Celia Cohen Chartered Physiotherapist

13/04/2026

Attention! - It's giveaway time 🔔
We've teamed up with Equisafety to bring you this fantastic giveaway... Fancy getting your hands on one of TWO popular Hi-Vis Air Waistcoats?! If so, all you need to do is simply:

✅ Like this post
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Waistcoats reads: "Horse in training, pass at 10mph" and are both size XL

Competition ends midnight THIS SUNDAY (19/04/26)... and the winners will be announced shortly after. T&Cs Apply. Good Luck 🍀

23/02/2026

Interesting article . The principle applies to any mammal . The racing industry could learn and adapt appropriately if they fully understood bone adaptation vs soft tissue and CV adaptation .

Reframing bone stress injury post No. 2

THEY ARE NOT ALL THE SAME!!!🤯

Stop trying to treat them all the same or taking advice from someone whose BSI isn’t the same as yours!

Bone Stress Injuries: Why the Location Matters More Than You Think 🦴🏃‍♀️

Not all bone stress injuries are created equal. Where your BSI occurs can double your rehab time and triple your complication risk.

Here’s what you need to know 👇

High Risk vs Low Risk Sites

📍 High-risk BSI locations (Femoral neck, Navicular, Anterior tibia, Medial malleolus, 5th metatarsal)
➡️ Slower healing
➡️ Higher complication rates
➡️ Greater risk if rushed back too soon

📍 Lower-risk BSI locations (Posteromedial tibial shaft, Fibula, 1st–4th mets, P***c bone)
➡️ Usually heal faster
➡️ Safer, earlier progression when symptoms allow

From Hoenig et al., 2023 (systematic review & meta-analysis):

📆 Mean return-to-sport timelines varied hugely
• Femoral neck: ~107 days
• Tarsal navicular: ~127 days
• Medial malleolus: ~106 days
• Tibial shaft: ~44 days
• Fibula: ~56 days

💡 Same injury type, different bone = completely different rehab plan.

Why the Difference?

🔬 Trabecular vs Cortical bone

Trabecular (e.g., femoral neck) = more vulnerable to overload → slower healing

Cortical (e.g., tibial shaft, fibula) = more tolerant → quicker return

⚠️High-risk sites often carry >40% complication rates if progressed aggressively.

23/02/2026

Reframing bone stress injuries post No 3.

TIMING AND TRAINING HISTORY REALLY MATTER!!

A large retrospective cohort study of U.S. Army soldiers by Kardouni et al. (2021) assessed the timing of Stress Fractures in Soldiers During the First 6 Career Months.

These soldiers undergo standardised, progressive training with controlled physical loads—making it a powerful model for understanding how bone responds to increasing training stress.

Key Findings:

Bone stress injury (BSI) risk peaks between weeks 4–10 of a new training cycle.

The incidence peak occurs after several weeks of load accumulation—not immediately after a spike.

Females experienced higher incidence rates than males throughout the training period, particularly at the peak.

After ~10 weeks, injury incidence gradually declined as bone adapted to the new load environment.

Why the Lag Matters

Bone adapts more slowly than muscles, tendons, and cardiovascular fitness. This creates the classic “performance outpaces tissue tolerance” problem:

Your fitness skyrockets early in a programme.

Your bones are still catching up.

You feel great… right when BSI risk is highest.

This delayed mismatch is what drives the 4–10 week injury cluster.

🏃‍♂️ Practical Implications for Training Plan Design

1️⃣ Early weeks require more caution than athletes expect

Many runners think the danger zone is the first couple of weeks. This study shows the opposite:
Weeks 4–10 are the red zone for bone stress accumulation.

2️⃣ Avoid stacking multiple load progressions at once

BSIs often follow layered stressors such as:

Increasing long run + adding speed + new strength work

Running more days/week + higher intensity

Terrain changes (hills/trails) + mileage increases

Pick ONE primary progression at a time.

3️⃣ Build in “absorption weeks”

Every 3–4 weeks, include:

Lower volume
Fewer impact loads
Reduced intensity

These aren’t “easy weeks”—they’re bone consolidation weeks.

4️⃣ Strength training is a protective tool

Bone is mechanosensitive. Lifting that includes:

Heavy lower-body loading
Multiplanar stress
Plyometric exposure

supports bone remodeling and reduces BSI risk when paired with sensible running load progressions.

5️⃣ Watch for early signs between weeks 4–10

Subtle indicators matter:

Persistent deep ache after running
Pain that appears earlier in runs
One-leg hopping pain
Night ache

These signs often appear before any imaging changes.

