Benoy Mathew @function2fitnes

𝐏𝐫𝐨𝐱𝐢𝐦𝐚𝐥 𝐇𝐚𝐦𝐬𝐭𝐫𝐢𝐧𝐠 𝐓𝐞𝐧𝐝𝐢𝐧𝐨𝐩𝐚𝐭𝐡𝐲 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐧𝐨𝐭 𝐫𝐞𝐬𝐩𝐨𝐧𝐝𝐢𝐧𝐠 𝐭𝐨 𝐩𝐫𝐨𝐠𝐫𝐞𝐬𝐬𝐢𝐯𝐞 𝐥𝐨𝐚𝐝𝐢𝐧𝐠? 𝐋𝐨𝐨𝐤 𝟏-𝟐 𝐜𝐦 𝐥𝐚𝐭𝐞𝐫𝐚𝐥. Why this matters: -Semimembranosus arises lateral to the conjoined tendon, placing it closest to the sciatic nerve. -Thickening — plus the fibrous banding described in "hamstring syndrome" — can tether and sensitise the nerve, not just the tendon. -A sensitised nerve won't respond to tendon loading alone. You're treating the wrong structure. Screen with neurodynamic testing and structural differentiation — and always clear the lumbar spine. Think neural, not just tendon: Doesn't track with load: poor correlation between running/loading dose and symptoms; night pain. Exclude: lumbar radiculopathy, deep gluteal/piriformis-related entrapment, Ischio-femoral impingement, hip joint referral. 𝐈𝐧𝐭𝐞𝐫𝐞𝐬𝐭𝐞𝐝 𝐢𝐧 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠 𝐦𝐨𝐫𝐞 𝐨𝐧 𝐭𝐫𝐢𝐜𝐤𝐲 𝐡𝐢𝐩𝐬, 𝐰𝐞'𝐫𝐞 𝐛𝐫𝐢𝐧𝐠𝐢𝐧𝐠 𝐭𝐡𝐞 𝐀𝐝𝐮𝐥𝐭 𝐇𝐢𝐩 𝐂𝐨𝐮𝐫𝐬𝐞 𝐭𝐨 𝐦𝐮𝐥𝐭𝐢𝐩𝐥𝐞 𝐥𝐨𝐜𝐚𝐭𝐢𝐨𝐧𝐬 𝐢𝐧 𝟐𝟎𝟐𝟔: 📍 London 📍 Manchester 📍 Holland (3-separate days format) 📍 Dubai Links below. If you're struggling with a complex hip case and based in London, I'm also available for second opinion consultations at London Bridge. UK Courses: lnkd.in/eZXPHg_3 International Courses: lnkd.in/gzdUx77V

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Many thanks to Jason Patel, Director of Freedom Clinics, for the kind invitation to discuss the application of ultrasound and to integrate it in the current set-up and future training for their staff. They have a successful therapy unit and an ultrasound-guided intervention unit run by multiple Sports doc consultants. It was great to meet Dr Richard Antbring, Sports and Exercise Medicine Consultant in person. We discussed and reviewed various injection options, particularly around the hip region: - Transverse in-plane approach for the hip joint, which is way better (in my humble opinion), than the traditional long axis in-plane approach, both in approach, needle visualisation , less procedural pain and also safety and avoiding the circumflex artery, during the procedure. - Visualising CAM morphology on ultrasound and how it complements XR and MRI. - Peritendinous injection into the iliopsoas tendon sheath, which can be useful for younger patients with hip impingement when we want to limit multiple intra-articular injections. - Visualisation the LCFN nerve in meralgia paraesthetica, using ultrasound (Don’t forget to track down to the intermuscular fat pad between the sartorius and TFL muscle)As many know, I enjoy discussing hip pathology, and one of my key aims for the coming years, is to raise awareness of Diagnostic ultrasound in hips (not just for shoulders and tendons) and the different ultrasound-guided injection options around the hip, which are currently underused in my opinion.

