Physicians Fitness

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.

11/06/2025

"It's hard to trust an individual, it's easier to trust an image"- patients with low back pain want imaging as a means of coping with uncertainty

Abstract

Background: Evidence-based guidelines for low back pain recommend against routine imaging. Despite these guidelines, many patients still seek imaging. We sought to understand why patients with low back pain may want imaging, using a qualitative approach grounded in the Common-Sense Self-Regulation Model (CSSRM), a model that frames how patients' beliefs and actions are shaped by their past experiences and understanding of an illness.

Methods: We interviewed 28 patients from a larger study in Ontario, Canada. Participants were recruited by family physicians (n = 8), chiropractors (n = 10), and physiotherapists (n = 10), and most (82.1%) had previous episodes of low back pain. Participants completed intake questionnaires and semi-structured interviews that explored their experiences with low back pain care and perspectives on imaging. We analyzed the interview transcripts using the CSSRM.

Results: The CSSRM domains were represented in patients' narratives: Stimuli and Illness Representations, Coping Procedures, and Appraisal of Outcomes. Within Stimuli and Representations, patients described perceptions of the causes of their pain, and they associated obtaining an image with gaining a sense of control over their diagnosis. Within Coping Procedures, Cognitive Reappraisal emerged as the construct with the most discourse, reflecting how patients interpreted and reassessed their low back pain over time. Many patients expressed the belief that imaging would resolve uncertainty, validate their experience, and confirm that nothing serious had been overlooked. Patients emphasized that imaging would "show what's going on," or help them "feel taken seriously". Within Appraisal of Outcomes, patients described the self-limiting nature of their LBP; the limited discourse about emotional outcomes was often linked to frustrations and fears. The beliefs expressed in interviews were not consistent with participants' questionnaire answers from months previously, suggesting that beliefs may shift over time.

Conclusions: Many patients believed imaging for low back pain was important to gain certainty in diagnosis and reassurance that treatment was appropriate. However, their beliefs about the value of imaging may not be stable over time, as they are influenced by ongoing experiences and reappraisals. To reduce unwarranted imaging, clinicians should consider providing consistent and contextualized messaging that meets the patient's ongoing illness experience.

Haslam-Larmer L, Norman KE, Patey AM, Thomas IM, Green ME, Grimshaw JM, Hayden JA, Hartvigsen J, Ivers NM, Jenkins H, French SD. "It's hard to trust an individual, it's easier to trust an image"-patients with low back pain want imaging as a means of coping with uncertainty. BMC Prim Care. 2025 Oct 31;26(1):332. doi: 10.1186/s12875-025-02998-5. PMID: 41174481; PMCID: PMC12576980.

10/30/2025

“... to move things is all that mankind can do, for such the sole executant is muscle, whether in whispering a syllable or felling a forest.”
Charles Sherrington, 1924

How are your muscles doing?

10/16/2025

"Abstract

Purpose:
The purpose of this study was to investigate differences in the associations between passive ankle dorsiflexion range of motion (ROM) and stiffness of the triceps surae, sciatic nerve, and deep fascia located in the posterior leg between young and older people.

Methods:
Twenty young and twenty older males were recruited and were placed in a prone position with their hip and knee fully extended. Passive ankle dorsiflexion ROM was determined based on the onset of pain during passive dorsiflexion at 1°·s using an isokinetic dynamometer. Shear wave speeds (as a stiffness index) of the triceps surae, the sciatic nerve, and the deep fascia in the posterior leg were evaluated by ultrasound shear wave elastography.

Results:
The shear wave speeds of the medial and lateral gastrocnemius measured at 15° dorsiflexion correlated negatively with passive ROM in young but not in older participants. The shear wave speed of the sciatic nerve measured at 15° dorsiflexion correlated negatively with passive ROM only in older participants. No association was observed between passive ROM and shear wave speed of the deep fascia in the posterior leg. For data measured at maximal dorsiflexion angle (as an index of stretch tolerance), shear wave speeds of the triceps surae and passive joint torque correlated positively with passive ROM in both groups.

Conclusion:
These results suggest that the tissues limiting passive ankle dorsiflexion ROM are muscle and nerve for young and older people, respectively, whereas stretch tolerance influences passive ROM for both groups. This implies that the relative contribution of nonmuscular tissues to joint flexibility become stronger than that of muscles with age."

Hirata K, Yamadera R, Akagi R. Associations between Range of Motion and Tissue Stiffness in Young and Older People. Med Sci Sports Exerc. 2020 Oct;52(10):2179-2188. doi: 10.1249/MSS.0000000000002360. PMID: 32348099; PMCID: PMC7497479.

10/02/2025

The musculoskeletal syndrome of menopause

"ABSTRACT

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes inmidlife and ultimately stops, it is estimated that more than 47 million women worldwide enter themenopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% willbe disabled by them through the transition from perimenopause to postmenopause. This often-unrecognizedcollective of musculoskeletal symptoms, largely influenced by estrogen flux, includes arthralgia, loss ofmuscle mass, loss of bone density and progression of osteoarthritis, among others. In isolation, it canbe difficult for clinicians and patients to adequately appreciate the substantial role of decreasingestrogen, anticipate the onset of related symptoms and actively treat to mitigate future detrimentalprocesses. Thus, in this review we introduce a new term, the musculoskeletal syndrome of menopause,to describe the collective musculoskeletal signs and symptoms associated with the loss of estrogen.Given the significant effects of these processes on quality of life and the associated personal andfinancial costs, it is important for clinicians and the women they care for to be aware of this terminologyand the constellation of musculoskeletal processes for which proper risk assessment and prophylacticmanagement are of consequence."

