Karen Ferreira Physiotherapy

14/04/2026

Over the decades your strength fades, muscle mass declines, as your aerobic capacity tanks. Tendons and connective tissues lose substance, stiffness, and resilience. For years the body compensated... quietly. Then one day a knee hurts during a run to get the train, or shoulder aches reaching overhead, or a back tightens lifting something simple.

At that point the story usually becomes more about structural damage. An MRI gets ordered. Welcome to high-tech, low-medicine. And the MRI almost always finds something. A meniscus tear. A rotator cuff tear. A disc bulge. Why? Because by midlife these findings are extremely common — even in people with no pain at all. If you have a tear in one shoulder, image the other shoulder... you probably have the same tear there. But I digress.

Once the scan appears, the narrative changes. The image becomes the diagnosis. Now the patient believes something is broken, and the focus often shifts to fixing what the MRI shows.

What often gets lost in this is the reason the symptoms appeared in the first place. Many so-called “atraumatic” orthopedic complaints are not purely mechanical failures. They are the moment when reduced strength, declining tissue capacity, and sometimes broader metabolic health issues finally reach a tipping point. Our tissues change over the decades... get over it.

In other words, the MRI didn’t create the problem. Well... it sort of did in this scenario. But all the MRI showed was something that was already there.... because of your age, lifestyle, health and so on.

The real driver of symptoms is often loss of physiologic reserve. Less muscle. Less tendon or aerobic resilience. Less tolerance for load, etc.

Once the MRI enters the picture, the risk becomes overtreatment. This is probably the number one reason people have surgery. When in many cases the most powerful intervention was never the scan or the procedure.

10/04/2026

One of the most counterproductive things that happens to people with this condition is that they stop doing everything. Their elbow hurts, so they stop lifting, stop exercising, stop the activities that keep them healthy and sane.

There is a significant difference between activities that provoke severe elbow pain and activities that don’t. If you can run, ride a bike, do lower-body training, or swim without significant elbow pain, keep doing those things. Deconditioning is not a treatment. Maintaining your overall fitness, your metabolic health, and your sense of agency over your own body is part of recovery, not something to defer until the elbow is perfect.

I’ve now had this in both elbows. I kept working out, but I had to adjust certain movements. I couldn’t lift the dumbbells from the ground to bench press. But if someone handed them to me once I was lying down, I was fine. Adjust as needed. Don’t wait until this goes away completely.

You limit what you do based on what actually hurts not based on a general instruction to rest. That instruction is often well-intentioned and frequently wrong.

10/04/2026

https://www.medicalbrief.co.za/brief-bursts-of-hard-exercise-may-slash-disease-risk-large-global-study/

Vigorous exercise has a substantial link to a reduced risk of developing eight different conditions or groups of conditions, including type 2 diabetes, immune-mediated inflammatory disorders like rheumatoid arthritis, and atrial fibrillation, according to a large international study in the European....

01/04/2026

Corticosteroid injections are the intervention I want to address most directly, because they remain commonly offered and the evidence against them, particularly for long-term outcomes, is consistent and compelling. Cortisone injections for tennis elbow should be avoided in most cases. Let me explain…

A well-designed RCT published in JAMA found that while corticosteroid injections provided superior short-term pain relief at six weeks compared to physiotherapy and watchful waiting, by 12 months the injection group had significantly worse outcomes than both other groups, with higher recurrence rates (Coombes et al. 2013). Short-term relief followed by long-term recurrence and potentially worse tendon biology is not a trade worth making for a condition that resolves on its own. I recommend avoiding corticosteroid injections for this problem.

PRP (platelet-rich plasma) injections are a different conversation, the evidence is more nuanced, and certain PRP preparations may have a role in recalcitrant cases. If you are considering PRP, understand that not all PRP is equal. Preparation technique, platelet concentration, and injection protocols all matter. This is a discussion to have with a physician experienced in PRP for tendinopathy.

