Fit As A Physio

Evidence-Based Management of Lateral Ankle Ligament Sprains

PHYSIO MOSMAN: https://www.fitasaphysio.com/ REF: Managing ankle ligament sprains and tears: current opinion (R. P. McGovern & R. L. Martin, 2016) This professional review explores the pathology, diagnosis, and clinical management of lateral ankle ligament injuries and chronic ankle instability. The authors emphasise that accurate injury grading and the exclusion of differential diagnoses, such as fractures or high-ankle sprains, are vital for establishing a clear prognosis. Effective recovery strategies prioritise early weight-bearing supported by bracing, alongside manual therapy and specialised exercise programs to restore motion and strength. The text highlights that while most patients improve quickly, a significant number suffer from long-term deficits in balance and coordination that increase the risk of re-injury. Consequently, a comprehensive rehabilitation approach addressing both local ankle mechanics and proximal hip stability is recommended to ensure a safe return to sports. Emerging research also suggests that techniques like dry needling and specific taping may offer additional benefits for those with persistent instability. READ MORE: https://www.fitasaphysio.com/blog/evidence-based-management-of-lateral-ankle-ligament-sprains Support the show

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Surgical vs. Nonoperative Treatment of Achilles' Tendon Rupture

PHYSIO MOSMAN: https://www.fitasaphysio.com/ REF: Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture (Myhrvold et al., 2022) This study investigated the effectiveness of nonoperative treatment compared to open-repair and minimally invasive surgery for patients with acute Achilles’ tendon ruptures. Researchers conducted a large randomized, controlled trial in Norway, tracking 526 patients to measure physical performance and quality-of-life scores over 12 months. The results indicated that surgical intervention provided no significant advantage over nonsurgical care regarding long-term functional recovery or patient-reported health status. While patients treated without surgery faced a higher risk of tendon rerupture, those who underwent minimally invasive procedures experienced more frequent nerve injuries. Ultimately, the findings suggest that the choice of treatment does not substantially alter a patient's physical outcome after one year. READ MORE: https://www.fitasaphysio.com/blog/surgical-vs-nonoperative-treatment-of-achilles-tendon-rupture Support the show

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Decision-Making Experiences and Treatment Advice for ACL Injuries

PHYSIO MOSMAN: https://www.fitasaphysio.com/ A mixed methods study exploring anterior cruciate ligament (ACL) injury treatment decisions from the perspective of 734 patients. (Filbay et al., 2025) This mixed-methods study investigates how Australians with anterior cruciate ligament (ACL) injuries make treatment decisions and the specific advice they receive from healthcare professionals. The research reveals that a vast majority of clinicians, particularly orthopaedic surgeons, promote reconstruction surgery as the superior or only path to recovery, often downplaying risks and disregarding evidence that rehabilitation alone can yield similar results. Patients frequently reported feeling pressured or poorly informed due to rushed consultations and a lack of balanced, evidence-based information regarding non-surgical alternatives. While physiotherapists provided the most varied advice, general practitioners were viewed primarily as conduits for referrals rather than sources of management expertise. Ultimately, the study highlights a significant gap in shared decision-making, suggesting that current clinical practices often fail to provide the objective overview necessary for informed patient consent. These findings underscore the urgent need for patient decision aids and updated clinical training to align treatment recommendations with the latest research evidence. READ MORE: https://www.fitasaphysio.com/blog/decision-making-experiences-and-treatment-advice-for-acl-injuries Support the show

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The Myth of Spinal Load as a Cause of Pain

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Insufficient Evidence for Load as the Primary Cause of Nonspecific (Chronic) Low Back Pain. A Scoping Review (De Bruin et al., 2024) This scoping review evaluates whether physical loading of the spine is the primary cause of nonspecific low back pain. By applying the Bradford-Hill criteria for causality to a wide range of medical literature, the researchers sought to determine if activities like lifting or specific postures directly lead to the onset or persistence of pain. Their analysis revealed insufficient evidence to support a definitive causal relationship, noting that structural spinal changes are often found in individuals without any symptoms. The findings suggest that the traditional biomedical model, which focuses on unloading the spine to prevent injury, may be overly simplistic for such a multifactorial condition. Instead, the authors advocate for a biopsychosocial approach that considers individual experience, nervous system adaptations, and social factors. Ultimately, the source concludes that load management should not be the sole strategy for treatment, as the impact of physical strain on back pain has likely been overestimated. READ MORE: https://www.fitasaphysio.com/blog/the-myth-of-spinal-load-as-a-cause-of-pain Support the show

