Ryan MacLeod

Advanced Practitioner Physiotherapist in Primary Care, within NHSAAA. Physiotherapist at Physiomac Physiotherapy. Occasional Tweeter. Views my own.

[Ryan MacLeod @physiomacPT]

@adamdobson123 Disagree only with the first line. It is a red flag. It does exactly what it should do which is raise your index of suspicion to the possible presence of sinister pathology. That said I whole heartedly agree with the nuance that you highlight &the importance of red flag clusters

[Ryan MacLeod @physiomacPT]

At nearly 38, this is realistically my first and last chance to be called up to @ScotlandNT for a World Cup. Fingers crossed.

[Ryan MacLeod @physiomacPT]

@northwoods1980 Unlikely unless a seizure or previous dislocations!

[Howard Luks MD @hjluks]

Your imaging report is information. It is not a verdict. Most patients who walk into my office with a cuff tear on MRI have a shoulder that can be rehabilitated without ever seeing the inside of an operating room. That is the conversation most people deserve... and some never get to have.

[Ryan MacLeod @physiomacPT]

Good to see Sir Stephen Fry branching into football punditry

[Ryan MacLeod @physiomacPT]

Has the @scotgov planned the holiday for when @jmcginn7 scores the winner against England in the WC final in July?

[Howard Luks MD @hjluks]

The hardest conversation I have in my office isn't about surgery. It's about time.

A 58-year-old sat across from me with knee pain. She’s otherwise healthy, but menopause has been rough on her. Her MRI shows some cartilage changes — age-appropriate, and a typical meniscus tear... basically, nothing that requires surgery. But she hasn't done any physical work in 15 years. She stopped playing tennis at 43. Stopped walking regularly at 50. Now the knee hurts when she climbs stairs.

The knee isn't the problem. The knee is just the messenger.

What has really happened is fifteen years of progressive capacity loss. Muscle mass has declined while tendon capacity has dropped. Her metabolic health shifted, and menopause has contributed to these changes. The knee was affected secondarily. The knee doesn't require my attention... that needs to be directed elsewhere.

I can't 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 synthesize new muscle protein after a single resistance-training session. The window of opportunity does narrow with age, but it never closes. Recovery takes longer. The risk of injury is likely higher. Progress is slower. But the biology of adaptation doesn't abandon you at 58, or 68, or 78.

What changes is the cost of waiting. Every year of inactivity makes the starting point harder and the ceiling lower. The leverage you have at 40 is real and significant — and it's greater than the leverage you'll have at 60.
That's not a reason for despair... It's a reason to start, wherever you find yourself now.

3 months later, after a solid strength/power program, she's walking daily with her weighted vest and is back on the tennis court.

[Ryan MacLeod @physiomacPT]

@_markpetchey @asud683385 Does he say which Dunlop Ball? The Dunlop Fort All Courts are woeful these days in terms of durability. The ATP Championship ones are better.

[Ryan MacLeod @physiomacPT]

@JArcher100 @adamdobson123 Much to dissect here:

- poking & rubbing RARELY does good
- loaded exercise into vulnerable ranges CAN be good, for many reasons including confidence and tissue capacity
- "no bias". Is this you staying physios have no bias, or you specifically? Either is a naive take at best

[Elon Musk @elonmusk]

@Ryanair I really want to put a Ryan in charge of Ryan Air. It is your destiny.

[Ryan MacLeod @physiomacPT]

This is about half of the actual saga. I should also include attempts to bill all my KWH at standard rate based on a meter reading submitted manually! 3/3.

[Ryan MacLeod @physiomacPT]

@g__j 2nd time in a year my electric smart meter is not working. Earlier complaint upheld by Ombudsman- problem "resolved". In October this year I noticed smart meter not working since August. Issue raised with Octopus. Further complaint raised 26th November. Still no meter. 1/3

[Ryan MacLeod @physiomacPT]

My account £929.23 credit. Refund requested. "We can't refund you because we haven't billed you". How is this a customer issue? Is this even legal? I'm on Intelligent Go- now a 2 EV household. Why would I stay? Paying a standing charge for a service not provided. 2/3

[Ryan MacLeod @physiomacPT]

@WSorare Man Utd fan, but it ruins the game otherwise. Yellow at best.

[Ryan MacLeod @physiomacPT]

@rsalmonuk Well done on setting up Rob

[Rob Salmon @rsalmonuk]

I'm saddened by the LTA's decision to make the 2025 Winter County Cup the last ever staging of this historic event. If you LOVE County Cup & County Week, I've put a Facebook group together so we can celebrate what makes them great! Please join!
https://t.co/mYtynSlBRZ

[Ryan MacLeod @physiomacPT]

Scheffenos.

Ps come on Tommy Fleetwood.

#pgatour #PGA #scottiescheffler #FedExCup

[Ryan MacLeod @physiomacPT]

@Quinny3001 The biggest issue for me, is referees allowing soft fouls, for what is essentially diving. This breaks up play, allows teams to gather shape, and denies free flowing or spontaneous football. At one stage in Arsenal Vs Real last night he let 3 such "fouls" go, and it was great.

[Howard Luks MD @hjluks]

"What If You Looked at Fitness Like a Retirement Account?"

Too many people view fitness as a short-term endeavor: getting fit for summer, losing weight for a wedding, or preparing for an event.

But what if we flipped the script? What if you thought of your muscle mass, bone density, VO2 max, and aerobic capacity like a retirement account?

Here’s the thing: as we age, we experience a natural decline in muscle mass, aerobic capacity, and balance. The less we start with, the faster we feel the effects of aging. This is why strength, resilience, and fitness are compound investments—the more you build and maintain now, the more you’ll have to "withdraw" when you need it later in life.

Worse, once people notice the changes, far too few are willing or able to make the effort to stem the further decline. This puts their functional independence in jeopardy as they enter their latter decades.

How do you start investing in your "fitness account"?
Strength training to build and preserve muscle—it’s like your 401(k) for functional independence.

Walk, hike, or do aerobic exercise to boost your VO2 max—it’s your reserve for energy and endurance.

Train your balance—your insurance against falls could derail your health in later years.

Here’s the kicker: even small "deposits" matter. A 30-minute walk today, 15 minutes of bodyweight exercises tomorrow, or a longer workout on the weekend—all of it adds up!!

As a physician, I’ve seen the vast difference between those who treat fitness as a lifelong investment and those who wait until it’s too late. The delta between the two escalates as we age. The ones who invest early and often are stronger, healthier, and more active well into their later decades.

So here’s my question: What are you doing today to invest in your future self?
Remember, fitness isn’t just about the now—it’s about ensuring the life you want tomorrow. I've just come back from a visit down to Florida to visit my parents. The loss of functional independence in their region is far too prevalent and has become a harsh reality for many.

[Ryan MacLeod @physiomacPT]

@DrJN_SportsMed Regarding point 2. It's not treated that way yet...