog/5-surprising-truths-about-frozen-shoulder-that-go-beyond-the-joint

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Recent highlights and uncertainties in exercise management of knee osteoarthritis (Haber et al., 2025)

A narrative review published in the Journal of Physiotherapy summarises recent research concerning the exercise management of knee osteoarthritis (OA) between 2020 and early 2025. The authors identify and discuss six key themes addressing the effectiveness and uncertainties of exercise therapy for knee OA, including questions about optimal dosage, adherence, delivery methods like telehealth, and how communication influences patient beliefs. Notably, the review highlights recent evidence suggesting reduced certainty in the clinical effectiveness of exercise compared to previous understanding and points out that the mechanisms of how exercise works remain largely unknown. The document also suggests numerous future research directions to better inform clinical practice in this area.

READ MORE: https://www.fitasaphysio.com/blog/five-surprising-new-truths-about-exercise-for-knee-arthritis

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How much running is too much? Identifying high-­ risk running sessions in a 5200-­ person cohort study (Frandsen et al., 2024)

An academic article, published in the British Journal of Sports Medicine, presents the findings of a large cohort study titled, "How much running is too much? Identifying high-risk running sessions in a 5200-person cohort study." This study explored the relationship between sudden increases in running distance and the risk of overuse injuries among adult runners, utilizing data collected from Garmin devices over an eighteen-month period. The researchers found a significant dose-response relationship between the distance covered in a single running session and injury risk, specifically noting that an increase of more than 10% compared to the longest run in the prior 30 days significantly raised the risk of overuse injury. Importantly, the study challenges traditional weekly load metrics, such as the acute:chronic workload ratio (ACWR), concluding that they were not associated with increased injury rates and advocating for a new "single-session paradigm" for injury prevention. The text includes detailed methodology, results with hazard rate ratios, and a discussion of the study's implications for coaches and healthcare professionals.

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Management of achilles tendon injury: A current concepts systematic review (Gulati, et al., 2015) / Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs (She, et al., 2021) / Early controlled motion of the ankle compared with immobilisation in non-operative treatment of patients with an acute Achilles tendon rupture (Barfod, et al., 2020) / Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture (Myhrvold, et al., 2022) / Early Motion for Achilles Tendon Ruptures: Is Surgery Important? (Twaddle and Poon, 2007) / I Ruptured My Achilles Tendon: Should I have Surgery? (BMJ, 2023)

These sources consist of a multicenter, randomized, controlled trial and two systematic reviews/meta-analyses, all focusing on the optimal treatment for acute Achilles’ tendon rupture (ATR). The randomized trial found that surgery (open repair or minimally invasive surgery) did not yield better patient-reported outcomes than nonoperative treatment at 12 months, although surgery significantly reduced the risk of rerupture. Both systematic reviews examined the continuing controversy over whether surgical or conservative management is superior, generally finding that conservative treatment with accelerated rehabilitation can achieve similar functional outcomes to surgery. However, the meta-analysis noted that while surgery reduced rerupture rates, it was associated with a higher overall complication rate compared to conservative care. Ultimately, the sources suggest that the decision between surgical and nonoperative management requires considering the patient’s status, functional expectations, and the trade-off between a lower rerupture risk (with surgery) and a lower complication risk (with conservative treatment).

READ MORE: https://www.fitasaphysio.com/blog/ruptured-achilles-tendon-a-guide-to-your-treatment-options

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Gluteus Maximus Activation during Common Strength and Hypertrophy Exercises: A Systematic Review (Neto, et al., 2020)

