Physicians Fitness

02/12/2026

Naming or labeling your disease may not be as helpful as you think...

The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials

“OBJECTIVE: To assess how different diagnostic labels affect treatment preferences and beliefs in people with musculoskeletal pain.

RESULTS: Five vignette-based randomized trials involving 7575 participants were included. Risk of bias was rated as low to some concerns across all outcomes. Low-certainty evidence suggested that specific diagnostic labels may increase patient preferences for imaging and surgery and may increase the perceived seriousness of the condition. Non-specific labels may lead to more positive recovery beliefs and reduced perceived need for invasive treatments, and to lower patient satisfaction. The information accompanying these labels (eg, explanations, reassurance) may have influenced outcomes.

CONCLUSION: Based on low-certainty evidence, specific diagnostic labels may increase demand for invasive care and foster more negative recovery expectations. Non-specific labels may encourage non-invasive management but can contribute to patient dissatisfaction. J Orthop Sports Phys Ther 2026;56(1):4-15. Epub 3 December 2025. doi:10.2519/jospt.2025.13759

DESIGN: Systematic review of randomized trials.

LITERATURE SEARCH: PubMed, Web of Science, MEDLINE, CINAHL, SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the Australian New Zealand Clinical Trials Registry (ANZCTR) (from inception to September 17, 2025).

STUDY SELECTION CRITERIA: Randomized trials evaluating the impact of diagnostic labels for musculoskeletal pain on treatment preferences and beliefs. Studies using hypothetical vignettes were eligible.

DATA SYNTHESIS: The primary outcomes were patient treatment preferences and beliefs. Due to heterogeneity of labels and accompanying explanations, a narrative synthesis approach was conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.”

Martin S, Smith M, Wilson DA, Zadro JR, Ferreira GE, O'Keeffe M. The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials. J Orthop Sports Phys Ther. 2026 Jan;56(1):4-15. doi: 10.2519/jospt.2025.13759. PMID: 41476426.

01/29/2026

Is labeling the reason for your musculoskeletal symptoms always the right thing to do? Maybe not...

"CONCLUSION

There was low-certainty evidence that specific diagnostic labels
for MSK pain may increase patient preferences for imaging and surgery, and worsen beliefs about recovery and activity. Non-specific labels were associated with more positive treatment and recov- ery beliefstbut may lead to patient dissatisfaction.

KEY POINTS

FINDINGS: Specific labels (eg, “degeneration,” “rotator cuff tear”) may increase patient preferences for imaging and surgery and may lead to more negative beliefs about recovery and activity. Non-specific labels supported more positive beliefs and non-surgical care but may reduce satisfaction.

IMPLICATIONS: Clinicians should avoid specific labels that imply damage, especially for LBP and hip pain. Clear explanations and reassurance are essential regardless of label.

CAUTION: All studies used hypothetical vignettes, limiting generalizability. Effects of labels may vary depending on the condition and context."

"Clinical Implications
Clinicians face a dilemma when choosing between specific and non-specific labels. Specific labels may offer clarity and align with patient expectations, but they often imply a structural cause that can be inaccurate, provoke fear, and may drive overtreatment.17,21 In contrast, non- specific labels may better reflect the multifaceted nature of MSK pain. However, these labels can be perceived as vague.21 Importantly, our findings suggest the explanation and reassurance accompanying a label play a key role in shaping patient beliefs. Therefore, a potential solution to this dilemma is to pair non-specific labels with clear, evidence-based explanations and tailored reassurance. This approach maintains diagnostic accuracy while addressing patient concerns and expectations."

Martin S, Smith M, Wilson DA, Zadro JR, Ferreira GE, O'Keeffe M. The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials. J Orthop Sports Phys Ther. 2026 Jan;56(1):4-15. doi: 10.2519/jospt.2025.13759. PMID: 41476426.

01/22/2026

Postinactivity Exercise Training Improves Sarcopenia Traits in 40–60-Year-Old Women Regardless of Fortified Milk Supplementation

"ABSTRACT

Background:
The term sarcopenia was introduced to describe the age-related decline in muscle mass, but current definitions also include measures of muscle strength and function. Menopause increases sarcopenia risk and may exacerbate the adverse effects of physical inactivity. Exercise training is a potent stimulus to restore muscle health, and nutritional supplementation can further improve the outcomes. The purposes of this study were to examine the changes in a set of sarcopenia-related phenotypes induced by a 14-day step-reduction period followed by a 12-week exercise training programme, with or without fortified milk supplementation in healthy 40–60-year-old females, and to determine whether menopausal status interacted with these changes. Methods: In this double-blind, placebo-controlled randomized trial, females aged 40–60years were evaluated before and after 2 weeks of reduced activity monitored through pedometer and after a subsequent 12-week exercise + nutrition programme with ingestion of a fortified milk product (FMP) or placebo. Muscle volume (dual-energy X-ray absorptiometry [DXA] and peripheral quantitative computed tomography), handgrip (hydraulic handheld dynamometer), knee extensor and plantar flexor strength (isokinetic dynamometer) and a variety of physical function measures were assessed at all time points.

