Exercise Professional Education

03/31/2026

Catastrophizing contributes to the association between posttraumatic stress symptoms and pain outcomes in individuals with chronic low back pain: Differential effects as a function of s*x

"Abstract
Posttraumatic stress symptoms (PTSS) are prevalent among individuals with chronic low back pain (CLBP) and are associated with worse pain-related outcomes. Pain catastrophizing is a cognitive factor associated with both trauma symptoms and pain, though it remains unclear whether these associations differ by s*x, particularly given evidence that males and females may differ in trauma-related cognitive and emotional responses to pain. This study examined the extent to which pain catastrophizing contributes to the association between PTSS and pain outcomes in patients with CLBP, and whether these associations vary by s*x. Participants were 742 adults with opioid-treated CLBP enrolled in a multisite randomized trial. Self-report measures assessed presence of PTSS (i.e., positive screen), pain catastrophizing, severity, and interference, and CLBP-related disability. Moderated mediation analyses were conducted using PROCESS Macro, controlling for psychological well-being, age, opioid dose, and study site. Results indicated that a positive PTSS screen was associated with higher catastrophizing, which in turn was associated with worse pain outcomes (severity, interference, and disability). S*x moderated the association between PTSS and catastrophizing, with a stronger relationship in males than females. Consequently, the indirect associations of PTSS with all pain outcomes via catastrophizing were significantly stronger among males. Findings support catastrophizing as a cognitive factor influencing the association between PTSS and pain-related outcomes in CLBP, and this association appears more salient in males. These findings highlight the importance of screening for PTSS and pain-related cognitive processes. Trauma-responsive interventions, informed by s*x-related differences in coping and socialization, may enhance precision care in CLBP."

Yamin JB, Wilson JM, Meints SM, Jamison RN, Aglio LS, Zgierska AE, Barrett B, Garland EL, Burzinski CA, Goldstein E, Edwards RR. Catastrophizing contributes to the association between posttraumatic stress symptoms and pain outcomes in individuals with chronic low back pain: Differential effects as a function of s*x. J Pain. 2026 Feb 25;42:106250. doi: 10.1016/j.jpain.2026.106250. Epub ahead of print. PMID: 41759690.

03/24/2026

Five-year follow-up of patients with knee osteoarthritis not eligible for total knee replacement: results from a randomised trial

"ABSTRACT

Objectives
The main objective was to investigate 5-year outcomes in patients with knee osteoarthritis, randomised to one of two non-surgical treatments.

Setting
Two outpatient clinics.

Participants
At baseline, 100 patients with radiographic and symptomatic knee osteoarthritis not found eligible for knee replacement (KR) were included. Main exclusion criteria were average score above 75 of the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, function of daily living and quality of life; KOOS4 and average knee pain the previous week greater than 60 mm on a 100 mm visual analogue scale.

Interventions
Patients were randomised to supervised
non-surgical treatment consisting of patient education, supervised exercise, weight loss, insoles, and pain medication (the MEDIC treatment) or written advice. The 12-week MEDIC treatment included patient education, neuromuscular exercise, insoles and a dietary weight loss programme and/or pain medication if needed and written advice consisted of two leaflets.

Primary and secondary outcome measures
Primary outcome was 5-year mean change for KOOS4. Secondary outcomes included KOOS subscales, self-reported health, usage of pain medication and self-reported physical activity.

Results
Thirty-nine (78%) and 36 (72%) from the MEDIC and written advice groups responded at 5 years. There were no between-group differences in KOOS4 (difference5.3 (95% CI −1.5 to 12.1) or any secondary outcomes. However, the 95% CI included the minimal clinically important difference for the main outcome. Seventy-six percent of the MEDIC group and 66% of the written advice group experienced clinically important improvements in KOOS4. Fifteen patients (30%) from the MEDIC group and 17 (34%) from the written advice group received KR in the index knee. Undergoing KR did not result in a statistically significant greater improvement in KOOS4 (difference 6.1 (95% CI −1.1 to 13.4).

Conclusions
No statistically significant differences between supervised non-surgical treatment and written advice were demonstrated at 5 years. Most patients experienced clinically important improvements, irrespective of initial treatment strategy or KR."

