Terry Mclaren Functional Physio

15/03/2026

So interesting

23/02/2026

Ppl need to understand 👍

23/02/2026

So true! Keep it real and increase slowly 🙏

Over the last few weeks, running Instagram has been filled with stress fracture posts, reactions, hot takes, and finger-pointing.

Some blame influencers, some defend them.

Most people are not actually discussing the nuances and specifics of bone stress injury, but more so, they are arguing about people.

As a coach + physio, I’m more interested in the patterns and science.

I actually think anything that brings important topics to the fore is / can be beneficial.

Bone stress injury has gained traction recently in the research and rehab world and we are starting to understand and treat it much more effectively.

A few grounding truths:

Stress fractures are common in runners
They’re not new. They’re not rare. They’re not a moral failing.

They are not new, we just understand them more.

Posting about an injury ≠ proof of bad training

Social media shows highlights, not load history, fuelling, sleep, stress, or bone health.

Training through a bone stress injury is not “gritty”. It’s a reliable way to turn weeks into months.

Bone adapts slower than fitness. You can feel great while quietly accumulating risk.

We need to be better and acknowledging fact and dismissing trends / nonsense (influencer or expert!) and marketing (influencer or expert!).

Excitingly, we are experiencing another running boom which had shown a huge growth in recreational running.

More people are trying to train like “serious athletes”, but they lack the support systems and professionalism of the elite.

Generally though, there is a limited public understanding of bone physiology, that doesn’t make anyone a villain for sharing their thoughts / experiences or takes on it.

But it does raise the bar for how we talk about injury. Instead of discussing things like “Who messed up?”, let’s try “What increases bone stress risk?”.

Let’s discuss:

Rapid load increases
Stacking progressions (mileage + intensity + hills + strength)
Low energy availability / under-fuelling
Poor sleep / high life stress
Long gaps between consolidation weeks

These apply to everyone. Influencer or not. Let’s stop focussing on what one influencer does or says is best to do, what their training is or is supposed to be.

Let’s discuss patterns and principles such as:

Gradual progressions
Regular absorption weeks
Adequate fuelling
Strength training
Early response to niggles

“Stress fracture-gate” shouldn’t be about cancelling creators, but it should highlight that where and who delivers information is important.

It’s about improving collective understanding of how bone actually adapts.

We need less outrage, clearer literacy that when combined leads to a better running culture.

Over the coming posts I will try to get this moving forward, let’s discuss based on years of experience and expertise why bone lags behind fitness?, what are the warning signs?, What absorption weeks look like? What are the Return-to-run principles post bone stress injury?

19/02/2026

😳

Taken from

99% of people over 40 have a rotator cuff ‘abnormality’ on MRI.

Do we round up to, everyone?

The FIMAGE study just dropped in JAMA Internal Medicine and it’s important for several reasons.

Here’s a quick overview of the study:

→ 602 people randomly selected from the Finnish general population (not a clinic sample)
→ Aged 41–76
→ Bilateral 3T MRI of both shoulders
→ Blinded reads by experienced musculoskeletal radiologists
→ Standardised clinical exams by shoulder surgeons with 10+ years experience

They found:

→ 98.7% had at least one RC abnormality
→ 7 out of 602 had completely normal tendons
→ 62% had partial-thickness tears
→ 11% had full-thickness tears (rose with age)
→ RC abnormalities were in 96% of pain-free shoulders AND 98% of painful shoulders

78% of all full-thickness tears were found in shoulders with zero symptoms.

Even combining state-of-the-art 3T MRI with experienced surgeon clinical exams could not reliably distinguish a symptomatic shoulder from an asymptomatic one.

The authors argue, and I think the data supports this, that most RC findings after 40 represent normal age-related structural change. Like grey hair. Like wrinkles. Like holes in your socks.

They emphasise a shift in language is warranted: away from ‘tear’ (which implies trauma and repair) toward terms like ‘structural alteration’ or ‘age-related change.’

When the baseline prevalence of an MRI finding approaches 100%, the finding itself has almost no diagnostic value.