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Plantar Heel Pain

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Physiotherapy management of plantar heel pain (Cotchett M, Morrissey D, 2026) The article presents a comprehensive clinical guide for the diagnosis and treatment of plantar heel pain (PHP), integrating research data with expert and patient perspectives. It advocates for a stepped-care approach, beginning with a core treatment phase of stretching, taping, and tailored education. If symptoms persist beyond six weeks, the sources suggest advancing to secondary interventions such as extracorporeal shockwave therapy and custom foot orthoses. The documents emphasise the importance of individualised assessment, considering factors like footwear, physical load, and systemic health. Furthermore, the text highlights the value of co-designing education strategies with patients to ensure clarity and adherence. By synthesising high-quality trial data with clinical reasoning, the guide offers a practical framework for evidence-based management of this common condition. READ MORE: https://www.fitasaphysio.com/blog/plantar-fasciitis-heel-pain Support the show

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Biomechanical Risk Factors for Achilles Tendinopathy

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Biomechanical insights into Achilles tendinopathy risk and protection in runners: a large prospective study 4HAIE (Jandacka et al., 2025) This research examines the biomechanical and behavioral factors that contribute to the development of Achilles tendinopathy in both runners and non-runners. By monitoring a large cohort of over 900 participants for one year, the study identified that higher weekly running distances and specific movement patterns significantly increase injury risk. Specifically, a reduced peak ankle external rotation and a lower peak ankle inversion moment during the stance phase were found to be primary predictors of the condition. Interestingly, the data suggests that footfall patterns, such as rearfoot or forefoot striking, do not play a significant role in the onset of this injury. These findings encourage clinicians to focus on training volume management and ankle stability rather than altering strike types for prevention. Ultimately, the study highlights how maintaining sufficient ankle control and energy absorption can act as a protective mechanism against tendon degradation. READ MORE: https://www.fitasaphysio.com/blog/risk-factors-for-achilles-tendinopathy-in-runners Support the show

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Workload Spikes and Injury Risk in Elite Fast Bowlers

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers (Hulin et al., 2013) This study examines how sudden increases in training intensity impact the injury rates of elite cricket fast bowlers. Researchers tracked both internal workloads, based on athlete perception of effort, and external workloads, measured by the number of balls delivered. The findings reveal that when short-term (acute) workloads significantly exceed long-term (chronic) averages, the risk of injury rises sharply in the following week. Specifically, bowlers whose weekly activity more than doubled their four-week average faced a three-to-fourfold increase in injury likelihood. Conversely, maintaining a high, consistent chronic workload appeared to provide a protective effect against physical breakdowns. Ultimately, the data suggests that careful monitoring of training-stress balance is essential for keeping athletes healthy and prepared for competition. READ MORE: https://www.fitasaphysio.com/blog/training-stress-balance Support the show

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Protecting Hamstrings Through High Speed Exposure

PHYSIO MOSMAN: https://www.fitasaphysio.com/ If You Want to Prevent Hamstring Injuries in Soccer, Run Fast: A Narrative Review about Practical Considerations of Sprint Training (Gómez-Piqueras, P.; Alcaraz, P.E., 2024) This academic review explores the critical role of sprint training as a preventative measure against hamstring strain injuries (HSIs) in professional soccer. It highlights that since most hamstring injuries occur during high-speed running, exposing players to maximal sprinting speedsacts as a protective "vaccine" by strengthening specific muscles like the biceps femoris. The authors propose a practical multidirectional speed model that integrates linear and curvilinear sprints into the weekly training microcycle using a control-chaos continuum. Effective implementation requires individualized monitoring through GPS technology, focusing on relative speed thresholds rather than just absolute values to ensure players reach at least 85-95% of their maximum velocity. By balancing optimal dosage and timing, coaches can enhance athletic performance while significantly reducing the economic and physical burden of muscle injuries. Overcoming the "sprint paradox" involves transitioning from analytical drills to game-specific transitions to prepare athletes for the chaotic demands of elite competition. READ MORE: https://www.fitasaphysio.com/blog/the-sprint-vaccine-protecting-hamstrings-through-high-speed-exposure Support the show

