I know subgrouping has not been great for dictating treatment but I still feel there are pain phenotypes/archetypes that help nudge our treatment in a certain direction.

I'm going to list a few that our behaviour and pathology informed. Please feel free to add yours.

1/ Archetype 1: Avoidant

People just stop doing the things that are good for them. Fear alone might drive sensitivity but it is also the lack of things that are healthy/fun/meaningful.

Fear Avoidance is tricky because it can lead to a 2nd archetype...2/

Strength training to build "capacity" to run is often promoted to prepare someone to tolerate the 4-6x body weight loads that occur in multiple areas. Its argued we therefore need heavy strength training to match this load.

While strength training might help...1/ with recovery I think it's a bit myopic to think it's because we are matching those body weight loads. For example, a runner taking 160 steps per minute loads the PFJ for a total of 320 body weights per minute, or 19 200 body weights per hour...2/

You don't have to be weak to benefit from resistance exercise if you have knee pain. Nor should we think that people get better because they improved strength. Its a possibility but not currently supported.

pubmed.ncbi.nlm.nih.gov/27904794/
1/ In this study we see that responders to exercise don't show greater hip abductor gains in strength. But they do show increases in other strength measures.

Nor do we see weaker people responding better to resistance exercise.

Knee Valgus and ACL injuries.

A reflective thread on what we can say.

If you retweet what should be a comment I'm not responding :)

Keep it clean!

Let's go 1/x Large and violent amounts of dynamic knee valgus are absolutely one potential method of tearing the ACL. Both cadaver studies and video analyses will confirm this.

pubmed.ncbi.nlm.nih.gov/32561515/

For 20 years I've been one of those saying that its a MYTH that stretching prevents running injuries.

Surprisingly, when you take a deep dive into the research you see that making strong statements (e.g its a MYTH) can't be said.

There are a few reasons for this: 1/ 1. The reviews often include studies that don't evaluate distance runners ncbi.nlm.nih.gov/pubmed/15076777
ncbi.nlm.nih.gov/pubmed/27912252
ncbi.nlm.nih.gov/pubmed/21735382

2. The interventions are extremely under dosed (e.g One 20s stretch before a run or 2 x 10s) ncbi.nlm.nih.gov/pubmed/8238713

The value or necessity of building strength for rehab might be oversold for many painful conditions. But there are probably cases where strength increases are needed and there are fewer options for rehab choices.

Thread to follow on when strength should be improved 1/ Add cases if you wish @AdamMeakins @Bill_Vicenzino @DerekGriffin86

OK. Hold on for this one. We are doing a session of "In Lehman's terms" where we dive into a research paper with a long Tweet Thread. Specifically, the Motor Control Issue from @JOSPT jospt.org/doi/abs/10.251… 1/ The basic question is whether instability is relevant to low back pain. My primary issue is that it was assumed from the start and throughout the paper that it is relevant. No counterpoint was made 2/