Athletic Performance & Therapy

Athletic Performance & Therapy Sports Rehabilitation Athletic Performance & Therapy is committed to helping you achieve your personal sporting endeavors.

Based in Portsmouth UK, we can help you with whatever your needs. You may be an elite athlete, a gym goer, a running enthusiast, a dog walker, a post-natal mother, or simply suffering from aches and pains – whatever your age – APT can help. We assess, diagnose and treat by reviewing your everyday activities, your gait, and any other functional factors that might be causing your pain. Offering ther

apy via manual therapy and exercise-based interventions, and a host of different treatments, our aim is to get you moving pain-free. Using a holistic approach in our assessments and treatments, we aim to help you to understand why your body is hurting as well as helping you to move more freely. So we don’t only treat your symptom - we identify the cause of the problem.

Asymptomatic meniscal tears are highly prevalent, particularly in individuals over the age of 50, and are most commonly ...
11/04/2026

Asymptomatic meniscal tears are highly prevalent, particularly in individuals over the age of 50, and are most commonly degenerative in origin rather than traumatic. These lesions are frequently identified incidentally on MRI, with evidence suggesting that up to 76% of asymptomatic individuals over 60 demonstrate meniscal pathology.
Epidemiological data indicate that over 35% of adults above 50 years of age have degenerative meniscal tears in the absence of knee symptoms. Such findings are widely considered part of the normal ageing process and are closely associated with early Osteoarthritis rather than representing acute injury.
Current best evidence supports non-operative management as the first-line approach. Conservative strategies, including structured physiotherapy and muscle strengthening, are recommended, as many tears remain clinically silent and do not result in pain or functional impairment.
Surgical intervention is generally not indicated for asymptomatic or uncomplicated degenerative tears. Treatment escalation is typically reserved for cases presenting with persistent symptoms, particularly true mechanical locking, or the later development of pain and functional limitation.


25/03/2026

After recording a podcast with I thought i'd share my 'Informed Care Pathway' showing that there is a structured route from initial consult to discharge!

24/03/2026

Key Message

Meniscus Tear Type + Patient Profile Drive Treatment Decisions

🧠 Study Overview

Natural Language Processing (NLP) study analysing large volumes of clinical notes to identify:

How tear morphology

And patient demographics influence whether patients receive surgical vs non-surgical treatment

🔍 Key Findings

🦵 Tear Morphology Matters Most

Complex, bucket-handle, and root tears → More likely surgical management

Degenerative, horizontal, and stable tears → More likely non-operative care

👤 Patient Demographics Influence Decisions

Younger patients → Higher likelihood of surgery

Older patients → More likely conservative treatment

Activity level plays a major role

(higher demand → more surgery)

⚖️ Degenerative vs Traumatic

Traumatic tears → Surgery more common

Degenerative tears → Exercise-based rehab preferred

📊 Clinical Interpretation

✅ Surgery tends to be favoured when:

Mechanical symptoms (locking/catching)

Repairable tear patterns (e.g. vertical, root)

Younger, active individuals

✅ Non-surgical care preferred when:

Degenerative changes present

No true mechanical locking

Lower functional demands

🏃 Rehabilitation Implications

Don’t default to MRI findings alone

Match treatment to:

Function

Symptoms

Patient goals

Progressive load-based rehab remains key

💡 Take-Home Message

“Not all meniscus tears are equal. Treatment should be individualised, not protocol-driven.”

22/03/2026

Self-management works best when care is truly patient-centered.

Self-management is essential, but it's not always easy.
- Many factors can either support or hinder a patient's ability to manage their condition effectively.
- Knowledge, Skills, and Attitudes
Do patients and healthcare professionals have the right tools and understanding?
- Environmental Context and Resources
Does the system provide adequate support and access to care?
- Role Clarity
Are responsibilities clearly defined between patients and clinicians?
- Confidence
Do patients feel capable and empowered to take action?
- Patient Expectations
Are beliefs aligned with realistic self-management goals?

Understanding these factors is key to improving quality of care and clinical
outcomes.

= Van Dijk et al., 2023

Disclaimer:
- Sharing a study is NOT an endorsement
- You should read the original research yourself and be critical





21/03/2026

🟦 Traumatic Multiligament Knee Injury + Patellar Tendon Rupture
Case Report Summary | Chiaramonti & Krebs

“Complex Knee Trauma: Surgical Strategy & Rehabilitation Insights”

🟩 CASE OVERVIEW
Patient Presentation
High-energy traumatic knee injury
Multiligament involvement (ACL, PCL ± MCL/LCL)
Concurrent patellar tendon rupture (rare + complex)
Key Challenge ➡️ Loss of both passive stability AND active extensor mechanism

🟥 MECHANISM OF INJURY
Typically high-force trauma (e.g. sport/contact, RTC)
Combination of:
Hyperflexion / hyperextension
Rotational load
Direct anterior force

🟦 CLINICAL PRIORITIES
✔️ Restore knee stability
✔️ Re-establish extensor mechanism
✔️ Protect vascular & neural structures
✔️ Optimise long-term function

