Manchester Therapy Centre

23/01/2026

3 key sprinting phases and how to train them! 🏃💨

Based on a fantastic overview of sprinting performance by Haugen et al. (2019) in Sports Medicine - Open.

It's *open access* so be sure to read the full article!

20/01/2026

12/01/2026

11/01/2026

10/01/2026

10/01/2026

06/01/2026

I’ve been asked lots lately to share some thoughts on super shoes due to people wanting to invest in new ones (more ones!).

I’ve got lots of thoughts to share, some good, some not so good, I’ll discuss maybe on the upcoming podcast to not lose context, but this is one of the key things I chat to other therapists and athletes about.

It’s common knowledge that the “super shoe” phenomenon can have tangible performance benefits.

Metabolic cost is reduced by 2-4% which allows us to perform more efficiently and economically compared to without them.

However, is there a paradox where they could have a pathology linked downside?

What’s the potential hidden cost?

We see from the evidence that there is increased work through the forefoot and mid foot.

In clinic, I definitely see a trend developing from new or increased use of super shoes.

Pain and irritation to the plantar fascia, metatarsals, and calf complex are common when the shoes are used too frequently or when use is introduced and ramped too quickly.

But, here is the key takeaway: supershoes are not “bad”, these things happen because they allow performance beyond preparation.

Get the preparation right and they can be a huge aid to improved performance.

Of note, athletes who may be less experienced, have previous injury history in these areas and potentially older athletes should be particularly vigilant for these factors.

When pace improves faster than tissue capacity → bone and fascia can potentially pay the price.

Remember, Supershoes are race tools, not daily trainers. I do encourage athletes to wear them for certain phases of our training, but generally advise:

1 session/week max initially in the weeks pre race, or weekly with more use and experience.

Avoid back-to-back plated sessions.

Build shoe rotation plans, not shoe preferences.

Treat pace improvements as load increases, monitor:

Forefoot and mid foot soreness
forefoot but mainly Midfoot stiffness.

plantar pain with, but largely without heel tenderness.

For clinicians picking up patients with these problems linked ask about super shoe use:

How often are they used?
What pace do they enable?
What capacity was missing?

Bone stress is rarely sudden — it’s usually performance outpacing adaptation

Educate rather than restrict!

We’ve made it easier to run faster than we’re prepared to tolerate.

29/12/2025

🎊🌲Between Christmas and the beginning of the new year, we traditionally publish our ‘Best of’ series featuring the most influential posts of the year that is coming to an end.

📣 Today 🥇 # place 14 in 2025

𝗖𝗮𝗻 𝗯𝗮𝘀𝗲𝗹𝗶𝗻𝗲 𝗠𝗥𝗜 𝗳𝗶𝗻𝗱𝗶𝗻𝗴𝘀 𝗶𝗱𝗲𝗻𝘁𝗶𝗳𝘆 𝘄𝗵𝗼 𝗿𝗲𝘀𝗽𝗼𝗻𝗱𝘀 𝗯𝗲𝘁𝘁𝗲𝗿 𝘁𝗼 𝗲𝗮𝗿𝗹𝘆 𝘀𝘂𝗿𝗴𝗲𝗿𝘆 𝘃𝗲𝗿𝘀𝘂𝘀 𝗲𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗮𝗻𝗱 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗶𝗻 𝘆𝗼𝘂𝗻𝗴 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗶𝘁𝗵 𝗺𝗲𝗻𝗶𝘀𝗰𝗮𝗹 𝘁𝗲𝗮𝗿𝘀 ?

Knee arthroscopy for meniscal injuries remains among the most frequently performed orthopedic procedures (https://pmc.ncbi.nlm.nih.gov/articles/PMC6584718/, https://pubmed.ncbi.nlm.nih.gov/21531866/, https://pubmed.ncbi.nlm.nih.gov/37434234/). Recent randomized controlled trials (RCTs) in young adults with meniscal tears found that early arthroscopic surgery did not provide superior patient-reported outcomes at 12 or 24 months compared to a strategy of exercise and education, with subsequent surgery if needed https://pubmed.ncbi.nlm.nih.gov/37879858/, https://pubmed.ncbi.nlm.nih.gov/38319181/, https://pubmed.ncbi.nlm.nih.gov/35676079/).