How does this change the way you talk to your patients about their MRI results?

19/02/2026

Wow 😮

One week of short sleep in otherwise healthy adults. Not "sleep deprived" by strict definition. Just 4-5 hours a night. Testosterone dropped 15%. Insulin sensitivity dropped 20%. Muscle protein synthesis dropped 19%. Hunger hormones rose 28%. Cortisol rose 51%. These aren't the only systems affected. They're just some of the ones that have been measured in controlled settings. No supplement, no diet hack, no training program (crazy claim, I know, but you can't outrain poor sleep...) outperforms sleep at keeping systems "online".

References:
Leproult & Van Cauter, JAMA, 2011. Buxton et al., Diabetes, 2010. Zuraikat et al., Diabetes Care, 2024. Spiegel et al., Lancet, 1999. Saner et al., J Physiol, 2020. Spiegel et al., Ann Intern Med, 2004.

16/02/2026

Are you getting in the garden?

In all blue zones, people continue to garden even into their 90s and 100s. Gardening is the epitome of a blue zones activity because it engineers more mindless movement into our lives. But did you know that gardening is good for your mental health, too?

7 BENEFITS OF GARDENING ON YOUR MENTAL HEALTH

YOU CAN DEPEND ON IT: Studies show uncertainty affects our mental health. A neatly cut lawn or a yard full of blooming flowers can put some normalcy and certainty back into your life.

GREEN IS GOOD: Just being outside in a green space is good for your mental health and can result in reduced stress.

BETTER NUTRITION: It's no secret that healthy eating boosts your mental health. Plant an array of colorful vegetables such as sweet potatoes, eggplant, green beans, and swiss chard for a healthier menu.

GARDENING AS EXERCISE: It’s not just running and biking that gets the endorphins going. Researchers say gardening counts as exercise, too. Just a few minutes of gardening can help lower your levels of the stress hormone cortisol.

GARDENING AS CONNECTION: Caring for a living garden, or better yet a community garden, can reconnect you with a sense of purpose, and keep you surrounded by like-minded people.

BEING MINDFUL: Activities such as pruning roses or cutting back bushes, afford you the opportunity to practice being in the moment. It’s a practice that has proven mental health benefits.

PRIDE OF ACCOMPLISHMENT: Don’t have a big plot of land? Create a balcony garden or kitchen herb garden to improve your mental health.

Read more: https://www.bluezones.com/2022/06/7-benefits-of-gardening-and-yardwork-on-your-mental-health/

Illustration:

10/02/2026

Everyone, what’s your excuse for not?

How Low Can You Go?

The Minimum Effective Dose of RT (for health)

For too long, strength training has been pigeonholed as a pursuit for "big muscles" or athletic performance. But we need to reframe the conversation: Resistance Training (RT) is not just lifting; it is a full prescription for mobility, combating sarcopenia, metabolic health, and bone density.

While we know aerobic exercise is critical for cardiovascular health, the magic truly happens when the two are combined. The synergy of aerobic work plus strengthening provides the greatest protection against all-cause mortality.

However, we have a compliance crisis on the strength side of that equation.
According to a massive systematic review of over 2.6 million participants, only 22.8% of adults are meeting the guidelines for muscle-strengthening exercise (MSE).

Why? For many, the barriers are time and the intimidation of high-volume routines and “gym culture.”

The result? We have a strength crisis. According to a massive systematic review of over 2.6 million participants, only 22.8% of adults are meeting the guidelines for muscle-strengthening exercise. Bear in mind this is self-report and strengthening exercises often include things like gardening.

But here is the good news: The "dose" required for health benefits is likely much lower than you think. We need to shift the narrative from "maximum gains" to "minimum effective dose."