🟨 SURGICAL MANAGEMENT
Staged vs Single-Stage Approach (Case Dependent)
In This Case:
Patellar tendon repair (urgent priority)
Multiligament reconstruction (ACL/PCL ± collaterals)
Key Considerations
Graft selection
Tunnel placement conflict
Soft tissue condition
Risk of stiffness

🟩 REHABILITATION PRINCIPLES
🔹 Early Phase (0–6 weeks)
Protected knee extension
Limited flexion range
Brace in extension
Isometric quadriceps activation
🔹 Mid Phase (6–16 weeks)
Gradual ROM progression
Strength development
Neuromuscular control
🔹 Late Phase (4–9 months)
Functional strengthening
Plyometrics (progressive)
Return-to-sport preparation

🟥 REHAB CHALLENGES
⚠️ Conflicting demands:
Protect patellar tendon repair (avoid early flexion overload)
Protect ligament reconstructions (avoid instability stress)
➡️ Requires carefully staged progression

🟦 KEY OUTCOMES
Successful restoration of:
Knee stability
Extensor mechanism function
Return to functional activity achievable
Requires highly structured rehab pathway

🟨 CLINICAL TAKEAWAYS
✔️ Rare but severe injury combination
✔️ Early recognition is critical
✔️ Surgical planning must be individualised
✔️ Rehab requires precision + patience
✔️ Multidisciplinary approach is essential

19/03/2026

I use hop test in rehab with my athletes/patients, but I also use the EasyForce dynamometer.

Headline Insight
Quadriceps strength is a stronger predictor of patient function than the single-leg forward hop test in late-stage ACL rehab.

📊 What the Evidence Shows
✔ Greater quadriceps strength → higher functional outcomes
✔ Hop distance alone may overestimate readiness
✔ Strength deficits can persist despite “passing” hop tests
✔ Objective strength testing is critical before return to sport

⚠️ Clinical Interpretation
Hop tests = performance based
Strength = capacity based
👉 Patients can compensate in hop tests
👉 They cannot compensate for true strength deficits

🏋️ Rehabilitation Focus
✔ Restore quadriceps symmetry (≥90–95%)
✔ Prioritise eccentric strength development
✔ Use isokinetic or dynamometry testing where possible
✔ Combine strength + functional tests (NOT in isolation)

🔁 Clinical Takeaway
Don’t rely on hop tests alone
Measure strength to determine true readiness

orthopaedicsportsmedicine

Managing exercise phobia after ACL reconstruction requires a multidisciplinary, biopsychosocial approach, including earl...
18/03/2026

Managing exercise phobia after ACL reconstruction requires a multidisciplinary, biopsychosocial approach, including early screening, cognitive-behavioral techniques, and graded exposure, to reduce high rates of fear-avoidance behaviors. A 2026 evidence summary by Zheng et al. highlights the need for proactive, patient-centered strategies to improve rehab adherence and return-to-sport outcomes.

15/03/2026

Knee Extensor Strength After Total Knee Arthroplasty

Study Overview
Cutoff Values of Knee Extensor Strength for Stair Ascent and Descent After Bicruciate-Stabilized Total Knee Arthroplasty

Authors: Furumoto et al.
Journal: Journal of Orthopaedics (2026)

Objective:
To determine the quadriceps strength thresholds required for safe stair ascent and descent following bicruciate-stabilised total knee arthroplasty (TKA).

Why This Matters
Stair negotiation is one of the most challenging functional tasks after knee replacement.

Insufficient quadriceps strength may lead to:
• Difficulty ascending stairs
• Poor eccentric control descending stairs
• Increased fall risk
• Reduced independence in daily activities

Key Findings

Stair Ascent
Patients required approximately:
≥ 0.40 Nm/kg
knee extensor strength
to ascend stairs independently.

Stair Descent
Patients required approximately:
≥ 0.60 Nm/kg
to descend stairs safely.

Descending stairs demands greater eccentric quadriceps control, explaining the higher strength threshold.

Clinical Implications

Rehabilitation should prioritise:

• Progressive quadriceps strengthening
• Eccentric loading exercises
• Functional stair training
• Objective strength testing before discharge from rehab

Strength deficits below these thresholds may indicate ongoing functional limitations.

Example Rehabilitation Focus

Early Phase • Quadriceps activation
• Sit-to-stand training

Mid Phase • Step-ups
• Controlled step-downs

Late Phase • Loaded step descent drills
• Single-leg functional strengthening

Key Takeaway
Adequate quadriceps strength is critical for stair function after TKA.
Target ≥0.60 Nm/kg knee extensor strength
to ensure safe stair negotiation.

orthopaedicsportsmedicine orthopaedics sportsrehabilitation sportsrehabspecialist sportsperformancetraining sportsrecovery

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.”

ELITE SPORT vs REALITYSurgery Success vs Return to Sport🎯 THE ELITE SPORT NARRATIVE🔵 Surgery = “Accepted Solution”📈 >90%...
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:
🔹

To date, research in tendinopathy rehabilitation focuses the most part, on physical factors whilst less is known to addr...
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

Bottom-line takeaway for patients.If you have an Achilles injury:The goal isn’t just to heal — it’s to heal strong, orga...
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

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