5 Sep 2025
Due to the wide range of shoulder instability symptoms,… Light therapy, or photobiomodulation therapy (PBMT), is a medicinal…
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5 Sep 2025
Jensen, RL. and Ebben, WP. (2007). Quantifying plyometric exercise intensity via rate of force development, knee joint, and ground reaction forces. Journal of Strength and Conditioning Research, 21(3), 763-767.
Level of Evidence IB evidence from at least one randomized controlled trial
How This Study is Important: This study quantifying plyometricexercise intensity. Other studies have included intensity based on joint power absorption, time to stabilization, muscle activity, biomechanics.This study provides information about the rates of eccentric force development (E-RFD) in various plyometric exercises. Exercises that required rapid foot adjustment and/or unilateral stances produced higher knee joint reaction forces (K-JRF) K-JRF, although this did not correlate with Peak E-RFD or Peak GRF. For example, single leg jumps were significantly more “intense” than depth jumps based on K-JRF. However depth jumps showed the highest peak E-RFD.
How the Findings Apply to Practice: This study provides data on the peak ground reaction forces (GRF), rate of eccentric force development (E-RFD) and knee joint reaction forces (K-JRF) for commonly used plyometric exercises. The findings suggest that progressions may need to be modified based on goal and joint “health”,but may be less dependent on GRF
| Peak GRF (low-high): | Peak E-RFD (low-high): | Peak K-JRF (low-high) |
| Single leg jumpSquat jumpDepth jump (46cm)Pike jumpCountermovement jumpTuck jumpDumbbell squat jumpDepth jump (61cm) | Dumbbell squat jump (30%RM)Squat jumpPike jumpSingle leg jumpDepth jump (46cm)Tuck jumpCountermovement jumpDepth jump (61cm) | Dumbbell squat jump (30%RM)Countermovement jumpDepth jump (61cm)Depth jump (46cm)Squat JumpSingle leg jumpPike jumpTuck jump |
Strengths and Weaknesses: This study had many methodological strengths which include:
Weaknesses should be noted prior to clinical integration of the findings:
Clinical commentary:
Encourages incorporating progressions into all aspects of an exercise program. This includes (but is not limited to) progressing from isolated activation to integrated activation techniques. Gradully progress from stable to unstable training surfaces in strength training exercises, and from stability/endurance training to max strength/power training. This study’s findings suggest that physiotherapist may need to consider both eccentric rate of force development (E-RFD) and knee joint reaction forces (K-JRF) when determining intensity for plyometric exercise.
image : Google coutsey
5 Sep 2025
D’Onofrio R. Tamburrino P. Bruno C. Tamburrino G. Bhatt J.
Ita. J. Sports Reh. Po. 2017,4,1 ; 701 -722
ISSN 2385-1988 [Online) IBSN 007-111-19-55
Whiplash is a term commonly used to describe a pathology or series of auto-crash symptoms that can be associated with a cervical acceleration acceleration / deceleration (CAD) acceleration movement. The effects of the so-called “whiplash”, however, are not just related to automobile crashes, but can also be found in many contact sports – such as football and hockey, martial arts, rugby and American football. The presence of Whiplash-type sport injuries is the result of the scientific evidence and the etiopathogenetic-functional knowledge of the primary techniques of both physical and athletic gestures involving the cervical tract during sports activities. Even small muscular traumas located in the anatomical neck / head during sporting gestation, can lead to a series of Whiplash-Associated Disorder (WAD) related symptoms. These clinical manifestations resulting from the back-end or side impact are sustained by a widespread use of medications and rehabilitation strategies in WAD forms.
5 Sep 2025
Why this studies are relevant?
Hamstring injuries have long been the bane of athletes’ participation in sport among those who engage in sprinting and explosive movements, primarily because of both the high occurrence and recurrence rates. These injuries appear to create subsequent weakness at the muscle’s lengthened state, predisposing the athlete to further injury. Lengthened state eccentric training may increase the end range strength resulting in fewer reinjuries and therefore should be incorporated in the rehabilitation process.
These articles summarize the studies on hamstring strain, mechanism, to identify the risk factors in the last several decades and to provide compendium of the current evidence for the clinicians to improve quality of rehabilitation, decision making for return to the sports after hamstring injuries, examine the risk factors contributing to such a high recurrence rate and propose a unique rehabilitation strategy addressing these factors in order to decrease the rate of reinjury.