These sources primarily examine the effects of hip-extension exercises, such as the hip thrust (HT) and glute bridge (GB), on both muscle growth (hypertrophy) and athletic performance, specifically sprint capability. One study from the European Journal of Sport Science investigates the acute effects of HT and GB, with varying loads, on sprint performance and horizontal force–velocity profiles in adolescent soccer players, suggesting both exercises can enhance post-activation performance, with GB potentially rivaling HT. Another source, an article from the International Journal of Strength and Conditioning, demonstrates that adding the barbell hip thrust to a resistance training regimen significantly increases gluteus maximus muscle thickness in untrained young women compared to other lower-body exercises alone. Finally, a systematic review focuses on the use of electromyography (EMG) to measure gluteus maximus activation across various loaded dynamic exercises, finding that exercises like the step-up, deadlifts, and hip thrusts can achieve very high levels of activation. Collectively, the texts explore the biomechanical rationale and measured outcomes related to the efficacy of these exercises for developing the gluteal muscles and improving athletic power.

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The Anti-Inflammatory Actions of Exercise Training (Flynn, et al., 2007)

These sources collectively examine the anti-inflammatory effects of exercise and the underlying mechanisms involved. Multiple studies investigate how both acute and chronic exercise modulates the immune system, showing that physical activity generally reduces markers of systemic and localized inflammation, such as Tumor Necrosis Factor-alpha (TNF) and C-reactive protein (CRP), which are implicated in chronic diseases like cardiovascular disease and osteoarthritis. Specifically, one study demonstrates that moderate exercise inhibits monocytic TNF production through elevated epinephrine levels acting on beta-2 adrenergic receptors and another suggests that regular exercise activates inflammation-countering Regulatory T cells (Tregs) in muscles, leading to improved endurance. Furthermore, research on knee joints reveals that running acutely decreases the concentration of pro-inflammatory cytokines like GM-CSF and IL-15 in the synovial fluid, suggesting a protective mechanism for joint health, while broader reviews discuss the role of IL-6, stress hormones, and reduced visceral fat in contributing to exercise-induced anti-inflammation.

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Exercise Therapy “Wears Down” My Knee Joint: Myth or Reality? (Bricca, et al., 2025)

This source comprise a clinical commentary from the Journal of Orthopaedic & Sports Physical Therapy addressing the widespread belief that exercise therapy harms or "wears down" the knee joint in patients with osteoarthritis (OA). The authors, Alessio Bricca, Carsten Bogh Juhl, and Ewa M. Roos, assert that this misconception stems from misinterpretations of early laboratory findings and the "wear and tear" analogy often used to describe OA. Systematic reviews and randomized controlled trials do not support this fear, consistently demonstrating that exercise therapy is safe and does not negatively impact cartilage structure or quality; it may even improve it. The text encourages clinicians to proactively dispel this myth using communication strategies, such as the "sponge analogy," to promote exercise therapy as a safe and essential first-line treatment for knee OA.

READ ARTICLE: https://www.fitasaphysio.com/uploads/4/3/3/4/43345381/ebsco-fulltext-08_10_2025.pdf

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“The only way you're ever going to play sport again is if you go through surgery”: A mixed methods study exploring anterior cruciate ligament (ACL) injury treatment decisions from the perspective of 734 patients (Filbay, et al, 2025)

ACL Treatment Decisions: Patient Experiences and Clinician Advice

This text is an excerpt from an original research article published in the Journal of Science and Medicine in Sport, focusing on Anterior Cruciate Ligament (ACL) injury treatment decisions from the perspective of 734 Australian patients. The study employed a mixed-methods design, using both a survey and semi-structured interviews to explore patient beliefs and decision-making experiences regarding treatment options like ACL reconstruction (ACLR) or rehabilitation alone. Key findings indicate that a majority of patients reported that surgeons and other clinicians often presented surgery as the best or only option, frequently providing an unbalanced overview that did not fully align with current research evidence. Qualitative results emphasized that patient consultations often felt rushed and poorly informed, with clinicians tending to downplay the risks and impacts of surgery. Ultimately, the study concludes that a balanced, evidence-based overview of treatment options is necessary to enable informed decision-making for ACL rupture patients.