Larsen JB, Roos EM,Laursen M, et al. Five-yearfollow-upof patientswith knee osteoarthritisnot eligible for total kneereplacement: results from arandomised trial. BMJ Open2022;12:e060169. doi:10.1136/bmjopen-2021-060169

03/17/2026

Physical activity behavior predicts endogenous pain modulation in older adults

"Abstract
Older adults compared with younger adults are characterized by greater endogenous pain facilitation and a reduced capacity to endogenously inhibit pain, potentially placing them at a greater risk for chronic pain. Previous research suggests that higher levels of self-reported physical activity are associated with more effective pain inhibition and less pain facilitation on quantitative sensory tests in healthy adults. However, no studies have directly tested the relationship between physical activity behavior and pain modulatory function in older adults. This study examined whether objective measures of physical activity behavior cross-sectionally predicted pain inhibitory function on the conditioned pain modulation (CPM) test and pain facilitation on the temporal summation (TS) test in healthy older adults. Fifty-one older adults wore an accelerometer on the hip for 7 days and completed the CPM and TS tests. Measures of sedentary time, light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were obtained from the accelerometer. Hierarchical linear regressions were conducted to determine the relationship of TS and CPM with levels of physical activity, while controlling for demographic, psychological, and test variables. The results indicated that sedentary time and LPA significantly predicted pain inhibitory function on the CPM test, with less sedentary time and greater LPA per day associated with greater pain inhibitory capacity. Additionally, MVPA predicted pain facilitation on the TS test, with greater MVPA associated with less TS of pain. These results suggest that different types of physical activity behavior may differentially impact pain inhibitory and facilitatory processes in older adults."

Naugle KM, Ohlman T, Naugle KE, Riley ZA, Keith NR. Physical activity behavior predicts endogenous pain modulation in older adults. Pain. 2017 Mar;158(3):383-390. doi: 10.1097/j.pain.0000000000000769. PMID: 28187102.

03/15/2026

It was an excellent weekend in Columbus with our colleagues Evan Broadhead and Logan DeSellems, with Charlie Rowe and Will Fox supporting MSS Advanced Course 1 - Executing and Interpreting the QMAMC complete! A critical competency for successful practice.

03/14/2026

Cool video

03/11/2026

Nice device very innovative!

https://www.facebook.com/stories/2172292446122369/UzpfSVNDOjE1NTM2NTEzNzU3MzQyMTY=/?view_single=1&source=shared_permalink&mibextid=wwXIfr

03/10/2026

Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging

"Abstract

Importance:
Shoulder pain is a common musculoskeletal complaint often attributed to rotator cuff (RC) abnormalities. Diagnostic imaging is frequently used, but the association between RC abnormalities and shoulder symptoms remains uncertain.

Objective:
To determine the prevalence of RC abnormalities in a general population sample and their association with shoulder symptoms.

Design, setting, and participants:
Population-based cross-sectional study in a nationally representative random sample of adults aged 41 to 76 years who underwent standardized clinical assessment and bilateral 3-Tesla magnetic resonance imaging (MRI) of the shoulders conducted from February 2023 to April 2024 in Finland. Eligibility criteria included ability to undergo MRI and absence of previous shoulder replacement surgery.

Exposures:
Structured interviews, standardized questionnaires, clinical shoulder tests, and shoulder MRI.

Main outcomes and measures:
RC tendon status was classified on MRI as normal, tendinopathic, partial-thickness tear (PTT), or full-thickness tear (FTT). Shoulder symptoms were defined as pain or dysfunction in the preceding week. The prevalence of RC abnormalities was compared across age groups and between symptomatic and asymptomatic shoulders, adjusting for demographic factors, concurrent MRI findings, and clinical examination."

Results:
Among 602 participants (median age, 58 [range, 41-76] years; 52% female), RC abnormalities on MRI were found in 595 (98.7%; 95% CI, 97.5%-99.5%): 25% tendinopathy, 62% PTT, and 11% FTT. The prevalence and severity of abnormalities increased with age but did not differ between s*xes. RC abnormalities were present in 96% of asymptomatic shoulders (1039 of 1076) and 98% of symptomatic shoulders (126 of 128). Only FTTs were more prevalent in symptomatic shoulders (14.6%) than in asymptomatic shoulders (6.5%), but this difference diminished after adjustment (absolute difference, 0.8%; 95% CI, -3.4% to 6.0%).

Conclusions and relevance:
In this population-based study, RC abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms. These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain."

Ibounig T, Järvinen TLN, Raatikainen S, Härkänen T, Sillanpää N, Bensch F, Haapamäki V, Toivonen P, Björkenheim R, Ryösä A, Kanto K, Lepola V, Joukainen A, Paavola M, Koskinen S, Rämö L, Buchbinder R, Taimela S. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. 2026 Feb 16:e257903. doi: 10.1001/jamainternmed.2025.7903. Epub ahead of print. PMID: 41697693; PMCID: PMC12910452.

03/03/2026

Dysfunction of the muscles can lead to persistent postpartum low back pain.