Results:
Eighty-three self-reported healthy females (50.7±5.3years; 52 postmenopausal) completed the reduced-activity pe- riod, and 67 completed the subsequent exercise training+nutrition phase. At baseline, participants averaged 8323±3077 daily steps and then decreased to 1876±729 during the reduced-activity period. Mean sarcopenia outcomes declined after 2weeks of activity restriction, with significant changes (p 0.05 for all variables). All muscle mass, strength and function outcomes were not only improved after exercise training + nutrition but also significantly increased compared to preintervention baseline (all p 0.05)."

Trezise J, Lima RM, Poppitt SD, Fanning AC, Devine A, Blazevich AJ. Postinactivity Exercise Training Improves Sarcopenia Traits in 40-60-Year-Old Women Regardless of Fortified Milk Supplementation. J Cachexia Sarcopenia Muscle. 2025 Dec;16(6):e70080. doi: 10.1002/jcsm.70080. PMID: 41184220; PMCID: PMC12582911.

01/15/2026

Age-related change in muscle strength, muscle mass, and fat mass between the dominant and non-dominant upper limbs

"Background: Any form of physical activity is recommended for the older adults to maintain their physical function; however, the effect of daily activities on muscle function still needs to be investigated. Humans always use one dominant hand to perform tasks, providing a natural situation for research on the effect of daily activities on muscle function.

Methods: Five hundred and twenty-six healthy adults were recruited from the community in Beijing. Muscle strength was assessed using a handgrip dynamometer, lean mass, fat mass, bone area and bone mineral content of upper limbs were assessed using dual-energy X ray-absorptiometry. The results were compared between the dominant and non-dominant upper limbs.

Results: The dominant upper limb had better muscle strength, lean mass, bone area and bone mineral content than the non-dominant side. The difference in muscle strength and lean mass between the two upper limbs decreased with the advanced age. In older age, fat mass of upper limbs increased in men, but not in women.

Conclusion: Daily activities can maintain better muscle function in the dominant upper limb than in the non-dominant side; however, the delaying effect on age- related decline in muscle function was limited."

Pang J, Tu F, Han Y, Zhang E, Zhang Y and Zhang T (2023) Age-related change in muscle strength, muscle mass, and fat mass between the dominant and non-dominant upper limbs. Front. Public Health 11:1284959.
doi: 10.3389/fpubh.2023.1284959

01/08/2026

Chronic Plantar Heel Pain is Principally Associated With Waist Girth (Systemic) and Pain (Central) Factors, Not Foot Factors: A Case-Control Study

Objectives
To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain.

Design
Case-control.

Methods
We investigated associations by comparing 220 participants with chronic plantar heel pain (>3 months) and 100 age- and sex-matched controls recruited randomly from the electoral roll. Exposures measured were waist girth, BMI, body composition, clinical measures of foot and leg function, physical activity by accelerometry, depression and pain catastrophising, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analysed using multivariable conditional logistic regression.

Results
Waist girth (cm) (OR 1.06; 95% CI 1.03 to 1.09), ankle plantarflexor strength (kg) (OR 0.98; 95% CI 0.97 to 0.99), pain at multiple sites (OR 2.76; 95% CI 1.29 to 5.91 (pain at 1 other site), to OR 10.45; 95% CI 3.66 to 29.81 (pain at 4 or more other sites)) and pain catastrophising status (none, some or catastrophiser) (OR 2.91; 95% CI 1.33 to 6.37 (some), OR 6.79; 95% CI 1.91 to 24.11 (catastrophising)) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension ROM, depression and BMI, and no significant associations with physical activity or body composition by bioimpedance analysis.

Conclusion
Waist girth, ankle plantarflexor strength, multisite pain and pain catastrophising, but not foot-specific factors, were independently associated with chronic plantar heel pain. Three of four of these factors reflect central or systemic associations."

J Orthop Sports Phys Ther, Epub 7 May 2021. doi:10.2519/jospt.2021.10018

01/07/2026

Optimizing acute pain relief in severe knee Osteoarthritis: The influence of resistance exercise volume and psychosocial factors

“ABSTRACT

Background:
While exercise is a key part of knee osteoarthritis (OA) management, the optimal dose for acute pain relief remains unclear. We aimed to determine the optimal resistance exercise volume to induce exercise-induced hypoalgesia (EIH) in older adults with severe knee OA.

