Alex Peters - Sports PT & Athletic Trainer

This systematic review on chronic shoulder adaptations in pitchers is worth a read. Baseball clinicians have to understand the difference between bony and soft tissue range of motion (ROM) restrictions in throwing shoulders. Here is a summary of the findings:

@NickHoopes_ Especially with a concomitant meniscus repair, those things move so slow early and are super irritable. The slower we push the faster it goes. Exactly why I often delay running until 4-6 months.

@NickHoopes_ The more ACLs I rehab the slower I go. Early in my career I felt like I wanted more load quicker and felt like I was pushing. Now I go a lot slower and end up with better results. I think often PTs don’t respect healing enough and just push too much, myself included previously.

Had an influx of early post-op ACLRs lately. Reminded me of the importance of nailing the basics. 1. Full AROM. 2. Strong cortical drive to the quad. 3. Normalize gait mechanics. A quad set is every bit as important as a squat. You can’t build a mansion on a poor foundation

@2Goalies1Mic Looks like an anterior shoulder dislocation. If associated with a labral tear and instability, could brace and rehab it, but could also be season ending depending on severity.

Carrick fights Anders Lee for the Norris hit. It looks like he may have hurt his shoulder at the end

As participation increases for female youth athletes in flag football, we need to make sure the same emphasis on ACL prevention programs that we see in soccer are carried over to flag football. I have seen a tremendous increase in ACL injuries from this sport the past few years

Wharton researchers gave nearly 1,000 high school math students access to ChatGPT during practice problems Result: chatGPT is the perfect trap. Look at the red bars. Students with ChatGPT crushed their practice sessions. The basic ChatGPT group solved more problems and those on the "tutor" version did even more. Now look at the gray bars. That's the exam. No AI allowed. The ChatGPT group scored 17% worse than kids who practiced with zero technology. And the fancy tutor version? No better than working alone. The researchers called AI a "crutch." When they analyzed what students actually typed into ChatGPT, most of them just wrote - “What’s the answer?” The kicker: students who used ChatGPT believed it hadn't hurt their learning. They were confidently wrong. This is the AI trap in education. Outsourcing your thinking. Of course, lots of half-baked AI literacy curricula being rolled out in schools now Let’s of course ignore that basic literacy (the ability to read) is possible for <50% of 8th graders Source: Bastani et al. (2025), "Generative AI Can Harm Learning," PNAS

“There is insufficient evidence to support the idea that hip abductor or external rotator strength is a primary determinant of running biomechanics in healthy runners. Furthermore, strengthening these muscles in isolation is unlikely to predictably alter running form.”

@WillyRontgen @northwoods1980 @hjluks @ASK_MSK That joint would’ve fused itself if they gave it more time. Sounds like skipping a few steps in treating that patient conservatively to make a decent paycheck to me.

Why are we doing SI joint fusions on young people with stone cold normal joints? @northwoods1980 @hjluks @ASK_MSK

You are NOT your MRI findings. Sometimes we see lots of findings in patients with very little pain. Sometimes we see very little findings in patients with lots of pain. Here is a great example. Just because your MRI had findings, does not mean you need surgery.

@lahti_johan Most groups now do a push or pull based long lever and short lever test in supine in a make test fashion. 2001 paper was done in a break test fashion IIRC as well - and the testing at the NHL combine also reflects break testing. You can debate make vs break, both have utility

Ice hockey and groin testing. In the original Tyler et al. 2001 study that is famous for underpinning the hip adduction:abduction (ADD:ABD) ratio <0.80 being an issue for ice-hockey players. journals.sagepub.com/doi/abs/10.117… Their test position was done in a side-lying position, propsoed bt Kendall and McCreary (figure below). However, i havent really found replications of this exact testing position (has someone else?). Studies that have have not found an association like Wörner et al 2021 study that tested supine with straight legs, #i1938-162X-57-1-72-b19" target="_blank" rel="nofollow noopener">pmc.ncbi.nlm.nih.gov/articles/PMC87… with @KThorborg protocol i believe. Many teams test with different hip flexion angles also. But what is the current most evidence guided advice on appropriate testing positions for add/abd in ice-hockey?

@LenMacPT I could see NWB&110 deg for 4 if they’re nervous about the repair, but you’re right, it’s a completely arbitrary number. So many menisci that would’ve been debrided before are being fixed now which is fantastic, but the surgical techniques and devices have far outpaced protocols

@Alex_Peters_ Boston docs ultra conservative!

Updating my meniscus repair/debridement talk and just needed to dig more into this 90-degree ROM restriction that's still out there for 4 weeks after surgery. I mainly ignore it and lecture on why you should too! Different in WB than non-WB motion too!

@Jtfawver @LenMacPT Plus the whole doctors can’t own hospitals thing

@Alex_Peters_ @LenMacPT Not just hospital expansion, but ACA killing private practice. Can’t build new surgical centers & ones in place are limited on how much they can grow. It’s insanity.

Punt and start over. ACA an epic failure. I don’t save $2500 and I didn’t keep my doc, as promised

Quick guide for the BAMIC (Muscle Injury Classification) in practice. 1) Grade the injury. 2) Define the location. 3) Predict recovery. Save it for your reference. #MSKRadiology #SportsMedicine #MRI #ReturnToPlay #BAMIC

“I need you to lock in stop being distracted right. I BELIEVE in you but YOU’VE got to want this moment. This isn’t my story alright?” IM READY TO RUN THROUGH A BRICK WALL

This highlight from today’s Padres-Brewers telecast is presented by authority of @JLevering4 and @BrewersFanCamp and may not be disseminated without the express written consent of the Milwaukee @Brewers. 🤣

The collaboration between orthopedic surgeon and physical therapist is key for a successful outcomes after surgery.

Please stop telling people with osteoporosis not to lift anything heavy... I've heard it from docs, PTs, Trainers, etc... This might seem protective... but it's not. This risk calculation... A hip fracture in an older adult carries a one-year mortality rate of roughly 25 percent. Half of those who survive never walk independently again. That is the cost of fragility. The risk of a well-supervised, progressively loaded heavy (80-85% 1RM) strength program (LIFTMOR) is a muscle strain or a bruise. These are not equivalent risks, and treating them as equivalent, as avoidance does, is not caution. It is a decision to accept the larger risk in order to avoid the smaller one.

Fun day .. “You’re my 5th opinion.” Knee injury These are usually a problem. Previous 4… -Only one exam -All repeated X-rays -2 MRIs. - One Special NY hospital often insists their MRIs are better and wants new ones 🤦‍♂️. The fourth doc started PT 🙌 🥳 4 surgical recommendations... but 3 different procedures. PT is working. Me: “Do you think you need an operation?” Them: No. I feel pretty good. Me again. “Cool… nice meeting you. Have a great weekend”. I wish these were rare or isolated cases.