Vonda J. Wright, Jonathan D. Schwartzman, Rafael Itinoche & JocelynWittstein (2024) The musculoskeletal syndrome of menopause, Climacteric, 27:5, 466-472, DOI:10.1080/13697137.2024.2380363To link to this article:

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter ...

09/26/2025

If you're heading for a total knee joint replacement, it appears that strength and conditioning is the way to go...

One-year results of voluntary-based supervised exercise or treatment at orthopedic clinic for radiographic severe knee osteoarthritis..

Abstract

[Purpose]
In this study, we investigated the efficacy of supervised physical exercise or conventional treatment on symptomatic knee osteoarthritis with severe morphological degeneration.

[Subjects] Sixty-six patients with severe radiographic knee osteoarthritis were enrolled. [Methods] Participants were separated into two groups: in one group patients conducted physical exercise under supervision; while in the other group they were treated by conventional clinical methods for one year. Participants filled out two types of questionnaires; the Japanese Knee Osteoarthritis Measure and the Pain Disability Assessment Scale at baseline and one year following enrollment in the study. Two-way repeated measures analysis of variance was used to examine the effects over time and by group for a total of 43 participants; consisting of an exercise group (n=20) and a clinical group (n=23) excluding 23 dropouts.

[Results]
Analysis did not show a significant time-course effect or interaction between time-course and the groups in both questionnaires. On the other hand, there were significant group effects in both questionnaires with an advantage in the exercise group.

[Conclusion] These results indicate that patients with knee osteoarthritis under supervised exercise conditions are more likely to maintain a better clinical outcome at one-year follow-up, despite the severe morphological degeneration in their knees.

J Phys Ther Sci. 2016 Mar;28(3):906-10. doi: 10.1589/jpts.28.906. Epub 2016 Mar 31.

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09/18/2025

Your teeth are hooked up to your brain!

09/04/2025

Research: Olfactory function and motor function relationship?

Apparently so…

“Abstract

Background: Among older adults, both olfaction and motor function predict future cognitive decline and dementia, suggesting potential shared causal pathways. However, it is not known whether olfactory and motor function are independently related in late life.

Methods: We assessed cross-sectional associations of olfaction with motor and cognitive function, using concurrent data on olfactory function, mobility, balance, fine motor function, manual dexterity, and cognition in 163 Baltimore Longitudinal Study of Aging participants aged 60 and older without common neurological diseases (n = 114 with available cognitive data). Using multiple linear regression, we adjusted for age, s*x, race, smoking history, height, and weight for mobility and balance, and education for cognition. We used multiple linear regression to test whether olfaction-motor associations were independent of cognition and depressive symptoms.

Results: Olfactory scores were significantly associated with mobility (usual gait speed, rapid gait speed, 400-m walk time, and Health ABC Physical Performance Battery score), balance, fine motor function, and manual dexterity (all p < .05). In those with available cognitive data, additional adjustment for depressive symptoms, verbal memory, or visuoperceptual speed demonstrated especially strong independent relationships with challenging motor tasks such as 400-m walk and nondominant hand manual dexterity (p < .005)

Conclusions: This study demonstrates for the first time that, in older adults, olfactory function is associated with mobility, balance, fine motor function, and manual dexterity, and independent of cognitive function, with challenging upper and lower extremity motor function tasks. Longitudinal studies are needed to determine if olfactory performance predicts future mobility and functional decline.”

Tian Q, Resnick SM, Studenski SA. Olfaction Is Related to Motor Function in Older Adults. J Gerontol A Biol Sci Med Sci. 2017 Aug 1;72(8):1067-1071. doi: 10.1093/gerona/glw222. PMID: 27811155; PMCID: PMC5861968.

08/28/2025

Surgery can solve some challenging problems, but also create some...

"Adhesions and Scar Tissue

Approximately 1 in 14 hospital readmissions following abdominal surgery are due to adhesion-related problems (Parker et al., 2001). Every time tissue undergoes trauma, as in the case of abdominal surgery and laparoscopic adhesiolysis to remove adhesions, scar tissue forms. Adhesive scar tissue develops when the layers of tissue do not heal separately but ‘stick’ together causing decreased tissue elasticity, protective postural patterns, changes in proprioceptive input, altered neurovascular activity and complications including pain syndromes (Kobesova et al., 2007)."

Ryan C. Kelly, Michelle Armstrong, Alyssa Bensky, Abigail Foti, Jennifer B. Wasserman, Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design, Journal of Bodywork and Movement Therapies, Volume 23, Issue 4, 2019, Pages 805-814,
ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2019.04.010.
(https://www.sciencedirect.com/science/article/pii/S1360859219301238)