Manchester Therapy Centre

05/12/2025

There are lots of potential stress fracture sites around the foot and ankle. Some are considered 'high risk' (due to delayed healing or potential ) and others low risk

05/12/2025

Lateral Hip Pain is often aggravated by activities involving hip adduction. Modifying or reducing these can help symptoms.

Just remember that long term avoidance is not the answer! Aim to adapt activity rather than avoid and plan a graded return when ready.

02/12/2025

Weak at end-range? Hello Achilles overload 👋

This drill helps rehabilitate your Achilles patients back to full potential!

👉 Watch the Dr Ebonie Rio's Practical FREE for 7 days here: https://www.physio-network.com/practicals/

30/11/2025

Just published 🔥

𝗥𝗲𝗰𝗼𝘃𝗲𝗿𝘆 𝗦𝘁𝗮𝗴𝗲𝘀 𝗔𝗳𝘁𝗲𝗿 𝗔𝗻𝘁𝗲𝗿𝗶𝗼𝗿 𝗖𝗿𝘂𝗰𝘂𝗶𝗮𝘁𝗲 𝗟𝗶𝗴𝗮𝗺𝗲𝗻𝘁 𝗥𝗲𝗰𝗼𝗻𝘀𝘁𝗿𝘂𝗰𝘁𝗶𝗼𝗻 🦵

📘 https://pubmed.ncbi.nlm.nih.gov/41314701/

Postoperative rehabilitation after an anterior cruciate ligament (ACL) reconstruction is critical for restoring strength, function, and confidence while reducing the risk of reinjury. Recovery generally takes 9 to 12 months and follows a phased, time- and criterion-based progression that guides safe advancement through rehabilitation (https://pubmed.ncbi.nlm.nih.gov/27539507/).

𝗘𝗮𝗿𝗹𝘆 𝗣𝗵𝗮𝘀𝗲 (𝗪𝗲𝗲𝗸𝘀 0–6)
This phase focuses on reducing pain and swelling, restoring knee range of motion (ROM), and reactivating the quadriceps—aiming for a quadriceps limb symmetry index (LSI) ≥60%. Modalities such as neuromuscular electrical stimulation and blood flow restriction (BFR, https://pubmed.ncbi.nlm.nih.gov/38889851/) training may support early strength gains. Open kinetic chain exercises can be gradually incorporated to strengthen the quadriceps without overloading the graft (safe start after 4 weeks within a restricted range of motion (ROM) of 90-45°, https://pubmed.ncbi.nlm.nih.gov/39985872/)

𝗜𝗻𝘁𝗲𝗿𝗺𝗲𝗱𝗶𝗮𝘁𝗲 𝗣𝗵𝗮𝘀𝗲 (𝗪𝗲𝗲𝗸𝘀 7–9)
Entry into this phase requires achieving 0°–115° of ROM, ≤1+ effusion, and a normalized gait. Rehabilitation emphasizes balance work, neuromuscular re-education, and aerobic conditioning. The major goals are full, symmetrical ROM and quadriceps strength reaching an LSI of at least 70%, typically achieved through progressive overload strength training.

𝗟𝗮𝘁𝗲 𝗣𝗵𝗮𝘀𝗲 (𝗪𝗲𝗲𝗸𝘀 10–16)
Running is introduced once quadriceps strength (and hop tests) reaches an LSI ≥70-80%, no or minimal pain (

30/11/2025

MRI “Abnormalities” Do not Equal Injury — Here’s What the Research Really Shows….

Following on from my recent post about running and arthritis, here’s another important myth-buster that every athlete, patient, and clinician should understand.

A large review by Culvenor et al. (2018) looked at 63 studies and over 5,300 knee MRIs in people with no knee pain or injury. What they found is incredibly important:

Almost 20% of people under 40 with zero symptoms had “changes” on MRI

Almost 50% of people over 40 with zero symptoms had “changes” on MRI

And what were these “changes”?
Things like: Meniscal tears, Cartilage defects, Bone bruising, Bone spurs, Degeneration as
well as other findings often labelled as “wear and tear”

In other words… Perfectly healthy, pain-free knees often look “abnormal” on scans.

🔍 Why does this matter?