“Abstract

Abdominal muscles may be both morphologically and functionally affected by pregnancy. Dysfunction of the muscles can lead to persistent postpartum low back pain. The recovery process of the abdominal muscles following childbirth is not well understood. This study aimed to demonstrate the changes in the thickness and contractile function of abdominal muscles during the first six months postpartum. Nine perinatal and 15 nulliparous females participated. The thicknesses and contraction/relaxation thickness ratios of the re**us abdominis (RA), external abdominal oblique (EO), internal abdominal oblique (IO), and transverse abdominis (TrA) were measured using ultrasound images from 36–39 weeks’ gestation until six months postpartum. The RA, IO, and TrA muscles were thinner in perinatal females than controls at 36–39 weeks of gestation (4.8 vs. 9.47 mm (RA), 5.45 vs. 7.73 mm (IO), 2.56 vs. 3.38 mm (TrA), respectively). The thinner IO muscle persisted for six months after delivery. The decreased TrA thickness ratio persisted until four months post-delivery. Abdominal muscle thickness and contractile function decreased in the postpartum period. Therefore, abdominal muscle exercises might help prevent postpartum symptoms; however, because deterioration of muscle function is significant in the first four months, careful attention should be paid to exercise intensity. The study limitation was a relatively small sample size, thus future studies should involve more participants.”

Fukano M, Tsukahara Y, Takei S, Nose-Ogura S, Fujii T, Torii S. Recovery of Abdominal Muscle Thickness and Contractile Function in Women after Childbirth. Int J Environ Res Public Health. 2021 Feb 22;18(4):2130. doi: 10.3390/ijerph18042130. PMID: 33671663; PMCID: PMC7926552.

02/24/2026

Gotta be careful about when to initiate active ROM post rotator cuff repair…

Healing After Surgical Repair? A Systematic Review and Meta-analysis

“Background:
The timing of passive range of motion (ROM) after surgical repair of the rotator cuff (RC) has been shown to affect healing. However, it is unknown if early or delayed active ROM affects healing.

Purpose:
To determine whether early versus delayed active ROM affects structural results of RC repair surgery.

Study Design: Systematic review and meta-analysis.

Methods:
A systematic review of articles published between January 2004 and April 2014 was conducted. Structural results were compared for early (\6 weeks after surgery) versus delayed (!6 weeks after surgery) active ROM using chi-square and Fisher exact tests, as well as relative risks (RRs) and 95% CIs. The analyses were stratified by tear size and repair method.

Results:
A total of 37 studies (2251 repairs) were included in the analysis, with 10 (649 repairs) in the early group and 27 (1602 repairs) in the delayed group. For tears "3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for transosseous plus single-row suture anchor repairs (39.7% vs 24.3%; RR, 1.63 [95% CI, 1.28-2.08]). For tears .3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for suture bridge repairs (48% vs 17.5%; RR, 2.74 [95% CI, 1.59-4.73]) and all repair methods combined (40.5% vs 26.7%; RR, 1.52 [95% CI, 1.17-1.97]). For tears .5 cm, the risk of structural tendon defect was higher in the early versus delayed group for suture bridge repairs (100% vs 16.7%; RR, 6.00 [95% CI, 1.69-21.26]). There were no statistically significant associations for tears measuring "1, 1-3, or 3-5 cm.

Conclusion:
Early active ROM was associated with increased risk of a structural defect for small and large RC tears, and thus might not be advisable after RC repair.”

Am J Sports Med published online May 5, 2015 Melissa A. Kluczynski, Maureen M. Isenburg, John M. Marzo and Leslie J. Bisson A Systematic Review and Meta-analysis Does Early Versus Delayed Active Range of Motion Affect Rotator Cuff Healing After Surgical Repair?

02/19/2026

Tough article for exercise professionals advocating for “stretching” …

Stretching not exactly a pillar of fitness, 20 experts agree.

20 stretching experts pooled their expertise for an ambitious consensus paper (Warneke et al. PMID 40513717).

This is not a “scientific review,” exactly: it formalizes expert opinion of existing reviews, which is more clinically useful, more PRACTICAL and broader in scope than a scientific review.

The clickbait headline for this would be “The Great Stretching Myth: 20 Scientists Reveal What Actually Works — and What Doesn’t.”

And it doesn’t work for much.

Speaking of consensus, this paper mostly has my back on everything I’ve ever written about stretching. It’s like a summary of my own work on the topic!

HERDING EXPERT CATS

A bunch of experts is a proverbial “herd of cats,” so how do you get them on the same page? You use a structured “Delphi” process — a formal, multi-round method for reaching expert agreement. The all met up to kick things off, and then after that it was all written opinions, iterative and anonymized (although I bet some opinions didn’t have to be signed to be recognizable). They settled on definitions for the three main types of stretching: static (holding a muscle at length), dynamic (controlled movement through range), and PNF (a combination of stretching and muscle contraction).