READ THE ARTICLE: https://www.fitasaphysio.com/uploads/4/3/3/4/43345381/piis1440244025001562.pdf

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The Myth of Stretching: What Science Says

These sources challenge conventional wisdom regarding stretching and flexibility, primarily advocating for the reassessment of flexibility as a major component of physical fitness. We highlight limited evidence supporting static stretching's effectiveness in preventing injury, reducing muscle soreness, or significantly improving athletic performance for most individuals. Instead, the authors argue that other exercise modalities, like resistance training, offer more robust health benefits while also contributing to or maintaining functional flexibility. The "Myth of Stretching" details how static stretching can even acutely impair performance, while the "Retiring Flexibility" paper calls for the de-emphasis of stretching in exercise prescriptions to improve training efficiency and avoid misinterpretations of fitness status.

REFERENCES: https://www.fitasaphysio.com/blog/how-important-is-stretching

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Achilles Tendinopathy: A Clinical Practice Guideline Update

Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association (Chimenti, et al., 2024)

We discuss the 2024 Clinical Practice Guidelines for midportion Achilles tendinopathy, developed by the Academy of Orthopaedic Physical Therapy. It offers an updated, evidence-based framework for physical therapy management, covering diagnosis, prognosis, and intervention strategies. The guidelines specifically address various treatment modalities, including different forms of exercise, patient education, manual therapy, dry needling, and the use of heel lifts and taping, while also discussing the efficacy of modalities like low-level laser therapy and therapeutic ultrasound. The content is structured with summaries of recommendations, evidence updates, and identified gaps in current knowledge for each intervention, aiming to inform clinicians and improve patient outcomes.

LINK TO ARTICLE: https://www.fitasaphysio.com/uploads/4/3/3/4/43345381/chimenti-et-al-2024-achilles-pain-stiffness-and-muscle-power-deficits-midportion-achilles-tendinopathy-revision-2024.pdf

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Football Recovery Strategies: Science and Reality (Dupont, et al., 2015)

This text examines how congested match schedules in elite soccer lead to physical and mental exhaustion, emphasizing that a single game can require several days for full recovery. High-level players often face increased injury risks and performance drops when they are unable to restore their bodies between frequent competitions. The authors analyze the biological mechanisms of fatigue, such as muscle damage, glycogen depletion, and central nervous system strain. To combat these issues, the source identifies evidence-based recovery strategies, specifically highlighting the effectiveness of proper nutrition, hydration, sleep, and cold-water immersion. Conversely, common practices like stretching and massage are noted for lacking strong scientific support regarding performance restoration. Finally, the article provides a practical protocol for teams to systematically manage athlete health through disciplined post-match routines.

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A recent article from "The Conversation", discuss the common misconception that running damages knees. It explains that while running involves significant impact, the body is designed to adapt, and this load can actually strengthen bones and cartilage. The article suggests that runners tend to have healthier knees and better bone density than non-runners, and that cartilage temporarily thinning during a run may even facilitate nutrient flow. Furthermore, the sources address the safety of starting running later in life, noting that studies on high-intensity jump training in older adults suggest running is likely safe and effective, provided one starts slowly. Finally, it clarifies that most running-related injuries are "overuse" injuries, caused by increasing intensity too quickly, rather than running inherently being bad for the body, emphasizing the importance of gradual progression, proper nutrition, and listening to one's body to mitigate risks.

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Predicting Resistance Repetitions at Various Loads: A Meta-Analysis (Nuzzo, et al., 2023)

This review article focuses on the maximal number of repetitions (REPS) achievable at various percentages of one repetition maximum (%1RM), a critical relationship for resistance exercise programming. The authors conducted a meta-regression and moderator analysis using data from nearly 7,000 individuals to update existing guidelines, which were based on limited studies and lacked measures of uncertainty or individual variation. Their findings suggest that while sex, age, and training status have minimal influence on this relationship, specific exercises like the leg press and bench press demonstrate unique REPS ~ %1RM profiles, necessitating separate recommendations. Ultimately, this research provides more precise and comprehensive tables for prescribing resistance exercises, acknowledging the need for further data collection on other exercises and diverse populations.