Here is what the latest science tells us:

1. Resistance Training is Essential Healthcare
It is no longer just for bodybuilders. As highlighted in ACSM’s Health & Fitness Journal, resistance exercise has "come of age" as a primary intervention for long-term health, acting as a buffer against aging and chronic disease.
👉 Read more here https://journals.lww.com/acsm-healthfitness/fulltext/2023/11000/the_coming_of_age_of_resistance_exercise_as_a.7.aspx

2. The Dose is Surprisingly Low
If you are short on time, you don't need hour-long splits. A Jan/Feb 2026 review on minimum-effective doses suggests that meaningful adaptations can occur with as little as:
4 working sets per muscle group per week for hypertrophy.
2-3 working sets per exercise per week for strength.
This makes Single-Set Training (SST) a viable strategy. A full-body session can be completed in just 15–20 minutes.
👉 See https://journals.lww.com/acsm-healthfitness/fulltext/2026/01000/minimum_effective_resistance_training_doses.10.aspx

3. You Don't Need to Train to Failure
One of the biggest barriers for beginners is the discomfort of training to "momentary failure." New data indicates that stopping ~2 repetitions shy of failure (Repetitions in Reserve ~ 2) yields similar results to training to failure for Single-Set Training. You can make progress without the extreme fatigue.

4. No Time? Or Not a Priority?
Time-efficiency strategies are critical for adherence. As detailed in the "No Time to Lift?" review, prioritizing multi-joint movements and reducing volume can effectively maintain strength and health markers even during busy periods.
👉 Check the review here https://link.springer.com/article/10.1007/s40279-021-01490-1

The Takeaway
If you are part of the ~77% not engaging in strengthening work...
Start small.
One set, twice a week, 20 minutes total.
The best program is the one you do.

Prevalence Data Source: https://www.sciencedirect.com/science/article/pii/S1728869X24000443

08/02/2026

👍

Hot off the Press 🔥

𝗛𝘆𝗽𝗲𝗿𝘁𝗿𝗼𝗽𝗵𝗶𝗰 𝗘𝗳𝗳𝗲𝗰𝘁𝘀 𝗼𝗳 𝗦𝗶𝗻𝗴𝗹𝗲- 𝘃𝗲𝗿𝘀𝘂𝘀 𝗠𝘂𝗹𝘁𝗶-𝗝𝗼𝗶𝗻𝘁 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲: 𝗔 𝗗𝗶𝗿𝗲𝗰𝘁 𝗖𝗼𝗺𝗽𝗮𝗿𝗶𝘀𝗼𝗻 𝗕𝗲𝘁𝘄𝗲𝗲𝗻 𝗞𝗻𝗲𝗲 𝗘𝘅𝘁𝗲𝗻𝘀𝗶𝗼𝗻 𝗮𝗻𝗱 𝗟𝗲𝗴 𝗣𝗿𝗲𝘀𝘀

🦵 Single-joint knee extension (KE) and multi-joint leg press (LP) are commonly used exercises to train the quadriceps femoris (QF), the largest muscle group in humans. However, their comparative effectiveness for inducing QF hypertrophy remains unclear. Furthermore, the specific muscles hypertrophied by LP are not well characterized.

📘 A brand-new study by Kinosh*ta and colleagues compared the hypertrophic effects of KE and LP on the QF and other lower-limb muscles (https://pubmed.ncbi.nlm.nih.gov/41630124/)

📋 Methods

🏋️‍♂️ Seventeen untrained adults performed KE with one leg and LP with the contralateral leg at 70% of one-repetition maximum, 10 reps/set, 5 sets/session, 2 sessions/week for 12 weeks. MRI was used to assess pre- and post-training muscle volumes of 17 individual muscles, including the four QF heads, gluteus muscles, hamstrings, and adductors.

📊 Results (s. infographic)

Muscle volumes of the individual and whole QF significantly increased in both conditions ( P ≤ 0.026), except for the re**us femoris in the LP condition ( P = 0.379).

✅ Re**us femoris volume gains were greater for KE than LP (+13.2% vs. +1.1%, P ≤ 0.001), but gains in the vasti muscles (+5.0-7.2% vs. +4.4-6.2%) and whole QF (+7.1% vs. +4.9%) were comparable between conditions ( P ≥ 0.319).

✅ LP, but not KE, increased volumes of the gluteus maximus (+15.4%) and the adductor magnus (+6.2%) ( P ≤ 0.001).

