Dr. Hanjabam Barun, Sports & Exercise Medicine Specialist

17/10/2025

✅ 1. Understanding the Role of Proprioception in OA

▪️ A significant clinical takeaway is that impaired proprioceptive accuracy may play an important role in OA, particularly in the knee joint and its related structures.
▪️ Impact of Impairment: Impaired proprioception in OA patients is linked to reduced joint control, altered movement patterns, and an increased risk of falls, all of which can contribute further to joint degeneration. Maintaining proper proprioceptive function is essential for joint stability, coordinated movement, and injury prevention.
▪️ Link to Severity: Clinical studies have demonstrated that the number of mechanoreceptors found in the posterior cruciate ligament (PCL) decreased significantly with increasing WOMAC score (a measure of knee OA severity).
▪️ Pathophysiological Basis: Proprioceptive deficits are possibly due to changes in mechanoreceptors (Ruffini, Pacini, and Golgi Mazzoni corpuscles). Dysfunctional articular mechanoreceptors, which are prevalent in cases of severe OA, may lead to impaired proprioceptive accuracy. Specifically, studies found that the numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings, and small vessels in the PCL were low in OA patients.

🔍 2. Diagnostic and Assessment Insights
▪️ Deficit Detection: A significant proprioceptive deficit has been detected in patients with chondral injuries (cartilage lesions) when compared to healthy controls, especially through the use of dynamic, single-leg, postural stabilometry.
▪️ Ligament and Meniscal Involvement: A proprioception deficit was detected in patients with knee OA who also had a co-existing medial meniscal tear.
▪️ Joint Specificity: Proprioceptive impairments associated with knee OA may be localized to the knee joint and may not necessarily extend to other body regions affected by OA, such as the ankle or elbow. While hip abduction and knee flexion motion sense were similar to subjects without knee OA, the motion sense of ankle/subtalar joints was negatively affected in OA patients in one study.
▪️ Assessment Tool Caveats: Clinicians should be aware that assessment methods such as stabilometry and isokinetic dynamometry do not provide direct measures of proprioception, but rather reveal balance impairments and difficulties in maintaining stability, which may be indicative of underlying proprioceptive deficits.

💪 3. Therapeutic and Management Strategies
▪️ Physical Training: Includes proprioceptive exercises (e.g., joint position sense training and balance training), strengthening exercises, manual therapy techniques, aquatic therapy, and mind–body practices such as Tai Chi and yoga.
▪️ Technology/Devices: Incorporates neuromuscular electrical stimulation, sensory training using methods like vibration and biofeedback, and the use of bracing or orthotics.
▪️ Holistic/Cognitive Approaches: Involves cognitive training and patient education focused on joint protection and lifestyle modifications.
▪️ Adjunctive Treatments: Includes medications and supplements such as nonsteroidal anti-inflammatory drugs (NSAIDs) and glucosamine/chondroitin, which may aid by reducing pain and inflammation, potentially enhancing proprioceptive feedback.
▪️ Personalization: Consulting with a healthcare provider or physical therapist is essential to develop a personalized proprioceptive training program and select the most appropriate treatments.

⚙️ 4. Surgical Implications (Total Knee Arthroplasty)
▪️ For total knee arthroplasty (TKA), one retrospective study found that proprioceptive capacities recover to at least the state of the non-operated side, but the PCL does not appear to contribute significantly to this recovery in the context of TKA design (cruciate substituting vs. cruciate retaining).

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

17/10/2025

💡 In contrast to common beliefs that stretching decreased stiffness parameters and would therefore hamper running economy, current evidence does not support any effect of stretching on running economy in running athletes.

👉🏻 This is from the new paper "Acute and Chronic Effects of Stretching on Running Economy: A Systematic Review with Meta-Analysis" by Warneke et al 2025

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Disclaimer: Sharing a study is NOT an endorsement. You should read the original research yourself and be critical.

17/10/2025

If you need another reason to squat, how about training your pelvic floor?

A 2025 study compared several exercises such as parallel squats, planks, side planks, standing and supine positions, and even work on stable vs unstable surfaces.

Interestingly, squatting showed the highest activation of the pelvic floor muscles, suggesting it can be a powerful way to train this area alongside more traditional methods.

