Benoy Mathew

𝐏𝐨𝐬𝐭𝐞𝐫𝐢𝐨𝐫 𝐡𝐢𝐩 𝐩𝐚𝐢𝐧 𝐢𝐬 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐨𝐯𝐞𝐫-𝐥𝐚𝐛𝐞𝐥𝐥𝐞𝐝, 𝐮𝐧𝐝𝐞𝐫-𝐫𝐞𝐚𝐬𝐨𝐧𝐞𝐝 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐌𝐒𝐊 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞. Conditions overlap. Referrals look identical. Patients arrive carrying labels that don't fit. The fix isn't a longer differential list. It's a sharper reasoning sequence. I've just published a clinical guide, walking through the framework I use in clinic and teach on my hip course: → Why labels fail → The 6 discriminating questions that narrow the field fast → The 3 clinical pathways that follow → What commonly gets missed (Ischio-femoral impingement, pudendal entrapment, sacral BSI ) → When to image and which modality answers which question Free 14-page PDF guide inside it. If it sharpens one assessment this week, it's done its job. 🔗 Link below to download function-2-fitness.kit.com/0bd45c8f23

@DrPeteMalliaras Less than 50% success with conservative management. Not great.

𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟔 - 𝐌𝐨𝐫𝐩𝐡𝐨𝐥𝐨𝐠𝐲 𝐈𝐬𝐧'𝐭 𝐃𝐞𝐬𝐭𝐢𝐧𝐲: 𝐑𝐞𝐭𝐡𝐢𝐧𝐤𝐢𝐧𝐠 𝐇𝐨𝐰 𝐖𝐞 𝐌𝐚𝐧𝐚𝐠𝐞 𝐅𝐀𝐈 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞 Your patient has FAI Syndrome. They're in pain, frustrated, and wondering if they'll ever squat, sit comfortably, or train hard again. The answer? They almost certainly can — but only if we stop blaming morphology and start managing load. In this episode, we break down exactly how to modify everyday activity and gym exposure, so your patients keep moving, keep training, and actually start recovering. From the sitting habits silently driving flare-ups, to the squat, deadlift, and spin class tweaks that take the heat out of the anterior hip — this is the practical playbook you can take straight into clinic on Monday morning. What you'll learn: Why FAIS is a cumulative compression problem, not a single-event injury How to modify sitting, walking, stairs, car transfers, and sleep to calm an irritable hip Gym adjustments for squats, deadlifts, lunges, leg press, and core work — without pulling strength training away from your patient How CAM vs pincer morphology should shape your walking and loading advice Saddle height, handlebar position, and cadence tweaks for cyclists and spin class regulars The five clinician mistakes that keep FAIS patients stuck — including chasing perfect posture and over-restricting flexion Range isn't the enemy-unprepared range under load is. We modify to restore tolerance, not to protect forever. Tune in, take notes, and share it with a colleague who's still telling their FAI patients to avoid the squat rack. 𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists, strength coaches, and any health care professional managing active patients with hip and groin complaints. 🎙 𝐅𝐮𝐥𝐥 𝐞𝐩𝐢𝐬𝐨𝐝𝐞 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 🎧Spotify: spti.fi/sBkoO98 💻Youtube: tinyurl.com/4auffpkm 🎧Itunes: tinyurl.com/3be7v49j Amazon Music: tinyurl.com/2xyv5ksu