Methods:
28 participants (11/17 women/men; mean age = 71.6 ± 5.2 years) with severe knee OA awaiting unilateral Total Knee Arthroplasty were recruited. They were randomised to four experimental conditions (cross- over design) conducted with a separation of 4 days. Knee extension exercises with elastic resistance were per- formed at single exercise sessions at 10 repetition maximum (RM) intensity, while varying the number of sets (control with no exercise, 4 sets, 8 sets, and 12 sets).

Results:
Higher exercise volumes (12 and 8 sets) induced greater EIH 10 min post-exercise compared to lower volumes (4 sets) or no exercise, with significant differences favouring the 12-set exercise intervention (η2 = 0.472, p < 0.001). Pain intensity increased immediately post-exercise in all exercise interventions but returned to baseline after 10 min in the 4- and 12-set exercise interventions. PPT increased post-10 min in the 8- and 12-set exercise interventions for both the affected and contralateral limbs (p < 0.05). PCS moderated the EIH response, reducing its effect in the 12-set (r = − 0.436, p < 0.05) and 8-set (r = − 0.418, p < 0.05) exercise intervention. Conclusions: Greater resistance exercise volume appears to be associated with an initial increase in pain perception followed by a delayed hypoalgesic response in patients with severe knee OA. These exploratory findings suggest that higher-volume resistance exercise may be a valuable strategy for acute pain relief, although clinicians should balance short-term discomfort with long-term benefits, considering both physical and psychosocial factors, to improve pain-related outcomes aimed at reducing acute pain in this population. However, further research is needed to confirm these effects beyond a controlled, single-exercise acute intervention. “

Sánchez-Sabater A, Suso-Martí L, Núñez-Cortés R, López-Bueno R, Cruz-Montecinos C, Salazar-Méndez J, Orenga V, Andersen LL, Casaña J, Calatayud J. Optimizing acute pain relief in severe knee Osteoarthritis: The influence of resistance exercise volume and psychosocial factors. Musculoskelet Sci Pract. 2025 Oct;79:103390. doi: 10.1016/j.msksp.2025.103390. Epub 2025 Jul 29. PMID: 40753853.

01/01/2026

12/18/2025

Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?

"Abstract
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Intra-articular corticosteroid (IACS) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treatment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this report is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications."

Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought? Radiology. 2019 Dec;293(3):656-663. doi: 10.1148/radiol.2019190341. Epub 2019 Oct 15. PMID: 31617798.

12/11/2025

Age and recovery

"Old people (> 60 yrs old) respond differently to strength training compared to young people. One feature is their ability to recover from exercise. Animal models have shown that old subjects display more muscle damage in response to a workout of eccentric contractions compared to young subjects. This appears to be caused by their muscle fibers having reduced capacity for lateral force transmission (due to a loss of dystrophin), leading to overstretching of the muscle fibers. Yet, human studies do not always report that old people display more post-workout fatigue than young people. This observation can likely be attributed to their lower levels of motor unit recruitment (indeed, the fast twitch muscle fibers of the highest-threshold motor units are the most vulnerable to damage). Even so, recovery rates post-workout are much slower in elderly people (even when exactly the same amount of fatigue is experienced immediately after exercise). This indicates that the repair and regeneration processes that facilitate recovery from post-workout fatigue are less effective in elderly muscle tissue. In practice, this means that elderly lifters cannot make use of the same volume-frequency combinations as young lifters. Animal models have shown that while young subjects can recover from a given workout volume performed 3 times per week (and thereby make gains in strength and size), old subjects cannot recover from the same training program (and so do not make gains in strength or size). Yet, those same old subjects can make progress by doing the same workout volumes twice per week (or by doing lower workout volumes 3 times per week)."

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12/04/2025

Emphasizing the importance of trunk endurance in training programs for runners.

Effect of trunk muscles fatigue on lower limb mechanical work and stiffness in recreational runners

“Abstract
During running, trunk muscles contribute to generation and transmission of mechanical power and work. The effect of trunk muscle fatigue on lower limb mechanical work and leg stiffness (Kleg) is not well known. This study aimed to examine the effects of trunk muscle fatigue on Kleg and lower limb mechanical work in recreational runners. Thirty recreational rearfoot-strike runners completed overground running trials before and after trunk muscle fatigue. From a biomechanical assessment, we calculated the Kleg, positive and negative mechanical work, and the relative contribution of mechanical work of the hip, knee, and ankle joints across the three anatomical planes. After trunk muscle fatigue, an increase in Kleg was observed. At the ankle joint, trunk muscle fatigue increased negative and positive works in the sagittal plane, while increased knee joint positive work in the sagittal and frontal planes. In the sagittal plane, trunk muscle fatigue decreased knee joint negative work relative contribution and hip joint positive work relative contribution, and increased ankle joint positive work relative contribution. Increases in knee joint positive work relative contribution in the frontal plane, and hip joint positive work relative contribution in the horizontal plane were observed. It is evident from the findings that compensatory changes in lower-limb biomechanics occur in response to trunk muscle fatigue. This could include increased stiffness and redistribution of joint mechanical work, particularly toward distal joints. Such adaptations highlight the role of trunk stability in running performance and injury prevention, emphasizing the importance of trunk endurance in training programs.”

