Athletic Performance & Therapy

16/02/2026

A round up of the week.

As always...
👉 Sharing a study is NOT an endorsement.
👉 You should read the original research (in the title of most of the slides) yourself and be critical.
🤪 Apologies for the spelling mistakes in some of the slides.

orthopaedicsportsmedicine sportsrehabilitation sportsrehabspecialist sportsperformancetraining sportsrecovery
orthopaedics
aclrehab

“The right information is powerful medicine.”

15/02/2026

ELITE SPORT vs REALITY
Surgery Success vs Return to Sport

🎯 THE ELITE SPORT NARRATIVE
🔵 Surgery = “Accepted Solution”
📈 >90% “Success” Rate
(In the best surgical hands)
✔ High-level surgical expertise
✔ Structured rehab
✔ Performance environment

⚠️ BUT WHAT HAPPENS OUTSIDE ELITE SPORT?
📉 Return to Previous Level of Activity:
🔹

29/01/2026

To date, research in tendinopathy rehabilitation focuses the most part, on physical factors whilst less is known to address pain psychology in those with tendinopathy of whom remain symptomatic in the long-term. 2, 4

People with tendinopathy exhibited increased pain catastrophising. Depression and anxiety were more prevalent in individuals with lower-limb tendinopathies, but not upper-limb tendinopathies, compared with those without tendinopathy, indicating poorer mental health in the lower-limb group.

Mest et al. (2025) Journal of Orthopaedic & Sports Physiotherapy

orthopaedicsportsmedicine orthopaedics sportsrehabilitation sportsrehabspecialist sportsperformancetraining sportsrecovery

22/12/2025

Bottom-line takeaway for patients.
If you have an Achilles injury:
The goal isn’t just to heal — it’s to heal strong, organised, and load-tolerant.
And that only happens with appropriate loading at the right time.

orthopaedicsportsmedicine orthopaedics sportsrehabilitation sportsrehabspecialist sportsperformancetraining sportsrecovery

18/12/2025

In life and in rehabilitation, we don’t succeed because of what we’re capable of—we succeed only to the depth of the habits we practice every day.

Rehabilitation, like life, is not limited by potential but defined by consistency—we heal, adapt, and return only as far as our daily habits carry us.

07/12/2025

Why This Anatomy Study Matters for ACL Patients

When surgeons repair a torn ACL, they often use one of the hamstring tendons (usually semitendinosus) as the new ligament. These hamstring muscles are controlled by small nerve branches that come from the sciatic nerve.

This study looked closely at exactly where those nerves travel, and found that they can vary from person to person.

What This Means for You

Surgeons can harvest your hamstring tendon more safely when they understand where the nerves are most likely to be.

This helps reduce the chance of nerve irritation or muscle weakness after surgery.

It also helps clinicians understand why your hamstrings may feel weak during rehab — sometimes it’s due to the tendon harvest, sometimes due to changes in nerve activation.

Strong hamstrings help protect your knee and your new ACL, so understanding this anatomy helps your team guide recovery more accurately.

01/12/2025

Shout out to

Why isometrics are particularly advantageous for menopausal women:

1. Large BP reduction from short sessions
Most protocols require only ~8 minutes/session, 3–4 days per week (e.g., wall-sit protocol). That’s extremely manageable compared to longer aerobic sessions.

2. Lower joint stress
Ideal for women with knee, hip, foot or spine pain — issues that often become more common in midlife.

3. High adherence
Simple to learn, no equipment (wall sits) or minimal equipment (handgrip). High adherence = better long-term BP control.

4. Autonomic benefits
Isometrics improve baroreflex sensitivity and vascular function — both areas affected by menopause.

5. Pairs well with strength and aerobic training
You don’t need to give up anything. Isometrics can be added as a “power tool” in a broader programme.

🧩 The key protocol (for practical use)

The protocol that consistently produces the strongest BP reductions:

Isometric wall-sit protocol

4 × 2-minute wall sits

2-minute rest between sets

3 days per week

8 weeks minimum

Work at ~95% of maximal heart rate at the end of each bout (per study monitoring method)

30/11/2025

30/11/2025

The Truth About Icing and Healing.
​The idea of using ice to heal injuries has been around for a long time. However, the scientific proof that the standard ICE method (Ice, Compression, Elevation) actually works isn't very strong.
​In fact, some recent studies are beginning to suggest that using ice might actually be a bad idea. These experts argue that it could be better to just let your body's natural healing system do its job without freezing it.
​Today, using cold for healing—called cryotherapy—comes in many forms. This includes the regular ice packs you have at home, as well as more complex things like full-body cold chambers, dunking yourself in cold water, or special cooling wraps.
​You can find these cold therapies everywhere now: in places where athletes train, at health spas, and in regular people's houses.
​The problem is, even though scientists are still trying to understand how cold affects the body at a tiny, molecular level, we don't have clear, agreed-upon rules for how and when to use these cold treatments

29/11/2025

Tendons are viscoelastic. When they are loaded and held at a constant length—such as during an isometric contraction—the internal tension decreases over ~30 seconds as collagen fibers slide and water is expelled (stress relaxation). Atkinson et al. (1999, https://pubmed.ncbi.nlm.nih.gov/10460127/) showed that 60% of stress relaxation occurs within 30 seconds.