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Evolution of Running Footwear Paradigms and Injury Prevention Strategies

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Running Injury Paradigms and Their Influence on Footwear Design Features and Runner Assessment Methods: A Focused Review to Advance Evidence-Based Practice for Running Medicine Clinicians (Agresta et al., 2022) This review explores the evolution of running footwear design and its relationship to injury prevention and athletic performance. The authors examine four primary scientific paradigms—pronation control, impact force modification, habitual joint motion path, and the comfort filter—noting that historical methods like matching shoe type to arch height lack strong empirical support. While traditional features like midsole cushioning aim to reduce repetitive stress, modern innovations such as carbon fiber plates and high-resiliency foams focus on enhancing running economy and speed. The text highlights a significant gap between technical research and clinical practice, often leading to recommendations that are not scientifically grounded. Consequently, the authors suggest that clinicians prioritize lightweight and comfortable footwear while considering the specific biomechanical needs of each individual runner. Overall, the source serves as an evidence-based guide to help medical practitioners navigate the complex landscape of modern shoe construction and runner assessment. READ MORE: https://www.fitasaphysio.com/blog/the-great-running-shoe-myth-5-science-backed-truths-that-will-change-how-you-shop Support the show

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Frozen Shoulder: What the World’s Largest Clinical Trial Reveals About Surgery vs. Therapy

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial (Rangan et al., 2020) The UK FROST study was a multicentre randomised clinical trial conducted to determine the most effective treatment for adults suffering from primary frozen shoulder. Researchers compared three common interventions: early structured physiotherapy with a steroid injection, manipulation under anaesthesia, and arthroscopic capsular release. The trial findings revealed that none of the treatments were clinically superior to the others regarding long-term pain relief and improved shoulder function at the one-year mark. While capsular release surgery carried the highest risks and costs, manipulation under anaesthesia was identified as the most cost-effective option within the UK healthcare system. Consequently, the authors suggest that doctors should prioritise less invasive treatments and reserve surgery for cases where initial therapies fail. READ MORE: https://www.fitasaphysio.com/blog/frozen-shoulder-what-the-worlds-largest-clinical-trial-reveals-about-surgery-vs-therapy Support the show

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Optimising Training Recovery Strategies for Endurance Athletes

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Effectiveness of Recovery Strategies After Training and Competition in Endurance Athletes: An Umbrella Review (Shuting et al., 2024) This umbrella review by Li et al. (2024) evaluates the effectiveness of various recovery strategies specifically for endurance athletes, such as cyclists and runners. The researchers analyzed twenty-two systematic reviews and meta-analyses to determine if methods like compression garments, cryotherapy, massage, and nutritional supplements actually improve performance or physiological markers. Their findings indicate that no single strategy provides consistent, universal benefits across all recovery parameters for this specific population. However, individual data suggests that compression garments and cold-water immersion show the most promise for enhancing recovery between intense training sessions. The authors conclude that while these passive techniques may reduce muscle soreness, more high-quality research is needed to establish definitive guidelines. Overall, the study emphasizes that endurance athletes may respond differently to these interventions compared to team-sport athletes. READ MORE: https://www.fitasaphysio.com/blog/optimizing-training-recovery-strategies-for-endurance-athletes Support the show

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Evidence-Based Protective Strategies for Heading in Youth Football