👉 details of the exercise prograhttps://www.bodyworkmovementtherapies.com/cms/10.1016/j.jbmt.2017.07.010/attachment/31656b55-b97c-4b6a-ac12-7ad51c95a933/mmc1.pdf

👉 However, certain patient subgroups may respond better to one treatment approach over the other (https://pubmed.ncbi.nlm.nih.gov/36878666/). Identifying these subgroups based on clinical characteristics that modify treatment effects (https://pubmed.ncbi.nlm.nih.gov/36244961/) could enhance patient counselling and support more personalized treatment decisions.

📘 A brand-new study by Clausen et al. (2025, https://www.jospt.org/doi/10.2519/jospt.2025.12994), a secondary subgroup analysis of the DREAM trial, investigated whether specific baseline MRI findings could predict which young patients with meniscal tears would benefit more from early surgery compared to exercise and education.

✅ Objectives of the Study

The study focused on three predefined MRI characteristics as potential effect modifiers:

1️⃣ Type of meniscal tear – categorized as simple (radial/longitudinal) or complex (bucket-handle, displaced, or complex tears, s. illustration, https://pubmed.ncbi.nlm.nih.gov/26724644/).

2️⃣ Meniscus affected – whether the tear was located in the medial or lateral meniscus.

3️⃣ Presence of knee effusion/synovitis – present in any knee recess versus no effusion/synovitis

✅ Methods

The study utilized data from the DREAM trial, a randomized controlled trial (RCT) comparing early meniscal surgery to a structured exercise program with patient education. The study population consisted of 121 patients aged 18–40 years with MRI-confirmed meniscal tears, with 60 in the surgical group and 61 in the exercise group. Patients were followed for 12 months, and outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS4).

A linear mixed model was used to analyse treatment effects, and an adjusted effect difference of ≥10 points on KOOS4 was considered clinically relevant.

✅ Key Findings

🔑 Knee Effusion/Synovitis as a Potential Modifier: Patients with knee effusion/synovitis showed a greater improvement in KOOS4 after early surgery compared to exercise therapy.

▶️ The mean improvement was 11.1 points in favour of early surgery (p=0.07), which was considered clinically significant.

▶️ This suggests that signs of persistent inflammation (inflammatory phenotype) of the knee may predict better outcomes with surgery.

🔑 No Effect Modification by Tear Type: Contrary to expectations, patients with complex tears did not benefit more from early surgery than those with simple tears.

▶️ The difference between complex and simple tears was minimal (4.5 vs. 4.8 points on KOOS4, p=0.95), suggesting that both groups responded similarly to treatment.

🔑 No Effect Modification by Meniscus Location: The study hypothesized that medial meniscus tears would respond better to surgery due to biomechanical forces acting more on the medial compartment.

▶️ However, the results showed the opposite trend, with lateral tears showing a greater response to surgery (9.6 points) than medial tears (4.6 points, p=0.47).

▶️ This unexpected finding challenges previous assumptions about meniscus biomechanics.

💡 Discussion and Clinical Implications

▶️ Knee effusion/synovitis may be an MRI-defined effect modifier on patient-reported outcomes in favour of early meniscal surgery. These findings reinforce the importance of personalized treatment planning, considering MRI findings alongside patient symptoms (mechanical symptoms may be better improved by early surgery, https://pubmed.ncbi.nlm.nih.gov/36878666/) and patient preferences.

▶️ The lack of effect modification by tear type and location suggests that meniscal tear morphology alone should not determine treatment strategy.

▶️ The findings challenge the traditional assumption that medial meniscus tears are more problematic than lateral tears.

▶️ Exercise therapy remains a viable first-line treatment for most young adults with meniscal tears, given that complex tears did not significantly favour surgery.

⭕ Limitations

▶️ The study was not powered to detect small subgroup differences, meaning that some trends may not have reached statistical significance due to the sample size.

▶️ MRI scans were conducted at multiple centers, which could introduce variability in image interpretation.

▶️ Long-term effects beyond 12 months were not analyzed, leaving uncertainty about the durability of the observed benefits.

Illustration: https://doi.org/10.1016/j.ejrad.2015.10.022