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𝐀 𝐟𝐢𝐭 𝐦𝐚𝐥𝐞 𝐢𝐧 𝐡𝐢𝐬 𝐥𝐚𝐭𝐞 𝟐𝟎𝐬. 𝐁𝐢𝐥𝐚𝐭𝐞𝐫𝐚𝐥 𝐡𝐢𝐩 𝐩𝐚𝐢𝐧. 𝐑𝐞𝐟𝐞𝐫𝐫𝐞𝐝 𝐚𝐬 𝐆𝐓𝐏𝐒 𝐚𝐧𝐝 𝐅𝐚𝐢𝐥𝐞𝐝 𝐑𝐞𝐡𝐚𝐛 𝐟𝐨𝐫 𝐒𝐞𝐜𝐨𝐧𝐝 𝐎𝐩𝐢𝐧𝐢𝐨𝐧. It wasn't GTPS. And that diagnostic label nearly cost him months of misdirected rehab. Today at London Bridge — a complex one worth unpacking. Active male, late 20s. High volume Hyrox, 5-a-side football. Referred by a colleague with non-resolving bilateral lateral hip pain, already treated as gluteal tendinopathy. On the surface? It looked the part. What the history actually told us: 🔹 Lateral hip pain — yes, but diffuse, 🔹 Deep squat and running provocation — present 🔹 But crucially: a persistent background stiffness, not a load-sensitive tendon response Point-of-care ultrasound as a supporting tool: In clinic I have access to ultrasound, and on the anterior hip we could visualise a clear cam-type morphology — that characteristic loss of the normal concavity at the head-neck junction. A useful finding. But an important caveat: Not all cam lesions are visible on ultrasound. Plain radiograph remains your gold standard for cam morphology assessment. Three things to take into your clinic this week: 1️⃣ FAI syndrome does not always present with groin pain. Lateral hip pain is common — but it tends to be diffuse, stiffness-dominant, and poorly responsive to tendon loading strategies 2️⃣ Demographic profiling matters. A male under 40 with "GTPS" needs a differential diagnosis, not a treatment plan 3️⃣ Asymmetric internal rotation loss is a clinical sign you cannot afford to miss in lateral hip pain presentations If this kind of reasoning is what you want more of — we're bringing the Adult Hip Course to multiple locations in 2025: 📍 London 📍 Manchester 📍 Holland (3-separate days format) 📍 Dubai Links in the comments. If you're struggling with a complex hip case and based in London, I'm also available for second opinion consultations at London Bridge. UK Courses: buytickets.at/function2fitne… International Courses: lnk.bio/function2fitne…

𝐀 𝐭𝐢𝐛𝐢𝐚𝐥 𝐬𝐭𝐫𝐞𝐬𝐬 𝐟𝐫𝐚𝐜𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐚 𝐟𝐞𝐦𝐨𝐫𝐚𝐥 𝐧𝐞𝐜𝐤 𝐬𝐭𝐫𝐞𝐬𝐬 𝐟𝐫𝐚𝐜𝐭𝐮𝐫𝐞 𝐚𝐫𝐞 𝐧𝐨𝐭 𝐭𝐡𝐞 𝐬𝐚𝐦𝐞 𝐢𝐧𝐣𝐮𝐫𝐲. But most clinicians manage them the same way. Same load screening. Same return-to-run protocol. Same biomechanical focus. The problem? For high-risk sites — femoral neck, sacrum, pelvis — biomechanics isn't the primary driver. You may be treating the wrong system entirely. Here's what the evidence actually tells us: -Location changes everything — high-risk BSI is driven by systemic bone health, not just training load -BMD matters — nearly half of women with high-risk BSI had bone density below clinical thresholds for weight-bearing athletes -Sleep is a bone health issue — 80% of high-risk BSI patients slept fewer than 7 hours per weeknight. Are you asking about sleep? -Disordered eating doesn't need a diagnosis to be clinically relevant — subclinical patterns are enough to drive risk Load rates alone won't explain it — gait retraining has its place, but not as your primary tool for every BSI I've put together a free clinical guide breaking all of this down — based on Tenforde et al. (2024) in the Orthopaedic Journal of Sports Medicine,  in association with Physio Tutors 𝐓𝐰𝐨 𝐜𝐚𝐬𝐞 𝐬𝐜𝐞𝐧𝐚𝐫𝐢𝐨𝐬 𝐢𝐧𝐜𝐥𝐮𝐝𝐞𝐝. 𝐒𝐭𝐫𝐚𝐢𝐠𝐡𝐭 𝐢𝐧𝐭𝐨 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞.👉 Download it here: function-2-fitness.kit.com/bonestress Want to go deeper in person? We're bringing the Advanced Running Rehab course to Manchester on 20 September and London on 18 October. Full details and booking: lnk.bio/function2fitne… Closing the gap between research and clinical practice.