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Is it time for evidence-­ based protective strategies for heading in youth football? (Sutehall et al., 2026) Current medical research is investigating the long-term neurological risks associated with purposeful heading in youth and professional football. While football offers significant physical and mental health benefits, concerns persist regarding how repeated subconcussive impacts might affect the developing brain. In response, governing bodies have implemented safety guidelines to restrict heading frequency during training, yet scientific evidence remains limited and primarily focused on adults. Experts emphasize the need for comprehensive studies to establish a safe dosage of head impacts without discouraging participation in the sport. Ultimately, higher-quality data is required to balance the social advantages of play with the preservation of player safety. READ MORE: https://www.fitasaphysio.com/blog/evidence-based-protective-strategies-for-heading-in-youth-football Support the show

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Why Exercise Heals Your Pain (Even When You’re Not Getting Stronger)

PHYSIO MOSMAN: https://www.fitasaphysio.com/ It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief (Powell et al., 2026) This editorial challenges the traditional belief that muscle strength gains are the primary reason exercise relieves musculoskeletal pain. While physical activity is highly effective for recovery, current research suggests that biomechanical changes often fail to explain why patients feel better. Instead, the authors highlight biopsychosocial factors, such as increased confidence, reduced fear of movement, and improved biochemical balance, as more likely drivers of improvement. They urge clinicians to move beyond simplistic strength-based narratives to avoid demoralizing patients who do not see physical gains. Ultimately, while strength remains vital for general health, the sources emphasize that the mind-body connection and the therapeutic relationship are more central to pain rehabilitation. READ MORE: https://www.fitasaphysio.com/blog/strength-in-musculoskeletal-pain-rehabilitation Support the show

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The ACL Myth: Surgery Versus Rehabilitation

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-­ analysis (Saueressig et al., 2022) This living systematic review and meta-analysis evaluates whether early surgical reconstruction or primary rehabilitation—with the option of later surgery—offers better outcomes for anterior cruciate ligament (ACL) injuries. After analyzing data from multiple randomized controlled trials, the researchers found no clinically significant differencesbetween the two strategies regarding self-reported knee function, sports participation, or quality of life. The study highlights that rehabilitative management may trend toward a lower risk of radiological osteoarthritis, while surgery shows a slight potential benefit for meniscal health, though both findings carry low certainty. These results challenge the traditional medical paradigm that immediate surgery is necessary to ensure optimal long-term recovery. Consequently, the authors suggest that clinical guidelines should be updated to recommend a "stepped care approach" that prioritizes physical therapy as the first line of treatment. Continuous annual updates are planned for this review to incorporate emerging data from ongoing clinical trials. READ MORE: https://www.fitasaphysio.com/blog/surgery-versus-rehabilitation-for-acl-rupture Support the show

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Everything You Knew About Stretching Might Be Wrong

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Practical recommendations on stretching exercise: A Delphi consensus statement of international research experts (Warneke et al., 2025) This consensus statement provides evidence-based practical recommendations and standardized definitions regarding the diverse effects of stretching on human health and performance. Developed by a panel of twenty international experts using the Delphi method, the document clarifies that stretching effectively improves range of motion and reduces muscle stiffness in both acute and chronic contexts. Conversely, the researchers conclude that stretching is ineffective as a primary tool for increasing muscle mass or strength, correcting posture, or accelerating post-exercise recovery. While the panel notes potential benefits for vascular health, they categorize the evidence for general injury prevention as inconsistent or unsupportive. Ultimately, this source serves to bridge the gap between scientific evidence and athletic or clinical practice by addressing long-standing misconceptions in exercise science. READ MORE: https://www.fitasaphysio.com/blog/everything-you-knew-about-stretching-might-be-wrong Support the show

Exercise for Depression and Anxiety: A Systematic Meta-Analysis

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-­analysis (Munro et al., 2025) This meta-analysis synthesises evidence from numerous studies to evaluate how structured physical activity alleviates symptoms of depression and anxiety across various demographics. The research concludes that exercise is a highly effective intervention, often matching or surpassing the results of traditional medication and psychotherapy. While all forms of movement are beneficial, aerobic activities and supervised group settings offer the most significant relief for depressive symptoms. Conversely, shorter, low-intensity routines appear particularly efficacious for managing anxiety. The authors specifically highlight emerging adults and postnatal women as groups that experience the greatest mental health improvements from these interventions. Ultimately, the study advocates for health professionals to prescribe tailored exercise programs as a primary, cost-effective treatment for psychological distress. READ MORE: https://www.fitasaphysio.com/blog/exercise-for-depression-and-anxiety Support the show

Can A Herniated Disc Heal?