ABSTRACT :
Hamstring strain injuries are one of the commonest injuries in sports which involve high speed skilled movements of lower limbs or extensive muscle lengthening type maneuver with hip flexion and knee extensions. Basic science studies have demonstrated that a muscle strain injury occurs due to excessive strain in eccentric contraction instead of force, and that elongation speed and duration of activation before eccentric contraction affect the severity of the injury. The purpose of this narrative review of literature is to summarize the studies on hamstring strain, mechanism, to identify the risk factors in the last several decades and to provide compendium of the current evidence for the clinicians to improve quality of rehabilitation and decision making for return to the sports after hamstring injuries.
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5 Sep 2025
To generate power, you need mobility. To have mobility, you need stability. Proximal stability feeds distal mobility. Instability signals the brain and nervous system to put the brakes on power output because it feels threatened. A lack of stability is a threat to your nervous system.
When dysfunctional movement patterns exist, the brain will simply choose an easier alternate path to accomplishing a given task.
When the patient complains of pain in neck for long period of time and after doing certain activities e.g pushing an object) when they have poor core muscles, the SCM activate and gradually with the repetition of task the pain triggers.
Try this,
Lie on your back with your leg straight. Now tie one of your legs to strong elastic band
[restrict] and try to bring your knee towards the chest. If resistance is strong enough to restrict you from pulling knee into your chest, you wil start to lift neck and shoulder off the floor. You are performing the hip flexion but your neck is coming into play.Why this happens because Sternocleidomasoid have a synergistic relationship to hip flexor (read Thomas myers’ anatomy trains superficial front line) for more details).
Now if the hip flexors are not working correctly (whether they are ‘weak’ or ‘inhibited’) then the SCM will have to work extra hard.
A SCM that is working extra hard to do the job for the hip flexors will also become ‘stronger’ which may result in the muscles at the back of the neck becoming inefficient to produce force for neck .
Now if this continues then over time the SCM may develop trigger points Trigger points in the SCM have been found to cause jaw pain, earache, toothache, hearing loss, and migraines. So when hip flexors are not working efficiently, the synergistic SCM has to work more. If this continues over period of time then SCM wil have to over work and neck extensors become inefficient.
Over a period of time SCM will develop active trigger points, which have been found to cause jaw pain, earache, tooth ache, hearing loss, and headache.
So when patient comes to you with headache try to figure out the possibility of hip flexor weakness. Always Think out of box.
the treatment of overactive SCM also requires hip flexor recruitment strategy exercises.
conclusion :
Release SCM and activate semi spenalis and Longus Coli and psoas.
I hope you find this post helpful.
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5 Sep 2025
There are many tests reported in the literature, commonly including:
This conclusion must be taken with caution since frequent methodological design flaws exist within the included studies, most studies suffered from various biases, and between-study heterogeneity makes pooled data unreliable.”
We don’t even do the Apley’s compression test. Never saw a value, like the Thessaly Test. Nice in theory but just not good enough when tried in a clinical practice.
Even need to Diagnose Meniscus Tears?
We must accurately diagnose and explain to the patient that many people have meniscal tears in their knee when they have trauma . The recent literature builds a strong case for a very good recovery without surgery. That’s right, surgery is often not needed for many people diagnosed with a meniscus tear.
This paper really created waves when it was released in 2013. They stated that “outcomes after arthroscopic partial meniscectomy were no better than those after a surgical procedure.”
Don’t get me wrong, surgery may be needed, especially for the people sustaining an acute meniscus tear. But that may only be a small portion of the people presenting to us in the clinic.
In these people, We reduce the inflammation and restore ROM , strength and see how they do. Maybe a 6 week PT course is all they need, you never know.
The research does not support using these tests to diagnose and may add to the fear avoidance a patient may exhibit after such a diagnosis. This systematic review and meta-analysis in the British Medical Journal stated:
“The results of this systematic review indicate that the accuracy of McMurray’s, Apley’s, JLT and Thessaly to diagnose meniscal tears remains poor.
What meniscus tests do do?
[restrict]we believe in clinical examination which is very important to help guide the treatment plan.
The exam NEEDS to match the clinical history.
According to patient history and it’s problem, you should decide the test.So,here is the test :
We would say joint line palpation and end range of motion are my 2 most valuable tests. We do the McMurray’s test to see if it can add to the clinical findings.