They were more divided on the definition of “dynamic stretching” than anything else they covered — just 80% agreement. Very on-brand for exercise science. 😏

After definitions, they reviewed the reviews on eight major stretching topics: range of motion (ROM), strength, muscle growth (hypertrophy), stiffness, injury prevention, recovery, posture, and cardiovascular health.

THE LEAST BAD NEWS: FLEXIBILITY

The clearest finding (95% panel agreement): stretching reliably improves flexibility. “It is known”: both short-term (acute) and long-term (chronic) stretching increase ROM. But curb your enthusiasm, because stretching is not the only way to unlock this achievement — other activities like resistance training or foam rolling can improve flexibility just as well, and arguably resistance training offers far better bang for your exercise buck.

And it’s also the only benefit of stretching the panel confirmed wholeheartedly. All other benefits were minimal and heavily disclaimed.

THE NEXT CLOSEST THING TO GOOD NEWS: FLEXIBLE BLOOD VESSELS

Warneke et al. give us a very cautious recommendation to stretch for … cardiovascular health? There’s some evidence that stretching reduces arterial stiffness and improves cardiovascular health. But the evidence isn’t good enough yet, and this benefit (like flexibility) can likely be had better with other kinds of exercise — leaving it only as a practical option “for those unable to engage in active (therapeutical) exercise.”

PLENTY OF MIXED AND BAD NEWS

They also acknowledge that stretching might reduce the stiffness of muscles or tendons, but with important caveats: it takes a huge dosage, it’s not a strong effect, and it’s not even clearly a good thing (tendon stiffness is probably a FEATURE, not a bug).

On strength and muscle size: a good dose of stretching (>60s) makes you temporarily weaker, acutely undermining explosive effort. Over weeks, high-volume static stretching can (weirdly) increase strength and muscle mass — but only slightly and requires a surprising time investment: do 15 minutes per muscle per day for six weeks, and you may not have time for much else, and all for what? “Slight” strength gains. The panel bluntly states stretching is not recommended as a primary strategy for building strength or muscle.

Injury prevention? Despite decades of hopeful practice and research, the thin evidence definitely does not support stretching as a general injury-prevention tool. Some data suggest static stretching might reduce muscle injuries, but maybe at the COST of more bone/joint injuries (plausible, but based only on scraps of evidence so far).

Soreness? Does it take the edge off? The panel agreed 100% on this one: no!

The other recommendation they were unanimous on: don’t bother stretching to improve posture. Not that posture generally needs much improving. But even if it did, stretch wouldn’t help.

“MORE STUDY NEEDED,” OF COURSE — BUT IT’S SURE NOT LOOKING GOOD FOR STRETCHING

Some limitations: the panel was overwhelmingly male, they focused on healthy populations, and they relied on existing systematic reviews — which rest on a foundation of trials that leaves much to be desired. As the authors note, “scientific research is an ever-evolving process,” and “a number of stretching applications have barely been explored in the literature.”

Stretching is nowhere close to being a pillar of fitness like so many people assume. It has only a couple known or half-known benefits, and even those aren't clean wins, because other kinds of exercise do the same and more. Stretching remains something to do almost entirely because it feels good; most common goals that people have in mind for it are faith-based at best, or actually contradicted by the science we have so far.

~ Paul Ingraham, PainScience.com publisher

02/17/2026

Assessing Agreement in Lower-Body Joint Interlimb Asymmetries in Isometric, Dynamic, and Loaded Conditions

"Abstract
Rosenblum, LJ, Lovalekar, M, Martin, BJ, Feigel, ED, Mroz, KH, McCarthy, AM, Koltun, KJ, Stefl, TJ, Forse, JN, Doyle, TLA, and Nindl, BC. Assessing agreement in lower body joint inter-limb asymmetries in isometric, dynamic, and loaded conditions. J Strength Cond Res XX(X): 000–000, 2025—Interlimb asymmetry (ILA) for static and dynamic movements can indicate aberrant musculoskeletal and neuromuscular function. The purpose of this analysis was to measure ILA agreement in different isometric, dynamic, and loaded conditions at the ankle, knee, and hip, for single-joint and lower-body ILA; to assess the effect of a load on kinetic and kinematic ILA during jumps; and to evaluate the effect of physiological fatigue on gait ILA. Twenty-two men (30.2 ± 5.0 years, 1.8 ± 0.08 m, 85.6 ± 10.0 kg, 16.9 ± 5.4% body fat) participated in ankle, knee, hip, and lower-body assessments of relative (N·kg−1) and peak isometric strength (N); dynamic peak range of motion (º) and dynamic peak forces (N) without and with load (9.7 kg); and tibial impact (g) during aerobic capacity tests (pre- and at-fatigue). Agreements between ILA (≥10% vs.