Stewart Physiotherapy

17/11/2025

🤓 Toresdahl et al 2023 did a study on runners 🏃 training for the New York city marathon and found that most injuries sustained were associated with rapid increases in training volume where their acute:chronic workload ratio (ACWR) was 1.5 or more. (Acute is this week’s training and Chronic is the average of the least 4 week’s training)

Another interesting note was that injuries in this study doubled in the first and final 4 weeks of the athlete’s training program. 🙈

➡️So the main conclusion is that runners 🏃‍♂️ need to avoid rapid increases in volume!
physio

www.stewartphysiotherapy.co.za

17/11/2025

🤓 Toresdahl et al 2023 did a study on runners 🏃 training for the New York city marathon and found that most injuries sustained were associated with rapid increases in training volume where their acute:chronic workload ratio (ACWR) was 1.5 or more. (Acute is this week's training and Chronic is the average of the least 4 week's training)

Another interesting note was that injuries in this study doubled in the first and final 4 weeks of the athlete's training program. 🙈

➡️So the main conclusion is that runners 🏃‍♂️ need to avoid rapid increases in training volume!

RunningPhysio

www.stewartphysiotherapy.co.za

Why do marathon runners get injured? 🤔
A recent study of over 700 runners who were training for New York City Marathon reported that 40% developed an injury during training. The majority of these were considered minor injuries and only 30 people (4.1% of runners) had a ‘major’ injury which prevented them from running the marathon.
Injuries were associated with rapid increases in training volume but were not associated with exceeding the popular ‘10% rule’. Instead they were related to a measure called acute:chronic workload ratio (ACWR) which compares acute training (i.e. this week) with chronic training (the average of the last 4 weeks). ACWR of 1.5 or more was associated with injury (see paper below for details). Also of note - prevalence of injuries doubled between the first 4 weeks of the training plan and the final 4 weeks.
As with any study there are limitations. Running data was taken from Strava, training pace/ intensity or type was not recorded and injuries were self-reported.
Take home messages:
- Help runners plan their training to avoid rapid increases in volume
- Don’t rely on the 10% rule in isolation!
- Think of marathon training as 6 months, not 4. The first 2 months are for building a baseline to prepare for the 4 month plan and prevent the need for rapid increases.
Reference:
Toresdahl BG, Metzl JD, Kinderknecht J, McElheny K, de Mille P, Quijano B, Fontana MA. Training patterns associated with injury in New York City Marathon runners. Br J Sports Med. 2023 Feb;57(3):146-152. doi: 10.1136/bjsports-2022-105670. Epub 2022 Sep 16. PMID: 36113976.

31/10/2025

So grateful to be able to work with this special team and amazing people! 💛🙌🏼



www.stewartphysiotherapy.co.za

25/09/2025

Celebrating Heritage Day 🇿🇦❤️🇿🇦 and the beauty of so many different cultures! 🙌🏼❣️

www.stewartphysiotherapy.co.za


🇿🇦

❤️

08/09/2025

Still pinching ourselves! 🎉Just over 24 hours ago finished presenting one of the most brilliant courses, in Johannesburg, South Africa. 🇿🇦

The Painful Shoulder: Complex doesn’t 🟰complicated💪🏽💪🏽💪🏽

The shoulder now makes a lot more sense: we have come away with tips and tricks to connect better with patients, to do sound clinical reasoning and some world class rehab.

Adam inspires one to be accountable as a therapist, using evidence to support assessment and treatment. He encourages us to question and challenge possibly outdated beliefs and to use good clinical reasoning to formulate our own ideas instead. 🤓 He also supports the use of clear, uncomplicated strategies for a patient’s education and rehab, which can actually be much harder for therapists to achieve.

We should never be afraid to change, if we can soundly be shown otherwise. This in itself is a sign of true intelligence. 🙌🏼

This past weekend has been a highlight in our physio careers. Thank you from everyone Adam. 💥🙏

05/09/2025

Happy administrative professionals day for the 3rd September Maria and Mamo! What you do for the practice, on a daily basis, is invaluable and we are so lucky and appreciative to have such wonderful women at the front of house! Celebrating you both this week! 💥🙌🏼🎉❤️🤓

www.stewartphysiotherapy.co.za





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25/08/2025

➡️For women over the age of 50, 1 in 4 women are thought to struggle with gluteal tendinopathy. A drop in oestrogen levels, which is associated with menopause, is considered to a big factor in affecting collagen tensile strength and synthesis. 💪🏽

According to a study by Cowan et al (2021) "Menopausal hormone therapy with any exercise plus education was associated with greater improvements in pain and dysfunction as compared with placebo cream in a subgroup of participants (BMI

Can HRT help patients with Gluteal Tendinopathy?
Gluteal Tendinopathy (GT) is thought to affect 1 in 4 women over the age of 50. Changes in oestrogen levels that are associated with the menopause are thought to be a key factor and may influence collagen synthesis and tensile strength.
Hormone Replacement Therapy (HRT) has the potential to help address these hormone changes but hasn’t been studied as a treatment in tendinopathy until recently. Cowan et al. (2021) found the addition of Menopausal Hormone Therapy improved outcomes for patients with GT but only in a subgroup of participants with a BMI of less than 25.
More research is needed but it’s worth discussing with your patients, especially if they are considering HRT for other health benefits. For peri-menopausal patients who present with tendon pain it can help to slow down the progress of rehab and return to activity to allow more time for adaptation. For runners a gradual return to training is needed, especially with provocative sessions like hill running and faster workouts. Other factors like general health, previous injury, obesity and mental wellbeing should also be considered.
Key Reference:
Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med. 2022 Feb;50(2):515-525. doi: 10.1177/03635465211061142. Epub 2021 Dec 13. PMID: 34898293.

28/07/2025

10 beautiful happy years at Stewart Physiotherapy. 🥳🎉🎈Thank you to all the therapists, patients, receptionists, and administrators who have been part of our journey! 🙌🏼

www.stewartphysiotherapy.co.za

18/07/2025

Meet Anecia! 👋 Anecia has been with us for just over a year, but has officially joined the practice full time from July 2025.

Anecia obtained her BSc Physiotherapy degree from Sefako Makgatho Health Sciences University in 2022. She has since completed Dry Needling level 1 and 2, a comprehensive Strapping Course and is currently completing her Practical Sports Physiotherapy Course. Her special interests include orthopaedic and respiratory conditions. Anecia is committed to helping patients through every stage of their healing journey.

www.stewartphysiotherapy.co.za

08/07/2025

Injury (and pain) can be influenced by many different factors in our lives. People who sleep less than 8 hours per night are at a 1.7x greater risk of being injured. Work on good sleep hygiene as part of your general health and injury prevention plan. 😴



www.stewartphysiotherapy.co.za

07/07/2025

Awesome morning learning more about the elbow. Thanks to Tanya Belle-Jenje and . Such a great online course about lateral elbow pain! 💪🏽 🤓

Also had some fun playing with our hand dynamometer. Josh is definitely the strongest with Onika a close second! 🙌🏼

www.stewartphysiotherapy.co.za

27/06/2025

Wow 💨