Of course, every study has its limitations... this one involved only 25 participants, all of whom were female rugby players. So while we can’t directly generalise to the wider population, the findings still offer valuable insight into how functional, full-body movements can support pelvic floor health.

This is great news for anyone looking to train the pelvic floor beyond Kegels. Since isolated pre-activation work has its limits, squatting offers a dynamic way to integrate pelvic floor strength with the glutes, quads, and pelvic diaphragm, exactly how the body works in real life.

So next time you cue a squat, think “pelvic floor training” too.

If you’d like more evidence-based tips and tools to help your clients train their pelvic floors dynamically, comment “floor” and I’ll send you details about my Pelvic Floor Program for Pilates Teachers — discount ends this Sunday!

Movement is medicine

Tom

17/10/2025

✅ The Vicious Cycle of Reduced Physical Independence
The vicious cycle of reduced physical independence is a detrimental process observed in aging individuals, schematically represented as the increasing cycle of sedentarism that can eventually lead to dependency.
This cycle is described in the context of declining muscle health (sarcopenia) and mobility loss.

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⚙️ Mechanism of the Vicious Cycle

▪️ Activities of daily living become more difficult
▪️ As a result, these individuals often avoid engaging in these tasks
▪️ This avoidance leads to an increasing cycle of sedentarism
▪️ Ultimately, this sedentarism increases the risk for physical dependence

⏳ Context and Acceleration of the Cycle

▪️ The vulnerability to entering this cycle is linked to age-related decline in muscle function and periods of disuse, which accelerate the process of sarcopenia (the progressive loss of skeletal muscle mass, strength, and function).

💪 Muscle Loss and Function
▪️ Aging is naturally accompanied by a decline in muscle mass, strength, and physical function.
▪️ This decline is termed sarcopenia.
▪️ Muscle strength and power decline at a rate of approximately 3% per year.

🚫 Impact of Disuse
▪️ Muscle disuse, such as that caused by decreased physical activity, illness, or hospitalization, results in a rapid decline in muscle mass in aging individuals and effectively accelerates sarcopenia.

⚠️ Crossing the Threshold
▪️ A period of disuse may cause older individuals to cross the threshold of physical dependence a lot sooner due to mobility loss.
▪️ For instance, older individuals immobilized for two weeks experienced a decline in muscle strength equivalent to roughly 2–3 years of normal aging, highlighting that disuse can resemble accelerated aging.

❤️ Compromised Health States
▪️ The presence of underlying chronic conditions—such as type 2 diabetes, metabolic syndrome, or peripheral arterial disease—could play an additive role in the drastic reduction in muscle mass experienced during hospitalization or periods of disuse, making older adults much more vulnerable to muscle atrophy and the development of sarcopenia.

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🛡️ Mitigating the Cycle

Counteracting this vicious cycle involves interventions focused on maintaining or preserving muscle mass and function.

🏃‍♂️ Exercise and Activity
▪️ Exercise training and increased physical activity in older adults are related to improved mobility and function.
▪️ Engaging in resistance and aerobic exercise will aid in the preservation of muscle mass.

🍗 Nutrition
▪️ Consuming protein at levels above the current recommended intakes (at least 50–100% higher than ~0.8 g protein/kg bodyweight/d) is also critical.

⚙️ Combined Strategy
▪️ A combination of both resistance and aerobic exercise along with adequate protein consumption appears to be a potent strategy to mitigate muscle aging detriments.
▪️ For example, a whey supplement combined with lower-load resistance training attenuated the decline in muscle protein synthesis rates and preserved muscle mass during a two-week step reduction protocol.

🎯 Overall Goal
▪️ The overall goal is to promote mitigation of the decline in muscle mass, which is considered better than having to treat the consequences of low muscle mass and attempting to restore lost muscle.

17/10/2025

💪 Sarcopenia and Accelerated Aging

▪ Definition: Sarcopenia, defined as the progressive decline in muscle mass, strength, and physical function that accompanies aging, is a hallmark of the aging process. This decline is measurable starting in the fourth-to-fifth decade of life (40-50 years old).

▪ Consequences of Sarcopenia: The reduction in muscle mass places individuals at risk for metabolic disorders such as type 2 diabetes mellitus, as muscle is a metabolically active sink for glucose. Declines in strength (often measured as grip strength) are correlated with reduced health-related quality of life and increased risk of mobility declines and cardiovascular disease.

