Milo Strength Rehab

03/30/2026

🤷‍♂️

03/25/2026

Imaging can be useful but here’s some more data supporting the limitations of its use!

Many asymptomatic people display an anatomical rotator cuff abnormalities WITHOUT accompanying symptoms.

Importantly:
👉 abnormalities increased with age beginning with tendinopathy as a common finding in 45-54 and increasing damage after that
👉 worse damage was associated with more likelihood of symptoms
👉 no substantial differences between genders
👉 most abnormalities were found in asymptomatic individuals underlaying the poor causality between symptoms and imaging

“Consequently, a positive MRI result does not confirm causality unless features such as a clear traumatic event, acute strength loss, or persistent functional deficit increase the pretest probability.”

So that tear you see on the MRI? Do we really know that it wasn’t already there when you started developing pain recently? NO. Yet we are so quick to push people towards surgeries 👉 maybe this is why we see a lot of sham surgeries having similar outcomes 🤷‍♂️

Unless there is
👉 clear mechanism of injury
👉 acute strength loss
👉 lack of improvement with skilled care

… we CANNOT say that the abnormality found on imaging alone is the cause for the dysfunction.

The shoulder is a complicated beast, sometimes the issue doesn’t lay within the first hypothesis we think we identify 🧐

Further reading 📖:

Ibounig, T., Järvinen, T. L. N., 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. (2026). Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA internal medicine, e257903. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.7903

03/20/2026

Excited to once again present at an VA state clinic! There’s a great line up of speakers which leads to an awesome learning opportunity from some of the industry leaders.

Register at https://www.nsca.com/events/state-and-regional/virginia-state-clinic/

03/16/2026

03/14/2026

💥 Research spotlight 💥

What 👉 impact of Nordic Hamstring Curl (NHC) training and detraining on the muscle

Background and objective 🔍: NHC has been shown to be effective at reducing hamstring strain injury. Specific adaptations of all the hamstring musculature have not been documented.

Goal 👉 identify structural adaptations to NHC training and detraining

Methods 🧐: 11 subjects completed 9 weeks of supervised NHC training (4-5 sets 6-8 reps) followed by a detraining period. MRI was utilized to determine muscle architectural changes.

Inclusion criteria: no history of lower limb injury or previous training of NHC within the last year

Exclusion criteria: n/a

Results 📝: NHC significantly increased size and fascicle length of the hamstrings. Hypertrophic changes were greater in the semitendinosus and biceps femoris long head vs semimembranosus and biceps femoris short head. With detraining, fiber tract length rapidly decreased back to baseline compared to volume and cross sectional gains which were maintained for the most part.

Limitations 🚨:
1️⃣ absence of control group
2️⃣ small sample size
3️⃣ lack of control of hip and knee angles

Discussion/implications 📖:

Many times the risk of hamstring related injury is not a flexibility issue but a fascicle length issue - increasing this could lead to better injury prevention of hamstring related injury. Additionally, the NHC increases volume which leads to better force production (theoretically) decreasing the risk of overload injuries. The NHC also seems to target the biceps femoris and semitendinosis implicating specific muscular protective mechanisms.

03/14/2026

Is it actually this bad? No. But what’s a little hyperbole between professionals 🤷‍♂️

03/05/2026

Listen… it’s different when you have exercise homework 🤷‍♂️

02/28/2026

“Not everything that is faced can be changed, but nothing can be changed until it is faced.”

02/24/2026

Experience is proportional to what you think you know versus what you actually know.

True experience will begin to teach you that you don’t actually know nearly as much as you think you do.

The ability to know your role in a healthcare team based on this is crucial - overestimation is only hindering your athletes.

The ability to change what you may have thought of as good rehab based on quality advice/evidence is a foundation of a good clinician.