Lau Saugman

@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 :-).

@GregLehman @StephenSeiler @hjluks @mikesebroadley which trials show that ? I was under the impression the the tendon "doesn't care" if it is isometric/concentric/excentric - the tendon can only feel strain

@StephenSeiler @hjluks @mikesebroadley And if you truly want heavy loading what it really means is high tendon strain which is a factor of load and joint position. You can’t just train isometrically in neutral. You need heavy plus ROM to get 4.5-6% strain to catalyze stiffness adaptations.

Just published 🔥 Great editorial in BJSM by @JaredPowell12 and colleagues It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief 👇👇👇 bjsm.bmj.com/content/early/…

One slide easily showing what one review suggests does (and doesn’t) work for changing behaviour. And here’s the article ⬇️ pubmed.ncbi.nlm.nih.gov/40909436/

@DrJN_SportsMed Thanks...

@LSaugman More than 4/5 beats piques my interest

Consent✅ Cervicalgia & R scapula pain - occasional parasthesiae in hand MRI to assess for R sided nerve root compression MRI - C4/5 central disc protrusion causing cord compression - increased signal in the cord is of concern Inflammatory disc changes suggestive of infective disciitis as well - but no constitutional symptoms On further questioning at review - "Yes, my partner has noticed my walking has changed subtly" .... ? UMN signs in lower limbs now Mild clonus on exam & increased tone Urgent neurosurgical opinion

📢Patient-led goal setting + pain science education reduces chronic low back pain by boosting self-efficacy, lowering fear of movement & improving quality of life. Target mechanisms, improve outcomes!📢 Read here: doi.org/10.1016/j.jphy… @Pain_NeuRa #Physiotherapy #LowBackPain

Evidence for a detrimental causal effect of social isolation on cognitive function in older adults #google_vignette" target="_blank" rel="nofollow noopener">academic.oup.com/psychsocgeront…

Neuroimmune interactions in musculoskeletal conditions. An introduction for clinicians. 2025. sciencedirect.com/science/articl…

@BJSM_BMJ Great study with prospective design but also another add to the messy world of biomechanical associations with pain.

🚨 Biomechanical insights into Achilles tendinopathy risk and protection in runners 🏃‍♀️ What were identified as significant predictors of the onset of Achilles tendinopathy? 🤷‍♂️ NEW large prospective study 4HAIE 📄 #OpenAccess 👉 bit.ly/48MdkAD

This meta-analysis finds that, as resistance training volume (weekly sets) increases, both muscle hypertrophy and strength gains tend to increase, with stronger diminishing returns for strength gains, and as frequency (sessions per week) increases, there is a negligible effect for muscle hypertrophy but a meaningful effect with diminishing returns for strength gains.

@GregLehman @DerekGriffin86 Even though mechanistic research shows "saturation of osteoblasts" after few cycles? There are physiology we do not know yet?

@DerekGriffin86 @LSaugman I think its the same thing with bone density in runners. if someone has a BSI then running, when applied in a healthier person, can be stimulus for the bone to adapt.

While commonly cited that plyometric training doesn't enhance tendon stiffness, the evidence is more nuanced. It looks like there is variation between individuals. Tendon stiffness increased in some & not for others 👇 journals.physiology.org/doi/full/10.11…

@DerekGriffin86 @GregLehman Greg had a podcast episode with falk Mersmann. He gave done some nice studies on the topic : movementoptimism.libsyn.com/dr-falk-mersma…

@GregLehman @LSaugman Also if tendon loses stiffness with tendinopathy, then a lower %MVC is required to achieve the required strain value for adaptation. Hence it should be easier to enhance the stiffness of a tendinopathic tendon vs a healthy (stiffer) tendon.

@GregLehman is this one of few prospective papers looking at non RT exercise for tendon adaptions ? in your running course you mention papers on AT (e.g. Kubo and Histen). It also goes against the dogma that tendon stifness only increase with high strain with longer duration.

File this under "the doing is the fixing"? A favourite question is why isn't the goal task the best way to "build up" somebody to run. Here we see tendon adaptions with a running program (not inconsistent with other work) pubmed.ncbi.nlm.nih.gov/38085619/