David Ding

Hands-on vs hands-off physios. Here’s what I’ve seen. There’s always debate in the physio world about which is better, hands-on or hands-off. But here’s what I’ve actually seen in practice: the best physios don’t pick a side. They know hands-on therapy creates trust. Fast. When a patient feels better quickly, whether through manual therapy, massage, or dry needling, they start believing in the process. And once they believe, they actually buy into the plan. They show up. They do the work. They stay the course. Of course exercise matters. Of course education matters. But good rehab often starts with making the patient feel better first. Not months later. Not weeks later. Today. Hands-on care isn’t outdated. It’s the bridge that leads to long-term change. You don’t have to choose between movement and manual therapy. They should work together. Would be keen to hear your thoughts, have you seen the same in your own practice? #physiotherapy #rehab #sportsrehab #privatepractice

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🚨 Cervical myelopathy is a “can’t-miss” diagnosis. I’ve put together a one-slide guide (below) for fellow First Contact Physiotherapists that boils it down to four quick steps: Recognise → Screen → Assess → Act Early recognition and an urgent MRI / neurosurgery referral can make all the difference for our patients’ long-term function. Have a look, share with your team, and let me know how you’re weaving these checks into your clinics. 👇 #FCP #Physiotherapy #CervicalMyelopathy #SpineHealth #NHS

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Return to running after Tibial Bone Stress Injury 🏃‍♂️ Bone Stress Injuries (BSI) have a high recurrence rate so a cautious, consistent approach is needed for successful return to running. George et al. (2024) discuss this in detail in their recent scoping review and I’ve summarised 5 of the key considerations in our graphic. High-risk BSI require an especially careful approach and tend to take longer for return to sport than low-risk sites. A stress injury of the posteromedial tibia may return to sport in an average of around 44 days (Hoenig et al. 2023) while anterior tibial BSI is estimated to be around 7 to 9 months! It’s also important to have realistic expectations of what a return to running plan involves. Often it starts with very short bouts of 30 to 60 seconds of easy running, typically just 2 or 3 reps separated by 1 minute walk breaks. Running should be pain-free both during and after and if this is the case then these reps can be gradually increased then walk breaks can be phased out. It may be necessary to repeat severe stages before progressing (e.g. have 2 or 3 runs of 3 x 1 minute before progressing to 4 x 1 min). This is thought to allow more time for bone adaptation. As a result it may take 5 to 6 weeks or more to build up to as little as 10 minutes of continuous running. While this can feel slow and frustrating for athletes it is sometimes necessary as a prior BSI has been found to increase risk recurrence rate sixfold in females and sevenfold in males (Tenforde et al. 2014, cited in George et al. 2024). Cross-training and S&C can be used during the rehab process and return to sport providing they are pain-free and energy needs are addressed first. See our recent post on training and RED-S for more info. Main Reference: George ERM, Sheerin KR, Reid D. Criteria and Guidelines for Returning to Running Following a Tibial Bone Stress Injury: A Scoping Review. Sports Med. 2024 Sep;54(9):2247-2265. doi: 10.1007/s40279-024-02051-y. Epub 2024 Aug 14. PMID: 39141251; PMCID: PMC11393297.

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Core Principles of Hamstring Rehab After ACLR Let me just give the silver lining from the get go, A well-rounded, strategic approach that supports long-term recovery and performance is going to be the bread and butter of any rehab plan, but especially the hamstring group after ACLR. We need to consider neural, morphological, and mechanical factors — like muscle activation, tendon health, and force production — because they all contribute in how well the hamstrings recover and function. Yes strength is important, but it's not as black and white as this, how well the muscles coordinate with the rest of the body is evenly (if not more) as important. One of the most important principles is criterion-based progression. This means we don’t just move on to the next phase because a certain amount of time has passed — we advance only when specific functional goals are met. For example, Early on, we focus on reducing swelling, restoring range of motion (ROM), and hitting strength benchmarks, making sure we build on a solid foundation without rushing the hamstring.   Each stage of ACL rehab has distinct hamstring goals.   1. Pre-op focuses on reducing pain and swelling while maintaining neural activation. 2. Early-stage rehab (0–6 weeks post-op) protects the graft and minimises muscle atrophy with low-load isometrics. 3. By mid-stage (6–12 weeks), we work on neuromuscular control and functional strength with moderate-load exercises. Late-stage (3–6 months) introduces high-load eccentric training and plyometrics, 4. Return-to-sport (6+ months) emphasises high-velocity movements and sport-specific drills. Exercise selection and progression follow a functional task hierarchy. We start with weight-bearing exercises like step-ups and squats, move to high-load control with landing mechanics and jump training, and finally integrate sport-specific agility and sprinting. Monitoring joint loading, muscle activation, and rate of force production ensures proper adaptation at every stage. For those with a hamstring graft, unique considerations apply. Early on, avoiding excessive hamstring stretching protects the healing graft. In mid and late phases, eccentric loading rebuilds tendon integrity, and addressing compensatory patterns like quad over reliance ensures balanced strength and proper mechanics ---- I break down sports medicine research, give fun infographics and clinical tips in my weekly newsletter: Full Read --> https://lnkd.in/eRcc4gRb Study: Buckthorpe, M., Danelon, F., La Rosa, G., Nanni, G., Stride, M. and Della Villa, F., 2021. Recommendations for hamstring function recovery after ACL reconstruction. Sports Medicine, 51(4), pp.607-624.