✅ A follow-up experiment using surface electromyography showed that muscle excitation patterns during KE and LP generally mirrored the between-condition hypertrophic differences and similarities observed after the training intervention.

💡Conclusions

LP induces significant hypertrophy in the gluteus maximus and adductor magnus while producing similar vasti and overall QF growth as KE, indicating that LP is a highly time-efficient exercise.

However, KE is essential for effectively targeting the re**us femoris, which may have clinical relevance given its high susceptibility to strain injuries and marked re**us atrophy after anterior cruciate ligament reconstruction.

08/02/2026

So true. How your body runs is more important!

Have We Been Looking in the Wrong Place?

I’ve been a surgeon for over 25 years, and the longer I practice, the less I’m interested in structure — and the more I’m drawn to physiology... the entire person sitting before me.

I don’t ignore the structure… but I weigh the findings differently.
Early in my career, I obsessed over images. MRIs, X-rays, cartilage wear, meniscus tears — the structure told the story, or so I thought.

But experience humbles you. It teaches you that what shows up on a scan often matters far less than what’s happening in the body that scan belongs to.

Many cases of adult joint/tendon pain are just another manifestation of metabolic disease. It's true. The inflammation from your fatty liver, insulin resistance, diabetes, etc. It all plays a role in how much pain you're currently having.

Most of my patients are metabolically “sub-optimal”. And that has made me care less about what’s torn, worn, or frayed — and far more about inflammation, insulin resistance, central adiposity, elevated uric acid, and being under-muscled.

Again, I don’t ignore the structural changes… I see their contribution to the plan differently.

Lean muscle, central adiposity, systemic inflammation, mitochondrial health — these are the quiet variables that determine how someone feels, heals, adapts, and recovers.

Structure breaks down when our foundational physiology fails. Tendons degenerate when uric acid/ insulin, glucose and inflammation stays high. Cartilage thins when inflammation rises. Bone weakens when load is absent.

As surgeons, we were trained to fix anatomy. But biology is where the leverage is. Improve the chemistry, improve the outcome!! Remember that's one.

I still look at the images — but I look through them now. Because behind many joints that hurt is a system that’s out of balance.

07/02/2026

So right 🙏

05/02/2026

So get moving! And keep at it 🙏

𝗧𝗵𝗲 𝗥𝗶𝘀𝗲 𝗮𝗻𝗱 𝗙𝗮𝗹𝗹 𝗼𝗳 𝗣𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝗖𝗮𝗽𝗮𝗰𝗶𝘁𝘆: 𝗜𝗻𝘀𝗶𝗴𝗵𝘁𝘀 𝗳𝗿𝗼𝗺 𝗮 𝟰𝟳-𝗬𝗲𝗮𝗿 𝗟𝗼𝗻𝗴𝗶𝘁𝘂𝗱𝗶𝗻𝗮𝗹 𝗦𝘁𝘂𝗱𝘆

𝗢𝘃𝗲𝗿𝘃𝗶𝗲𝘄 📘

◻️ A groundbreaking study published in the Journal of Cachexia, Sarcopenia and Muscle offers a rare, long-term look at how human physical capacity changes from adolescence to early old age.
◻️ By following a representative cohort of Swedish men and women for nearly half a century, researchers mapped the trajectory of physical peak and decline.
◻️ The findings offer critical insights into aging, lifestyle, and the window of opportunity for intervention.

𝗦𝘁𝘂𝗱𝘆 𝗗𝗲𝘀𝗶𝗴𝗻 🧪

◻️ The "Swedish Population Cohort for Physical Activity and Fitness" tracked individuals born in 1958.
◻️ Data collection began in 1974 when participants were 16 years old and continued through ages 27, 34, 52, and finally 63 years old.
◻️ Unlike cross-sectional studies that compare different people at different ages, this longitudinal design allowed researchers to observe true individual aging trajectories across three key metrics:
◻️ Aerobic Capacity: Measured via cycle ergometer and run tests.
◻️ Muscular Endurance: Measured via bench press.
◻️ Muscular Power: Measured via the Sargent vertical jump test.

𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀

𝟭. 𝗪𝗵𝗲𝗻 𝗗𝗼 𝗪𝗲 𝗣𝗲𝗮𝗸? ⛰️
◻️ The study identified that physical capacity generally peaks well before middle age, confirming patterns previously seen in elite athletes.
◻️ Aerobic Capacity & Muscular Endurance: Both men and women reached their peak between the ages of 26 and 36.
◻️ Muscular Power: This peaked earlier, particularly for women. Men peaked at age 27, while women peaked as early as age 19.
𝟮. 𝗧𝗵𝗲 𝗧𝗿𝗮𝗷𝗲𝗰𝘁𝗼𝗿𝘆 𝗼𝗳 𝗗𝗲𝗰𝗹𝗶𝗻𝗲 📉
◻️ Once peak capacity is passed, the decline is not linear; it accelerates with age.
◻️ Initial Decline: In the years immediately following peak performance, the decline is gradual, ranging from 0.2% to 0.6% per year.
◻️ Accelerated Decline: By age 63, the rate of loss accelerates significantly to approximately 2.0% to 2.5% per year.
◻️ Total Loss: From their peak to age 63, participants lost between 30% and 48% of their physical capacity.
◻️ Women saw a 48% cumulative decline in jump height over 44 years.
𝟯. 𝗡𝗼 𝗚𝗲𝗻𝗱𝗲𝗿 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝗰𝗲𝘀 𝗶𝗻 𝘁𝗵𝗲 𝗥𝗮𝘁𝗲 𝗼𝗳 𝗔𝗴𝗶𝗻𝗴 ⚖️
◻️ While men generally possessed higher absolute capacity values than women throughout the study, the rate of decline was remarkably similar between the s*xes.
◻️ The study found no significant s*x difference in the slope of decline for aerobic capacity, muscular endurance, or power.
◻️ This suggests that the shape of the performance curve in adulthood is innate and biological rather than determined by s*x.
𝟰. 𝗧𝗵𝗲 "𝗪𝗶𝗱𝗲𝗻𝗶𝗻𝗴 𝗚𝗮𝗽" 𝗕𝗲𝘁𝘄𝗲𝗲𝗻 𝗜𝗻𝗱𝗶𝘃𝗶𝗱𝘂𝗮𝗹𝘀 📊
◻️ One of the most profound findings is how the difference between the "fittest" and "least fit" individuals grows drastically over time.
◻️ The study reports a massive increase in group variance from adolescence to age 63:
◻️ Relative Aerobic Capacity: Variance increased 25-fold.
◻️ Jump Height: Variance increased nearly 5-fold.
◻️ Muscular Endurance: Variance increased 3-fold.
◻️ This indicates that while everyone declines, the gap between those who maintain function and those who do not widens significantly with age.

𝗧𝗵𝗲 𝗥𝗼𝗹𝗲 𝗼𝗳 𝗟𝗶𝗳𝗲𝘀𝘁𝘆𝗹𝗲 𝗮𝗻𝗱 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 🌱

◻️ Physical Activity: Participants who were active in their leisure time at age 16 had better physical performance throughout adulthood.
◻️ However, early activity is not the only path to fitness; becoming active in adulthood was associated with better performance across all outcomes.
◻️ Switching from inactive to active led to measurable improvements, contradicting the idea that early inactivity causes irreversible damage.
◻️ Education: Higher socioeconomic status, measured by having a university degree, was positively associated with higher absolute aerobic capacity and muscular endurance.
◻️ Modifiable Factors: The study concludes that while the timing of the peak is fixed, the height of the peak and the rate of the subsequent decline are modifiable through physical activity.

𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻 🎯

◻️ This 47-year study confirms that physiological decline begins earlier than clinically observed, often starting before age 40.
◻️ However, it also proves that physical capacity is highly responsive to lifestyle changes.
◻️ Taking up physical activity at any age can attenuate the accelerating loss of function that leads to sarcopenia and physical disability in later life.



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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