▪ Role of Inactivity: Muscle disuse or reduced physical activity accelerates sarcopenia significantly. A period of muscle disuse, such as hospitalization, illness, or even reduced daily steps, leads to rapid atrophy, especially in older adults, often having implications equivalent to years of normal aging. Older adults also demonstrate an impaired ability to regain lost muscle and strength following disuse compared to younger persons.

▪ Muscle Protein Balance: Muscle mass is governed by the balance between muscle protein synthesis (MPS) and muscle protein breakdown (MPB). As individuals age, MPS does not increase as robustly in response to protein ingestion, a phenomenon known as anabolic resistance, making it difficult to maintain muscle mass.

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⚙️ Physiological Drivers of Muscle Decline

▪ Muscle Fiber Changes: There is a reduction in both the size and number of muscle fibers, with the most evident decline occurring in Type 2 fibers (which are crucial for force production). Other myofibrillar changes include a loss of motor units (up to 40% loss by age 70), decreased sensitivity to calcium, reduced elasticity (increased stiffness), and compromised force production due to weak cross-bridges formed by post-translational modifications of myosin.

▪ Mitochondrial Dysfunction: Mitochondrial function and structure decline with age, a key theory in aging, and this decline is exacerbated by inactivity and disease. Dysfunction includes increased Reactive Oxygen Species (ROS) production, damaged mitochondrial DNA, and reduced expression of PGC-1a (a regulator of mitochondrial biogenesis). This reduction in mitochondrial function contributes to lower muscular function and higher insulin resistance.

▪ Connective Tissue and ECM Changes: Intramuscular connective tissue, which functions as a supportive force-transferring lattice, shows detrimental changes with age. Aging increases the presence of non-enzymatic crosslinks known as Advanced Glycation End Products (AGEs), causing the extracellular matrix (ECM) to become stiffer and more resistant to turnover (fibrosis).

▪ Muscle Stem Cells and Inflammaging: The muscle satellite cell pool decreases with age, and the capacity for muscle repair/regeneration is reduced. Furthermore, a pro-inflammatory state associated with age, known as inflammaging, involves increased systemic concentrations of markers like IL-6 and CRP, which have detrimental impacts on muscle health and are associated with increased risk of muscle loss and weakness.

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🥗 Mitigation Strategies: Nutrition and Exercise

▪ Protein Intake: Due to anabolic resistance, aging individuals require protein consumption levels significantly higher (at least 50–100% higher) than the current recommended intakes of ~0.8 g protein/kg bodyweight/d to optimally stimulate MPS. A dose of 0.4 g/kg of protein per meal, resulting in a total intake of at least 1.2 g/kg/day, is recommended to maintain muscle mass. Older adults should also focus on distributing protein evenly throughout the day and choosing high-quality sources, such as dairy proteins, which are rich in leucine.

▪ Exercise: Resistance Exercise Training (RET) is highly effective for stimulating MPS and promoting muscle hypertrophy and strength. Lower-load (30–50% 1RM), higher-volume RET may be an alternative training mode that benefits older adults by potentially addressing physiological deficits like improving glycemic control and increasing mitochondrial content. Endurance exercise is effective at stimulating mitochondrial biogenesis and function.

▪ Combined Approach: A regimen combining resistance and aerobic exercise, along with adequate protein, is highly impactful for improving glycemic control, strength, body composition, and function in older adults.

▪ Pre-habilitation: Engaging in physical activity and exercise (pre-habilitation) before predictable periods of disuse (like surgery or illness) is a crucial strategy to attenuate muscle loss and improve recovery outcomes.

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

16/10/2025

🔬Creatine is a naturally occurring compound found in every cell in the human
body that plays a critical role in cellular metabolism, supporting muscle function and like this study shows, cognitive health.

🤔Did you know?

The body requires 2–4 grams of creatine daily, depending on muscle mass and activity levels. About half is synthesized from the amino acids arginine, glycine, and methionine, while the rest comes from diet or supplements.

🥩Meat and fish are the richest dietary sources, providing 1–2 grams per pound, but they can be expensive and high in calories. Creatine supplementation offers a more affordable and efficient alternative.

💊Vegans and vegetarians often have lower creatine intake, making supplementation a valuable option to meet daily needs.

