Centro Fisioterapia e Osteopatia Martinelli Gianluca

22/02/2026

𝗠𝘂𝘀𝗰𝗹𝗲 𝗵𝘆𝗽𝗲𝗿𝘁𝗿𝗼𝗽𝗵𝘆 𝗳𝗿𝗼𝗺 𝗽𝗮𝗿𝘁𝗶𝗮𝗹 𝗿𝗲𝗽𝗲𝘁𝗶𝘁𝗶𝗼𝗻 𝗮𝘁 𝗹𝗼𝗻𝗴 𝘃𝘀. 𝘀𝗵𝗼𝗿𝘁 𝗺𝘂𝘀𝗰𝗹𝗲 𝗹𝗲𝗻𝗴𝘁𝗵: 𝗔 𝘀𝘆𝘀𝘁𝗲𝗺𝗮𝘁𝗶𝗰 𝗿𝗲𝘃𝗶𝗲𝘄 𝗮𝗻𝗱 𝗺𝗲𝘁𝗮-𝗮𝗻𝗮𝗹𝘆𝘀𝗶𝘀

📘 A recent systematic review and meta-analysis by Strey and colleagues (https://link.springer.com/article/10.1007/s11332-025-01586-5) examined whether resistance training performed at longer muscle lengths (LL) leads to greater muscle hypertrophy than training performed at shorter muscle lengths (SL).

SL resistance training was defined as any angle interval from 0 to half of the Full ROM, LL as any interval from half of the Full ROM.

Eight randomized controlled trials involving a total of 138 participants met the inclusion criteria. Muscle size was assessed using MRI or ultrasound. All interventions lasted at least four weeks.

📋 The included studies investigated several muscle groups. Most data were available for the quadriceps, including the vastus lateralis (n = 5), re**us femoris (n = 3), vastus medialis (n = 2), and vastus intermedius (n = 2). Additional muscles examined included the medial and lateral gastrocnemius (n = 1 each), as well as the biceps brachii and brachialis (n = 1).

💪 Across studies, resistance training performed at longer muscle lengths resulted in significantly greater increases in muscle size compared with training at shorter muscle lengths (ES = 0.283; 95% CI 0.04–0.52; p = 0.036). Analyses of regional hypertrophy showed a similar pattern. Long-length training produced greater hypertrophy in the distal (ES = 0.433; 95% CI 0.01–0.85; p = 0.048) and central muscle regions (ES = 0.276; 95% CI 0.01–0.48; p = 0.028), whereas differences in proximal hypertrophy were less clear.

💡Several mechanisms may account for the advantage observed with training at longer muscle lengths. One explanation is the higher mechanical tension typically generated in lengthened positions. Increased passive and active tension may provide a stronger stimulus for muscle growth. In addition, stretch-related signaling pathways have been proposed as potential contributors, especially increased mTOR activity and greater satellite cell activation. At present, however, it remains difficult to distinguish the specific effects of muscle stretch from those of increased force production. Previous work by Kubo and colleagues (https://pubmed.ncbi.nlm.nih.gov/16643193) reported force levels approximately 2.3 times higher at longer muscle lengths, suggesting that mechanical tension alone could explain at least part of the observed hypertrophy differences. A review by Wolf and colleagues

𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗮𝗹 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀 𝗳𝗼𝗿 𝗧𝗵𝗲𝗿𝗮𝗽𝗶𝘀𝘁𝘀

▶️ From a rehabilitation perspective, the findings suggest that resistance exercises performed in lengthened muscle positions offer a modest but consistent advantage for promoting muscle hypertrophy. Whenever symptoms allow, exercises should include loading at longer muscle lengths, such as deeper joint angles (i.e. squat, https://pubmed.ncbi.nlm.nih.gov/31230110/) or positions closer to end range.

▶️ When full range-of-motion training is not feasible, loading the lengthened portion of the range appears preferable to working primarily in shortened positions. This approach may help preserve or stimulate muscle growth even when joint motion is limited.

▶️ Because exercises performed at longer muscle lengths may initially produce greater mechanical stress and muscle soreness, a gradual progression toward end-range loading is advisable. Carefully staged increases in range of motion and intensity may improve tolerance while still taking advantage of the hypertrophic stimulus associated with lengthened training.

20/02/2026

𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝘀𝗺 𝗼𝗳 𝗔𝗰𝘁𝗶𝗼𝗻 𝗼𝗳 𝗧𝗵𝗲𝗿𝗮𝗽𝗲𝘂𝘁𝗶𝗰 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗶𝗻 𝗥𝗼𝘁𝗮𝘁𝗼𝗿 𝗖𝘂𝗳𝗳 𝗧𝗲𝗻𝗱𝗶𝗻𝗼𝗽𝗮𝘁𝗵𝘆: 𝗪𝗵𝗮𝘁 𝗗𝗼𝗲𝘀 𝗘𝗹𝗮𝘀𝘁𝗼𝗴𝗿𝗮𝗽𝗵𝘆 𝗔𝗱𝗱?

