 For anyone with a creaky, painful knee, the advice from doctors and physiotherapists has always been simple and unshakeable: "Just exercise." It's the first-line treatment recommended in every clinical guideline for knee osteoarthritis. But what if the reason it helps has almost nothing to do with the exercise itself? A wave of high-quality research from the last five years is revealing a more complex and surprising picture, challenging some of the most fundamental beliefs about how, why, and how much exercise helps. These findings don't suggest exercise is a bad idea, but they are radically shifting our understanding of what’s really happening. The new science suggests the benefits of exercise are less about the physical changes in the joint and more about the psychological and contextual experience of care. Drawing on a major 2025 narrative review in the Journal of Physiotherapy, here are five of the most impactful takeaways that are changing how experts think about exercise for knee osteoarthritis. 1. The benefits of exercise might be smaller—and more mysterious—than we thought. The conventional wisdom has long been that exercise is a highly effective treatment. A landmark 2015 Cochrane Review was so confident in its findings that its authors concluded further evidence was unlikely to change their conclusion. But recent, more sophisticated analyses are painting a different picture. Two major reviews—an individual participant data (IPD) meta-analysis and an updated 2024 Cochrane Review—found that while exercise does help, the effects on pain and function are small. What does "small" mean? On a 100-point pain scale, the updated Cochrane Review found exercise improved pain by about 13 points. However, the minimum improvement researchers believe patients would actually notice is around 12 points, putting the benefit right on the edge of being meaningful. What’s more, we don't really know how exercise achieves its benefits. One study set out to see if changes in factors like knee strength could explain the improvements. Surprisingly, it found that changes in knee extension strength explained only 2% of the positive effects, leaving the other 98% of the mechanism a complete "black box." This has led some researchers to question the source of the benefits. According to an editorial in Osteoarthritis and Cartilage, any observed clinical benefits of exercise may be attributed more to contextual effects (like the patient-therapist relationship) and regression to the mean (a statistical phenomenon where people who seek help when their pain is at its worst will naturally tend to feel a bit better over time, regardless of treatment) than to specific physiological effects of the exercise itself. This "black box" may help explain another surprising finding: when it comes to exercise for knee pain, more isn’t necessarily better. 2. The 'more is better' approach to exercise is likely a myth. Many patients and clinicians operate on a logical assumption: if some exercise is good, then a higher "dose"—more intensity, more frequency, or more volume—must be better. However, recent research has consistently failed to support this dose-response relationship. A systematic review investigating the link between exercise volume and its effects on pain and function found no association. This means that, on the whole, doing more did not lead to better results. This finding is backed by several high-quality randomized controlled trials (RCTs):
The takeaway for patients is liberating: the pressure to grind through high-intensity or high-volume workouts is likely unnecessary. And if a higher physical dose doesn't improve outcomes, it starts to make sense why perfect adherence to that dose might not be the magic bullet we once thought. 3. Improving exercise adherence might not actually improve outcomes. This next finding may be the most challenging for clinicians and patients to accept. Another deeply ingrained belief is that for an exercise program to work, you have to stick with it. Clinicians often focus on improving a patient's adherence, assuming that better adherence will directly translate to better results. Remarkably, new research directly challenges this assumption. A large systematic review found no association between how well patients adhered to their prescribed exercise programs and their ultimate improvements in pain or function. This counter-intuitive finding has been tested in recent RCTs with consistent results:
As the authors of that study concluded, the findings questioned the long-held assumptions "that doing more lower limb exercise, with greater individualisation, exercise progression and supervision, leads to better pain and function." So, if the physical dose doesn't matter and adherence to that dose doesn't matter, what does? The emerging evidence points to the power of the therapeutic experience itself. 