ARTICLE: https://www.fitasaphysio.com/uploads/4/3/3/4/43345381/s40279-023-01937-7.pdf

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We provide a comprehensive overview of low back pain (LBP), distinguishing between the common, non-specific type and rare, serious pathologies. They explain that LBP is highly prevalent, often self-limiting, and rarely indicates structural damage, with pain intensity frequently reflecting the body's protective sensitivity rather than injury severity. We emphasize the importance of early assessment, identifying psychosocial factors, and judiciously using imaging only when serious conditions are suspected. Furthermore, we advocate for patient education, self-management through activity and lifestyle changes, and judicious use of pain medication, promoting active coping strategies and a multidisciplinary approach to care.

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A comprehensive overview of anterior cruciate ligament (ACL) ruptures, explaining what the ligament is and how it functions as a stabilizer in the knee. They detail common causes of injury, often sports-related, and list symptoms that may indicate an ACL tear. TheY present various treatment options, including surgical reconstruction, non-surgical rehabilitation, and the ACL Cross Bracing Protocol, outlining the advantages and disadvantages of each. Furthermore, they emphasise the importance of post-injury rehabilitation and discuss factors influencing recovery time and return to sport.

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Osgood-Schlatter's Disease is an overuse injury affecting the front of the knee, particularly common in growing children aged 9-12 who participate in activities involving a lot of running and jumping. This condition results from the body's inability to recover sufficiently during periods of rapid growth and intense physical training. It is a self-limiting condition with no long-term complications, resolving once growth stops. Management primarily involves conservative approaches such as rest, ice, improved nutrition, and adjusting training load based on pain levels, rather than requiring invasive procedures.

LEARN MORE: https://www.fitasaphysio.com/blog/osgood-schlatters-disease

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This podcast from Fit As A Physio discusses load management for injury prevention in athletes. It highlights the importance of balancing acute workload (recent training) with chronic workload (longer-term training history) to reduce injury risk. The post explains how to measure training load using session RPE multiplied by duration and introduces the concept of training-stress balance. A negative balance, where recent workload significantly exceeds chronic workload, is shown to increase injury risk, emphasising the need to avoid sudden large increases in training volume, especially for those more prone to injury.

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Risk factors for the development of knee osteoarthritis across the lifespan: A systematic review and meta-analysis (Duong, et al., 2025)

This discussion summarises a systematic review and meta-analysis that investigated risk factors for developing knee osteoarthritis (KOA) throughout life. The study identified over 150 potential factors through a review of 131 studies. Key findings indicate that previous knee injury, older age, and high bone mineral density are significantly associated with an increased risk of radiographic KOA. Notably, overweight/obesity and prior knee injury together account for a substantial portion of incident radiographic KOA cases. The authors conclude that new interventions targeting modifiable risks like weight, knee injuries, and occupational physical activity are essential to mitigate the overall impact of KOA.

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This discussion provides an overview of osteoarthritis (OA), a condition characterized by structural changes in joints due to cartilage damage and bone build-up. It explains that OA is a major cause of disability and highlights key contributing factors, including previous injury, genetics, and body mass index (BMI), with inflammation linked to fat tissue playing a significant role. While joint changes are common with age, pain is not always present and may fluctuate, often linked to the body's perception of joint vulnerability. Effective management strategies discussed include weight loss, exercise, and pain relief methods, with surgery considered for severe, unmanageable pain, but noting that arthroscopic procedures are often less effective than exercise.

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Whiplash Associated Disorder (WAD), commonly resulting from car accidents, is a frequent source of insurance claims. Its symptoms vary widely, encompassing pain, stiffness, and neurological issues, and its severity is clinically graded from no complaint to fracture or dislocation. While recovery timelines differ, staying activeand using simple pain relief are recommended, whereas certain treatments like collars and decreased activity can be detrimental. Effective management focuses on reassurance and movement, while many popular therapies have been proven ineffective.