𝐏𝐮𝐝𝐞𝐧𝐝𝐚𝐥 𝐍𝐞𝐮𝐫𝐚𝐥𝐠𝐢𝐚 The diagnosis that slips through every filter — MRI, nerve conduction, and often our own clinical radar. A 42-year-old cyclist. 8 months of "groin pain." Normal hip MRI. Normal lumbar MRI. Negative FADIR, negative FABER. But sitting for more than 10 minutes? Agony. Standing? Relief within seconds. That pattern is the clue. Here's what physios need to know: 1️⃣ A key differential for cauda equina. Both can present with perineal symptoms and bladder or bowel change. Pudendal neuralgia is typically unilateral, position-dependent, and spares motor function. Cauda equina won't. 2️⃣ It hides inside hip and groin pathology. Deep gluteal syndrome, proximal hamstring tendinopathy, FAI, post-partum pelvic pain — pudendal irritation can coexist or masquerade. Miss it and rehab stalls. 3️⃣ MRI and nerve conduction studies are often normal. The pudendal nerve is small, deep, and runs through Alcock's canal between the sacrospinous and sacrotuberous ligaments. Standard imaging rarely catches entrapment. Diagnosis is clinical — lean on the Nantes criteria. Cluster the red flags: 🟣 Burning or stabbing perineal, genital, or anal pain 🟣 Worse with sitting, relieved standing or on a toilet seat 🟣 No nocturnal pain, no sensory loss 🟣 Cyclists, post-partum, post-surgical, chronic "groin" presentations If the story doesn't fit the scan — listen to the story. At YOS Health, we manage pudendal neuralgia through an integrated model — combining hip-focused MSK physiotherapy with specialist pelvic health input, lead by Fran Roca BSc MSc HCPC MCSP under one roof and specialist Protocol using Focus Shockwave (done in very few centres in UK & Europe) This condition rarely sits in one lane, and neither should the care. If you're stuck with a case that isn't adding up, we're happy to help. 🔗 yoshealth.co.uk

𝐒𝐩𝐨𝐭𝐭𝐢𝐧𝐠 𝐚 𝐅𝐮𝐥𝐥-𝐓𝐡𝐢𝐜𝐤𝐧𝐞𝐬𝐬 𝐒𝐮𝐩𝐫𝐚𝐬𝐩𝐢𝐧𝐚𝐭𝐮𝐬 𝐓𝐞𝐚𝐫 𝐨𝐧 𝐔𝐥𝐭𝐫𝐚𝐬𝐨𝐮𝐧𝐝: 𝐃𝐨𝐧’𝐭 𝐌𝐢𝐬𝐬 𝐭𝐡𝐞 𝐈𝐧𝐝𝐢𝐫𝐞𝐜𝐭 𝐒𝐢𝐠𝐧𝐬 Chronic full-thickness supraspinatus tears can sometimes, be tricky on ultrasound. Defects are often filled with fibrous tissue, giving the illusion of tendon continuity. That’s where indirect signs become essential. Here’s a practical approach I use: -Look for the sagging pre-bursal fat sign on the transverse view. It’s been reported to have around 88% sensitivity for full-thickness tears. -Then increase your confidence by checking for cortical irregularities at the footprint. In this case, they’re clearly present. When the pre-bursal fat sag sign is combined with cortical irregularities, specificity and positive predictive value can approach 100%. Ref: sciencedirect.com/science/articl… These are the cases where careful attention to indirect signs makes all the difference in diagnosing rotator cuff tears. If you’d like to dive deeper or develop your diagnostic skills, our mentorship programme at the award-winning MSK Team at Guy's and St Thomas'​ NHS Foundation Trust can help. Feel free to reach out –contact paul.deane1@nhs.net for more details

𝐎𝐧𝐥𝐢𝐧𝐞 𝐂𝐏𝐃 𝐡𝐚𝐬 𝐢𝐭𝐬 𝐩𝐥𝐚𝐜𝐞. But there's something it can't replicate — a room full of clinicians wrestling with real cases, together. This weekend at Whittington Hospital London, we ran Advanced Running Rehab. Dominic joined us for his very first in-person CPD. His feedback (video below) is exactly why we built this course: → Complex running injuries you won't meet in a textbook → Integrating technology into your clinical reasoning → Hands-on work, live debate, real patient problems No slides-and-scroll. No passive listening. Just clinicians getting stuck in. Huge thanks to everyone who made the room what it was — and to Dominic for trusting us with his first CPD experience. Next stop: Manchester, September — DM "RUN" for details. Co-created with the brilliant yasmin palfrey, who keeps the clinical bar impossibly high.