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🚨 Physiotherapy or Circus? 🚨 Why is DGHS questioning our credentials ? Because quacks have turned physiotherapy into a joke. 👉 Rehab for ₹99/- without even a physical assessment. 👉 Influencers turning treatment into “content” for views. 👉 Massage therapists and gym trainers calling themselves “physios.” 👉 So‑called “resource persons” teaching dry needling to anyone (Masseur, Gym Instructor) - This is just one Example. This isn’t just unprofessional—it’s unsafe and dangerous for patients. Let’s not forget: It takes 7 years of science, exams, and clinical hours to be a specialist in physiotherapy. Not YouTube. Not 2‑day workshops. Not 99/- offers. We are independent healthcare professionals, and it’s time to reclaim our respect. Here’s what NEEDS to change under NCAHP: 🔥 Mandatory entrance exam for BPT/MPT. 🔥 Faculty exams to check teaching quality. 🔥 Strict, enforceable rules against quacks and misuse of “Physiotherapist.” 🔥 Ban on unregulated workshops and online rehab “gurus.” 🔥 National license + official credential system for workshops & CME. 🔥 Awareness for students: know the difference between physiotherapy and nonsense. Physiotherapy is not a side hustle and not a social media gimmick. It is healthcare. It is science. It transforms lives. If you are a genuine physiotherapist, this is your fight too. Let’s raise our voice louder than these quacks. 🔗 #Physiotherapy #Healthcare #Quacks #NCAHP #PatientSafety

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Physios, be honest - do you only book your patients one session at a time so you don’t sound “salesy”? I used to do the same thing. It felt polite. Ethical. Less pushy. “Just book in next week” Those five words feel safe… but they’re quietly sabotaging your patient’s recovery. Here’s what actually happens: They start to feel a bit better. Life gets busy. The next appointment never gets booked, or is easily cancelled. They disappear at 70% better - and weeks later, they flare up again. And they don’t blame themselves. In their mind, physio “didn’t work.” And they're right - they were let down by a lack of clear planning. Clarity isn’t sales. It’s care. When you map out the full recovery journey from Day One - with milestones, timelines, and a clear plan - you’re not selling sessions. You’re showing them the right way forward. Patients don’t want “let’s see how you go.” They want to know where they’re going - and how you’ll get them there.

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Last week I asked "does the meniscus of the knee move during extension & flexion or is it static/fixed? 🧐 The vast majority of clinicians felt the meniscus was mobile, which is in fact the correct answer. However, interestingly the medial and lateral menisci move very differently during knee flexion and extension? How you ask... Lateral meniscus: Highly mobile, guided posteriorly by the popliteus which attaches via connective tissue to the posterior horn. Medial meniscus: Tethered by strong fascial attachments at zone 3, including the deep MCL and connective tissue resulting in significantly less mobility. This difference matters: During flexion, both menisci move posteriorly, but the medial side is more constrained. In extension, they move anteriorly, again, lateral more so than medial. Why it’s clinically important: Medial meniscus injuries (e.g., posterior horn, ramp lesions) are more common in >35's often due to this restricted movement + the aging process. From a surgical perspective when undertaking meniscal repairs it is also vitally important that the kinematics & biomechanics of the meniscus are considered to ensure the best outcomes. Video credit to Anatomy Standard, which emphasises the motion of the meniscus Alastair Jones Michael Cooke Damian Buck Matt Walmsley Andy Goldman #Orthopeadics #Physiotherapy #SportsMedicine #KneeInjury #Meniscus #Anatomy #Biomechanics

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