6️⃣ Training history changes the risk

The study used soldiers—many of whom were relatively untrained. For athletes:

Beginners & return-from-injury runners = highest risk

Well-trained runners with stable, year-round load = lower risk but still vulnerable after big training shifts

17/01/2026

This is the boy who needs harness . I’m sending one . Anyone else who has a ‘help em up’ harness they would donate please contact me . Thank you

Dexter outside enjoying some physiotherapy today ☀️
Well that was the plan anyway, but he had other plans..
He is wearing his harness proudly like a backpack for his physio sessions 🥹
The only other dog who used this harness was our angel Baloo who we sadly lost 💔 Couldn't bring myself to get it out of the bag for a year. It still smelt like him.
But Dexter is a extra special boy so now the harness is his 🥰
His physio sessions are slowly showing improvement. He is showing strength in his back leg which is a huge step really considering he has been paralysed for a very long time. After his owner broke his leg, he was unable to move at all.. so overtime he just forgot how to walk and severe muscle wastage began. Of course the pain was severe too.
Will be a little while until he is going for proper walks but he can make a few steps now 🥹
Little steps making massive impacts for his future.
His face just melts our hearts, he is the biggest soppy boy 🥰

https://www.paypal.me/fpohr

17/01/2026

These guys do some amazing work . They really need some lifting/ walking aids for the dogs . I am sending them a new ‘help em up’ harness for Dexter , a young GSD who was thrown off a roof 🥲
Does anyone have an old ‘help em up ‘ harness they would donate ? . I’m sure my one is not enough . Thank you x

WE HIT 12 THOUSAND FOLLOWERS! 🥳🩷

We would like to give the warmest welcome to our new members of the Four Paws community 🥰
Thank you so much for choosing to support us on this journey ….
We may still be a small independent rescue, but our passion and our hearts are large 🥹❤️
Four Paws started almost two years ago, and since then we have saved over 160 dogs and cats, and a beautiful green monkey Abu ☺️

We save dogs, cats and monkeys from Egypt, they are rescued from the streets, dog fighters and the markets 💔
Every one of them has experienced a severe level of cruelty, neglect and abuse.
Our mission, our dream is to save as many of these beautiful souls as we can and try our hardest to give them the most beautiful life full kindness, safety, commitment, happiness and most importantly LOVE ❤️
To spread awareness and give them a voice, to be seeing and heard 💖
To try encourage change to the justice system and laws 🙏

We have so much respect for life, and strongly believe that every life holds so much value and meaning ❤️
We can’t sadly save them all, but every life we can save we will always fight for ✊
Their lives are as precious to them as ours are to us.
They are more than rescues, they are our family and we love every one of them deeply 💖

But we could not do this alone, it is every single person involved that makes this dream a reality ….
Our team of caring, compassionate and dedicated ladies from the UK and Ireland. Our vets that are the miracle workers. Our amazing drivers, our incredible adopters, our devoted kind supporters and Georgia who is the founder of the rescue 🥰
She is truly the strongest, bravest, kindest, passionate and caring human who does everything she can, she never ever stops.
Her love for these precious souls is so pure and unconditional, they are her children.

We also have the most compassionate, kind, caring and wonderful supporters who are with us every step of the way ❤️
They are the reason the rescue can continue, without them these beautiful babies would not be here today 🥹
Together we have made something that seems at times impossible, possible 💖

We are so incredibly grateful to them, we like to think we are more than a community and a family ☺️
Thank you for joining this family and following us on this rollercoaster. You may cry tears of sadness and joy. You may smile or weep.
But one thing for certain is it will bring you so much joy and happiness watching them go from a life of torment and hell to one of pure happiness and love 🥰

We look forward to seen all your new names and please feel free to say hi 👋☺️

04/12/2025

📌 𝗧𝗵𝗲 𝗧𝗵𝗿𝗲𝗲 𝗦𝘁𝗮𝗴𝗲𝘀 𝗼𝗳 𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝘆

▪️ Tendinopathy is a prevalent tendon disorder causing persistent, localized pain, and loss of strength and function.
▪️ These common musculoskeletal injuries result from factors like overuse or excessive mechanical loading, which push the tissue beyond its physiological threshold and lead to an insufficient healing response.
▪️ Tendon pathology is generally understood to progress through a three-stage continuum: reactive tendinopathy, tendon disrepair, and degenerative tendinopathy.
▪️ Recognizing these stages is crucial, as the severity of the injury and the likelihood of successful repair are often dependent on the stage of progression.

🔵 𝙎𝙩𝙖𝙜𝙚 1: 𝙍𝙚𝙖𝙘𝙩𝙞𝙫𝙚 𝙏𝙚𝙣𝙙𝙞𝙣𝙤𝙥𝙖𝙩𝙝𝙮

▪️ This is the initial stage following an acute injury.
▪️ Key Features: Inflammatory responses begin immediately.
▪️ Tissue Changes: The tendon displays minimal collagen damage. This stage is characterized by the release of pro-inflammatory cytokines, increased fluid in the extracellular matrix (ECM), altered tenocyte shape, and de-tensioned collagen.
▪️ Reversibility: If treated within this first stage, the process is generally reversible.