𝐄𝐥𝐞𝐯𝐚𝐭𝐢𝐧𝐠 𝐅𝐨𝐨𝐭 𝐚𝐧𝐝 𝐀𝐧𝐤𝐥𝐞 𝐂𝐚𝐫𝐞: 𝐓𝐫𝐚𝐢𝐧𝐢𝐧𝐠 𝐇𝐢𝐠𝐡𝐥𝐢𝐠𝐡𝐭𝐬 One of the benefits of working in a large teaching hospital is the regular in‑service training with outstanding speakers. Last weekend, we were fortunate to host advanced practice physiotherapist and foot and ankle specialist Lizzie Marlow @emarlow89 for a masterclass on often-overlooked pathologies. Key topics included: -Persistent pain after ankle sprain -Forefoot conditions: sesamoiditis and intermetatarsal bursitis -Practical implications for rehabilitation and footwear advice We also had an excellent session from my colleague Michael Gale on manual therapy for the foot and ankle. There’s a common misconception that NHS physios don’t provide manual therapy—this isn’t the case. For the right patients, manual interventions can make a meaningful difference, especially in foot and ankle pathologies. On behalf of the Guy’s and St Thomas’ team, a huge thank you to Lizzie for her expertise. If any departments are looking for an update on foot and ankle pathology, I’d highly recommend Lizzie’s teaching.

𝐌𝐨𝐬𝐭 𝐜𝐥𝐢𝐧𝐢𝐜𝐢𝐚𝐧𝐬 𝐦𝐢𝐬𝐬 𝐒𝐞𝐬𝐚𝐦𝐨𝐢𝐝𝐢𝐭𝐢𝐬 𝐨𝐧 𝐩𝐚𝐥𝐩𝐚𝐭𝐢𝐨𝐧 𝐚𝐥𝐨𝐧𝐞 — 𝐧𝐨𝐭 𝐛𝐞𝐜𝐚𝐮𝐬𝐞 𝐢𝐭'𝐬 𝐧𝐨𝐭 𝐭𝐡𝐞𝐫𝐞, 𝐛𝐮𝐭 𝐛𝐞𝐜𝐚𝐮𝐬𝐞 𝐭𝐡𝐞 𝐚𝐧𝐚𝐭𝐨𝐦𝐲 𝐢𝐬 𝐡𝐢𝐝𝐢𝐧𝐠 𝐢𝐭. The sesamoids sit beneath a dense soft tissue sandwich: the sesamoid apparatus, FHB tendon, and a specialised subcutaneous layer. Simple pressure rarely reproduces concordant symptoms. The Passive Axial Compression (PAC) Test changes that. Here's how it works — 4 steps: 1️⃣ Palpate and localise both sesamoids under the 1st metatarsal head 2️⃣ Maximally dorsiflex the hallux to migrate the sesamoids distally 3️⃣ Apply firm proximal compression with your index finger — blocking their return 4️⃣ Passively plantarflex the 1st MTPJ — concordant pain = positive test All surrounding soft tissues are in a relaxed position during step 4, making this test relatively specific to the sesamoid complex. 💬 𝐃𝐨𝐰𝐧𝐥𝐨𝐚𝐝 𝐭𝐡𝐞 𝐟𝐫𝐞𝐞 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐫𝐞𝐟𝐞𝐫𝐞𝐧𝐜𝐞 𝐏𝐃𝐅 — 𝐬𝐭𝐞𝐩-𝐛𝐲-𝐬𝐭𝐞𝐩 𝐠𝐮𝐢𝐝𝐞 𝐰𝐢𝐭𝐡 𝐩𝐡𝐨𝐭𝐨𝐬, 𝐫𝐚𝐭𝐢𝐨𝐧𝐚𝐥𝐞, 𝐚𝐧𝐝 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐩𝐞𝐚𝐫𝐥𝐬. (𝐋𝐈𝐍𝐊 𝐄𝐗𝐏𝐈𝐑𝐄𝐒 𝐢𝐧 𝟑 𝐃𝐀𝐘𝐒) lnkd.in/eqA3q4SV