𝐂𝐞𝐫𝐚𝐦𝐢𝐜 𝐇𝐢𝐩 𝐑𝐞𝐬𝐮𝐫𝐟𝐚𝐜𝐢𝐧𝐠 𝐈𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧𝐬 𝐚𝐭 𝐔𝐂𝐋 -You're too young for a hip replacement. -You're too active to slow down. -And you've been told resurfacing isn't an option — maybe because of your size, your sex (Female), or the risks of metal implants. So what now? Recently, I spent an afternoon at UCL with Mr. Kartik Logishetty onsultant hip surgeon, exploring one of the most important advances I've seen in hip surgery in years: ceramic hip resurfacing. Here's what it actually means for young, active patients with Hip OA, who have failed conservative management: 1️⃣ No metal ions. Traditional metal-on-metal resurfacing carried a real risk of reactions in the surrounding tissue. Ceramic takes that concern off the table. 2️⃣ Built to last. Ceramic is harder and smoother than metal, so the bearing surface stands up to years of running, lifting, training, and the demands of an active life. 3️⃣ Your bone is preserved. Unlike a full hip replacement, resurfacing keeps your natural femoral head — which matters if you're young and want to keep your options open down the line. 4️⃣ 𝐀 𝐑𝐞𝐚𝐥 𝐨𝐩𝐭𝐢𝐨𝐧 𝐟𝐨𝐫 𝐖𝐨𝐦𝐞𝐧 𝐚𝐧𝐝 𝐬𝐦𝐚𝐥𝐥𝐞𝐫-𝐟𝐫𝐚𝐦𝐞𝐝 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬. A group who, until now, have been consistently told they weren't suitable. That's changing. I reviewed post-op cases with Mr Karthik and worked through some complex hip dysplasia cases — the kind of conversations that directly shape how I guide my patients in my complex cases – review clinic at Guys and St. Thomas Hospital. A full discussion — ceramic hip resurfacing vs traditional hip replacement, who it suits, and who it doesn't — is coming soon on the Straight from the Hip podcast. Genuine thanks to Mr Karthik and the UCL team for their time and generosity. If you've been told your only option is a hip replacement — or simply to "wait and see" — it may be worth a second look.

COME WORK WITH ME! Looking for a physiotherapist role where you can build your skills, work with runners, and enjoy the lifestyle outside the clinic? Send me your resume + cover letter at "info@movemed.ca"

Months of work. Now in print. The Advanced Running Rehab course booklet has arrived — and holding it in your hands hits differently. Yasmin Palfrey and I have been heads down on this material for a long time. Seeing it come together as a finished product is a proper milestone. A few updates: 🔹 London cohort runs this Saturday — we cannot wait 🔹 Manchester dates are in the pipeline for September 🔹 Booking details drop next week All focus now on delivering the best possible experience for our London delegates. Watch this space.

𝐑𝐮𝐧𝐧𝐢𝐧𝐠 𝐑𝐞𝐡𝐚𝐛 𝐢𝐬 𝐂𝐡𝐚𝐧𝐠𝐢𝐧𝐠! And if you're still only managing ITB syndrome and plantar fasciitis, you're falling behind. The cases walking into our clinics now are different. We're seeing more: 1.    Femoral and tibial bone stress injuries 2.    Ischiofemoral impingement 3.    Chronic exertional compartment syndrome 4.    Complex presentations that don't fit neat diagnostic boxes The landscape has shifted too. Therapists now have access to point-of-care ultrasound, force plates, and advanced imaging pathways that didn't exist five years ago. The question is — are you using them? That's exactly why Yasmin Palfrey and I built this course. Beyond the Basics: Advanced Running Rehab for Complex Cases 📍 Holloway Community Health Centre, London 📅 18th April 2026 👥 Two tutors — more hands-on time, more clinical reasoning, more value for you This isn't a beginner course. This is for therapists already comfortable managing common running injuries who want to elevate their practice. We'll cover: → Complex case recognition and differential diagnosis → Imaging pathways — what to request and when → Integrating technology into your clinical reasoning → Practical treatment strategies for stubborn cases → Rehab progression frameworks with case-based learning Two tutors means smaller group interaction, real-time feedback, and the space to challenge your thinking. If you want to take your running rehab to the next level, come join us. Link below to book your place eventbrite.com/e/advanced-run…