🟡𝙎𝙩𝙖𝙜𝙚 2: 𝙏𝙚𝙣𝙙𝙤𝙣 𝘿𝙞𝙨𝙧𝙚𝙥𝙖𝙞𝙧

▪️ If the pathology progresses, the tendon enters the disrepair stage.
▪️ Key Features: This stage is characterized by the proliferation of abnormal tenocytes.
▪️ Tissue Changes: Features include collagen splitting and neovascularization (the formation of new blood vessels, often indicated by grouped endothelial cells). There is also an increase in type III collagen production.
▪️ Reversibility: The process is still generally reversible if treated during this stage.

🔴 𝙎𝙩𝙖𝙜𝙚 3: 𝘿𝙚𝙜𝙚𝙣𝙚𝙧𝙖𝙩𝙞𝙫𝙚 𝙏𝙚𝙣𝙙𝙞𝙣𝙤𝙥𝙖𝙩𝙝𝙮

▪️ This is considered the final or terminal stage of tendon pathology.
▪️ Key Features: This stage marks the most severe damage.
▪️ Tissue Changes: There is further disruption of collagen fibers, diffused cell death, and permanent ECM disorganization. Stage 3 also shows further increases in type III collagen production.
▪️ Treatment Outlook: Treatment becomes challenging in this terminal stage.

🧩 𝗧𝗵𝗲 𝗕𝗶𝗴𝗴𝗲𝗿 𝗣𝗶𝗰𝘁𝘂𝗿𝗲

▪️ Throughout these stages, the tendon fibers become de-tensioned (represented via thinning and looser organization of fibrils).
▪️ The progression involves the aggregation of endothelial cells, continuous inflammation, and a sustained increase in type III collagen.
▪️ It is important to note that Type I collagen constitutes more than 85% of the dry weight of a normal tendon.
▪️ Therefore, the progressive alterations in collagen phenotype (such as the increase in Type III collagen) are critical factors in determining the severity of the injury and the likelihood of successful repair.
▪️ Early detection and treatment of tendinopathies are challenging partly because of a prolonged asymptomatic phase during which ECM disorganization occurs.

01/12/2025

How amazing is the ‘engineering ‘ involved in anatomy. Blows my mind every time I think about it .

27/11/2025

In this evidence-based review, board-certified specialist Dr Mike Farrell explains how gabapentin works, its risks, and its benefits as a treatment for arthr...

27/11/2025

It’s all about the team work . A lovely example of physio/ farrier team work .
Prevention is better than cure .
Toe in, Valgus fore limb ( difficult to see in pic ) she’s over loading her medial joints / bone in the limb .
Clever farrier did this to help dissipate the load . Ben Tanner - DipWCF

08/10/2025

This we've teamed up with Bucas to bring you this exciting giveaway to win the Bucas Irish 150g Detachable Neck Turnout Rug in Espresso ☕️🍂🐴⁠
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The Bucas Irish Turnout combines toughness and comfort with its 1200 denier ripstop outer, 150g fill, and detachable neck for all-weather protection. Its silky Dermo-care lining wicks moisture to keep your horse’s coat glossy, while the magnetic Snap-lock closure and tailored shoulder darts deliver a secure, sleek fit without the fuss.⁠
⁠
It’s super easy to take part:⁠
1. Like our page⁠ and Bucas
2. Share this post
3. Tag a friend below! (Each comment is an entry) 👇⁠
⁠
Competition ends at 11:59pm on Tuesday the 14th of October and the winner will be announced shortly after. This competition is also running on our Instagram Page, so make sure you visit for extra entries!⁠
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🔗 See more info on our website: http://bit.ly/48faRQx

-Please be aware of scam & duplicate pages! Redpost Equestrian will NEVER contact winners or entrants before the competition end date, and will not request personal details or send a link for a prize to be⁠ claimed-⁠
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21/10/2024

https://www.jumblebee.co.uk/charddistrictrda

A great cause and for all my dog clients I donated a dog treatment . Get bidding xx

jumblebee offers a service to communities and charities, allowing communication, advertising, trading and fundraising, free silent auction

17/10/2024

I’ve been asked to do a talk for The BHS South West. What topics/ subjects are people interested in? I’m always a bit biased to the equines neck 😊 but it could be on anything Physiotherapy related . Even the human! -maintaining the older horse for soundness. -Identifying pain ?
Thoughts please
Thank you