4. Remote and digital care can be just as good as in-person therapy. Many people assume that telehealth or digital programs are a lesser substitute for traditional, in-person physiotherapy. But here’s where the story takes a truly remarkable turn. Strong new evidence shows this is not the case. A large, high-quality RCT compared a physiotherapy program delivered via videoconferencing to the exact same program delivered in person. The results showed that the remote option was "non-inferior"—meaning it was not unacceptably worse—for improving pain and function. In fact, patients reported higher satisfaction with the telehealth care. This finding reinforces the idea that the "contextual" part of care—feeling supported, heard, and guided—may be more important than the physical location where care happens. The evidence extends to fully digital, largely unsupervised programs as well. RCTs have shown that exercise programs delivered via websites or mobile apps, supported by automated text messages or minimal clinician contact, can be both effective and safe. This has led to "stepped care" models, where research suggests about one-third of patients can successfully manage their knee OA with digital tools alone, avoiding more intensive and costly in-person care. 5. How we talk about arthritis can directly impact recovery. The public narrative around OA is often filled with negative language. Phrases like "wear and tear," "degenerative," or "bone-on-bone" create a powerful impression that the joint is fragile and that exercise could cause further damage. If contextual effects are what truly drive improvement, then the language used to create that context isn't a soft skill—it's a primary component of the therapy itself. Recent RCTs have provided causal evidence that language has a direct and powerful impact on patient beliefs and confidence:
This research demonstrates that changing the conversation around OA—from one of damage to one of empowerment—is a crucial, evidence-based component of effective treatment. A New Chapter for Knee Pain Management The core recommendation for exercise in knee OA isn't being overturned, but our understanding is becoming far more nuanced. The simple rules we thought we knew—that the benefits are large, more is better, and perfect adherence is critical—are being challenged by high-quality evidence. It's not that exercise doesn't work, but our understanding of whyit works is shifting from a story about physiology to a more powerful story about psychology, confidence, and the therapeutic experience. As this new science unfolds, it prompts a critical question for both patients and clinicians: How can we shift our focus from simply prescribing exercises to creating empowering experiences that truly help people live well with osteoarthritis?  For countless runners, the story is painfully familiar: you meticulously track your mileage, you listen to your body, and you follow the conventional wisdom, only to be sidelined by another frustrating injury. The most common advice centers on the "too much, too soon" theory, which suggests that overuse injuries happen when runners increase their training load too quickly. But what does "too much" or "too soon" actually mean? The ambiguity has left many runners guessing.
Now, a massive new study published in the British Journal of Sports Medicine involving over 5,200 runners has uncovered a surprising and counter-intuitive truth about what really causes overuse injuries. The findings challenge the very metrics many runners—and their GPS watches—rely on to stay safe, suggesting we've been focusing on the wrong thing all along. Takeaway 1: The Real Danger Isn't Your Weekly Mileage—It's a Single Run. The study's most significant finding is a major shift in how we should think about training load. It found that the biggest risk for an overuse injury doesn't come from a gradual increase in mileage over a week, but from a sudden spike in distance within a single running session. The researchers propose a "single-session paradigm," identifying a specific risk threshold: running a single session that is more than 10% longer than your longest run in the preceding 30 days. Pushing past this 10% threshold was associated with a dramatic increase in injury rates. The specific hazard rates are striking:
While the risk for a 'moderate spike' appears slightly lower than for a 'small spike,' the overarching trend is clear: any jump in single-run distance greater than 10% significantly elevates injury risk, with the danger becoming most severe when doubling your distance. This is a critical shift in thinking because musculoskeletal tissues like tendons and bones adapt gradually over weeks, but a single session that dramatically overloads them can cause micro-damage faster than the body can repair it, initiating an injury. It suggests that your one ambitious long run on the weekend could be far more dangerous than the total number of kilometers you accumulate over the week. Takeaway 2: The Popular Training Metrics on Your Watch Might Be Misleading You. Many dedicated runners rely on their wearable devices to manage training load using popular metrics like the week-to-week ratio or the Acute:Chronic Workload Ratio (ACWR). The study investigated these methods and found their effectiveness to be questionable, at best. The results were surprising:
This is deeply counter-intuitive and challenges the tools many runners use to prevent injury. The study's authors issued a strong word of caution in their summary of the findings: Caution is advised when relying on recommended training load calculations such as the acute:chronic workload ratio and weekly- gradual changes, as no association, or even inverse associations, between these approaches and injury risk was found. This finding is disruptive because it directly questions the scientific basis of features built into many popular GPS watches and training apps. This surprising result may suggest that runners who successfully handle large acute-to-chronic workload spikes are already highly resilient, or that the ACWR metric itself is poorly suited to capturing the specific, acute stress of a single long run that appears to be the real driver of injury. Takeaway 3: A New, Simpler Rule to Guide Your Training. Based on these powerful findings, the study's authors propose a new, evidence-based guideline for runners. It's a simple rule of thumb you can apply to any training plan: Avoid running a distance in your current session that exceeds 10% of the longest distance you've covered in the previous 30 days. For example, if the longest distance you've run in the last month is 10 kilometres, this new research suggests you should keep your next longest run under 11 kilometres to significantly reduce your injury risk. It's important to note that even progressions under the 10% threshold aren't completely risk-free. The study found that jumps between 1% and 10% still correlated with a 19% higher injury rate, even if this figure wasn't statistically significant. Furthermore, this rule applies to a single session and doesn't account for the danger of stacking multiple progressions back-to-back without adequate recovery. Gradual, cautious progression is still the foundation of safe training. Conclusion: Rethinking Your Next Long Run For years, runners have been told to focus on gradual weekly increases in mileage. This landmark study suggests a paradigm shift is needed. The key to injury prevention may lie not in complex weekly load calculations, but in closely monitoring the acute stress of a single run. The real danger isn't just "too much, too soon," but "too long, right now." It's important to note that these findings came from a study group that was predominantly male (nearly 78%), so while the principle is powerful, more research is needed to confirm these specific thresholds apply equally to all runners. With this new insight, how will you plan your next big run differently? ARTICLE:  1. Understanding Your Injury and Your Choices 1.1. What is an Achilles Tendon Rupture? An Achilles tendon rupture is a complete separation of the two ends of the tendon, which connects your calf muscle to your heel bone. This is one of the most common musculoskeletal injuries and often occurs during sports or other activities that involve a sudden change of direction, resulting in a forced dorsiflexion (upward bending) of the ankle. Patients frequently report hearing a "popping" sound and feeling as though they were kicked in the back of the heel at the moment of injury. 1.2. The Two Main Paths: Surgery vs. Non-Surgery When you rupture your Achilles tendon, there are two primary treatment paths to consider, each with its own approach to healing the tendon:
The best choice for any individual patient involves carefully balancing the different types of risks and benefits associated with each of these approaches. 2. The Core Trade-Off: Comparing the Key Risks The central decision comes down to a clear trade-off: choosing the type of risk you are more comfortable with. While surgery lowers the risk of the tendon re-rupturing, it introduces risks related to the operation itself. Non-surgical treatment avoids operational risks but has a historically higher chance of re-rupture. Primary Risks of Each Treatment Path Non-Surgical Management: Higher Risk of Re-Rupture
Surgical Management: Lower Risk of Re-Rupture
Given these different risk profiles, the next logical question is whether they lead to different functional outcomes for patients in the long run. 3. The End Goal: How Will You Recover? While the initial treatment paths and their immediate risks differ, research shows that the final destination—long-term function and recovery—is remarkably similar for most patients. 3.1. The Surprising Finding: Similar Long-Term Function Multiple high-quality studies, including large randomized trials and comprehensive meta-analyses, have reached the same conclusion: at the 12-month mark, there are no significant differences between the surgical and non-surgical groups across several key recovery metrics:
3.2. Return to Work and Sports The ability to get back to daily life is a critical measure of success. Here too, the outcomes are largely equivalent.
These findings suggest that for the average patient, both paths lead to a similar destination. The best route, therefore, often depends on specific individual factors. 4. Making the Decision: Key Factors to Discuss With Your Doctor The choice between surgery and non-surgical care is not one-size-fits-all. It's a decision made in consultation with your doctor, weighing your unique anatomy, health, and the specifics of your injury.
Ultimately, regardless of whether you start with surgery or a cast, the success of your recovery is heavily dependent on the one component that is the same for both paths: a dedicated rehabilitation program. 5. Your Path Forward: The Crucial Role of Rehabilitation Rehabilitation is essential for a successful outcome, whether you have surgery or not. The process follows a very similar structure and timeline for both treatment groups, focusing on protecting the tendon as it heals and then gradually rebuilding strength and function.