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𝐒𝐭𝐨𝐩 𝐋𝐚𝐛𝐞𝐥𝐥𝐢𝐧𝐠. 𝐒𝐭𝐚𝐫𝐭 𝐑𝐞𝐚𝐬𝐨𝐧𝐢𝐧𝐠. 𝐀 𝐧𝐞𝐰 𝐟𝐫𝐞𝐞 𝐠𝐮𝐢𝐝𝐞 𝐟𝐨𝐫 𝐌𝐒𝐊 𝐩𝐡𝐲𝐬𝐢𝐨𝐭𝐡𝐞𝐫𝐚𝐩𝐢𝐬𝐭𝐬 𝐰𝐡𝐨 𝐚𝐫𝐞 𝐭𝐢𝐫𝐞𝐝 𝐨𝐟 𝐠𝐮𝐞𝐬𝐬𝐢𝐧𝐠 𝐰𝐢𝐭𝐡 𝐩𝐨𝐬𝐭𝐞𝐫𝐢𝐨𝐫 𝐡𝐢𝐩 𝐩𝐚𝐢𝐧. Your patient points to their buttock. They've already seen someone. They've been told it's their piriformis. Or their SI joint. Or that they need to stretch more. None of it worked. And now they're sitting in front of you. Here's the problem: most of us were taught posterior hip pain as a list. SIJ. Gluteal tendinopathy. Deep gluteal syndrome. Proximal hamstring tendinopathy. We match the location to a label and hope for the best. But posterior hip pain doesn't work like that. Conditions overlap. They coexist. They refer into each other's territory. And a labelling approach — matching a diagnosis to a spot on a diagram — will let you down more often than it helps. What you actually need isn't a better list. It's a better way of thinking. What's in the guide -I've put together a free clinical reasoning framework specifically for posterior hip and buttock pain. It's a PDF you can download, print, and pin up in your clinic. -It's built around six discriminating questions that help you systematically narrow the differential — not by memorising conditions, but by asking the right things in the right order. A printable cheat sheet table you can use as a quick-reference during assessments. Imaging guidance on when ultrasound, MRI, or plain film actually adds value. Link below for Free Download function-2-fitness.kit.com/0bd45c8f23

