Lau Saugman

@NickHoopes_ And if it is a patient that have a history of always seeking passive help I would be inclined to suggest doing nothing. Let them feel natural recovery to be more confident in the future

@LSaugman Sure. And there in lies the challenge. It could get better if we do nothing. But it also feels a bit dogmatic to not try and help with the immediate pain the patient is experiencing. The true skill lies in attempting to help without causing harm/reliance/poor narratives/etc.

Pragmatic Healthcare 🧵: I have a buddy. Fit, healthy, lifts heavy, great cardio. Hits the right markers. 5 days ago, tweaked his back lifting. Got worse. Quick. Had to call off work. Called me to see if I could help. Had him come in that day…

@NickHoopes_ Agree. I tend to discuss with patient and if passive intervention is used try not to make it flair up even further!

@NickHoopes_ I do the same. Could mention that we should discuss with pt that going from 8/10 to 4/10 on VAS could also happen without any intervention. At least that is what some trials show for acute LBP.

And that, in my opinion, is… Pragmatic Healthcare.

Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): an assessor-blinded, limited disclosure randomised controlled trial bjsm.bmj.com/content/early/…

@GregLehman Looking good!

Should I be worried about these repeated bouts of spine flexion? I think the fear here really helped any pain I had.

@simensletten Comprehensive and a lot of good info.

I've written a bit about the sacroiliac joint! Let me know what you think. The first post is a bit about myth busting. More to come. thescandiphysio.com/2026/04/26/sac…

Low back injury risk in deadlifting is not explained by spinal posture alone. A more precise framework integrates load management, movement variability, dynamic trunk control, and individual adaptation. doi.org/10.3390/sports…

@tomgoom Yes but could also be like many other msk pathologies that strengthening isn't the mediating factor.

@LSaugman Fair point, I think it depends on the population. I’d like to see it studied specifically in runners/ athletes

Intrinsic foot muscles can be weak in patients with Plantar Heel Pain🦶 Progressive strengthening of intrinsic and extrinsic muscles can be effective, especially in runners and active individuals. See my previous posts for recent research on which exercises are effective to target these muscles.

🪑A simple chair test can say a lot about lower-body function A pooled analysis of 45,470 adults aged 50+ from 14 European countries provides age- and sex-specific reference values for the 5x sit-to-stand test, showing slower times with advancing age 👵 pubmed.ncbi.nlm.nih.gov/40875134/

Osteopathic Manipulative Treatment for Pediatric Conditions: A Systematic Review publications.aap.org/pediatrics/art…

@GregLehman @JNicholsonnn Would be nice to see a study like done with insertional AT (Pringels 2025) where non-compressive HSR were superior

@GregLehman @JNicholsonnn do you know of other studies than this: pubmed.ncbi.nlm.nih.gov/40404553/ and Ganderton for directly comparing hip abd strength vs sham/general exercise ?

Best summary for treatment of lateral hip pain. (Which also happens to play into my personal biases) People look at me like I’m a charlatan when I tell them to stop stretching and load into tolerable levels of pain reproduction.

@GregLehman 😅 It's easy to feel stupid with many of these "pro's" videos. You could say: pain on palpation, pain with first step, no neurogenic/inflammatory pathology = PHP. Try exercise (Riel et al), heel cup, tape. Dont worry about food posture, flexor hallucis longus etc...

Theatre and showmanship.

@GregLehman Hope that @clairepatella will tune in and give her take on why she advocate this ?

Another physio tip. You don’t need to do this. There is nothing wrong with femoral IR. Shine your headlights wherever you like

@TDekkersPhysio @AdamMeakins I can see some prominent researchers in the references (Fritz, Ferreira). Do you find that any of the RCT's included in the SR include contemporary practice interventions ?

I understand your take here Adam - its been an under prioritised area of physio IMO. But the way I look at this is that its a research problem rather than a reflection of the capacity of physios to help those with radicular issues. We urgently need better research in the area that is aligned with modern practice- that doesn't worry me, it motivates me.

The fact that the evidence base is so poor and weak for Physio helping those with sciatica is most definitely something to be worried/concerned about! It’s not like the profession hasn’t had time or opportunity to demonstrate its worth or not here!

🧠A new study reveals that exercise therapy results in significantly greater reduction in pain and disability in the long-term compared with corticosteriod injection for shoulder pain management in general practice. Read the study here: buff.ly/EXIjuF8 #shoulder #exercise #injection

Effectiveness of manual therapy as a prophylactic treatment for migraine: a randomized controlled trial pubmed.ncbi.nlm.nih.gov/41705211/

@DrJN_SportsMed Variation in pain and sensation could be explained by neuroinflammation (Albrecht 2018). More inflammatory "soup" on side with worst pain even despite less stenosis

Doctor, 40s - ‘A Tale of Two Shins’ 😄 L4/5 destructive bacterial disciitis with osteomyelitic destruction of adjacent L4 and L5 vertebral bodies (MRI STIR sagittal) This led to bilateral foraminal stenosis, right worse than left radiographically on both MRI and CT (see axial - note debris in the left recess) But interestingly – Left sided radicular pain and foot sensory and temperature changes much more severe versus the right Left side much worse on lumbar extension; right worse on flexion Left ‘foot drop’ and tibialis anterior wasting much more pronounced Both worse at night and in the morning, and both aggravated by neural tensioning Although same L5 nerve roots affected and nerve oedema on MRI STIR sagittal images similar bilaterally the pattern of radicular pain is notably different side to side (see pain map) - On ‘worse’ radiological right side, only 3/10 shin ‘warm aching’ On left, most severe pain is deep electric shock superolateral gluteal 9/10 pain which ‘skips’ posterior thigh to re-emerge at the fibula head What do you think explains this variability side to side? Thoughts and discussion welcome Research link – tomjesson.substack.com/p/how-bad-are-…

@GregLehman @StephenSeiler @hjluks @mikesebroadley So that high load isometric contraction in 0 degree dorsiflexion will not strain the Achilles as much as if it is done from a more dorsiflexed position?

@LSaugman @StephenSeiler @hjluks @mikesebroadley Ya. Thats what I’m saying. You need load and position. High loads without passive stretch may not always be enough

LFG :-). Heavy day... I always wait for my achilles to bark... and it never does :-).