Shaun Tyler

Colchester based Osteopath interested in all things MSK, pain, running & health. Always looking to improve.

[Thomas Dekkers | Spinal Specialist Physiotherapist @TDekkersPhysio]

Great paper here for all clinicians- we need to understand and then leverage contextual factors 👇

[Thomas Dekkers | Spinal Specialist Physiotherapist @TDekkersPhysio]

The biggest disc herniations are often the ones most likely to disappear.

Here's the evidence — and how it should shape spinal rehab. 🧵

[TheParachuteRegiment @TheParachuteReg]

The Paras are recruiting now, click the link below for more information 🇬🇧

Ready for anything 🆎

#TheParachuteRegiment
#Paras
@BritishArmy
@16AirAssltBCT

https://t.co/q3ANpjq36X

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

Your muscle rebuilds in about three months. Your tendons and cartilage take roughly a year and a half. Your bone, up to two years. Adding 40 grams of whey daily for two weeks doesn't change any of those timelines.

That's the finding from a study published last month in the American Journal of Clinical Nutrition. The team measured rebuild rates across more than a dozen knee tissues in living older adults using a safe heavy-water tracer. Half the participants kept their habitual diet. Half added 40 grams of whey daily for 14 days. At the end, the rebuild rates of every tissue were the same in both groups.

Muscle rebuilt at about 1.2 percent per day. At that rate, your quadriceps theoretically turn over in roughly three months. The patellar tendon, the femoral cartilage, and the menisci all rebuilt at 0.18 to 0.21 percent per day, putting their full-pool turnover at roughly 1.3 to 1.5 years. Bone rebuilt at 0.12 to 0.21 percent per day across five sites, with the slowest taking up to 2.3 years for a complete cycle.

It does not say protein doesn't build connective tissue. It does. Every tissue in your body depends on dietary amino acids as substrate. What the study shows is that for these older adults on their normal diets, adding 40 grams of whey on top for two weeks did not accelerate the rebuild rate of any tissue measured.

Protein supplementation is a tool for closing intake gaps and for hitting the per-meal threshold that maximizes muscle protein synthesis after training. It's effective at those goals.

Cartilage damage from running mileage, tendon overuse injuries, bone density loss in postmenopausal women, ACL rehabilitation timelines: none of these can be hurried with whey.

The reality is that your body runs many tissue clocks at very different speeds. Muscle is the fast one. Most of what we call "tissue building" outside of muscle takes 1 to 2 years per cycle, not days.

Muscle responds to protein on a short timescale. Everything else responds on a long one. The two are not interchangeable.

citation:
Houtvast et al., Am J Clin Nutr, 2026

[Thomas Dekkers | Spinal Specialist Physiotherapist @TDekkersPhysio]

How high should a straight leg raise be before I’m happy for a patient with sciatica to run? 🤔

My answer: It depends.

Consider this athlete who is 14/52 post-microdiscectomy and still has a limited SLR of approx 75° on the affected left leg compared to 90° on the unaffected side.

I would NOT be happy for this patient to run. 🚫🏃

Why?

⚠️ Too close to surgery for my liking (potential re-herniation risk)
⚠️ Neural symptoms still need time to settle (risk of a radicular flare)
⚠️ Symptoms remain too irritable

Therefore, I would restrict running based on symptom irritability and the need to protect the surgical site.

Now consider a different scenario with the same 75 degrees of SLR with this presentation:

✅ Long-standing issue
✅ Stable disc findings on MRI
✅ Low symptom irritability in daily life
✅ Good overall function

In that case, I WOULD consider a return to running. 🏃‍♂️

My point? 👇

SLR range is only ONE factor in the return-to-running decision with sciatica.

We also need to consider:
🔹 Symptom irritability
🔹 Pathology
🔹 Expected healing timelines
🔹 Previous training history
🔹 Global fitness and capacity

A 75° SLR doesn’t automatically mean “no running”—and a 90° SLR doesn’t automatically mean “yes.” 🎯

Clinical decisions require context, not just measurements

[Physio Meets Science @PhysioMeScience]

Greater, lesser and third occipital nerve entrapment: Sonographic anatomy and imaging

https://t.co/cDkoF9NARN

[Mo Imam @MoAImam]

Lumbar Disc Herniation Made Visual
(Frank H. Netter, MD)

[Path of Men @PathOfMen_]

Zinc in the morning. Magnesium at night. Vitamin D with your first meal. Do it for 30 days and tell me your energy, your sleep and your mood didn't completely shift.

[Football Tweet ⚽ @Footballtweet]

🚨 Jürgen Klopp has launched a scathing attack on the cooling breaks being used during this World Cup. 👊

"Football is being held hostage by executives sitting in air-conditioned offices.

These breaks are being presented as a shield for player welfare, a noble weapon against the heat. In reality, they are nothing more than a golden cage built for sponsors.

When I saw players standing around during cooling breaks while television timeouts dictated the rhythm of the match, I couldn't help but ask myself: who is the World Cup really serving?

The supporters? The players? Or the advertisers?

A World Cup match should flow like a river. Instead, we are building dams in the middle of it so commercials can be shown.

It's dangerous for the spirit of the game. Football used to be the main event, but it now risks becoming background music for an advertising show."

He didn't hold back. 👏👏

[Corey Twine @CoreyTwine]

Recovery should be prescribed like training.

Not guessed.
Not copied.
Not selected because it looks impressive on social media.

We would never randomly prescribe sets, reps, load, tempo, or rest periods.