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More than two decades in clinical practice (NHS and Private) . Hundreds of complex cases. One skill that changed everything. 𝐃𝐢𝐚𝐠𝐧𝐨𝐬𝐭𝐢𝐜 𝐦𝐮𝐬𝐜𝐮𝐥𝐨𝐬𝐤𝐞𝐥𝐞𝐭𝐚𝐥 𝐮𝐥𝐭𝐫𝐚𝐬𝐨𝐮𝐧𝐝. Not because it's impressive technology. But because of what it actually does for your patient in front of you. It sharpens your clinical reasoning on cases that don't fit the textbook. It gives you prognostic data you simply can't generate from palpation alone. 𝐀𝐧𝐝 𝐩𝐞𝐫𝐡𝐚𝐩𝐬 𝐦𝐨𝐬𝐭 𝐩𝐨𝐰𝐞𝐫𝐟𝐮𝐥𝐥𝐲 — 𝐢𝐭 𝐭𝐫𝐚𝐧𝐬𝐟𝐨𝐫𝐦𝐬 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐮𝐧𝐝𝐞𝐫𝐬𝐭𝐚𝐧𝐝𝐢𝐧𝐠. 𝐖𝐡𝐞𝐧 𝐬𝐨𝐦𝐞𝐨𝐧𝐞 𝐜𝐚𝐧 𝐬𝐞𝐞 𝐭𝐡𝐞𝐢𝐫 𝐩𝐚𝐭𝐡𝐨𝐥𝐨𝐠𝐲 𝐨𝐧 𝐬𝐜𝐫𝐞𝐞𝐧, 𝐜𝐨𝐦𝐩𝐥𝐢𝐚𝐧𝐜𝐞 𝐜𝐡𝐚𝐧𝐠𝐞𝐬. 𝐄𝐧𝐠𝐚𝐠𝐞𝐦𝐞𝐧𝐭 𝐜𝐡𝐚𝐧𝐠𝐞𝐬. 𝐎𝐮𝐭𝐜𝐨𝐦𝐞𝐬 𝐜𝐡𝐚𝐧𝐠𝐞. If you're offering shockwave therapy or MSK Injections and you're not scanning first, I'd gently challenge you to reconsider. Here's my clinical position: the effectiveness of shockwave is significantly enhanced by pre-procedural ultrasound — both to confirm the diagnosis and to rule out conditions that can convincingly mimic tendon pathology. Calcific deposits, partial tears, bursitis, and neoplastic lesions don't all respond to shockwave the same way. Some shouldn't receive it at all. 𝐘𝐨𝐮𝐫 𝐞𝐲𝐞𝐬 𝐚𝐧𝐝 𝐡𝐚𝐧𝐝𝐬 𝐚𝐫𝐞 𝐞𝐱𝐜𝐞𝐥𝐥𝐞𝐧𝐭. 𝐁𝐮𝐭 𝐭𝐡𝐞𝐲 𝐡𝐚𝐯𝐞 𝐥𝐢𝐦𝐢𝐭𝐬. Last week I had the privilege of spending a full day with the osteopathic team at Ben Cohen Osteopathy in Epping — a deep dive into MSK ultrasound fundamentals with a particular focus on tendon pathology. Exactly the kind of clinically relevant upskilling that shockwave-offering clinics need more of. The day was organised by Venn Healthcare. The VINNO Ultrasound Vinno 6 cart-based device genuinely impressed me. In eight years of scanning across multiple platforms, its image quality ranks among one of the best I've worked with. I will share more images in the future. You can check out the image of supraspinatus in Long Axis. 𝐒𝐡𝐨𝐜𝐤𝐰𝐚𝐯𝐞 𝐚𝐧𝐝 𝐌𝐒𝐊 𝐈𝐧𝐣𝐞𝐜𝐭𝐢𝐨𝐧𝐬, 𝐰𝐢𝐭𝐡𝐨𝐮𝐭 𝐬𝐜𝐚𝐧𝐧𝐢𝐧𝐠 𝐢𝐬 𝐚𝐧 𝐞𝐝𝐮𝐜𝐚𝐭𝐞𝐝 𝐠𝐮𝐞𝐬𝐬. 𝐇𝐨𝐰𝐞𝐯𝐞𝐫, 𝐰𝐢𝐭𝐡 𝐬𝐜𝐚𝐧𝐧𝐢𝐧𝐠 𝐢𝐬 𝐩𝐫𝐞𝐜𝐢𝐬𝐢𝐨𝐧 𝐦𝐞𝐝𝐢𝐜𝐢𝐧𝐞. 𝐓𝐡𝐞 𝐛𝐚𝐫 𝐟𝐨𝐫 𝐨𝐮𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐝𝐞𝐬𝐞𝐫𝐯𝐞𝐬 𝐭𝐨 𝐛𝐞 𝐡𝐢𝐠𝐡𝐞𝐫. If you're interested in learning more about the Vinno 6 and how it can support your MSK ultrasound practice, reach out to @VennHealthcare directly — they're the people to speak to.

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𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟖 - 𝐓𝐡𝐞 𝐓𝐨𝐩 𝟓 𝐑𝐞𝐚𝐬𝐨𝐧𝐬 𝐏𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐅𝐚𝐢𝐥 𝐂𝐨𝐧𝐬𝐞𝐫𝐯𝐚𝐭𝐢𝐯𝐞 𝐂𝐚𝐫𝐞 𝐢𝐧 𝐅𝐀𝐈 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞 Conservative care fails FAI syndrome patients every day — but is it really the treatment that's failing, or the process surrounding it? In this episode, Benoy and Callum break down the five most common reasons why patients with femoroacetabular impingement syndrome don't respond to non-operative management. This isn't about blaming patients. It's about clinicians holding up a mirror and asking the harder questions. 🎙 𝐅𝐮𝐥𝐥 𝐞𝐩𝐢𝐬𝐨𝐝𝐞 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 🎧Spotify: spti.fi/sBkoO98 💻Youtube: tinyurl.com/4auffpkm 🎧Itunes: tinyurl.com/3be7v49j Amazon Music: tinyurl.com/2xyv5ksu

Why are practitioners still doing fluroscopic guided shoulder joint hydrodistensions for A capsulitis ? Any ideas @DrJN_SportsMed - four times the cost of US-guided without radiation. What am I missing here?