You all have question in your mind that why We didn’t even mention the Thessaly test. why we want to put our patient in a weight-bearing position, which is already painful knee.
Never mind the research telling us that the test is not very valid which goes completely against early research that said it was a valid test.
we may need to combine this test with others to help improve our accuracy in examination as stated in this paper .in this paper “Five positive findings on composite examination yielded a positive predictive value of 92.3%. Positive predictive values remained greater than 75% with composite scores of at least 3 in the absence of ACL and DJD pathologies.”
Keep in mind that the particular side of the meniscus tear may influence the ability to detect a pathology. Era net al said in his paper 2009, Lateral meniscal tears may be easier to distinguish than medial meniscal tears if we’re talking about joint line tenderness alone.
Take home message:
I’m pretty sure it has done us well over the years…and the research seems to match my thoughts too.
Read our previous post on meniscus rehabilitation
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5 Sep 2025
Background and objective :
TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone.
Inclusive criteria :
(1) age between 18 and 50 years, (2) history of at least one ankle sprain, (3) at least one episode of giving away in the previous 6 months, (4) ankle pain of intensity > 3 points on an 11-point numerical pain rate scale (NPRS), and (5) score of 25 or less on the Cumberland Ankle Instability Tool [18, 19]. In addition, participants also had to be physically active, defined as participating in vigorous physical activity at least 20 min a day, 3 times a week [20]. Participants were allowed to continue their regular physical activities during the study period.
Limitation of study:
(1) fracture in the lower extremity, (2) history of surgery in the lower extremity, (3) any concomitant lower extremity pathology, for example, vascular disease and osteoarthritis, (4) pregnancy, (5) regular use of medication, or (6) previous physical therapy interventions received on the lower extremity within the previous 6 months.
Result:
This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.
Implementation in clinical practice…..
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Ankle instability may occurs due to late firing of peronei during walking or running. Therefore it may go into relative flexibility. Which gradually leads to decrease the Proprioception .
Did you notice they used the trigger points in the peroneus longs muscle to needle? Though they didn’t say it, how this muscle influences both frontal and saggital plan stability.
For instance, restoration of the length of the muscle sarcomeres of the lateral peroneus may improve motor output of the muscle explaining the improvement in function, whereas the decrease in peripheral nociception could be related to the decrease in pain. It may decerease latency of peronei .
TrP-DN applied on the lateral peroneus muscles before the beginning of proprioceptive/strengthening exercises can improve the motor output of this muscle.
From this study , we can conclude that when we find ankle instability ,check for flexibility of peronei. Hence, TrP-DN along with propriocpetion exercise should included.
Guide for Proprioception exercise:
– to move from a position of nonweight bearing to weight bearing, -bilateral stance to unilateral stance, -eyes open to eyes closed,
-firm surface to soft surface, uneven or moving surface.
5 Sep 2025
What is Synergistic dominance ?
It is a self-serving substitution system that allows us to carry on life even though parts of our structure . It may be slowly breaking down and decompensating.
A typical synergistic pattern often exists in runners with a unilaterally tight/hypertonic iliopsoas that is reciprocally inhibiting the ipsilateral gluteus maximus. The hamstrings and adductor magnus (synergists in hip extension) are over active to help the weakened gluteus maximus in hip extension efforts.
This pattern is one of the primary causes of hamstring pulls and is initiated by the late firing of the weakened gluteals during hip extension, especially during activities that include running.
Arthrokinetic Dysfunction :
Synergistic dominance eventually end up with Arthrokinetic Dysfunction .which is the result of prolonged alterations of
[restrict]length-tension relationships of muscle forces at a joint . It results into abnormal joint movement and loss of joint play.
When overactive hamstrings are recruited to compensate for a weakened gluteus maximus, the constant unilateral pull on one ischial tuberosity loose the sacrotuberous, sacrospinous, long dorsal, and sometimes the iliolumbar ligaments causing the pelvis to lose alignment and stability.
Hence , the brain frequently send signal to piriformis muscle to constantly produce forces for contract isometricly on ipsilateral or contralateral side that help to stabilise SI joint.
What happen in Lumbo-pelvic region ?
There is often arthrokinetic Dysfunction seen in athlete .This imbalance commonaly presents as a unilateral dysfunction.