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QUADRICEPS CONTUSION
The podcast discusses quadriceps contusions, commonly known as "corks," which are muscle injuries resulting from significant impacts, particularly in sports like rugby. It details the causes, symptoms, and grading of these injuries, ranging from minor Grade I to severe Grade III. We emphasise initial management using compression as a primary method to control internal bleeding, along with ice and elevation. Furthermore, we outline a rehabilitation process involving gentle stretching, early muscle loading exercises, and a high-repetition, low-resistance program to encourage functional muscle repair and minimise scar tissue formation. Finally, we highlight a potential complication called Myositis Ossificans, where bone tissue forms within the muscle.

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Copenhagen Adduction: Preventing Groin Injuries in Football

A study highlighted in the British Journal of Sports Medicine demonstrated that the Copenhagen Adduction exercise significantly reduced groin injuries in male football players. The research found a 41% decrease in these common athletic injuries through the implementation of this straightforward strengthening routine. The exercise targets the adductor longus muscle, which is crucial as weaker groin muscles correlate with a higher risk of injury. Participants progressed through three resistance levels based on their pain tolerance, ensuring accessibility. Due to its brevity, the Copenhagen Adduction exercise had high compliance among the athletes. This finding suggests that incorporating this exercise into training regimens could be a valuable preventative measure against groin injuries, similar to the Nordic Hamstring Curl for hamstring strains.

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Injury prevention is crucial for success in both team and individual sports, as player availability directly impacts performance and team rankings. This conversation highlights that structured injury prevention programs, when integrated into training, can significantly reduce injury rates by 50-80%. Specific examples of such programs include FIFA11+ and Perform+ for football, the KNEE Program for netball, and FootyFirst for Australian Rules Football. These programs typically incorporate exercises focusing on plyometrics, neuromuscular control, and strength training to mitigate common sports-related injuries. Widespread adoption of these readily available programs is encouraged to enhance athlete durability and overall sporting success.

LEARN MORE: https://www.fitasaphysio.com/blog/injury-prevention-programs

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ACL Cross Bracing Protocol: Non-Surgical ACL Healing

The ACL Cross Bracing Protocol is an innovative non-surgical treatment designed to facilitate the natural healing of a ruptured anterior cruciate ligament. Developed by Dr. Merv and Dr. Tom Cross, this method involves immobilizing the knee at a 90-degree angle shortly after injury to bring the torn ligament ends closer together. Clinical data reveals high success rates, with over 90% of patients showing ligament repair on MRI scans within three months. The procedure requires a strict twelve-week bracing schedule, the use of anticoagulants, and a specialized rehabilitation program that gradually restores range of motion. By avoiding traditional reconstructive surgery, patients can potentially return to sports within one year while maintaining the integrity of their original ligament. This protocol offers a significant shift in orthopedic medicine for specific candidates who meet strict diagnostic criteria.

READ MORE: https://www.fitasaphysio.com/acl-cross-bracing-protocol.html

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We explore the biological and psychological drivers of exercise fatigue, highlighting how it diminishes physical performance and serves as a significant risk factor for athletic injuries. Effective recuperation often requires two to four days, and failing to provide adequate rest between competitions can lead to increased physical strain and inflammation. To combat these issues, the source outlines a comprehensive recovery protocol centered on immediate rehydration and nutritional intake to restore glycogen and repair muscle tissue. Additionally, the text evaluates various recovery techniques, identifying cold water immersion and compression garments as beneficial while noting that stretching and active recovery have minimal scientific support. Ultimately, achieving a sufficient amount of sleep is presented as a vital component for maintaining cognitive function and preventing musculoskeletal damage.

READ MORE: https://www.fitasaphysio.com/blog/recovery-protocol

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