ONeillsSportsTherapy

Clinic director at OST + Lecturer at City of Glasgow College/Queen Margaret University

[Lukáš Ronald Lukács @lucxsronald]

One more look how stages look like. #TDF2026

[Mike Morrison @MDMorrison82]

Lads we have a true emergency, shite. We got a mate lost his passport on the way to the game. Apologies to my brother/sister @MBTA @mbta_alerts social manager but the Wakefield bagpiper just sent me this. If Helen from Scotland can send me to the cup, we can do this. Cuz BOSTON

[Cory Calendine, M.D. @CoryCalendineMD]

The subscapularis tendon is the gatekeeper of shoulder replacement surgery. It must be detached to access the joint, then repaired and protected for six weeks. Failure rates range from 13-47% when precautions are ignored. Your recovery depends on following the protocol.

[Cory Calendine, M.D. @CoryCalendineMD]

94% of NFL team surgeons choose patellar tendon for ACL surgery in young athletes.
Hamstring? Down from 42% → 8% in one decade.
Bone-to-bone healing wins every time for explosive athletes. The science moved.
#ACLSurgery #OrthopedicSurgery

[Football Tweet ⚽ @Footballtweet]

🤢 The trend of wearing tiny shin pads must end now.

[Eurosport France @Eurosport_FR]

Depuis 130 ans, Paris-Roubaix ne se raconte pas. Elle se vit. ⚔️

"Paris-Roubaix, duels en enfer", un documentaire exceptionnel à retrouver ce vendredi sur Eurosport et HBO Max

[Lord Bebo @MyLordBebo]

🐺 They ran like crazy after seeing him probably

https://t.co/Sw4uaiCxHV

[Dr. Dominic Ng @DrDominicNg]

A signal in your brain - fired AFTER exercise - decides whether your body adapts at all.

Block it? Training did nothing.
Boost it? 2x the work output and 3x the endurance gains.

This might be the most important exercise paper in years. Here's what they found 🧵

[Professor Kristian Thorborg @KThorborg]

In great collaboration with Top-world expert on Inguinal-Related Groin Problems - Professor Aali Sheen - and I, have written an updated review on “Inguinal-Related Groin Pain and/or Disruption”

Covering aspects of anatomy, pathology, terminology, assessment, treatment pathways outcome and RTP.

We are very happy for it to be OPEN ACCESS and we hope that the sports physio/medicine community find it useful:

Download it FREE from here:

https://t.co/t57zsvInfX

Always learning🤩 - thanks Aali❤️ and all the great contributors in this space🏆

[Dr Claire Minshull @Claire_Minshull]

Delighted to share my open access paper:
Mastering the use of hand-held dynamometry in clinical practice

Intended to help clinicians simply navigate quality assessment & measurement science amid growing marketing hype & dynamometry device options.

https://t.co/QD5XDcu201

[James Noake @DrJN_SportsMed]

Consent ✅

Runner -

Relative Energy Deficiency in Sport (REDS) and prior eating disorder

High grade calcaneal stress fracture (with almost completed fracture line) - see MRI image

Immobilised in Aircast boot (ACB) for prolonged period based on persistent heel pain, despite follow up MRI showing appropriate healing and regression of bone marrow oedema

Patient adamant nature and location of pain now different

Now - burning, ‘horseshoe shape’ around heel and radiating into lateral plantar foot
(see patient's pain map; red - medial, blue - lateral)

Finally, out of AirCast boot and off crutches after third MRI - but pain persisting on return to longer walks and jogging

Found amitriptyline helpful in modifying what is clearly neuropathic pain in the interim

OE -

Calcaneal squeeze negative

Tinel’s along lateral plantar nerve (LPN) and anteromedial heel (Baxter’s nerve (BN) inferior calcaneal nerve course) very provocative

Images from first MRI (axial T2s) show LPN oedema and possibly BN which are immediately adjacent to the areas of calcaneal periostitis and inflammation

POCUS video of hydrodissection with low potency soluble dexamethasone and local anaesthetic (note - LPN thickened at point of maximal tenderness, provoked with hockey stick probe pressure)

As injecting – “Ouch! that’s the exact pain I’ve been having”

At follow up pain intensity reduced by 60-70% despite tentatively weaning off amitriptyline

For second hydrodissection, this time with 5DW

[ONeillsSportsTherapy @OSTRyan]

@DrJN_SportsMed Both!!

