Terry Mclaren Functional Physio

21/04/2026

Tighten that!! 😮‍💨

🔥 Which glute exercise packs the biggest punch?⁠

🍑 Collings et al. (2023) set out to determine gluteal muscle forces across different exercises.⁠ ⁠

📊 The authors ranked the exercises into different tiers based on the estimated muscle forces.⁠ ⁠

🏆️ The single leg RDL with resistance was the only exercise to be ranked a Tier 1 exercise in all three muscle groups.⁠ ⁠

🥇 Meanwhile, the body weight side plank was ranked as a Tier 1 exercise for the gluteus minimus and medius. ⁠ ⁠

💡 For rehabilitation purposes, we may want to consider utilizing lower tier exercises and/or reducing load for those that are more load compromised, and higher tier exercises for those that are able to tolerate higher muscle forces.

21/04/2026

Good to know 🙏

19/04/2026

Move!!!!!

Exercise actually moves the mental health needle. If you want to improve your mood, go for a walk — because it will truly work.

And maybe pass on the “single-session interventions” discussed in a recent post.

Exercise for depression and anxiety just got a resounding endorsement from an unusually large new META-META-analysis — yes, that’s TWO metas, meta^2. I don’t normally write about pure psychology, but this study is truly HUGE, big enough to swerve out of my lane for.

It’s also informative to compare those exercise results from Munro et al. to the SSI results reported by Ziadni et al., which were distinctly underwhelming — and about the same as what people get from cognitive behavioural therapy (CBT).

Small but significant benefits, the authors said. Standardized mean differences in the 0.25–0.37 range. Fine. Technically real, as reported. Not exactly a revolution. Even if you believe them.

And along comes Munro et al., covering 81 meta-analyses of over 1,000 component studies, with nearly 80K participants, all examining exercise for depression and anxiety.

The effect sizes? SMD was 0.61 for depression and 0.47 for anxiety. Quite a bit more than for SSI. And THAT is what I want to see in an effect size. Not necessarily huge, but … respectable.

For reference, 0.2 is considered “small,” 0.5 is “medium,” and 0.8 is “large.”

This is a casual apples-to-pears comparison I’m making between these studies: Munro was about exercise for PEOPLE WITHOUT DISEASES, while SSI had the handicap of focusing on PEOPLE IN CHRONIC PAIN, who often struggle with exercise. A direct comparison might narrow the gap.

Or … not? Because exercise for anxiety can work just as well for people with pain: SMD .63! Exercise for depression with pain is a different story: it didn’t work nearly so well, just .21 (much like SSI). See Amiri.

Exercise can truly affect psychological states, regardless of whether there is also pain involved (high confidence) … but SSI barely does so in people with pain (quite possibility not even that, because the data is so much weaker and fishier).

If your mind and mood are relevant to your pain at all, you should certainly be taking exercise more seriously than SSI/CBT. And that’s without even considering the other general health benefits of exercise.

I’ve collected a bunch of other highlights from Munro et al. for the PainSci bibliography. Link in the comments.

~ Paul Ingraham, PainScience.com publisher

17/04/2026

Move more.🙏

15/04/2026

🙏

Over the decades your strength fades, muscle mass declines, as your aerobic capacity tanks. Tendons and connective tissues lose substance, stiffness, and resilience. For years the body compensated... quietly. Then one day a knee hurts during a run to get the train, or shoulder aches reaching overhead, or a back tightens lifting something simple.

At that point the story usually becomes more about structural damage. An MRI gets ordered. Welcome to high-tech, low-medicine. And the MRI almost always finds something. A meniscus tear. A rotator cuff tear. A disc bulge. Why? Because by midlife these findings are extremely common — even in people with no pain at all. If you have a tear in one shoulder, image the other shoulder... you probably have the same tear there. But I digress.

Once the scan appears, the narrative changes. The image becomes the diagnosis. Now the patient believes something is broken, and the focus often shifts to fixing what the MRI shows.

What often gets lost in this is the reason the symptoms appeared in the first place. Many so-called “atraumatic” orthopedic complaints are not purely mechanical failures. They are the moment when reduced strength, declining tissue capacity, and sometimes broader metabolic health issues finally reach a tipping point. Our tissues change over the decades... get over it.

In other words, the MRI didn’t create the problem. Well... it sort of did in this scenario. But all the MRI showed was something that was already there.... because of your age, lifestyle, health and so on.

The real driver of symptoms is often loss of physiologic reserve. Less muscle. Less tendon or aerobic resilience. Less tolerance for load, etc.

Once the MRI enters the picture, the risk becomes overtreatment. This is probably the number one reason people have surgery. When in many cases the most powerful intervention was never the scan or the procedure.

15/04/2026

👍

13/04/2026

Great to know

According to the JOSPT Clinical Practice Guidelines, successful outcomes rely on a few core principles:

👉 Early mobilization
👉 Progressive loading
👉 Functional restoration

High-intensity strengthening—especially for the quadriceps—along with gait symmetry and functional training should be the foundation, not an afterthought.
At the same time, not every commonly used intervention is evidence-supported (yes, we’re talking about CPM 👀).

Modalities like neuromuscular re-education and cryotherapy can help—but they should support, not replace, active rehabilitation.

💡 CPGs aren’t perfect—but they provide a strong, evidence-informed framework to guide smarter clinical decisions and optimize patient outcomes.

12/04/2026

Good to know 👍

09/04/2026

So interesting 🧐

07/04/2026

Nice to hear 🙏

07/04/2026

Worth thinking about 🙏

The claim circulating widely online is that steady-state aerobic training chronically elevates cortisol in perimenopausal women in ways that accelerate muscle loss, worsen hormonal dysregulation, and compound the effects of menopause. This sounds plausible, and it is stated with enormous confidence. The evidence behind it is thin.

Cortisol does rise acutely during exercise, this is normal and necessary, and it is part of the signaling cascade that drives adaptation. What matters for health is our chronic resting cortisol pattern, not the acute exercise response. The studies most frequently cited to support the “zone 2 is harmful for women” claim are typically small, poorly controlled, and not specifically conducted in perimenopausal women. A 2021 systematic review in Sports Medicine found no evidence that moderate-intensity continuous training leads to chronically elevated cortisol levels in healthy women. Disordered eating, inadequate sleep, too little exercise, and extreme caloric restriction are all far more common in the wellness-optimization community than most acknowledge, are the actual drivers of the chronic cortisol dysregulation these coaches are warning against.

Sustained aerobic exercise does not chronically elevate cortisol in women who are sleeping adequately, eating sufficiently, and not overtraining. Moderate-intensity aerobic training, done consistently, improves cardiovascular risk markers, metabolic health, VO2 max, and mood in this population.

06/04/2026

Put in some effort, it’s worth it 🙏

Years ago, movement was effortless. Stairs were just stairs. Groceries were carried without thought. Life felt alive, and the body felt unstoppable.

Then comfort crept in, slowly and quietly. At the mall, elevators and escalators are everywhere, carrying people effortlessly upward, while the stairs sit forgotten, ignored. The elevator seems easier, the escalator faster, and little by little, the habit of taking the easy way steals your freedom.

But what if you challenged yourself to take the stairs? Why not? Simply climbing stairs strengthens your muscles, wakes your heart and lungs, improves balance, and reminds your body that it is capable. Every step is a small act of care for yourself, a way to feel alive, strong, and present in your own body.

So, if you see a stair wherever you are, just simply challenge yourself to choose the stairs and keep challenging yourself..