We prescribe strengthening exercises for rotator cuff–related shoulder pain almost automatically. They’re guideline-supported (https://pubmed.ncbi.nlm.nih.gov/40165544/, https://pubmed.ncbi.nlm.nih.gov/32007452/), widely used, and clinically effective. But what actually drives improvement?

📘 A brand-new study by Pérez-Porta and colleagues (https://pubmed.ncbi.nlm.nih.gov/41682699/) explored two potential mechanisms: strength gains and changes in supraspinatus muscle properties. Thirty-nine patients with rotator cuff–related shoulder pain (no full-thickness tears) completed a 6-month progressive strengthening program.

🏋️‍♂️ The program included (s. picture in comments):
Rotator cuff strengthening (especially abductors and external rotators)
Periscapular strengthening (protractors and retractors)
Posterior capsule stretching when indicated

Patients had five supervised sessions over three weeks, plus follow-ups at weeks 6 and 12 to progress loading. Exercises were progressed based on pain (≤4/10) or perceived exertion (≥6/10 if pain-free).

💪 Strength was measured with dynamometry. Supraspinatus muscle stiffness was assessed using shear wave elastography (SWE), which quantifies tissue stiffness via shear wave velocity.

📊 Results

✅ Clinically, most patients improved. Nearly 70% reported being much better or fully recovered.

✅ Strength gains, however, were small and not statistically significant. Even clearly improved patients did not show dramatic strength increases.

✅ What did change was muscle stiffness. After six months, supraspinatus stiffness at rest increased. Patients who improved functionally showed a clearer increase in resting stiffness than those who did not. Strength did not follow the same pattern.

✅ In this specific population — without major structural degeneration — increased stiffness is interpreted cautiously as a potential sign of improved muscle density or tissue quality rather than fibrosis. The authors suggest this may reflect adaptive remodeling in response to sustained loading.

💡 For practitioners, this is the interesting part: A well-structured, progressive strengthening program targeting cuff and scapular musculature may induce measurable changes in muscle properties — even if strength gains look modest. So perhaps exercise in RCRSP works less by dramatically increasing force output and more by gradually restoring tissue load capacity and muscle quality.

❎ Limitations: Small study. Exploratory data. Non-blinded assessor.

🤔 Maybe we’re not just building strength. Maybe we’re building better tissue. Further studies will show.

18/02/2026

𝗥𝗲𝘃𝗶𝗲𝘄 𝗔𝗻𝗮𝗹𝘆𝘀𝗶𝘀: 𝗥𝗲𝘀𝗶𝘀𝘁𝗮𝗻𝗰𝗲 𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗳𝗼𝗿 𝗖𝗵𝗿𝗼𝗻𝗶𝗰 𝗡𝗼𝗻𝘀𝗽𝗲𝗰𝗶𝗳𝗶𝗰 𝗟𝗼𝘄 𝗕𝗮𝗰𝗸 𝗣𝗮𝗶𝗻

🟦 𝗣𝗮𝗽𝗲𝗿: Does resistance training improve pain intensity, quality of life, and disability in people with chronic nonspecific low back pain? A systematic review and meta-analysis (2025)
🟦 𝗔𝘂𝘁𝗵𝗼𝗿𝘀: Rodríguez-Domínguez et al.
🟦 𝗝𝗼𝘂𝗿𝗻𝗮𝗹: Disability and Rehabilitation

𝗧𝗵𝗲 𝗖𝗼𝗿𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺

🟦 Chronic nonspecific low back pain (CNSLBP) is defined as pain persisting for more than 3 months without a clear underlying pathology like a fracture or tumor.
🟦 It affects 10–30% of the global population and is a leading cause of disability.
🟦 While exercise is generally recommended, the specific effectiveness of Resistance Training (RT) as a standalone intervention has been unclear until this review.

𝗦𝘁𝘂𝗱𝘆 𝗦𝗰𝗼𝗽𝗲

🟦 This systematic review analyzed 10 Randomized Controlled Trials involving 434 adults.
🟦 The researchers sought to determine if RT—defined as exercises causing muscular contraction against external resistance to increase strength, tone, or mass—is effective for improving pain, quality of life, and disability compared to other common treatments.

𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗧𝗵𝗲 “𝗕𝗶𝗴 𝗧𝗵𝗿𝗲𝗲” 𝗢𝘂𝘁𝗰𝗼𝗺𝗲𝘀

𝟭. 𝗣𝗮𝗶𝗻 𝗜𝗻𝘁𝗲𝗻𝘀𝗶𝘁𝘆 — 𝗧𝗵𝗲 𝗦𝘁𝗿𝗼𝗻𝗴𝗲𝘀𝘁 𝗥𝗲𝘀𝘂𝗹𝘁
🟦 RT showed a significant reduction in pain intensity (Standardized Mean Difference = −1.15).
🟦 Pain intensity was the only variable to reach clinical significance defined as a greater than 15 percent improvement perceived by the patient.
🟦 RT is a robust intervention for reducing pain.
𝟮. 𝗗𝗶𝘀𝗮𝗯𝗶𝗹𝗶𝘁𝘆
🟦 RT showed a large statistical reduction in disability (Standardized Mean Difference = −2.76).
🟦 While statistically significant, the improvement did not reach the threshold for clinical significance, with 12.58 percent improvement versus the 15 percent threshold.
𝟯. 𝗤𝘂𝗮𝗹𝗶𝘁𝘆 𝗼𝗳 𝗟𝗶𝗳𝗲
🟦 RT showed a significant improvement in quality of life scores (Standardized Mean Difference = 0.82).
🟦 Similar to disability, this improved statistically but did not meet the threshold for clinical significance.

𝗛𝗼𝘄 𝗥𝗲𝘀𝗶𝘀𝘁𝗮𝗻𝗰𝗲 𝗧𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗖𝗼𝗺𝗽𝗮𝗿𝗲𝘀 𝘁𝗼 𝗢𝘁𝗵𝗲𝗿 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁𝘀

🟦 RT was significantly superior to usual care, defined as no specific intervention or general lifestyle advice, for improving pain, disability, and quality of life.
🟦 RT resulted in significantly better pain reduction and quality of life scores than aerobic exercise.
🟦 When RT was compared to combined therapy, such as exercise plus education or manual therapy, there was no significant difference.
🟦 This suggests that RT alone is highly effective and does not necessarily require additional modalities to achieve pain reduction results.

𝗘𝘃𝗶𝗱𝗲𝗻𝗰𝗲-𝗕𝗮𝘀𝗲𝗱 𝗣𝗿𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 𝗛𝗼𝘄 𝘁𝗼 𝗧𝗿𝗮𝗶𝗻

🟦 One of the most valuable aspects of this review is the extraction of the F.I.T.T. parameters used in successful trials.
🟦 The authors identified a common effective protocol for clinicians and patients.
🟦 Frequency: 2–3 sessions per week.
🟦 Duration: Programs should last at least 12 weeks to achieve meaningful improvements.
🟦 Volume: 2–3 sets of 10–20 repetitions.
🟦 Intensity: Start at 30–40 percent of the one-repetition maximum or maximum voluntary contraction.
🟦 Exercise selection included a mix of global lifts and specific lumbar exercises.
🟦 Squats.
🟦 Deadlifts.
🟦 Back extensions.
🟦 Crunches.
🟦 Bench press and rows.

𝗖𝗼𝗻𝗳𝗶𝗱𝗲𝗻𝗰𝗲 𝗶𝗻 𝘁𝗵𝗲 𝗥𝗲𝘀𝘂𝗹𝘁𝘀

🟦 Using the GRADE approach, the authors rated the certainty of the evidence as Moderate for pain, disability, and quality of life.
🟦 This indicates that while the research is promising and RT can be recommended, future high-quality studies could potentially impact these findings.

𝗟𝗶𝗺𝗶𝘁𝗮𝘁𝗶𝗼𝗻𝘀 𝘁𝗼 𝗖𝗼𝗻𝘀𝗶𝗱𝗲𝗿

🟦 It is impossible to blind patients to the fact that they are lifting weights, which introduces a risk of bias.
🟦 The analysis did not stratify results by s*x, so it is unknown if men and women respond differently to these protocols.
🟦 There was substantial statistical heterogeneity between the studies, particularly regarding disability outcomes.

𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻

🟦 This 2025 review positions resistance training as a cornerstone intervention for chronic nonspecific low back pain.
🟦 It provides moderate evidence that lifting weights is superior to aerobic exercise and usual care for pain reduction.
🟦 Resistance training is a valid standalone treatment that does not necessarily need to be combined with other therapies to be effective.

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

Link to Article 👇

18/02/2026

16/02/2026

Under conditions of uncontrollable stress, there is a high level of catecholamine release in the brain, which impairs prefrontal cortex (PFC) function while strengthening the affective responses of the amygdala and the habitual responses of the basal ganglia. The amygdala plays a central role in this process by activating catecholamine systems during psychological stress and by coordinating other components of the stress response, such as projections to the periaqueductal gray.