01/04/2026

Strong muscles stabilize joints. Aerobic fitness improves metabolic health and tissue perfusion. Gradual loading restores tolerance. But people often don't take PT seriously prior to surgery. They often take PT very seriously afterwards. Therefore, PT is probably the reason you feel better, despite the surgery. The irony is that the treatment many people ultimately need is the same thing that might have prevented the problem in the first place. Staying strong. Staying active. Maintaining the reserve that protects our joints/tendons/muscles/abilities as we age. fix and make it a little emotional

01/04/2026

A 58 year old sits across from me with knee pain. She is otherwise healthy, but menopause has been difficult. The MRI shows some cartilage changes, age appropriate and not something that requires surgery. But she has not done anything physical in fifteen years. She stopped playing tennis at 43. Stopped walking regularly at 50. Now her knee hurts when she climbs stairs.

The knee is not the problem. The knee is the messenger.

What actually happened is fifteen years of progressive loss of capacity. Muscle mass declined, tendon capacity dropped, and her metabolic health shifted. Menopause plays a role in these changes as well.

The cartilage findings on the MRI would likely be there regardless, but the system around the knee lost its ability to support and protect it.

I cannot give her those fifteen years back, but I can help her start from where she is. And starting from where she is still works.

An 85 year old can still build new muscle protein after a resistance training session. The window of opportunity becomes smaller with age, but it never closes. Recovery takes longer. The risk of injury may be higher. Progress is slower. But the biology of adaptation does not abandon you at 58, or 68, or 78.

What changes is the cost of waiting. Every year of inactivity makes the starting point more difficult and lowers the potential ceiling. The advantage you have at 45 is real and meaningful, and greater than what you may have at 60. That is not a reason for despair. It is a reason to start, wherever you are now.

19/03/2026

https://www.medicalbrief.co.za/hospitals-botching-pain-management-south-african-study/

Most patients do not receive important pain treatment during and after surgery, reports GroundUp, with a recent local study – published in Lancet Africa – providing disturbing insight into how acute pain is managed in South African hospitals. The authors describe pain as being divided into two b...

18/03/2026

The prehab may or may not lead to avoiding the hip or knee replacement but it definitely makes recovery easier. So start exercising TODAY....any exercise

https://www.facebook.com/share/p/1CdcZZLkTS/

10/03/2026

100% agree

I’ve been saying this for over 15 years, even when it went against popular opinion: MRI scans don’t always tell the whole story. Many “abnormalities” seen on imaging appear in people who feel perfectly fine, while others in pain show almost nothing on their scans.

Pain is far more complex than what appears on a picture. It’s influenced by inflammation, nerve sensitivity, stress, past injuries, sleep quality, and even our mental and emotional state. That’s why doctors never rely on imaging alone. A careful history, a thorough physical exam, and understanding the bigger picture of your life are just as important and sometimes even more so than what the MRI shows.

For older adults, this is crucial to understand. Pain doesn’t always mean your body is “broken,” and imaging alone doesn’t define your strength, resilience, or potential for recovery. Learning this can reduce fear, encourage movement, and help you take control of your health, rather than letting scans dictate it.

10/03/2026

You don’t have to flip your life upside down to get stronger.
What matters is showing up, even in small ways.

Real change doesn’t come from chaos.
It comes from showing up, even in small ways.
A 10-minute walk.
One focused set.
A single choice to move when you could sit.
Day after day, those tiny steps stack, quietly building strength, confidence, and freedom.
More isn’t always better.
Better is better.

By the end of the year, you look back and see the life you didn’t have to overhaul became the life that transformed you.

05/03/2026

Worth listening to this discussion about pain.

Professor Lorimer Moseley is neuroscientist, who specialises in the complexities and mind-boggling nature of pain - what it is, why it exists, how it works a...

04/03/2026

https://youtu.be/n8s-8KtfgFM

There's an underlying myth that falls are an inevitable part of getting old. The surprising truth is our risk of a fall decreases with one thing - exercise....