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Conservatively treated massive prolapsed discs: a 7-year follow-up (Benson et al., 2010) This research investigates the natural history and recovery potential of massive lumbar disc herniations treated without surgery. By tracking patients over seven years, the study reveals that non-operative management is highly effective when early clinical progress is noted. Findings indicate that extruded disc material often shrinks significantly over time, with an average volume reduction of 64% seen on follow-up imaging. Most participants achieved a complete and sustained recovery, reporting high levels of long-term satisfaction and minimal recurrences. Ultimately, the authors conclude that conservative treatment is a safe and viable alternative to surgery, even for the largest spinal protrusions. READ MORE: https://www.fitasaphysio.com/blog/conservatively-treated-massive-prolapsed-discs-a-7-year-follow-up Support the show

Why Back Pain Does Not Mean Damage

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Recent highlights in low back pain research, Part I: Diagnosis and Prognosis (Pinto et al., 2025) This narrative review synthesizes recent research on the diagnosis and prognosis of low back pain, highlighting five core themes to assist clinical decision-making. The authors emphasize that serious spinal pathologies are extremely rare, suggesting that clinicians should evaluate overall patient risk rather than relying on isolated red flags. The text criticizes the continued overuse of diagnostic imaging, noting that most findings are common in healthy individuals and lack significant predictive value. Furthermore, the review suggests that embracing diagnostic uncertainty and focusing on modifiable lifestyle factors is more effective than providing potentially harmful structural labels. Findings indicate that while many patients recover quickly, recurrences are frequent, and traditional terms like "acute" or "chronic" often fail to reflect actual pain trajectories. Finally, the researchers identify psychological and physical prognostic factors for delayed recovery but conclude that current prediction models are not yet ready for practical implementation. READ MORE: https://www.fitasaphysio.com/blog/beyond-the-mri-5-truths-about-back-pain-that-might-change-how-you-heal Support the show

A Simple Way to Stop Your Back Pain From Coming Back

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial (Pocovi et al., 2024) The WalkBack trial investigated the effectiveness of a walking and education program in preventing the return of low back pain. Researchers conducted a randomized controlled trial in Australia, comparing participants who received physiotherapy-led health coaching to a group receiving no treatment. Results demonstrated that this low-cost, accessible intervention nearly doubled the median time between pain recurrences while significantly reducing pain-related disability. Beyond clinical benefits, the study found the program to be highly cost-effective from a societal perspective. Although the walking group reported more minor lower extremity injuries, the overall strategy offers a scalable, safe solution for managing a high-burden health condition. READ MORE: https://www.fitasaphysio.com/blog/new-study-reveals-a-surprisingly-simple-way-to-stop-your-back-pain-from-coming-back Support the show

Ice for Sports Injuries?

PHYSIO MOSMAN: https://www.fitasaphysio.com/ Cryotherapy for treating soft tissue injuries in sport medicine: a critical review (Raciness et al., 2024) A 2024 critical review titled "Cryotherapy for treating soft tissue injuries in sport medicine" challenges the common practice of using ice for injury treatment. The authors conducted a systematic literature search, finding a significant lack of human studies that demonstrate a positive effect of cryotherapy on tissue regeneration, contrasting with its established use for short-term pain relief. While acknowledging that cryotherapy is a basic principle in protocols like RICE, the review highlights that the bulk of evidence on tissue healing comes from animal studies, which often suggest that cryotherapy may delay or impair muscle and tendon regeneration post-injury, especially with prolonged use. Consequently, the authors conclude that cryotherapy should be recommended only in the first hours after an injury to manage pain and swelling, with caution advised for continued application until more conclusive human research is available. READ MORE: https://www.fitasaphysio.com/blog/rethinking-ice-5-surprising-truths-about-using-cold-therapy-for-injuries Support the show