Activation of the amygdala stimulates the locus coeruleus through corticotropin-releasing factor (CRF), increasing tonic firing and leading to elevated norepinephrine (NE) release. High levels of NE engage lower-affinity alpha-1 and beta receptors, which further enhance amygdala activity and weaken PFC regulation. This creates a vicious cycle in which primitive emotional and habitual circuits dominate behavior, while higher-order cognitive control is suppressed.

Reference: Arnsten, A. F. T., et al. (2015). ). The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder. Neurobiology of Stress

15/02/2026

Hot off the Press 🔥

𝗣𝗵𝘆𝘀𝗶𝗰𝗮𝗹 𝗮𝘀𝘀𝗲𝘀𝘀𝗺𝗲𝗻𝘁 𝗮𝗻𝗱 𝗿𝗲𝗵𝗮𝗯𝗶𝗹𝗶𝘁𝗮𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗻𝗲𝘂𝗿𝗼𝗴𝗲𝗻𝗶𝗰 𝘁𝗵𝗼𝗿𝗮𝗰𝗶𝗰 𝗼𝘂𝘁𝗹𝗲𝘁 𝘀𝘆𝗻𝗱𝗿𝗼𝗺𝗲 (𝗡𝗧𝗢𝗦): 𝗔 𝘀𝗰𝗼𝗽𝗶𝗻𝗴 𝗿𝗲𝘃𝗶𝗲𝘄

💁‍♂️ Neurogenic Thoracic Outlet Syndrome (NTOS) represents a significant clinical challenge within musculoskeletal and hand therapy, characterized by the dynamic compression of the brachial plexus. Neurogenic Thoracic Outlet Syndrome (NTOS) accounts for up to 95% of TOS csaes and is regarded as the more controversial and complex TOS subgroup due to the complexity of diagnosis and the constellation of signs and symptoms (https://pubmed.ncbi.nlm.nih.gov/36018621/, https://pubmed.ncbi.nlm.nih.gov/31037504/). NTOS is estimated to have a prevalence of 10 cases per 100,000 with an incidence of 2–3 cases per 100,000 per year (https://pubmed.ncbi.nlm.nih.gov/35978467/).

While specialist rehabilitation is widely considered the primary conservative treatment, the specific components of such programs have historically remained ill-defined and poorly reported. Early systematic reviews, such as the one conducted by Lo et al. (https://www.ncbi.nlm.nih.gov/books/NBK127550/) highlighted a lack of high-quality evidence regarding exercise efficacy, a sentiment echoed by the 2014 Cochrane review (https://pubmed.ncbi.nlm.nih.gov/25427003/) which noted the field was dominated by low-quality data. More recently, Luu et al. (https://pubmed.ncbi.nlm.nih.gov/35655698/) provided a scoping review of proposed exercise rationales, yet a detailed synthesis of comprehensive rehabilitation protocols and their clinical reasoning strategies was still lacking.

📘A brand-new scoping review by O'Sullivan et al. (https://pubmed.ncbi.nlm.nih.gov/41657761/) addressed this gap by analyzing 29 studies published since 2000 to map current physical assessment and rehabilitation practices. The findings reveal that assessment is heavily weighted toward diagnostic confirmation rather than identifying specific therapeutic targets. The most prevalent tools include provocation tests—specifically the Elevated Arm Stress Test (EAST), Upper Limb Tension Test (ULTT), and Adson’s test—alongside palpation of the pectoralis minor, scalenes, scalene triangle, subcoracoid space. Postural and scapulothoracic assessments are also common, reflecting a prevalent biomedical theory that "opening" the thoracic outlet and decompressing neurovascular structures are the primary goals of intervention.

🏋️‍♂️ Rehabilitation programs are predominantly exercise-based, with stretching and strengthening being the most frequent interventions. Stretching typically targets the scalene and pectoralis muscles to increase the width of the anatomical spaces, while strengthening focuses on scapular stabilizers, such as the serratus anterior and middle-lower trapezius. Other common adjuncts include neurodynamic exercises (nerve glides), diaphragmatic breathing, postural retraining, and activity modification. Interestingly, despite the chronic nature of NTOS, only one study incorporated psychologically informed treatment, suggesting a persistent bias toward biomechanical models over holistic, biopsychosocial approaches.

🤔 The review also identified significant inconsistencies in clinical reasoning and treatment dosage. For example, there is conflicting advice regarding scapular exercises, with some authors advocating for depression and retraction and others for scapular elevation and upward rotation to avoid mechanical stress on the plexus.