Many think creatine is just for bulking up, but your brain actually stores and uses it too. Learn more about creatine and recommended dosing: http://bit.ly/41wHSmO

16/10/2025

New research reveals a significant drop in testosterone levels among men, with a 1% decline every year since the 1970s, affecting not just older men but also younger generations. >> See comments 👇

16/10/2025

📃📌 Hamstring Injuries: Why They Happen, What Works, and The Hidden Keys to Prevention

▪️ Hamstring injuries are a massive challenge in sports, known for their high incidence and recurrence rates.
▪️ They account for about 10% of all injuries in field-based sports, with recurrence rates ranging widely from 15% to 70%.
▪️ Despite decades of intervention strategies, such as resistance training, the prevalence remains stubbornly high, demanding a deeper look into both injury mechanisms and prevention strategies.

⚙️ The Mechanism of Hamstring Injury

▪️ Most hamstring injuries (over 80%) occur during high-speed running.
▪️ The most vulnerable phase is the late swing phase, where the hamstrings act eccentrically.

⬜ 1. The Vulnerable Position:
During late swing, the hamstrings must produce large eccentric forces while operating at long muscle lengths to decelerate the leg.
Animal studies confirm that muscle injuries often happen when high strains occur at long muscle lengths.

⬜ 2. The Primary Victim:
The biceps femoris long head (BFlh) is the muscle most commonly affected.
Musculoskeletal modeling suggests the BFlh muscle–tendon unit (MTU) length peaks significantly longer (at 112% of upright standing length) compared to other hamstring muscles during this phase, placing significantly more strain on it.

⬜ 3. The Core Problem:
Injuries in this phase typically result from insufficient or delayed neural activation, or an inability to produce the necessary force to resist active overstretching.

▪️ Two major risk factors are consistently identified: low eccentric strength and short muscle fascicle lengths.
▪️ Athletes with short resting fascicle lengths (

16/10/2025

16/10/2025

New OPEN ACCESS research: 'Handgrip Strength and Trajectories of Preclinical Obesity Progression: A Multistate Model Analysis Using the UK Biobank'.

The authors studied 93,275 pre-clincially obese participants from the UK Biobank to determine the association between grip strength and the progression to obesity-induced organ dysfunctions or death.

Key findings:
📌 People with excess body fat who build and keep muscle may be less likely to develop obesity-induced heart, liver, or kidney damage or die early.
📌 The researchers found participants with a stronger handgrip, a simple test of muscle strength, were less likely to progress to obesity and to die during follow‑up, a mean follow‑up of 13.4 years.
📌 These findings underscore the importance of improving muscle mass and strength in preclinical obesity.


https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaf521/8277450?searchresult=1

16/10/2025

Sports injuries have traditionally been classified as acute or overuse based on their onset and associated circumstances. Hamstring strain injuries and anterior cruciate ligament (ACL) injuries are two common sports injuries that are typically implicitly considered to represent acute injuries. This brief review, however, argues that hamstring and ACL injuries may at least partly present as overuse injuries resulting from a mechanical fatigue phenomenon, rather than acute injuries. Human, animal, and cadaveric studies are discussed to support this view. For example, human studies show no kinematic deviation in the stride during which the hamstring injury occurs as compared to the preceding strides. Further, the location of injury and ultrastructural damage of hamstring injuries is largely comparable to that seen in repetitive muscle-tendon unit lengthening experiments in animals. For the ACL, repetitive simulated jump landings have been shown to lead to ACL failure despite the ACL load being well below its ultimate strength. Furthermore, analyses of ACL explants obtained from noncontact ACL-injured patients during reconstruction surgery indicate similar damage to cadaveric studies that repetitively loaded the ACL. In summary, studies with diverse methodological approaches support the view that mechanical fatigue may predispose hamstring and ACL tissues to failure at submaximal loads during seemingly normal movements. Although further research is needed to substantiate these hypotheses, recognizing mechanical fatigue as a factor in these injuries can inform training and rehabilitation protocols and open opportunities to use modeling approaches and wearable sensors to monitor tissue load and damage, ultimately reducing injury rates

Sports injuries have traditionally been classified as acute or overuse based on their onset and associated circumstances. Hamstring strain injuries and anterior cruciate ligament (ACL) injuries are two common sports injuries that are typically implicitly considered to represent acute injuries. This....