She limps to the bathroom every morning. 10 steps in, it eases off. By the time she's brushed her teeth, it's gone. So she ignores it. But that lateral hip ache? It's been whispering for months. Gluteal tendinopathy has a predictable 24-hour symptom cycle. Once you know it, you can't unsee it. Here's what to listen for: -Night pain — up to 90% of patients report it. Lying on the affected side compresses the tendon. Lying on the unaffected side stretches it. Either way, sleep suffers. -Morning stiffness — the classic "warms up" start. Stiff or limping for the first few minutes of walking, then it settles. This is one of the most under-recognised features. -Load-dependent aggravation — stairs, single-leg stance, crossing legs, low chairs. Anything that drives high adduction or high abductor demand reproduces pain consistently. -Latent pain — the delayed flare-up. Activity on Day 1, pain peaks the following morning. This is the one that confuses patients and clinicians alike. Pain character — persistent aching or burning over the lateral hip. Rarely sharp unless there's an acute tear or flare-up. The pattern matters. Night pain. Morning stiffness. Load-dependent aggravation. Latent flare-ups. When a patient describes this cycle, you're already halfway to your clinical reasoning before you've even examined them. Understanding the symptom profile changes the conversation

@AStudentPhysio Excellent 2 day Intro course by the Ultrasound site, organised by @swildmanphysio and team. Highly recommend!

@function2fitnes @function2fitnes any MSK POCUS courses you recommend in the uk ?

Some of the best conversations happen when old paths cross again. Recently, I reconnected with Nancy Venables — specialist ESP shoulder physiotherapist at St. Albans City Hospital (NHS). We worked together over 20 years ago at Barnet and Chase Farm Hospital. Back then, the landscape looked very different. -No ultrasound in clinic. -No image-guided injections. -A lot more guesswork. Comparing notes on how practice has evolved was fascinating — and one theme kept coming up: Ultrasound is transforming shoulder management. Here's why it matters: -It elevates diagnostic confidence at the point of care — no waiting weeks for imaging reports -It improves accuracy for guided injections, which directly enhances patient outcomes -The shoulder, with its superficial structures and dynamic pathology, lends itself exceptionally well to high-quality ultrasound assessment People often associate me with hip and groin work. Fair enough — it's a big part of what I do, along with complex running injuries. But shoulder ultrasound and ultrasound-guided procedures are a significant part of my NHS APP clinical practice too. GH joint injections under US guidance remain one of the most satisfying procedures I perform. Nancy is now planning to implement ultrasound-guided procedures within her service. I think this is the direction of travel for advanced practice clinics everywhere — bringing greater precision, efficiency, and tangible patient benefit. The profession is moving forward, especially in Advanced Practice. And conversations like this remind me why.