In addition, the review impressively shows that the current conservative rehabilitation paradigm involves decompression and opening of the thoracic outlet through strengthening and stretching. However, it is unclear whether these interventions actually achieve this objective (e.g. a change in the position of the scapula or anatomical change in the scalenus gap).

Furthermore, while expert consensus often recommends a six-month trial of conservative care, many empirical studies utilized much shorter intervention periods, and reporting on exercise intensity and frequency remains generally poor.

💡In terms of measurement, the QuickDASH and the Cervical Brachial Symptom Questionnaire (CBSQ) are the most frequently used Patient-Reported Outcome Measures (PROMs). Prognostic data suggests that patients with less severe baseline symptoms, lower tenderness scores, and higher tolerance during provocation testing are more likely to respond successfully to rehabilitation alone. Ultimately, the authors conclude that while a vast array of techniques exists, there is a critical need for standardized, reproducible protocols co-designed by clinicians and patients to improve the evidence base for NTOS management.

13/02/2026

𝗧𝗵𝗶𝗴𝗵 𝗠𝘂𝘀𝗰𝗹𝗲 𝗖𝗵𝗮𝗻𝗴𝗲𝘀 𝗶𝗻 𝘁𝗵𝗲 𝗔𝗖𝗟-𝗗𝗲𝗳𝗶𝗰𝗶𝗲𝗻𝘁 𝗞𝗻𝗲𝗲: 𝗔 4-𝗬𝗲𝗮𝗿 𝗟𝗼𝗻𝗴𝗶𝘁𝘂𝗱𝗶𝗻𝗮𝗹 𝗠𝗥𝗜 𝗦𝘁𝘂𝗱𝘆 𝗼𝗳 1,207 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀

🦵 The anterior cruciate ligament (ACL) serves as a fundamental mechanical and sensory stabilizer of the knee. ACL tears are among the most prevalent ligamentous injuries, with an annual U.S. incidence of 68.6 per 100,000 (https://pubmed.ncbi.nlm.nih.gov/26920430/). While much of clinical orthopaedics has traditionally focused on acute quadriceps weakness following injury, emerging evidence suggests that the long-term neuromuscular landscape is far more complex. Systematic reviews, such as those by Birchmeier et al. (2020, https://pubmed.ncbi.nlm.nih.gov/31608490/) and Schwartz et al. (2025, https://pubmed.ncbi.nlm.nih.gov/39800896/), have highlighted persistent strength deficits and muscle size alterations that remain even years after the initial trauma. This suggests that an ACL tear is not merely a structural failure but a catalyst for chronic, systemic adaptations in the lower limb.

📘 A brand-new longitudinal matched-cohort study by Alzobi and colleagues (https://pubmed.ncbi.nlm.nih.gov/41370366/), utilizing data from the Osteoarthritis Initiative (OAI), tracked 1,207 participants over a four-year period to observe how an unreconstructed ACL tear influences thigh muscle morphology and function. The researchers employed a deep-learning U-Net model to segment MRI data, allowing for precise quantification of muscle cross-sectional area (CSA) and intramuscular adipose tissue (IMAT).

🔑 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀

Contrary to the common clinical emphasis on the quadriceps, this study revealed that the most significant long-term deterioration occurs in the posterior thigh:

1️⃣ 𝗦𝗲𝗹𝗲𝗰𝘁𝗶𝘃𝗲 𝗔𝘁𝗿𝗼𝗽𝗵𝘆: ACL-deficient thighs experienced progressive atrophy in the hamstrings (-28.18 mm/year) and the sartorius (-3.02 mm/year).

2️⃣ 𝗤𝘂𝗮𝗱𝗿𝗶𝗰𝗲𝗽𝘀 𝗖𝗦𝗔 𝗦𝘁𝗮𝗯𝗶𝗹𝗶𝘁𝘆: Surprisingly, no significant longitudinal changes were observed in quadriceps or adductor CSA over the four-year window.

3️⃣ 𝗙𝘂𝗻𝗰𝘁𝗶𝗼𝗻𝗮𝗹 𝗗𝗲𝗰𝗹𝗶𝗻𝗲: Corresponding with the physical atrophy, hamstring strength decreased significantly (-3.49 N/year), while quadriceps force remained relatively stable.

4️⃣ 𝗠𝘂𝘀𝗰𝗹𝗲 𝗤𝘂𝗮𝗹𝗶𝘁𝘆: There were no significant differences in fat infiltration (IMAT) or contractile percentage between ACL-deficient and ACL-intact groups, suggesting the primary issue is muscle volume rather than "marbling" of the tissue.