So why do we randomly prescribe recovery?

That is what made Dupuy et al. 2018 worth reading.

They did not just ask, “Does recovery work?”

They compared recovery methods against specific outcomes:

DOMS.
Perceived fatigue.
Creatine kinase.
IL 6.
C reactive protein.

That matters.

Because recovery is not one thing.

Fatigue is not one thing.

Readiness is not one thing.

Massage showed strong effects for soreness and perceived fatigue.

Compression and water immersion also showed meaningful benefits.

Cold exposure had relevance for inflammatory related outcomes.

Stretching and electrostimulation were not strongly supported as primary strategies for soreness or fatigue in that analysis.

The bigger point is this:

Recovery strategies are tools.

Massage, cold water immersion, compression, active recovery, sleep, nutrition, hydration, and load management all have a place.

But tools only matter when they match the job.

A hammer is useful.

But not if the problem is a loose screw.

The better question is:

What did the session cost the system?

Was it muscle damage?
Metabolic stress?
Heat strain?
Dehydration?
Soreness?
Perceived fatigue?
A readiness issue before the next exposure?

The better model:

Identify the activity.
Identify the demand.
Identify the system cost.
Identify the dominant fatigue type.
Then select the recovery strategy that best mitigates the problem.

That is recovery prescription.

Recovery should not be passive.

Recovery should be planned.

[Physio Meets Science @PhysioMeScience]

Just published 🔥

𝗖𝗮𝗿𝗱𝗶𝗼𝗿𝗲𝘀𝗽𝗶𝗿𝗮𝘁𝗼𝗿𝘆 𝗳𝗶𝘁𝗻𝗲𝘀𝘀 𝗮𝗻𝗱 𝗽𝗮𝗶𝗻 𝘀𝗲𝘃𝗲𝗿𝗶𝘁𝘆?

👉Higher eCRF was associated with lower odds of chronic pain and with more favorable changes in pain severity in the general population.

https://t.co/4YeVRbVwB9

[JM Sequí-Sabater @drjsequirheum]

Is osteoarthritis really a non-inflammatory disease?
In this review we explore the inflammatory phenotype of OA and its clinical implications.

Great collaboration with Laura Muñoz-Llopis, @pilarortizl and @Fabry_BV

📖 https://t.co/lMQZ3RCpn8

#Osteoarthritis #Rheumatology #MRI

[Thomas Dekkers | Spinal Specialist Physiotherapist @TDekkersPhysio]

Documenting "Positive Straight leg raise" tells me almost nothing.

Here's what to actually record:
→ Angle of onset (when does the leg symptom start?)
→ Quality of reproduction (tingling? shooting? exact leg pain?)
→Side — ipsilateral or contralateral (crossed SLR matters)
→ Sensitisation response to dorsiflexion

The more data you collect, the better you can track progress.

[Thomas Dekkers | Spinal Specialist Physiotherapist @TDekkersPhysio]

@ml_muliebrity Plenty more discussed including why we need to retire "core-stability"

Full Podcast here - have a listen and let me know your thoughts.. 👇

https://t.co/yY2y8knCtu

[ɹǝʇlnoԀ pıʌɐᗡ 🚴🏻 🇺🇸 🇦🇺 🇬🇧 @Retlouping]

Pre-treatment risk factor assessment and safe management of the cervical spine: a survey among physical therapists https://t.co/nq40mmBFVy

[Jake Tuura @jake_tuura]

The only other study showing plantarflexor weakness predisposes to Achilles injury: https://t.co/T1z1SFrn1U

[Learn.Physio @LearnPhysio]

🫵 What's your go to exercise for patella tendon rehab?

🧐 These findings by Silva et al, (2023) might give you some guidance

📖 Full text: https://t.co/NthawcHm8e

💡 Learn more by watching the NEW Patella Tendinopathy Masterclass at https://t.co/PJOUFYmjHZ

[Physio Meets Science @PhysioMeScience]

𝗖𝗿𝗼𝘀𝘀-𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗼𝗳 𝘂𝗻𝗶𝗹𝗮𝘁𝗲𝗿𝗮𝗹 𝗿𝗲𝘀𝗶𝘀𝘁𝗮𝗻𝗰𝗲 𝘁𝗿𝗮𝗶𝗻𝗶𝗻𝗴 𝗮𝘀 𝗮 𝘀𝘁𝗿𝗮𝘁𝗲𝗴𝘆 𝘁𝗼 𝗺𝗶𝘁𝗶𝗴𝗮𝘁𝗲 𝗶𝗺𝗺𝗼𝗯𝗶𝗹𝗶𝘀𝗮𝘁𝗶𝗼𝗻-𝗶𝗻𝗱𝘂𝗰𝗲𝗱 𝗻𝗲𝘂𝗿𝗼𝗺𝘂𝘀𝗰𝘂𝗹𝗮𝗿 𝗱𝗲𝗰𝗹𝗶𝗻𝗲: 𝗔 SR and MA

https://t.co/sPAAt1OHcc

[Daniel Berglind, PhD @DanielBerglind]

Progressive overload does not “cause” muscle growth. Mechanical tension does
Train hard enough—close to failure—to recruit high-threshold motor units and create the stimulus for hypertrophy
Progression is often the result of adaptation, not the root cause

https://t.co/rO0TnOigIR

[Physio Meets Science @PhysioMeScience]

Effects of Physical Exercise on Pain in Patients With Lumbar Disc Herniation: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

https://t.co/qAxNbD7KMs