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11/04/2026

Comment PTGUIDE and I’ll send you the link to my free Patellar Tendinopathy cheat sheet.

The single-leg decline squat ranked highest out of 35 exercises on a combined patellar tendon-loading measure. It ranked above running, jumping and cutting on that score.

Peak force is a different comparison: cutting averaged 5.5 times body weight, repeated single-leg forward hops 5.3, and the decline squat 5.2. So it was not the highest peak-force task.

My practical takeaway: a familiar rehab exercise is not automatically an easy starting place for an athlete with an irritable tendon. Consider a tolerable starting demand and build toward the sport.

This was modelling in 20 healthy adults, not a trial showing that one progression produces better recovery. The index also depends on how its three loading measures were weighted.

Save this for your next patellar tendon case.

Study: Scattone Silva et al., MSSE 2024 (online 2023).
https://pmc.ncbi.nlm.nih.gov/articles/PMC10925836/

11/03/2026

Stop guessing on cartilage injuries. 🎯

The MRI shows a cartilage lesion… but does your athlete actually need surgery? My new video covers ICRS grading, microfracture vs OATS vs ACI vs MACI, non-op rehab, post-op loading and realistic return-to-sport timelines.

▶️ Watch the full video: https://youtu.be/nN-uxv0MVIU
📌 FREE evidence-based Articular Cartilage Injury Cheat Sheet: https://fitnesspainfree.com/programs/articular-cartilage-cheat-sheet-lead-magnet/
📝 Blog post + all the references: https://fitnesspainfree.com/2026/10/articular-cartilage-injuries-diagnosis-surgery-rehab/

Or comment MACI and I'll DM you the links 👇

11/02/2026

Get my free evidence-based Hamstring Strain Cheat Sheet for clinicians: https://fitnesspainfree.com/programs/hamstring-strain-cheat-sheet-lead-magnet/

RDL vs Nordic curl: which loads the hamstrings more?

For the biceps femoris long head, this study estimated peak force at 1.6× body weight during bilateral RDLs versus 0.9× during Nordics. That is muscle force estimated with a model—not the weight on the bar.

My takeaway: keep Nordics, and consider including RDLs. A knee-flexion exercise and a hip hinge give us different ways to challenge the hamstrings. For clinicians working with lifters and active adults, the useful question is which loading option fits the patient’s current capacity and return-to-training goals.

The RDL clip illustrates the movement; it does not reproduce the study’s loading protocol. This was an acute biomechanics study in 20 active adults, not a rehab trial showing that RDLs prevent more injuries or produce better recovery. Higher peak force alone does not settle exercise selection.

Save this for your next hamstring exercise discussion.

Study: Breed et al., BJSM 2026. DOI: 10.1136/bjsports-2025-110847

Music: “Funky Chunk” by Kevin MacLeod (incompetech.com), CC BY 4.0: https://creativecommons.org/licenses/by/4.0/ . Edited for length, fades and volume.

11/02/2026

Comment “INSTABILITYGUIDE” and I’ll send you my free evidence based shoulder instability cheat sheet. 📩

Four advanced loading options for posterior shoulder instability are shown here.

These drills add challenges to cuff control, closed-chain stability and the ability to absorb force. I use them after the patient has built the strength and control needed for the task.

Choose the position, resistance and speed from the examination and the response to earlier loading. Apprehension, a sense of slipping or a loss of control tells me to reassess the challenge.

For a lifter, the next step should connect to their pressing, pulling and overhead demands. Progress one variable at a time and check the response between sessions.

These are options within a rehabilitation plan. A postoperative shoulder also needs to follow the repair-specific restrictions.

11/01/2026

Comment FAI and I’ll send you the link to my free FAI clinical cheat sheet.

I generally tell patients with FAI to avoid stretching. This study made me look more closely at that advice.

PhysioFIRST compared two six-month physiotherapy programs in 154 adults with symptomatic cam-type FAI. Hip-related quality of life improved in both groups, with no significant between-group difference on the primary outcome.

The delivery matters: therapists adjusted stretching positions to reduce unreasonable pain and direct the stretch toward the intended muscles.

That gives me a more useful clinical question: which stretch, in which position, for which goal, and how does this patient respond?

Both groups received a package of care. There was no untreated comparison, so this trial cannot tell us how much improvement came from stretching itself. It also does not prove the programs were equivalent.

For a patient returning to training, I would still assess strength and build the capacity their activity demands.

The practical takeaway is to be specific with the advice and follow the response. Save this for your next FAI case.

Study: Kemp et al. PhysioFIRST. BJSM 2026;60:951–961.
https://bjsm.bmj.com/content/60/13/951

10/31/2026

Comment “FPFMINI” and I’ll send you my free mini course for clinicians. 📩

Face pulls can be useful. They also don't have to be the default answer for every painful shoulder.

The question I want clinicians asking is: what capacity are we trying to build?

This video shows other options, including side-lying external rotation and cable flyes. Choose exercises that match the examination, the patient's tolerance and the pressing or pulling demands they need to regain.