💡 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀

The results suggest that the loss of the ACL-hamstring reflex arc—a feedback loop where ACL mechanoreceptors trigger hamstring activation (https://pubmed.ncbi.nlm.nih.gov/3618871/, https://pubmed.ncbi.nlm.nih.gov/11206261/)—may lead to chronic disuse and subsequent wasting of the posterior muscles. This "quadriceps dominance" can further destabilize the knee by increasing anterior tibial shear. These findings challenge the traditional "quad-centric" view of ACL recovery. To protect the long-term health of the knee, rehabilitation must evolve to include rigorous, targeted strategies for hamstring preservation.

13/02/2026

13/02/2026

Benefits of short‐term and habitual exercise in the prevention of cardiovascular disease.

👉Single or short‐term exercise‐induced protection (SEP) against ischaemia–reperfusion (IR) injury may lessen the severity of myocardial injury from cardiac surgery or myocardial infarction, while habitual exercise training (days–years) leads to physiological adaptions and changes in traditional cardiovascular disease (CVD) risk factors that may prevent the occurrence of a cardiac event.

11/02/2026

𝗦𝗲𝗹𝗲𝗰𝘁𝗶𝘃𝗲 𝗺𝘂𝘀𝗰𝗹𝗲 𝘄𝗲𝗮𝗸𝗻𝗲𝘀𝘀 𝗶𝗻 𝗔𝗰𝗵𝗶𝗹𝗹𝗲𝘀 𝘁𝗲𝗻𝗱𝗶𝗻𝗼𝗽𝗮𝘁𝗵𝘆: 𝗶𝘀 𝗶𝘁 𝘁𝗶𝗺𝗲 𝘁𝗼 𝗹𝗼𝗼𝗸 𝗯𝗲𝘆𝗼𝗻𝗱 𝘁𝗵𝗲 𝘀𝗼𝗹𝗲𝘂𝘀?

📘 A brand-new review article by Fernandes and colleagues (https://pubmed.ncbi.nlm.nih.gov/41664282/) revisits the neuromuscular mechanisms underlying Achilles tendinopathy and questions the traditional soleus-centric explanation of plantarflexor deficits. While earlier models attributed reduced plantarflexion capacity primarily to soleus weakness, recent neurophysiological and biomechanical evidence suggests a more selective impairment within the triceps surae.

⬇️In particular, individuals with Achilles tendinopathy consistently demonstrate reduced neural drive, lower activation, and diminished force contribution of the gastrocnemius lateralis, especially during submaximal contractions (https://pubmed.ncbi.nlm.nih.gov/36418751/, https://pubmed.ncbi.nlm.nih.gov/40349309/). In contrast, soleus motor unit behaviour and force contribution appear largely preserved and may even increase as a compensatory response.

🦶 This altered coordination has important mechanical implications (graphic). Because the Achilles tendon is composed of distinct subtendons arising from each triceps surae muscle, changes in muscle-specific force sharing can modify how strain is distributed within the tendon. A reduced contribution from the gastrocnemius lateralis is therefore likely to create non-uniform strain patterns and elevated interfascicular shear stress, conditions associated with localised overload, microdamage, and maladaptive tendon remodelling. Structural findings such as selective gastrocnemius lateralis atrophy, altered muscle architecture, and reduced subtendon stiffness further support this mechanistic link. Nevertheless, whether these neuromuscular alterations precede tendon pathology or develop as protective adaptations to pain remains unresolved.

💡From a practical perspective, the review calls for a reassessment of current clinical practice. Rehabilitation approaches that focus predominantly on soleus strengthening—such as seated calf raises—may fail to address relevant muscle-specific deficits. Strategies that preferentially target the gastrocnemius lateralis, 𝗶𝗻𝗰𝗹𝘂𝗱𝗶𝗻𝗴 𝘀𝘁𝗿𝗮𝗶𝗴𝗵𝘁-𝗸𝗻𝗲𝗲 𝗹𝗼𝗮𝗱𝗶𝗻𝗴, 𝗶𝗻𝘄𝗮𝗿𝗱 𝗳𝗼𝗼𝘁 𝗽𝗼𝘀𝗶𝘁𝗶𝗼𝗻𝗶𝗻𝗴 𝗱𝘂𝗿𝗶𝗻𝗴 𝗽𝗹𝗮𝗻𝘁𝗮𝗿𝗳𝗹𝗲𝘅𝗶𝗼𝗻 (https://pubmed.ncbi.nlm.nih.gov/39985716/, https://pubmed.ncbi.nlm.nih.gov/32735428/), or biofeedback-guided activation training, may help restore more balanced force sharing within the triceps surae. However, these interventions remain hypothesis-driven, and their effectiveness for improving symptoms and function has yet to be established.