READ MORE:
 The fitness world is rightly obsessed with glute training. From improving athletic performance to building a powerful physique, the benefits of strong glutes are undeniable. Foundational exercises like squats, deadlifts, and the ever-popular barbell hip thrust have become the undisputed staples of countless leg-day routines. We perform them, we progress them, and we assume they represent the peak of glute development strategy.
But what if some of our most common assumptions are incomplete? As exercise science evolves, new research is providing surprising and often counter-intuitive insights that challenge this common wisdom. Studies that measure not just how a muscle feels, but how it activates, grows, and acutely impacts performance are painting a more nuanced picture of what truly works. This article cuts through the noise to bring you four of the most impactful, science-backed takeaways from recent studies. Whether your goal is strength, size, or speed, these findings will help you train smarter, challenge your assumptions, and potentially redesign your entire approach to building better glutes. 1. The Surprising King of Glute Activation Isn't What You Think In a fitness culture often focused on heavy barbells and complex machines, the barbell hip thrust has earned a legendary reputation for glute activation. However, against this backdrop of ever-heavier loads, a comprehensive systematic review published in the Journal of Sports Science and Medicine has identified a different, often-overlooked exercise as the top performer for firing up the glutes. The exercise with the highest levels of demonstrated gluteus maximus (GMax) activation is the step-up. The 2020 review by Krause Neto et al. found that the step-up and its variations—including lateral, diagonal, and crossover step-ups—averaged an incredible 125% of Maximal Voluntary Isometric Contraction (MVIC, the gold-standard measure of a muscle's maximum electrical activity). The likely reason for this superior activation is the multi-faceted demand of the movement. Step-ups are unilateral (single-leg) exercises that force the GMax to do more than just extend the hip. It must also work overtime to stabilize the pelvis and control the femur from adducting (moving inward) or rotating medially. This combined role of prime mover and stabilizer dramatically increases its total workload. This suggests that for pure neuromuscular stimulus, the load on the bar may be less important than the biomechanical demands of stabilizing the entire body on a single leg. For the lifter, this is your cue to treat step-ups not as a warm-up or accessory, but as a primary glute-strengthening movement worthy of progressive overload. 2. Adding Hip Thrusts Quantifiably Supercharges Glute Growth While muscle activation studies are insightful, they only tell us about an exercise's potential. To know if an exercise truly builds muscle, we need long-term studies that directly measure hypertrophy (muscle growth). A 2024 study provides definitive proof of the barbell hip thrust's potent muscle-building effects. In a study published in the International Journal of Strength and Conditioning, researchers Kassiano et al. compared two groups of untrained women over a 10-week training period. One group performed a routine consisting of 45º leg presses and stiff-leg deadlifts. The second group performed the exact same routine but added the barbell hip thrust. The results were clear and quantifiable. The group that added the barbell hip thrust saw a +9.3% increase in gluteus maximus thickness. The group that performed the leg presses and deadlifts alone saw a +6.0% increase. But the key takeaway isn't just that "more is better." The insight lies in why it worked. The researchers noted that exercises like the leg press and stiff-leg deadlift impose peak forces when the glutes are at long muscle lengths (i.e., stretched). The hip thrust, in contrast, creates peak force when the glutes are at short muscle lengths (i.e., fully contracted). By adding the hip thrust, the second group wasn't just adding volume; they were adding a different stimulus that trained the glutes in a way the other exercises did not, leading to more complete development. The current results suggest that performing barbell hip thrust, in addition to 45º leg press and stiff-leg deadlift, enhances muscle hypertrophy of the gluteus maximus compared to performing exclusively 45º leg press and stiff-leg deadlift. 3. Want to Be Faster? Do Hip Thrusts Right Before You Sprint One of the most fascinating findings relates to an exercise's ability to boost immediate performance. This phenomenon, known as Post-Activation Performance Enhancement (PAPE), is an acute performance increase in an explosive movement (like a sprint) that occurs after performing a heavy conditioning activity. Scientific research has confirmed that the hip thrust is a powerful tool for triggering PAPE. A systematic review by Krause Neto et al. (2019) noted that four separate studies found a significant improvement in sprint times immediately following a barbell hip thrust protocol. The mechanism is simple yet powerful: the heavy lift "wakes up" or primes the central nervous system, which allows for a more forceful and rapid muscle contraction in the subsequent sprint. The key insight here is the direction of force. While a heavy squat also primes the nervous system, its force vector is primarily vertical—pushing up against gravity. Sprinting, however, is an expression of horizontal force—propelling your body forward. The hip thrust is unique in its ability to train this horizontal force vector, making it an exceptionally specific tool for improving acceleration. For athletes, the practical application is clear: sports science literature suggests that performing a few heavy hip thrusts during a warm-up, followed by a 5-8 minute rest period, could provide an immediate and measurable edge in speed. This rest period is critical; it allows the acute fatigue from the heavy lift to dissipate while keeping the nervous system in a heightened state of readiness. 