The older wording about face pulls not strengthening “at-risk” tissues is too broad. Loading depends on the setup and dose, and no one exercise has been shown here to prevent shoulder injury.

Build a program with a clear purpose. Progress it from the patient's response.

10/30/2026

Comment FROZENSHOULDER and I’ll send you the link to my free frozen shoulder cheat sheet.

A stiff, painful shoulder needs a differential before it needs a more aggressive stretch.

Compare active and passive motion and look carefully at external rotation. Frozen shoulder commonly presents with restriction of both active and passive motion, but that pattern is not exclusive to it. Glenohumeral osteoarthritis can also limit passive motion.

Use onset, symptom behavior, the broader examination and appropriate imaging to clarify the working diagnosis. Then document the baseline consistently.

For the active adult, pair the range measurement with a task that matters: dressing, reaching or the position needed for their training. Follow both as treatment progresses.

This complements the earlier irritability post: first establish the clinical picture, then choose the dose from the patient’s current presentation. Do not let stiffness alone dictate either the label or treatment intensity.

Sources: https://pubmed.ncbi.nlm.nih.gov/23636125/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10256270/

10/29/2026

Comment DISCGUIDE for my free radicular low back pain cheat sheet—a related spine resource, not a spondylolysis protocol.

Start PT sooner after a spinal bone stress injury? Early supervised PT helped young athletes meet return-to-sport criteria 38 days sooner than waiting until pain-free. Both groups still stopped sport.

Selhorst and colleagues randomized 64 athletes aged 10–19 with MRI-confirmed active lumbar spondylolysis (a pars bone stress injury) to immediate supervised PT or rest until pain-free before PT. Follow-up lasted one year. BOTH groups stopped sport and neither used a brace.

WHAT THIS STUDY ADDS

• Median time to meet return-to-sport criteria: 74 days with immediate PT versus 112 days after waiting.

• Pain and function were better at one month with immediate PT.

• Medically treated back-pain recurrence was 3% versus 29% over the year.

POTENTIAL CLINICAL TAKEAWAY

Earlier, symptom-guided rehabilitation may be worth discussing with the treating team. Waiting for all pain to disappear before beginning PT may not be necessary for every athlete with this diagnosis.

Early PT did NOT mean early unrestricted sport. The trial used pain-free repeated trunk movements, two weeks of return-to-sport activity in PT without pain, and no reported disability as clearance criteria. Use these as study context, not a universal clearance checklist.

Important limits: a small trial at two paediatric centres; timing AND progression rules differed. The MRI findings were inconclusive between groups, so this does not prove equal bone healing or safety. Later pain/function differences were also less clear.

Save this for your next young athlete with a pars injury. The related cheat sheet covers radicular pain, a different diagnosis from a bone stress injury.

Selhorst et al. Online December 2025; 2026 journal issue. DOI: 10.1136/bjsports-2025-110606

Open-access full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC12911598/

10/29/2026

Comment “FROZENSHOULDER” and I’ll send you my free evidence based frozen shoulder cheat sheet. 📩

When frozen shoulder is easily aggravated, the starting dose matters.

Here are four options shown in the video:

1️⃣ Gentle posterior glenohumeral mobilization
2️⃣ Assisted flexion with a dowel
3️⃣ Gentle inferior glenohumeral mobilization
4️⃣ Assisted external rotation with the arm supported

I choose the range and intensity from the examination and the patient's response. Night pain, resting pain and pain before the available end range help me judge irritability.

The aim is comfortable, repeatable movement. Start with a manageable dose and reassess how the shoulder responds during and after the session.

10/28/2026

Patellar tendinopathy rehab needs a plan for what comes after strength work.

Breda et al. compared progressive tendon loading with eccentric exercise in 76 people with patellar tendinopathy. At 24 weeks, mean VISA-P improvement was 28 versus 18 points. The adjusted between-group difference was 9 points (95% CI 1–16).

That supports the progressive program used in this trial. It doesn’t mean eccentric exercise is useless—or that every patient will improve by the average amount.

The progressive program moved through four stages:
1. Isometric loading
2. Isotonic loading
3. Energy-storage loading
4. Sport-specific loading

For the clinician working with lifters and active adults, the practical question is: what demand are we preparing the tendon for next? A strength exercise and a return to jumping or sport belong to different parts of that plan.

The study used ≤3/10 pain on a single-leg squat provocation test, plus at least a week in a stage, as progression criteria. That is a detail of this protocol—not a universal pain threshold or clearance test. Both groups also received education and load-management advice.

One important limit: return to preinjury sport was 43% versus 27%, but that difference was not statistically significant (p=.13). Better pain/function scores should not be presented as proven superiority for return to sport.

Source: Breda et al., BJSM 2021. doi:10.1136/bjsports-2020-103403. Adapted from my Patellar and Quadriceps Tendinopathy teaching, slides 9–14.

Comment PTGUIDE and I’ll send you the link to the free cheat sheet.

Research: https://pmc.ncbi.nlm.nih.gov/articles/PMC8070614/

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