09/02/2026

VEXAS syndrome is a rare disease that usually affects adults, especially men over 50, which causes ongoing inflammation throughout the body and can lead to problems with bone marrow.

Although much has been uncovered in the 5 years since the discovery of VEXAS syndrome, there remain many unknowns in terms of pathophysiology, diagnostics, and therapeutics.

A new Review provides a comprehensive overview of disease development, clinical spectrum, and therapeutic strategies.

Find out more via the link in comments ⤵️

📊 Figure: Overview of VEXAS syndrome.

06/02/2026

𝗢𝗽𝘁𝗶𝗺𝗶𝘇𝗶𝗻𝗴 𝗔𝗰𝗵𝗶𝗹𝗹𝗲𝘀 𝗧𝗲𝗻𝗱𝗼𝗻 𝗥𝗲𝗵𝗮𝗯𝗶𝗹𝗶𝘁𝗮𝘁𝗶𝗼𝗻: 𝗔 𝗗𝗲𝗲𝗽 𝗗𝗶𝘃𝗲 𝗶𝗻𝘁𝗼 𝗟𝗼𝗮𝗱𝗶𝗻𝗴 𝗠𝗲𝗰𝗵𝗮𝗻𝗶𝗰𝘀 𝗮𝗻𝗱 𝗔𝗱𝗮𝗽𝘁𝗮𝘁𝗶𝗼𝗻

◻️ Resistance-based therapeutic exercise is widely recognized as the first-line treatment for Achilles tendinopathy.
◻️ However, despite its prevalence, the specific mechanisms that make exercise effective are still debated, and protocols vary significantly between clinicians.
◻️ A 2022 narrative review by Merry et al., published in the Journal of Clinical Medicine, explores the foundational principles of tendon remodeling and the biomechanics of the Achilles tendon to determine how to optimize therapeutic exercise prescriptions.
◻️ Here is a thorough breakdown of the review’s findings regarding anatomy, remodeling, and clinical parameters for exercise prescription.

𝟭. 𝗧𝗵𝗲 𝗔𝗻𝗮𝘁𝗼𝗺𝘆 𝗼𝗳 𝗟𝗼𝗮𝗱𝗶𝗻𝗴 🦵
◻️ The Achilles tendon is the largest and strongest tendon in the body, capable of withstanding forces of 5 to 7 body weights during running.
◻️ It acts as a spring, storing and returning energy to facilitate movement.
◻️ The tendon connects the triceps surae muscles (soleus, medial gastrocnemius, and lateral gastrocnemius) to the calcaneus.
◻️ A key anatomical feature is that these muscles insert via three distinct "subtendons" that rotate (clockwise on the left, counterclockwise on the right) as they travel distally.
◻️ Because the soleus and gastrocnemii have different force-production capacities and insertion pathways, understanding how force is transmitted through these subtendons is critical for understanding injury and rehabilitation.

𝟮. 𝗣𝗿𝗶𝗻𝗰𝗶𝗽𝗹𝗲𝘀 𝗼𝗳 𝗧𝗲𝗻𝗱𝗼𝗻 𝗥𝗲𝗺𝗼𝗱𝗲𝗹𝗶𝗻𝗴 🔬
◻️ To heal or strengthen a tendon, it must be subjected to mechanical loading that triggers mechanotransduction—the process by which cells convert mechanical signals into biochemical responses.
𝗛𝗲𝗮𝗹𝘁𝗵𝘆 𝗧𝗶𝘀𝘀𝘂𝗲 𝗔𝗱𝗮𝗽𝘁𝗮𝘁𝗶𝗼𝗻
◻️ For healthy tendons, adaptation is driven by strain (deformation).
◻️ The review highlights the following parameters for positive remodeling (increased stiffness and cross-sectional area):
◻️ Load Intensity: High-intensity loading is required. Loads greater than 70% of maximum voluntary contraction (MVC) are typically needed to induce stiffness adaptation.
◻️ Strain: The "sweet spot" for adaptation appears to be strain levels of 4.5–6.5%.
◻️ Duration: Interventions generally need to last around 12 weeks to see structural changes.

𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗧𝗶𝘀𝘀𝘂𝗲 𝗔𝗱𝗮𝗽𝘁𝗮𝘁𝗶𝗼𝗻

◻️ Tendinopathy results in a tendon that is thicker but less stiff, with a lower modulus (material quality).
◻️ While exercise aims to restore these properties, the review notes that structural improvements (like normalizing collagen structure) do not always correlate with pain reduction.
◻️ Clinical benefits may also stem from neuromuscular changes, such as increased muscle strength or shifts in the length-tension curve of the triceps surae.