𝐌𝐨𝐬𝐭 𝐅𝐀𝐈 𝐚𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭𝐬 𝐠𝐨 𝐰𝐫𝐨𝐧𝐠 𝐛𝐞𝐟𝐨𝐫𝐞 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐞𝐯𝐞𝐧 𝐠𝐞𝐭𝐬 𝐨𝐧 𝐭𝐡𝐞 𝐜𝐨𝐮𝐜𝐡. Not because clinicians don't care. Not because they lack experience. But because the subjective history is rushed — and the objective examination lacks a clear framework. So Callum East and I decided to do something about it. We've just released a FREE comprehensive clinical guide on the evaluation of FAI Syndrome — companion notes from Episodes 1 and 2 of our podcast, Straight from the Hip. Inside, you'll find: ✅ A structured subjective framework that gets you 60–70% of the way to your diagnosis before you touch the patient ✅ The clinical tests that actually matter — and how to perform them properly ✅ How to interpret movement findings without over-pathologising normal compensation ✅ How to communicate your findings in a way that builds patient confidence from session one ✅ A whole-system assessment approach — because FAI is never just about the hip This is built for physiotherapists, osteopaths, sports therapists, and S&C coaches working with hip and groin pain in everyday practice. 𝐍𝐨 𝐟𝐥𝐮𝐟𝐟. 𝐍𝐨 𝐭𝐞𝐱𝐭𝐛𝐨𝐨𝐤 𝐭𝐡𝐞𝐨𝐫𝐲. 𝐉𝐮𝐬𝐭 𝐰𝐡𝐚𝐭 𝐚𝐜𝐭𝐮𝐚𝐥𝐥𝐲 𝐦𝐚𝐭𝐭𝐞𝐫𝐬 𝐢𝐧 𝐜𝐥𝐢𝐧𝐢𝐜. 📥 Download it free here: function-2-fitness.kit.com/f43b0278d9 If this is useful, please share it with a colleague who sees hip and groin pain. The more clinicians we can reach, the better the outcomes for our patients.

@almeyda84 function-2-fitness.kit.com/0bd45c8f23

𝐏𝐨𝐬𝐭𝐞𝐫𝐢𝐨𝐫 𝐡𝐢𝐩 𝐩𝐚𝐢𝐧 𝐢𝐬 𝐭𝐡𝐞 𝐦𝐨𝐬𝐭 𝐨𝐯𝐞𝐫-𝐥𝐚𝐛𝐞𝐥𝐥𝐞𝐝, 𝐮𝐧𝐝𝐞𝐫-𝐫𝐞𝐚𝐬𝐨𝐧𝐞𝐝 𝐩𝐫𝐞𝐬𝐞𝐧𝐭𝐚𝐭𝐢𝐨𝐧 𝐢𝐧 𝐌𝐒𝐊 𝐩𝐫𝐚𝐜𝐭𝐢𝐜𝐞. Conditions overlap. Referrals look identical. Patients arrive carrying labels that don't fit. The fix isn't a longer differential list. It's a sharper reasoning sequence. I've just published a clinical guide, walking through the framework I use in clinic and teach on my hip course: → Why labels fail → The 6 discriminating questions that narrow the field fast → The 3 clinical pathways that follow → What commonly gets missed (Ischio-femoral impingement, pudendal entrapment, sacral BSI ) → When to image and which modality answers which question Free 14-page PDF guide inside it. If it sharpens one assessment this week, it's done its job. 🔗 Link below to download function-2-fitness.kit.com/0bd45c8f23

@DrPeteMalliaras Less than 50% success with conservative management. Not great.