4. The Hip Thrust's Overlooked Cousin is Just as Effective for Speed While the hip thrust's effectiveness is well-established, new research highlights a simpler, more accessible alternative for achieving the same performance-enhancing benefits: the glute bridge. A 2025 study by Çabuk et al. in the European Journal of Sport Science investigated the PAPE effects of both the hip thrust and the glute bridge on adolescent soccer players. Their research concluded that the glute bridge was also a highly effective tool for improving subsequent sprint performance. These findings suggest that GB [glute bridge] exercises may offer a viable alternative to HT [hip thrust] exercises for eliciting PAPE effects, particularly in enhancing SP [sprint performance] and related mechanics in adolescent soccer players. This is a significant practical finding. The glute bridge requires no bench and minimal setup, making it a convenient and powerful alternative for athletes in any setting, from a fully-equipped gym to a field-side warm-up. The study also revealed a subtle biomechanical difference: the hip thrust elicited greater activation in the vastus lateralis (a quadriceps muscle), whereas the glute bridge was associated with higher activation levels in the gluteus medius and gluteus maximus. What does this mean for the athlete? An athlete needing to prime the entire hip and knee extension chain might prefer the hip thrust. However, an athlete wanting to focus the PAPE stimulus almost exclusively on the gluteal complex, or perhaps one recovering from quadriceps fatigue, might find the glute bridge to be a more precise and effective tool. Conclusion: Rethink Your Next Leg Day The science of strength is constantly advancing, providing us with better tools and clearer strategies. This isn't just a list of tips; it's a new framework for smarter glute training. Prioritize unilateral stability for activation (step-ups), drive growth with targeted, heavy hip extension that trains the muscle at both long and short lengths (hip thrusts plus other compounds), and strategically use these powerful movements to prime the nervous system for peak performance (PAPE). The research is clear: the humble step-up is the surprising king of activation, the hip thrust is a proven growth-booster, and both it and its cousin, the glute bridge, can make you measurably faster, instantly. Now that you're armed with the latest science, how will you redesign your approach to building stronger, faster, and more powerful glutes? READ MORE:
 The Exercise Paradox
Inflammation is a fundamental part of the body's defense system. When you get a cut, the familiar signs of redness, swelling, and heat are the work of your immune system aggressively fighting off infection and responding to tissue damage. This acute response is essential for healing. However, when inflammation fails to turn off, it can become a chronic, low-grade "silent menace" that contributes to a wide range of diseases, including diabetes, heart disease, and neurodegenerative conditions. This brings us to a central paradox of health and wellness: exercise, a form of physical stress that causes temporary, acute inflammation in our muscles, is also one of our most powerful tools for combating the chronic, disease-causing type. While many assume this benefit is simply a byproduct of weight loss, the science reveals a far more sophisticated and immediate relationship between movement and our immune system. This article explores five surprising, science-backed ways that exercise directly rewires your body to fight chronic inflammation. The Anti-Inflammatory Effect Is Not Just About Weight Loss It’s a common and logical assumption that exercise reduces inflammation primarily by reducing body fat. Adipose tissue, particularly visceral fat, is known to produce and release a range of inflammatory signals that contribute to a state of chronic, low-grade inflammation throughout the body. However, research shows that exercise has powerful anti-inflammatory effects that are independent of any changes in body fat or Body Mass Index (BMI). For instance, a comprehensive review in the American Journal of Lifestyle Medicine concluded that exercise has potent, body fat–independent anti-inflammatory effects, making the benefits accessible regardless of weight loss. This is an incredibly empowering finding, as it makes the anti-inflammatory benefits of exercise accessible to everyone, no matter what the scale says. The positive changes are triggered by the act of moving, meaning every