The following muscles tend to be short/tight on one side only: iliopsoas, piriformis, rectus femoris, adductors, latissimus dorsi, and lumbar erectors.
The weak muscles which are gluteus maximus/medius, biceps femoris, transverse abdominus, internal obliques, mutifidi, and some pelvic floor muscles. The painful hip condition that ensues is a result of a unilateral pelvic tilt, functional short leg, compensatory lumbar scoliosis, and restricted lumbar facets on the contra lateral side .
This postural pattern may irritate the superior and/or inferior gluteal nerves due to pain originate from this postural dysfunction.These branches of the sciatic nerve located on the anterior side of the sacrum. The superior gluteal nerve supplies the gluteus medius/minimus and tensor fascia latae muscles and is many times mis-assessed as greater trochanteric bursitis.
Referances :
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What can be the different diagnosis?
5 Sep 2025
Recent studies have suggested that patients opting for physical therapy have demonstrated high satisfaction, an improvement in function, and success in avoiding surgery. It has been observed in patients whose repairs fail after surgical repair, that reported satisfaction levels and clinical outcome scores are similar to those with intact repairs.
The authors of this study suggest that the reason for these findings is that because most of the patients in these studies engaged in some form of structured post-operative physical therapy, that it is possible that the post-operative rehabilitation is more responsible for the improvements in outcome.
Rotator Cuff Injury Management CLINICAL PRESENTATION: It can vary by type of injury and mechanism of onset. In addition, superoposterior tears show a loss of active range of motion and weakness in external rotation with a positive lag sign.
Dysfunction of scapulohumeral rhythm and a compensatory shoulder shrug may be observed during active abduction and elevation. Finally, patients with long-standing rotator cuff tears may present with obvious atrophy, with muscular wasting in the supraspinatus also commonly associated with a concomitant infraspinatus tear.
Examination of the athlete should include: History including, palpation. Knowledge of the natural history of rotator cuff tears is important when making treatment decisions to achieve best outcomes for patients.
Glenohumeral stability : Athletes will often demonstrate a painful arc of active motion. . overhead athletes with rotator cuff pathology may present with GIRD; (excessive passive external rotation and limited internal rotation at 90 degrees of glenohumeral abduction (>20º vs. normal side)
IMAGINE INCLUDE:
X rays – rule out bony injury & assess for pre-existing degenerative changes .
MRI scan – gold standard to assess integrity of the rotator cuff tendon, musculature, labrum and articular cartilage. .
Diagnostic ultrasound – Dynamic assessment of rotator cuff injury.
REHABILITATION:
Conservative management should include a comprehensive program. .
A recent review by Edwards et al. (2016), provided an evidence-based 4-phase exercise protocol for the conservative management of rotator cuff injury.
Including:1. Range of motion2. Flexibility3. Strengthening
4. Advanced strengthening/proprioception. .
5 Sep 2025
Gluteal Amnesia and selecting the most effective interventions – Proactive Physio Knowledge
Most people spend a huge proportion of their time in a position of hip flexion (sitting down). An inactive lifestyle is a sure-fire way to create glute dysfunction. Extended periods of time in this posture over the long term will lead to negative adaptations in the hip flexor muscles.
Shortened hip flexors don’t allow for full hip extension, which is where your glutes are able to contract with the most force. Additionally, being an antagonistic pair, short and tight hip flexors will actually inhibit your glutes. The actual physical compression associated with sitting on your gluteus maximus will also impair blood flow and neuromuscular function.
Gluteal amnesia is a condition where your body can’t or forgets how to properly activate the gluteal muscles, whether it’s due to postural flaws or lack of use. As a result, you may lose the ability to move your hips through a full range of motion which adds stress to your knee, lower back, and even your shoulder joints! Common injuries associated with gluteal amnesia are patellofemoral pain syndrome, Iliotibial Band Syndrome, Disc Herniation, and Piriformis Syndrome. Fortunately, you can reverse this condition with the right corrective exercises.
A postural flaw that can lead to gluteal amnesia is known as anterior pelvic tilt. This occurs when the pelvis tilts forward and the stomach protrudes. The forward tilt of the pelvis stretches your gluteals into a relaxed state which decreases your ability to properly activate them. Other causes of gluteal amnesia are as follows:
• Too many quadriceps dominant exercises.• Poor sitting or static posture.• Improper abdominal training.• Soft tissue contractures (i.e., tight hip flexors and low back extensors).• Articular (joint) fixations.• Not landing properly from jumps (i.e., landing from a rebound in basketball).