🦋 𝐎𝐧𝐞 𝐭𝐞𝐬𝐭. 𝟑𝟎 𝐬𝐞𝐜𝐨𝐧𝐝𝐬. 𝐇𝐢𝐠𝐡 𝐬𝐩𝐞𝐜𝐢𝐟𝐢𝐜𝐢𝐭𝐲 𝐟𝐨𝐫 𝐆𝐥𝐮𝐭𝐞𝐚𝐥 𝐓𝐞𝐧𝐝𝐢𝐧𝐨𝐩𝐚𝐭𝐡𝐲! The Single Leg Stand test has become a staple in my clinical assessment — and for good reason. When a patient reports lateral hip pain, one of the first things I want to know is whether load through the gluteal tendons is provoking their symptoms. The single leg stand (30 seconds, unilateral) does exactly that — it places a sustained compressive and tensile load on the gluteal tendon, reproducing the patient's familiar pain. What makes this test particularly useful in practice is its high specificity. That means when it is positive, you can be reasonably confident you're dealing with gluteal tendinopathy — it's not picking up a lot of false positives. For me, that clinical certainty is invaluable when explaining the diagnosis to a patient and mapping out a loading programme. 💡 Clinical pearl: I always ask the patient to confirm whether the pain reproduced matches their usual symptoms — location, quality, familiarity. A positive test paired with a familiar pain response gives you real diagnostic confidence. It's a simple, low-tech, no-cost test that takes half a minute. If it's not already in your hip assessment toolkit, it's worth adding. 📍 This is just one of the topics I'll be exploring in the current management of hip tendons on my upcoming 1 day Big 4 TENDINOPATHY course in Holland Fysiolinks in two weeks — which has already sold out, where I will cover all the 4 tendons (Gluteal, Adductor, Proximal Hamstrings and Hip Flexor) Excited to dive deeper into this with a fantastic group of clinicians!

"𝐓𝐫𝐞𝐚𝐭 𝐭𝐡𝐞 𝐩𝐞𝐫𝐬𝐨𝐧, 𝐧𝐨𝐭 𝐭𝐡𝐞 𝐬𝐜𝐚𝐧." Easy to say. Harder to do when two patients share the same FAIS diagnosis but present with completely different pain patterns, movement strategies, and rehab needs. In Episode 5 of Straight from the Hip, we cover: → Why males and females present differently → How morphology shapes assessment findings → Where rehab priorities should actually sit Same label. Different clinical picture. Different plan. If you've ever wondered why some FAIS patients plateau despite doing "all the right things," this episode might change how you approach your next hip assessment. Same diagnosis doesn't mean same patient — treat the person, not the scan. 🎙 𝐅𝐮𝐥𝐥 𝐞𝐩𝐢𝐬𝐨𝐝𝐞 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 🎧Spotify: spti.fi/sBkoO98 💻Youtube: tinyurl.com/4auffpkm 🎧Itunes: tinyurl.com/3be7v49j Amazon Music: tinyurl.com/2xyv5ksu

Teaching Postgraduate Physios is one of my Favourite Things to do. This week, I had the privilege of being back at 𝐁𝐫𝐮𝐧𝐞𝐥 𝐔𝐧𝐢𝐯𝐞𝐫𝐬𝐢𝐭𝐲, working with an incredible cohort of MSK clinicians — from First Contact Practitioners and Advanced Practice physios through to those in private practice settings. The focus? 𝐓𝐡𝐞 𝐘𝐨𝐮𝐧𝐠 𝐇𝐢𝐩 We unpacked: 1️⃣ Local imaging pathways and when they actually serve the patient (XR vs MRI vs US) 2️⃣ Recognising red flags that warrant urgent escalation 3️⃣ Differentiating instability from hip impingement — and why it matters clinically 4️⃣ Surgical considerations and how to communicate them meaningfully 5️⃣ When and how to escalate to secondary care with confidence What struck me most was the quality of the discussion. These weren't passive learners — they were clinicians bringing real cases, real dilemmas, and real curiosity to the room. That's exactly the kind of environment where learning sticks. It's also the perfect warm-up for this weekend, where I'll be welcoming participants from across the UK and Europe to the 𝐀𝐝𝐮𝐥𝐭 𝐇𝐢𝐩 𝐜𝐨𝐮𝐫𝐬𝐞 𝐚𝐭 𝐂𝐡𝐞𝐥𝐬𝐞𝐚 𝐚𝐧𝐝 𝐖𝐞𝐬𝐭𝐦𝐢𝐧𝐬𝐭𝐞𝐫 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥, 𝐋𝐨𝐧𝐝𝐨𝐧. If you're working with hip pain and want to build genuine clinical depth — the next stop is 𝐇𝐨𝐥𝐥𝐚𝐧𝐝 𝐢𝐧 𝐀𝐩𝐫𝐢𝐥, organised by Fysiolinks Full details and booking at 👉 lnk.bio/function2fitne… “𝐓𝐡𝐞 𝐦𝐨𝐫𝐞 𝐰𝐞 𝐮𝐧𝐝𝐞𝐫𝐬𝐭𝐚𝐧𝐝 𝐭𝐡𝐞 𝐡𝐢𝐩, 𝐭𝐡𝐞 𝐛𝐞𝐭𝐭𝐞𝐫 𝐰𝐞 𝐬𝐞𝐫𝐯𝐞 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬, 𝐢𝐧 𝐟𝐫𝐨𝐧𝐭 𝐨𝐟 𝐮𝐬”