workout provides a direct anti-inflammatory benefit from day one. Your Muscles Release Their Own Anti-Inflammatory "Myokines" During exercise, your muscles do more than just contract; they act as endocrine organs, creating and releasing their own signaling molecules called "myokines" into the bloodstream. One of the most fascinating of these is Interleukin-6 (IL-6), which reveals a remarkable biological paradox. In states of chronic disease, IL-6 is typically known as a pro-inflammatory cytokine. However, when IL-6 is released from contracting muscles during a workout, it behaves very differently. This fascinating paradox, detailed in reviews from researchers at institutions like Loughborough University, highlights a key mechanism of exercise's benefits. This exercise-induced IL-6 travels through the body and signals for the release of other, powerful anti-inflammatory cytokines, specifically IL-10 and IL-1 receptor antagonist (IL-1RA). In effect, the IL-6 produced by your muscles orchestrates a systemic, anti-inflammatory response that helps calm the immune system. This means your own muscles are capable of manufacturing and dispensing molecules that create a healing, inflammation-reducing environment throughout your body. This internal pharmacy isn't just for long-term health; its effects can be surprisingly immediate. Just 20 Minutes Is Enough to Suppress Inflammation The anti-inflammatory benefits of exercise are not just a long-term adaptation that occurs over months of training; they are an immediate physiological response. A study published in Brain, Behavior, and Immunity demonstrated that a single 20-minute session of moderate treadmill exercise had a significant, suppressive effect on the body's inflammatory response. The mechanism was surprisingly direct. The workout caused a natural increase in catecholamines like epinephrine (adrenaline). This rise in epinephrine was shown to directly suppress the production of a key pro-inflammatory molecule called Tumor Necrosis Factor (TNF) in immune cells. This finding highlights that even short workouts are highly valuable for managing inflammation because they trigger an immediate chemical cascade that calms inflammatory pathways. "Decreased inflammatory responses during acute exercise may protect against chronic conditions with low-grade inflammation." Exercise Mobilizes Your Body's Inflammation-Fighting T-Cells The physical exertion of a workout causes temporary, localized inflammation within the working muscles. Rather than letting this process run unchecked, the body has a built-in system to manage it and turn it into a source of strength and adaptation. In response to this exertion-induced inflammation, the body mobilizes specialized immune cells called T-regulatory cells, or Tregs. A Harvard study conducted on mice found that these Tregs act as "peacekeepers," migrating directly to the muscle tissue to control the inflammation. With regular training, these cells not only subdue muscle damage but also help improve how muscles use energy, leading to enhanced endurance over time. This process shows how the body naturally leverages the stress of exercise to boost its own immune-regulating capacity, turning a potentially damaging event into a strengthening one. "Our research suggests that with exercise, we have a natural way to boost the body’s immune responses to reduce inflammation." — Diane Mathis, Harvard Medical School Running Fights Inflammation Inside Your Knees Many people fear that running is inherently "bad for the knees" and will lead to joint degeneration. However, a pilot study on recreational runners suggests the opposite may be true. Researchers directly measured the biochemical environment inside the knee joint before and after a workout. The findings directly countered the common assumption. A 30-minute run was shown to decrease the concentration of pro-inflammatory cytokines within the synovial fluid of the knee joint. Specifically, the levels of Granulocyte-macrophage colony-stimulating factor (GM-CSF) and Interleukin-15 (IL-15)—two molecules linked to the progression of joint disease—were lower after the run. Interestingly, the reduction in IL-15 was correlated with the number of foot strikes, suggesting that the mechanical loading itself is part of the beneficial signal. This research reframes running not as a destructive activity, but as one that may be chondroprotective by creating a less inflammatory environment inside the joint capsule. A New Perspective on Movement The anti-inflammatory power of exercise is far more sophisticated than just burning calories or reducing body fat. It is a multifaceted, immediate, and systemic process driven by elegant biological mechanisms. From muscles releasing their own anti-inflammatory medicine to the mobilization of specialized immune cells, exercise actively tunes our bodies for better health. It is important to note, however, that more is not always better. This "elite athlete paradox" is a crucial reminder that the same systems we've discussed—like the release of immunomodulating cytokines—require balance. Extreme training without adequate recovery can push these anti-inflammatory signals too far, temporarily suppressing the immune system. For most of us, however, the message is clear: our bodies are designed to turn movement into a powerful anti-inflammatory signal. Knowing that every step, jog, and stretch sends out these powerful signals, how might this change the way you think about your next workout? READ MORE:
I’d guess that most people feel guilty about not stretching enough. Interestingly, health professionals have changed our tune about the importance of stretching. Research over the last 15 years has suggested static stretching is not as beneficial as was once thought. I’ve been having conversations about the reasons to stretch (or not) for at least the last 15 years, but the current science on stretching just isn’t catching on with the general public. So, what do we know?… DOES STRETCHING PREVENT INJURIES?No. There is a lot of evidence that stretching does not reduce the risk of injury. This systematic review and meta-analysis of randomised controlled trials found stretching does not prevent injuries, whether done before or after training. This randomised controlled trial, and this systematic review concluded stretching before exercising only reduces the risk of injury by less than 1%. Therefore, in practical terms the average athlete would need to continuously stretch for 23 years to prevent one injury. Definitely not worth it. DOES STRETCHING HELP MUSCLE SORENESS?No. A systematic review concluded that stretching before or after exercising does not confer protection from muscle soreness (ref). Stretching was found to reduce muscle soreness by a trivially small amount - less than 2%. “Most athletes will consider effects of this magnitude too small to make stretching to prevent later muscle soreness worthwhile.” DOES STRETCHING INCREASE RANGE OF MOVEMENT?No. Stretching for the amount of time that most people hold their stretches, does not make any actual difference to flexibility. The mechanisms of stretching have been extensively studied. There is moderate evidence from a systematic review that stretching can increase flexibility (ref). However, to achieve an actual improvement in muscle compliance we know the total duration of stretching needs to be at least five minutes per muscle group (ref). Therefore to stretch hamstrings, quads, and calves, both left and right, as part of a warm up before sport, it should take at least 30 minutes - which is practically impossible as part of a warm up. We know the one or two, thirty second stretches the majority of athletes would perform during their warm up are just not enough to actually improve flexibility (ref). DOES STRETCHING HELP PERFORMANCE?What people find most surprising about static stretching is it impairs subsequent performance (ref). A substantial body of research has shown that sustained static stretching acutely decreases muscle strength and power (ref). Stretching before an endurance event lowers endurance performance and increases the energy cost of running (ref). Cycling efficiency and time to exhaustion are reduced after static stretching (ref). Pretty much any measure of performance is made worse by stretching. Static stretching impairs:
A comprehensive review (ref) from 2011 concludes: “Based on the majority of the literature, it would seem logical to recommend that prolonged static stretching not be performed prior to a high level or competitive athletic or training performance.” WHAT ABOUT DYNAMIC STRETCHING?Obviously, I’ve been talking about sustained, static stretching. It has been shown that there is no stretch-induced strength loss with dynamic stretching (ref). However, the efficacy of dynamic stretching for increasing flexibility is yet to be determined (ref). SO WHY STRETCH?I do get people to stretch if there’s a specific pathology that needs treating. And you do need to stretch if you need flexibility to achieve certain positions in your sporting performance (hurdlers / gymnasts / divers, etc). SO SHOULD WE STOP STRETCHING?If you’re happy with your stretching routine, keep doing it. If you think it feels good to stretch after exercise then there’s no harm. But I definitely wouldn’t recommend stretching at the expense of other techniques that are proven to aid recovery.  
 The two most important factors for successfully rehabbing a hamstring strain, are:
Three loading exercises to start from day 1, are:
ACTIVE KNEE EXTENSIONHold and stabilise the thigh of the injured leg with the hip flexed approximately 90° and then perform slow knee extensions to a point just before pain is felt. 20 repetitions, five times a day. SINGLE LEG ROMANIANS / ARABESQUEHip flexion (from an upright trunk position) of the injured, standing leg and simultaneous stretching of the arms forward and attempting maximal hip extension of the lifted leg while keeping the pelvis horizontal; angles at the knee should be maintained at 10–20° in the standing leg and at 90° in the lifted leg. Owing to its complexity, this exercise should be performed very slowly in the beginning. 20 repetitions, five times a day. HAMSTRING BRIDGESThis exercise is started in a supine position with the body weight on both heels and then the pelvis is lifted up and down slowly. Start with the knee in 90° of flexion. The load is increased by putting more of the body weight on the injured leg and by having a greater extension in the knee. Ultimately, only the slightly bent injured leg is carrying the load. 20 repetitions, five times a day.