• Knee or back pain sufferer.
The gluteus maximus and lower back stability
Activating and strengthening the glutes needs to form an important part of your core routine.
Co-contraction of the gluteus maximus with the psoas major contributes to lumbo-sacral stabilisation The gluteus maximus provides stability to the sacroiliac joint (SI joint) by bracing and compression. Excess movement at the SI joint would compromise the L5-S1 intervertebral joints and disc and could lead to SI joint dysfunction and low back pain.
Coutrsey : Ericdalton
The gluteus maximus also provides lower back stability through its connection with the erector spinae and thoraco-lumbar fascia. Some of its fibres are continuous with the fibres of the erector spinae. A contraction of the gluteus maximus will generate tension in the erector spinae muscle on the same side, providing stiffness to the spinal column.
Gluteus maximus contraction also exerts a pull on the lower end of the thoraco-lumbar fascia, which is a thick layer of ligamentous connective tissue. Tightening of this fascia stabilises the vertebras. People with low back pain often have weak and deconditioned glutes.
Here are some simple but superbly effective exercises to tone up glutes muscles.
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Purpose: Strengthen the hips (especially for the gluteus maximus).Start in a standing position with your feet shoulder-width apart.Squeeze the gluteal muscles for two seconds, then relax for two seconds. Count the two seconds out loud to avoid holding your breath.
Sets/Reps: 1-2 x 10, with 5-10-second holds and 5-10 seconds rest.
Purpose: Strengthen the hips (especially for the gluteus maximus).
Start on your hands and knees. Slowly raise your right arm and left leg so they are level to the floor. Turn your left foot slightly outward so you feel your gluteus maximus tightening. Hold this position for 10 seconds. Repeat with the opposite arm and leg.
Suggested Sets/Reps: 1-2 x 10 of 10-second holds.
Purpose: Strengthen the hips and legs.
Stand with your feet shoulder-width apart. Looking straight ahead, slowly squat down until your thighs are parallel to the floor while simultaneously raising both arms out in front of you like you are guarding an opponent in basketball or skiing down a hill.
Try to keep your knees behind your toes, maintain a normal arch in your lower back and keep your core tight. Once you master perfect technique using your body weight with this simple exercise (feet side by side)
Purpose: Strengthen the hips and legs.
Stand facing a step and hold on to a rail. Slowly step up and down on one side. Repeat with the opposite leg. Alternate version: perform the Step-Ups from the side, and progress by varying the step height from 4 or 6 inches to 8 inches.
Suggested Sets/Reps: 1-2 x 10-15
Purpose: Strengthen the hips and legs.
Start in a squatting position with your feet slightly wider than hip-width as if you were guarding an opponent in basketball.Take five to 10 steps to the right. Your step lengths should be approximately 50 percent of the starting position distance between your feet.Keep your knees aligned with the second toe. Repeat five to 10 steps to the left.
Once you master perfect technique using your own body weight.
Courtsey:Dr. Alex Jimenez D.C.,C.C.S.T
Purpose: Strengthen the hips and core.
Start by lying on your right side with your top leg straight and bottom leg bent. Place your top hand on the floor or mat in front of you for good support. Slowly raise your top leg up to approximately 40 degrees for the designated sets/reps.Keep your hips level and don’t over-arch your back.Repeat on the other side.To increase the difficulty, place an elastic band around your thighs (just above the knees) or an ankle weight just above your ankle.
Sets/Reps: 2-3x 0-15
Start by lying on your right side with both knees bent 90 degrees and hips bent 45 degrees. Place your right arm under your head and your left arm on the floor in front of you for stability. Slowly raise your top leg up to 30 degrees of abduction, then lower slowly for the designated sets/reps. To increase the difficulty, hold the 30-degree hip-abducted position for five to 30 seconds as a single repetition.
Sets/Reps: 2-3×10-15
Purpose: Strengthen the hips and core
Start by lying on your back with your knees bent 90 degrees and feet hip-width apart. Place a small, soft ball between your knees and squeeze with no more than 50 percent effort.Lift your hips off the floor approximately 4 inches, then slowly lower them while relaxing the squeeze between your knees.To increase the difficulty, hold for five to 10 seconds as a single set.
Sets/Reps: 2-3×10-15
Referances :
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