🏋️‍♀️ Thus, long isometric holds (≥30 s at high force, ~80% 1RM, 1 to 3 sets of 2 to 4 repetitions, i.e. leg extension, leg press, or spanish squats in patellar tendinopathy) allow sufficient relaxation so that stronger tissue no longer monopolises the load. Stronger and healthier fascicles relax first. As these stronger regions lose stiffness, the weaker or injured regions—which were previously “shielded”—begin to take more of the load and experience the tensile stimulus they were previously missing.

25/11/2025

The structure "Be + Do = Have" is a concise and actionable model that emphasises the importance of mindset ("Be") and effort ("Do") in achieving the desired outcome ("Have").
​
​The Rehabilitation Mindset: Be + Do = Have
​This framework is a tool for understanding and controlling your recovery process. It shifts the focus from simply hoping for an outcome to actively creating it through your mindset and action.

​1. Be (The Mindset: Inner Acceptance & Commitment)
​This represents the foundational, internal state required for successful rehabilitation.
​Be Accepting: The ability to accept your injury as a current reality, not a permanent identity. This means acknowledging the setback without letting it define your future.

​Be Committed: The mindset of believing in the process and committing to the hard work ahead. This is the inner determination to stick with the plan, even on tough days.

​Be Patient: Understanding that biological healing takes time. Embracing patience reduces frustration and prevents pushing too hard too soon.

​2. Do (The Action: Consistent Effort & Discipline)
​This is the observable, active part of the journey—the work you put in.
​Do Your Rehab Exercises: Consistent and correct ex*****on of your prescribed rehabilitation program, including range of motion, strengthening, and mobility work.

​Do Lifestyle Changes: Actively managing factors outside of the clinic, such as nutrition, sleep, and stress, to support the healing environment.

​Do Communicate: Engaging honestly with your clinician about pain, challenges, and successes.

​3. Have (The Outcome: Grasp, Control & Success)
​This is the result of consistently integrating the right mindset and action.

​Have A Grasp On The Work: You understand your recovery process, the 'why' behind the exercises, and the overall progression. You feel informed and not just a passive recipient of treatment.

​Have Control Over Your Journey: You feel empowered because you know that your daily choices (your "Be" and "Do") are the primary drivers of your progress.
​Have A Successful Outcome: Achieving the functional goals established for your recovery and returning to the activities you value.
​

25/11/2025

Full consent was given for the use of these photos.

Working with adolescent athletes...

1. Adolescence is a Critical Development Stage

Young athletes are still growing.
Their bones lengthen faster than their muscles and tendons adapt, which makes them more vulnerable to injury (e.g., growth plate issues, Osgood–Schlatter’s, Sever’s disease).
Understanding how to protect their bodies helps prevent long-term damage.

2. Early Habits Shape Lifelong Health

Teenagers who learn proper warm-ups, strength training, and recovery techniques are more likely to become adults who move well and stay active.
Education builds routines that:

improve performance,

reduce risk of injury, and

encourage lifelong participation in sport.

3. Reduces Fear and Misconceptions

Many adolescents either:

ignore pain and “push through”, or
become overly fearful and stop activity after injury.

Education teaches them the difference between normal training discomfort and injury warning signs, helping them respond appropriately and not delay treatment or risk further injury.

4. Promotes Safe Rehabilitation

Without proper guidance, young athletes may:

return to sport too early,

rely on rest alone,

misuse braces, ice, or pain medication,

or avoid rehab exercises that build strength and confidence.

Teaching adolescents about structured rehabilitation helps them recover fully instead of “just waiting for it to get better.”

5. Protects Long-Term Mental and Emotional Well-Being

Injuries can affect identity, confidence, and motivation.
Education encourages:

supportive responses from coaches and parents,

healthy mindset around pain and performance,

resilience throughout rehab.

This prevents feelings of isolation or failure when they can’t play.

6. Reduces Pressure From Sport Culture

Teen athletes often feel pressure from:

competition,

parents,

coaches,

social media expectations.

Education emphasises health and safe return to play, helping them make decisions based on well-being rather than external expectations. This encourages ethical coaching and reduces burnout.