Mahsa Sadat Hashemi Avanji, Hamed Esmaeili, Fatemeh Salari-Esker, Behzad Bashiri, Effect of trunk muscles fatigue on lower limb mechanical work and stiffness in recreational runners, Journal of Biomechanics, 2025, 113055, ISSN 0021-9290,
https://doi.org/10.1016/j.jbiomech.2025.113055.

11/20/2025

How many steps per day?

Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis

Abstract

Background: Despite the rapid increase in evidence from the past decade on daily steps and health-related outcomes, existing systematic reviews primarily focused on few outcomes, such as all-cause mortality. This study synthesised the prospective dose-response relationship between daily steps and health outcomes including all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, cognitive outcomes, mental health outcomes, physical function, and falls.

Methods: For this systematic review and meta-analysis, we searched PubMed and EBSCO CINAHL for literature published between Jan 1, 2014, and Feb 14, 2025, supplemented by other search strategies. Eligible prospective studies examined the relationship between device-measured daily steps and health outcomes among adults without restrictions on language or publication type. Pairs of reviewers (BN, KO, ML, and TN) independently did the study selection, data extraction, and risk of bias assessment using the 9-point Newcastle-Ottawa Scale. Hazard ratios (HRs) from individual studies were synthesised using random-effects dose-response meta-analysis where possible. Certainty of evidence was assessed using GRADE. This trial is registered with PROSPERO (CRD42024529706).
Findings: 57 studies from 35 cohorts were included in the systematic review and 31 studies from 24 cohorts were included in meta-analyses. For all-cause mortality, cardiovascular disease incidence, dementia, and falls, an inverse non-linear dose-response association was found, with inflection points at around 5000-7000 steps per day. An inverse linear association was found for cardiovascular disease mortality, cancer incidence, cancer mortality, type 2 diabetes incidence, and depressive symptoms. Based on our meta-analyses, compared with 2000 steps per day, 7000 steps per day was associated with a 47% lower risk of all-cause mortality (HR 0·53 [95% CI 0·46-0·60]; I2=36·3; 14 studies), a 25% lower risk of cardiovascular disease incidence (HR 0·75 [0·67-0·85]; I2=38·3%; six studies), a 47% lower risk of cardiovascular disease mortality (HR 0·53 [0·37-0·77]; I2=78·2%; three studies), a non-significant 6% lower risk of cancer incidence (HR 0·94 [0·87-1·01]; I2=73·7%; two studies), a 37% lower risk of cancer mortality (HR 0·63 [0·55-0·72]; I2=64·5%; three studies), a 14% lower risk of type 2 diabetes (HR 0·86 [0·74-0·99]; I2=48·5%; four studies), a 38% lower risk of dementia (HR 0·62 [0·53-0·73]; I2=0%; two studies), a 22% lower risk of depressive symptoms (HR 0·78 [0·73-0·83]; I2=36·2%; three studies), and a 28% lower risk of falls (HR 0·72 [0·65-0·81]; I2=47·5%; four studies). Studies on physical function (not based on meta-analysis) reported similar inverse associations. The evidence certainty was moderate for all outcomes except for cardiovascular disease mortality (low), cancer incidence (low), physical function (low), and falls (very low).

Interpretation: Although 10 000 steps per day can still be a viable target for those who are more active, 7000 steps per day is associated with clinically meaningful improvements in health outcomes and might be a more realistic and achievable target for some. The findings of the study should be interpreted in light of limitations, such as the small number of studies available for most outcomes, a lack of age-specific analysis and biases at the individual study level, including residual confounding.
Ding D, Nguyen B, Nau T, Luo M, Del Pozo Cruz B, Dempsey PC, Munn Z, Jefferis BJ, Sherrington C, Calleja EA, Hau Chong K, Davis R, Francois ME, Tiedemann A, Biddle SJH, Okely A, Bauman A, Ekelund U, Clare P, Owen K. Daily steps and health outcomes in adults: a systematic review and dose-response meta-analysis. Lancet Public Health. 2025 Aug;10(8):e668-e681. doi: 10.1016/S2468-2667(25)00164-1. Epub 2025 Jul 23. Erratum in: Lancet Public Health. 2025 Sep;10(9):e731. doi: 10.1016/S2468-2667(25)00199-9. PMID: 40713949.