[James Noake @DrJN_SportsMed]

Consent ✅

Late 20s - runner & footballer

10-year history of bilateral lower leg pain – described as “crampy” and “bursting”

All lower leg muscle compartments (anterior worst)

Rapid onset with run, adjust to slower pace to keep manageable

Some pain resolution on exercise cessation but persistent stiffness & subjective weakness

Previous bilateral anterior compartment mini-fasciotomies for presumed Chronic Exertional Compartment Syndrome (CECS) – no change in symptoms (no pre-operative work up or pressure testing)

At initial consultation – disproportionate calf and tibialis anterior muscle tone and definition, otherwise normal exam

Patient asked to go for run prior to follow up consult -

OE - (20 minutes post exercise):

Difficulty rising & walking from waiting room

Palpation – firm “woody” feel to all muscle compartments
Increased tone, discomfort on passive end range of movement
Muscle contraction uncomfortable
Reduced power globally vs initial consult; improved on continued testing
Pulses normal, reflexes and sensory neurological exam normal

Bloods normal including pre and post exercise Creatine Kinase (CK)

MRI (axial T2) post exercise – bilateral diffuse calf muscle oedema, reported as possible CECS or delayed onset muscle soreness (DOMS)

EMG – myotonic discharges of varying amplitude and frequency post contraction; producing a characteristic 'dive-bomber' sound (see trace)

Diagnosis – Myotonia Congenita (commonest non-dystrophic neuromuscular myopathy)

On further testing, mild changes in deltoids

Pearls –

Pattern of muscle involvement can mimic CECS – but MC is characterized by delayed muscle relaxation (myotonia), rigidity, cramping, whereas symptoms with CECS resolve rapidly with cessation of exercise

Symptoms also similar to those of metabolic myopathies eg McCardle’s Disease

Effect enhanced by cold, inactivity and adrenaline

‘Warm up’ phenomenon – relieved by continued activity and repetitive movement. This effect diminishes quickly with rest (whilst sat in waiting room!)

Patients often appear ‘muscular’ (see pic)

Most recognised forms:

‘Thomson disease’ (Autosomal Dominant) – earlier onset in childhood, lower limbs predominant
‘Becker disease’ (Autosomal Recessive) – more severe disability, upper limbs / face

Research links -

Chronic Exertional Compartment Syndrome: A Clinical Update https://t.co/qx3ieecsx1

Metabolic myopathies: functional evaluation by different exercise testing approaches
https://t.co/W94YV2bzBr

[Aitor Viribay @MVAitor]

Lactate metabolism in mitochondria. A Christmas read by Gladden´s group!

Since mitochondria was observed back in 1840 to contemporary understanding of its metabolism. This extensive review is worth reading.

It includes a debate: what´s the role of mLDH?

https://t.co/FELfWSeo1o

[William A. Wallace, Ph.D. @WilliamWallace]

The immune system has computation and memory.

This pathway map shows how innate and adaptive immunity coordinate threat detection, signal amplification, targeted killing, and long-term archival of antigen data.

-Innate: pattern-recognition receptors, complement, macrophages, neutrophils — rapid, non-specific control within minutes.

-Adaptive: antigen-specific B and T cells, clonal expansion, antibody class switching.

-IgM → IgG → IgA/IgE: sequential specialization depending on tissue and threat.

-Memory B/T cells: durable molecular records enabling accelerated responses on re-exposure.

What looks like a single “immune response” is actually a staged, multi-layered signaling system that detects, eliminates, and then remembers pathogens with exquisite precision.

[Iñigo San Millán @doctorinigo]

1️⃣ Lactate isn’t waste, it’s a central regulator of the tumor microenvironment (TME). It shapes immune responses, stromal behavior, angiogenesis, EMT, drug resistance, and metabolic reprogramming.
2️⃣ Lactate connects metabolism to epigenetics via lactylation, modifies signaling, and influences differentiation/immune cell fate.
3️⃣ Targeting LDH and MCTs isn’t just about starving tumors, it can synergize with immunotherapy by reshaping the metabolic milieu.

Key takeaway: Tumor lactate metabolism is both a driver & therapeutic vulnerability.
#Lactate #TME #MetabolicTherapy #CancerResearch

[Mo Imam @MoAImam]

Knees

[Agingdoc🩺Dr David Barzilai🔔MD PhD MS MBA DipABLM @agingdoc1]

Lactate metabolism in human health and disease

🔘Lactylation is a vital component of lactate function and is involved in tumor proliferation, neural excitation, inflammation and other biological processes.
🔘An indispensable substance for physiological cellular functions, and regulatory role in energy metabolism and signal transduction.
- Inflammatory responses 🔥
- Memory formation and neuroprotection 🧠
- Wound healing 🩹
- Ischemic injury 🫀
- Tumor growth and metastasis😷
- Lactate leads to ATP production are simpler and faster than those involved in the oxidative utilization of glucose ⚡️

A bit of history: my great-grandfather’s cousin, Nobel laureate Otto Meyerhof, uncovered the link between muscle contraction and lactic acid. He showed that glycogen is converted to lactic acid without oxygen, and that in the presence of oxygen, most of it is recycled back into glycogen—early evidence of a metabolic cycle in living cells. This work laid the foundation for our understanding of glycolysis (the Embden–Meyerhof pathway) and earned him the 1922 Nobel Prize, shared with Archibald Hill, for explaining how muscles use and recover energy. 👨‍⚕️

https://t.co/TEBrXDueJr

[Winston Lin @linstonwin]

This is one of the best short articles I've read on P-values, CIs, and significance tests

[Nutrition Science @NutrioSci]

Citric Acid Cycle

Credit: Nat Chem Biol #MedEd #MedX #Nutrition