 I had Osgood Schlatter's Disease myself in both knees as a kid. Mum entered some fun-runs in the 80's and we used to go running together. I was training more than I should have for cross-country in years 5, 6, and 7, and suffered terribly. Terrible night pain. I used to cry. Mum took me to a GP who confirmed the diagnosis with an x-ray and told me to stop running. Crazy sounding diagnosis. I ran less, and it eventually stopped hurting. I've still got decent bumps on my tibial tubercles to show for it. Osgood-Schlatter's is an overuse injury of the spot where the quadriceps muscle attaches on the front of the knee (tibial tubercle). It’s the tendon where the quad anchors onto the tibia. It gets sore with too much running, jumping, and kicking. Usually 9-12 year olds. Quite often if they’re having a bit of a growth spurt while they’re doing a lot of training. The body is busy spending resources on the growing, and so the recovery between training sessions doesn’t keep up.
It’s usually sore after training when you cool down. It can ache in bed at night. We say that it is self-limiting, which means it eventually gets better when you stop growing, but who wants to wait that long? There’s no long-term problems from it. Once it stops hurting it’s all OK. It doesn’t need an x-ray or a scan, or any injections or surgery. It's an easy clinical diagnosis and simple conservative management. DO:
DON’T:
It’s really a matter of adjusting the running load day-to-day depending on how sore it is. If it’s sore - do less. It's an injury that needs managing through the season. I try and get kids to do a bit less running at training and save it for game day. If it's sore on game day and you need to keep playing, it's safe, in that, it's not going to snap or pop. But it will hurt more for longer if you push through, which is what just has to be done some times. Funny sounding name. Not funny at all when it's sore. 
Load Management For Injury PreventionManaging training load is crucial in injury prevention and treatment. A graphic in Tom Goon’s blog visualises how training load outweighs all other factors. 
Historically we have advised that training loads shouldn’t increase by more than 10% a week. I’m not sure where this number comes from; I’ve got no problem with it; it seems reasonable, and I’ve quoted it hundreds of times. There’s a 2015 BJSM podcast interview with Tim Gabbett on load management for injury prevention. Specifically Tim talks about this paper:
Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers
- Billy T Hulin, Tim J Gabbett, Peter Blanch, Paul Chapman, David Bailey, John W Orchard, 2013. It is research into fast bowlers, but the principles apply just as well to any athlete. The authors measured the acute workload of the last 7 days (and call it “fatigue”) and compare that to the chronic workload of the previous 4 weeks (which they call “fitness”). Measuring Training Load
For runners, if the training is reasonably homogenous, we could most simply measure the workload as the total kms/week.
Or we could be more accurate and account for a mixed training program that may include a variety of hills / sprints / cross training etc, by giving each session a rate of perceived exertion (RPE) out of 10, and multiply that score by the number of training minutes:
Training load = session RPE x duration (minutes)
This is called a Foster’s Score, and provides a simple method for quantifying training loads from a variety of different training modalities.
The research subtracted the current one-week average from the previous 4-week average and called this number the “training-stress balance”. A negative training-stress balance increases the risk of injury by 4 times. So:
[Last 7 days’ session RPE x duration (minutes)] - ([Last 4 weeks’ session RPE x duration (minutes)] / 4) = TRAINING-STRESS BALANCE
Negative balance = 4 times risk of injury
Essentially this formula means you shouldn’t increase your training load by more than 25% a week.
For people that may be more vulnerable to injury I would change the 4-week average to a 6-week average, therefore, bringing the increase in load each week down from 25% to 16%. This more cautious group could include:
|
Archives
April 2026
Categories
All
|
RSS Feed
|
|
Copyright© 2026| Fit As A Physio | ABN 62855169241 | All rights reserved | Sitemap