Because too many people are told that:
❌ “Your MRI shows damage.”
❌ “You must stop running.”
❌ “You need surgery.”
❌ “This explains your pain.”

But the science is clear:

MRI findings only matter if they match your symptoms.

If you’re not in pain—and not limited in daily life—these findings are usually completely normal, harmless, and often just part of the body adapting and ageing.

Think of it this way:

Just like we get grey hairs and wrinkles on the outside, we get them on the inside too.

Imaging simply makes it easier to “see” them.

🏃‍♂️💬 What this doesn’t mean

This doesn’t mean MRIs are useless. They’re a powerful tool when used correctly—typically after a thorough clinical assessment, when symptoms and history indicate that imaging will change management.

But it does mean:
✔ A finding on MRI does not automatically explain pain
✔ A finding does not predict the future
✔ A finding does not mean you should reduce activity
✔ A finding does not mean you are damaged

🧠 The real take-home message

If you’re pain-free, active, and functioning well, then an MRI “abnormality” is often nothing more than internal grey hair and likely something you shouldn’t overly worry about.

If you do have pain, the goal is not to chase scan results, but to treat you — your movement, load tolerance, goals, worries, and the patterns behind your symptoms.

27/11/2025

Getting Ill Before a Race? Here’s What Endurance Athletes Need to Know 👇

There’s nothing more frustrating for an endurance athlete than getting ill right before a race.
And with the recent change in weather here in the UK, the questions have already started:

❓ “Can I still train?”
❓ “Can I still race?”

Here’s the simplest self-check you can use…

The Neck Check 🧠➡️🏃‍♂️

A quick rule of thumb that helps you decide whether training is sensible:

✅ Symptoms ABOVE the neck?

Runny nose, sore throat, sneezing, mild headache.
→ You can usually train, but keep intensity LOW.
→ No big miles. No hard sessions.
Trying to smash sessions with “above-the-neck” symptoms risks dragging the illness out and costing you MORE training time.

❌ Symptoms BELOW the neck?

Chest tightness, productive cough, fever, muscle aches, fatigue.
→ No training. No racing.
Your body is already under stress — adding endurance load can push you backwards.

A 2016 study by Van Tonder et al. looked at endurance athletes who ignored the neck check and raced while symptomatic.

Key findings:

🔹 Athletes with below-the-neck symptoms in the 8–12 days before a race had double the risk of a DNF.
🔹 When athletes were educated about the neck check, more made the smart decision not to start (DNS) — reducing risk and protecting long-term performance.

This aligns with what we see in practice: racing with systemic symptoms rarely ends well.

Bottom Line 🧵

👉 If it’s above the neck, reduce intensity and be sensible.
👉 If it’s below the neck, don’t train or race — protect your long-term performance, not just this one event.
👉 When in doubt, speak to a healthcare professional.

24/11/2025

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.

23/11/2025

22/11/2025

Athletes love a trend.

Right now 10 minutes in a bin of ice because some influencer said “it boosts recovery and performance” seems to be all the rage.

This is helped by the multitude of offers and discounts on home units available.

But many are simply sucked in simply by marketing and not real world application of the evidence.

Here’s the uncomfortable truth:

If you use ice baths at the wrong time or in the wrong way, you can literally blunt the training adaptations you’re working so hard for.

This isn’t a vibe. It’s data.

❄️ What ice baths actually do

Short term, cold water immersion (CWI):

Reduces soreness and perceived fatigue after hard sessions

Lowers tissue temperature and blood flow, damping down inflammation and pain

That can be helpful if:

You have to compete again soon (tournaments, multi-stage races, brutal training camps).

You need to feel better tomorrow more than you need maximum adaptation next month.

But that same mechanism is exactly why it can work against you.

Overusing ice baths during individual sessions or frequency can diminish your gains!

As an example, multiple studies and meta-analyses show that jumping into cold water immediately after resistance training can attenuate hypertrophy and strength gains over time.

Why?

Because you’re reducing blood flow and nutrient delivery to the muscle and dampening the anabolic signalling and satellite cell activity that drive growth and strength gains

You may feel “recovered”, but your numbers and muscle adaptations probably say otherwise.