𝐄𝐩𝐢𝐬𝐨𝐝𝐞 𝟔 - 𝐌𝐨𝐫𝐩𝐡𝐨𝐥𝐨𝐠𝐲 𝐈𝐬𝐧'𝐭 𝐃𝐞𝐬𝐭𝐢𝐧𝐲: 𝐑𝐞𝐭𝐡𝐢𝐧𝐤𝐢𝐧𝐠 𝐇𝐨𝐰 𝐖𝐞 𝐌𝐚𝐧𝐚𝐠𝐞 𝐅𝐀𝐈 𝐒𝐲𝐧𝐝𝐫𝐨𝐦𝐞 Your patient has FAI Syndrome. They're in pain, frustrated, and wondering if they'll ever squat, sit comfortably, or train hard again. The answer? They almost certainly can — but only if we stop blaming morphology and start managing load. In this episode, we break down exactly how to modify everyday activity and gym exposure, so your patients keep moving, keep training, and actually start recovering. From the sitting habits silently driving flare-ups, to the squat, deadlift, and spin class tweaks that take the heat out of the anterior hip — this is the practical playbook you can take straight into clinic on Monday morning. What you'll learn: Why FAIS is a cumulative compression problem, not a single-event injury How to modify sitting, walking, stairs, car transfers, and sleep to calm an irritable hip Gym adjustments for squats, deadlifts, lunges, leg press, and core work — without pulling strength training away from your patient How CAM vs pincer morphology should shape your walking and loading advice Saddle height, handlebar position, and cadence tweaks for cyclists and spin class regulars The five clinician mistakes that keep FAIS patients stuck — including chasing perfect posture and over-restricting flexion Range isn't the enemy-unprepared range under load is. We modify to restore tolerance, not to protect forever. Tune in, take notes, and share it with a colleague who's still telling their FAI patients to avoid the squat rack. 𝐏𝐞𝐫𝐟𝐞𝐜𝐭 𝐟𝐨𝐫: Physiotherapists, osteopaths, sports therapists, strength coaches, and any health care professional managing active patients with hip and groin complaints. 🎙 𝐅𝐮𝐥𝐥 𝐞𝐩𝐢𝐬𝐨𝐝𝐞 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 🎧Spotify: spti.fi/sBkoO98 💻Youtube: tinyurl.com/4auffpkm 🎧Itunes: tinyurl.com/3be7v49j Amazon Music: tinyurl.com/2xyv5ksu

𝐏𝐮𝐝𝐞𝐧𝐝𝐚𝐥 𝐍𝐞𝐮𝐫𝐚𝐥𝐠𝐢𝐚 The diagnosis that slips through every filter — MRI, nerve conduction, and often our own clinical radar. A 42-year-old cyclist. 8 months of "groin pain." Normal hip MRI. Normal lumbar MRI. Negative FADIR, negative FABER. But sitting for more than 10 minutes? Agony. Standing? Relief within seconds. That pattern is the clue. Here's what physios need to know: 1️⃣ A key differential for cauda equina. Both can present with perineal symptoms and bladder or bowel change. Pudendal neuralgia is typically unilateral, position-dependent, and spares motor function. Cauda equina won't. 2️⃣ It hides inside hip and groin pathology. Deep gluteal syndrome, proximal hamstring tendinopathy, FAI, post-partum pelvic pain — pudendal irritation can coexist or masquerade. Miss it and rehab stalls. 3️⃣ MRI and nerve conduction studies are often normal. The pudendal nerve is small, deep, and runs through Alcock's canal between the sacrospinous and sacrotuberous ligaments. Standard imaging rarely catches entrapment. Diagnosis is clinical — lean on the Nantes criteria. Cluster the red flags: 🟣 Burning or stabbing perineal, genital, or anal pain 🟣 Worse with sitting, relieved standing or on a toilet seat 🟣 No nocturnal pain, no sensory loss 🟣 Cyclists, post-partum, post-surgical, chronic "groin" presentations If the story doesn't fit the scan — listen to the story. At YOS Health, we manage pudendal neuralgia through an integrated model — combining hip-focused MSK physiotherapy with specialist pelvic health input, lead by Fran Roca BSc MSc HCPC MCSP under one roof and specialist Protocol using Focus Shockwave (done in very few centres in UK & Europe) This condition rarely sits in one lane, and neither should the care. If you're stuck with a case that isn't adding up, we're happy to help. 🔗 yoshealth.co.uk