𝟯. 𝗕𝗶𝗼𝗺𝗲𝗰𝗵𝗮𝗻𝗶𝗰𝗮𝗹 𝗖𝗼𝗻𝘀𝗶𝗱𝗲𝗿𝗮𝘁𝗶𝗼𝗻𝘀 𝗳𝗼𝗿 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗣𝗿𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻 ⚙️
◻️ The review analyzes five distinct parameters that clinicians modify when prescribing exercise for AT.
🟢 𝗔. 𝗠𝘂𝘀𝗰𝗹𝗲 𝗖𝗼𝗻𝘁𝗿𝗮𝗰𝘁𝗶𝗼𝗻 𝗧𝘆𝗽𝗲
◻️ Historically, eccentric (lengthening) exercise was the gold standard.
◻️ However, the review finds that mixed protocols (combining concentric and eccentric phases) and isometric protocols also produce comparable results.
◻️ Key Takeaway: There is insufficient evidence to exclusively prescribe eccentric exercises. Clinicians should focus on patient tolerability and engagement rather than a specific contraction type.
🟢 𝗕. 𝗟𝗼𝗮𝗱 𝗜𝗻𝘁𝗲𝗻𝘀𝗶𝘁𝘆
◻️ This is arguably the most critical factor.
◻️ In healthy individuals, high-magnitude loads (>70% MVC) are necessary to achieve the high strain levels required for adaptation.
◻️ The Challenge: Translating this to injured populations is difficult due to pain and strength deficits.
◻️ Heavy Slow Resistance (HSR): This approach is highlighted as a viable option. It uses heavy loads (up to 6-repetition maximum) and has shown clinical benefits and high patient satisfaction.
◻️ Key Takeaway: Prioritize high-magnitude loading and load progression over time to avoid a rehabilitation plateau.
🟢 𝗖. 𝗟𝗼𝗮𝗱𝗶𝗻𝗴 𝗙𝗿𝗲𝗾𝘂𝗲𝗻𝗰𝘆 𝗮𝗻𝗱 𝗥𝗮𝘁𝗲
◻️ While research in this specific area is limited, high loads combined with low frequencies (e.g., 3 seconds loading/3 seconds relaxation) appear superior for adaptation in healthy tissue.
◻️ Key Takeaway: Most successful AT protocols, such as HSR and Alfredson’s, utilize "slow" loading speeds (e.g., 6 seconds per repetition).
🟢 𝗗. 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗣𝗼𝘀𝗶𝘁𝗶𝗼𝗻𝗶𝗻𝗴
◻️ The position of the hip, knee, and ankle dictates how much force passes through the Achilles.
◻️ Knee Position: The soleus contributes to plantar flexion regardless of knee angle, but the gastrocnemius is disadvantaged when the knee is flexed. Therefore, performing exercises with the knee extended generally allows for greater force transmission and tendon strain.
◻️ Ankle Position: Maximum dorsiflexion increases force through the tendon.
◻️ Weight-Bearing (WB): WB exercises are preferred not necessarily because of the position itself, but because they facilitate high-magnitude loading by using body weight.
◻️ Caveat: For insertional Achilles tendinopathy, loading in deep dorsiflexion can be irritable and should often be avoided in early rehabilitation.
🟢 𝗘. 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗦𝗰𝗵𝗲𝗱𝘂𝗹𝗲
◻️ The famous "Alfredson protocol" prescribes a high volume of exercise: 180 repetitions per day (3 sets of 15, twice daily, 7 days a week).
◻️ Key Takeaway: This high volume may not be necessary. A "do-as-tolerated" approach has shown equal improvement to the standard 180-rep protocol.
◻️ A 12-week intervention duration remains the standard recommendation.

𝟰. 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗥𝗲𝗰𝗼𝗺𝗺𝗲𝗻𝗱𝗮𝘁𝗶𝗼𝗻𝘀 📋
◻️ Prioritize Magnitude: High-magnitude, repeatable loading is likely the most important factor for tendon adaptation. This can be achieved through weight-bearing exercises or non-weight-bearing exercises with added resistance.
◻️ Individualize the Program: There is no single "optimal" protocol. Exercise should be tailored to client tolerability to ensure adherence.
◻️ Use Heavy Loads: Progression toward heavy loads (>70% MVC or heavy slow resistance) is supported by principles of healthy tendon remodeling.
◻️ Simplify Positioning: While knee extension and dorsiflexion theoretically maximize load, achieving high-magnitude loading is more important than the specific posture. Weight-bearing positions are practical and effective.
◻️ Rethink Volume: Excessive repetition volume (like the strict Alfredson protocol) may not be superior to lower-volume, high-intensity approaches that are executed as tolerated.

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

Link to Article 👇