𝐎𝐧𝐞 𝐬𝐞𝐚𝐭 𝐥𝐞𝐟𝐭. 𝐓𝐡𝐢𝐬 𝐒𝐚𝐭𝐮𝐫𝐝𝐚𝐲. 𝐂𝐡𝐞𝐥𝐬𝐞𝐚 𝐚𝐧𝐝 𝐖𝐞𝐬𝐭𝐦𝐢𝐧𝐬𝐭𝐞𝐫 𝐇𝐨𝐬𝐩𝐢𝐭𝐚𝐥, 𝐋𝐎𝐍𝐃𝐎𝐍 We've had a late cancellation on our Adult Hip Course — and this could be your chance to grab the last remaining place. 𝐓𝐡𝐢𝐬 𝐢𝐬 𝐄𝐝𝐢𝐭𝐢𝐨𝐧 𝟏𝟐. Twelve years, we've refined this course. Over the years, we've listened to delegate feedback and sharpened the content. There's a reason it keeps selling out and has been delivered in 16 countries in the last 12 years. Here's what you'll get on Saturday 14th March: 1️⃣ A structured journey from early-stage to late-stage hip rehab — no gaps, no filler 2️⃣ Clinical reasoning frameworks you can apply with your first patient on Monday morning 3️⃣ Real-world management strategies from faculty who live this work daily 4️⃣ Practical, hands-on content — not a day of sitting through slides This isn't a course you watch. It's a course you use. If you've been eyeing this one up, waiting for the right time — this is it. One cancellation. One seat. Once it's gone, it's gone. 📍 Chelsea and Westminster Hospital, London 📅 Saturday 14th March 🔗 Book here: lnk.bio/function2fitne… Helping clinicians manage hip pathology with confidence — that's what we do

Running 10% faster doesn't increase bone damage by 10%. It increases it by a factor of six. That one statistic changed how I think about every speed session, every return-to-run programme, and every pair of racing flats I prescribe. And it's not even the most important part of the equation. The most important part? Whether the athlete is eating enough for their bones to repair overnight. More on this later this week — including an infographic that breaks down the science in a way you can actually use in clinic.

Last few places remaining! MSK Ultrasound Injection Skills Workshop: Upper Limb Essentials – a hands-on course to refine ultrasound-guided injection skills using live model scanning and advanced needle simulation 21 Mar 2026 | London More info: bit.ly/49CadLX

Grateful for a brilliant evening at Cromwell Hospital Thank you to everyone who joined our evening lecture event, organised by Cromwell Hospital. We explored foot and ankle injuries with a strong focus on running-related issues. - I shared current updates and a multimodal approach to managing medial tibial stress syndrome in runners yasmin palfrey covered tibialis posterior tendinopathy with practical insights - Mr. Simon Moyes discussed surgical options for chronic ankle instability, osteochondral defects, and related pathologies It was a fantastic evening, and the face-to-face interaction made it all the more energising—especially in a busy week. Events like this really put a spark in the middle of the schedule and set me up well for what’s ahead. Looking forward to more teaching events this week.