𝐒𝐩𝐨𝐭𝐭𝐢𝐧𝐠 𝐚 𝐅𝐮𝐥𝐥-𝐓𝐡𝐢𝐜𝐤𝐧𝐞𝐬𝐬 𝐒𝐮𝐩𝐫𝐚𝐬𝐩𝐢𝐧𝐚𝐭𝐮𝐬 𝐓𝐞𝐚𝐫 𝐨𝐧 𝐔𝐥𝐭𝐫𝐚𝐬𝐨𝐮𝐧𝐝: 𝐃𝐨𝐧’𝐭 𝐌𝐢𝐬𝐬 𝐭𝐡𝐞 𝐈𝐧𝐝𝐢𝐫𝐞𝐜𝐭 𝐒𝐢𝐠𝐧𝐬 Chronic full-thickness supraspinatus tears can sometimes, be tricky on ultrasound. Defects are often filled with fibrous tissue, giving the illusion of tendon continuity. That’s where indirect signs become essential. Here’s a practical approach I use: -Look for the sagging pre-bursal fat sign on the transverse view. It’s been reported to have around 88% sensitivity for full-thickness tears. -Then increase your confidence by checking for cortical irregularities at the footprint. In this case, they’re clearly present. When the pre-bursal fat sag sign is combined with cortical irregularities, specificity and positive predictive value can approach 100%. Ref: sciencedirect.com/science/articl… These are the cases where careful attention to indirect signs makes all the difference in diagnosing rotator cuff tears. If you’d like to dive deeper or develop your diagnostic skills, our mentorship programme at the award-winning MSK Team at Guy's and St Thomas'​ NHS Foundation Trust can help. Feel free to reach out –contact [email protected] for more details

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𝐎𝐧𝐥𝐢𝐧𝐞 𝐂𝐏𝐃 𝐡𝐚𝐬 𝐢𝐭𝐬 𝐩𝐥𝐚𝐜𝐞. But there's something it can't replicate — a room full of clinicians wrestling with real cases, together. This weekend at Whittington Hospital London, we ran Advanced Running Rehab. Dominic joined us for his very first in-person CPD. His feedback (video below) is exactly why we built this course: → Complex running injuries you won't meet in a textbook → Integrating technology into your clinical reasoning → Hands-on work, live debate, real patient problems No slides-and-scroll. No passive listening. Just clinicians getting stuck in. Huge thanks to everyone who made the room what it was — and to Dominic for trusting us with his first CPD experience. Next stop: Manchester, September — DM "RUN" for details. Co-created with the brilliant yasmin palfrey, who keeps the clinical bar impossibly high.

𝐂𝐞𝐫𝐚𝐦𝐢𝐜 𝐇𝐢𝐩 𝐑𝐞𝐬𝐮𝐫𝐟𝐚𝐜𝐢𝐧𝐠 𝐈𝐧𝐧𝐨𝐯𝐚𝐭𝐢𝐨𝐧𝐬 𝐚𝐭 𝐔𝐂𝐋 -You're too young for a hip replacement. -You're too active to slow down. -And you've been told resurfacing isn't an option — maybe because of your size, your sex (Female), or the risks of metal implants. So what now? Recently, I spent an afternoon at UCL with Mr. Kartik Logishetty onsultant hip surgeon, exploring one of the most important advances I've seen in hip surgery in years: ceramic hip resurfacing. Here's what it actually means for young, active patients with Hip OA, who have failed conservative management: 1️⃣ No metal ions. Traditional metal-on-metal resurfacing carried a real risk of reactions in the surrounding tissue. Ceramic takes that concern off the table. 2️⃣ Built to last. Ceramic is harder and smoother than metal, so the bearing surface stands up to years of running, lifting, training, and the demands of an active life. 3️⃣ Your bone is preserved. Unlike a full hip replacement, resurfacing keeps your natural femoral head — which matters if you're young and want to keep your options open down the line. 4️⃣ 𝐀 𝐑𝐞𝐚𝐥 𝐨𝐩𝐭𝐢𝐨𝐧 𝐟𝐨𝐫 𝐖𝐨𝐦𝐞𝐧 𝐚𝐧𝐝 𝐬𝐦𝐚𝐥𝐥𝐞𝐫-𝐟𝐫𝐚𝐦𝐞𝐝 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬. A group who, until now, have been consistently told they weren't suitable. That's changing. I reviewed post-op cases with Mr Karthik and worked through some complex hip dysplasia cases — the kind of conversations that directly shape how I guide my patients in my complex cases – review clinic at Guys and St. Thomas Hospital. A full discussion — ceramic hip resurfacing vs traditional hip replacement, who it suits, and who it doesn't — is coming soon on the Straight from the Hip podcast. Genuine thanks to Mr Karthik and the UCL team for their time and generosity. If you've been told your only option is a hip replacement — or simply to "wait and see" — it may be worth a second look.

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COME WORK WITH ME! Looking for a physiotherapist role where you can build your skills, work with runners, and enjoy the lifestyle outside the clinic? Send me your resume + cover letter at "[email protected]"

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