If your goals include lifting heavier and strengthening tendon and connective tissue for performance a post-lift ice bath is often a terrible choice.

Ice baths are great at making you feel better.

That doesn’t automatically mean:
Better adaptation
Lower injury risk
Improved long-term performance

The research is clear: CWI reduces soreness and perceived fatigue, but long-term performance benefits are mixed at best.

Stop confusing less soreness with better recovery If you always chase “I don’t feel sore” you can easily undercut the stimulus your body needs to actually adapt.

There’s some interesting work showing cold can enhance certain mitochondrial and oxidative markers when combined with endurance training.

But The evidence that it improves endurance performance long term is not strong or consistent.

For many endurance athletes, the bigger issue is that heavy strength work (which you should be doing) is being followed by an ice bath that blunts those strength gains.

If you’re a runner/triathlete doing gym work to get more robust, faster and harder to break… and then you sit in 10°C water straight after? You’re partly undoing the thing you just suffered for.

So your ice bath may actually be Potentially interfering with some endurance adaptations that you have worked so hard for!

🔥 Let’s talk influencers

If your recovery plan is based on:

Someone with a discount code and a six-pack

A reel with dramatic music and no nuance

that’s not performance. That’s marketing. I’ve been approached hundreds of times over the years with an affiliate deal or incentive to promote products. I’m old and ugly enough to resist the ones I don’t believe in but many aren’t.

Be careful if you see the Red flag checklist that may include/

“Ice baths supercharge recovery” with no mention of context or trade-offs ❌

“Do this after every session” ❌

“Claims of boosting hormones, immunity, longevity, fat loss – all from a 3-minute reel ❌

If the people you’re listening to never say “it depends on your goals”, they’re not talking to high-performance athletes. They’re talking to an algorithm.

🧊 BUT… ice baths can be useful

There are smart uses for CWI:

Tournament or multi-day racing: when you need to turn around quickly and perform again, and you accept a small trade-off in adaptation to protect performance tomorrow.

Brutal heat & big load blocks: as one of many tools to manage total strain and keep you training.

Mental health / mood: some people genuinely feel calmer, clearer, and more focused with cold exposure – and that absolutely matters. I think we’ve crossed wires on this one big time in recent years!

The point isn’t “never ice bath”.

The point is: stop using it blindly.

✅ What I Recommend

If you’re an athlete who wants performance and long-term progress, here’s the nuance.

1️⃣ After strength or power sessions (or tendon rehab)l Avoid ice baths for at least 4–6 hours after lifting, and ideally skip them completely on key strength days if muscle/tendon adaptation is a priority. You can’t buy adaptation with cold water. You earn it by letting your body do the inflammatory work.

2️⃣ After key endurance workouts

Ask yourself: “Do I need to be better tomorrow, or better in 6–12 weeks?”

If it’s a heavy training block and adaptation is king → use ice baths sparingly, not after every big session.

If it’s competition, a camp, or back-to-back hard days where tomorrow’s performance is critical → an ice bath can be an intentional trade-off.

3️⃣ How often and how cold?

Based on current evidence and expert guidance:

Temperature: around 10–15°C (50–59°F) often I see it much much colder! Or not checked at all!

Duration: roughly 8–15 minutes total (can be split into short bouts) often I see it much much longer or not enough!

You do not get extra benefit from “colder, longer, more suffering”. You just increase risk.

Frequency:

Think 1–2x per week, strategically placed, not “every single session because recovery”.

4️⃣ Using cold for mood / stress

If you love the mental reset:

Put cold plunges on rest days, easy days, or mornings away from hard strength work, rather than straight after your key lift or intense session.

Shorter exposures (cold showers, brief immersions) can still give a psychological lift without constantly hammering your post-training signalling.

5️⃣ Who should be cautious?

Anyone with:

Cardiovascular disease
Uncontrolled high blood pressure
History of cardiac events, Raynaud’s, or significant circulatory problems

You really should talk to a medical professional first. Cold shock is real, not “mindset”.

Final thought

Ice baths are a tool, not a personality.

Used well: they can help you turn around faster and cope with big blocks.

Used blindly: they can quietly rob you of the adaptations you’re training for.

Thanks for taking the time to read.