Adam Stenman

In a more race like trial design, 100g/h outperform 60g/h. Next step would be a group consuming 150g/h and maybe use even longer pre exhaust protocols (5-6h, more like the classics and longer than half ironman distance).

This works for the wrist as well (tape around the DRUJ and load axially). Can make a huge difference.

Absolutely A or B. Living in E.

Rough day at work

....bruh 🫠🔫

My first reaction was ofc to suspect a stress fracture. But looking at the limp it's also not impossible that it's a soleus tear.

I'm doing the rehab for a guy who has had a medial meniscus root repaired at 65. It had been symptomatic for 8 months or so before the repair and x-ray did not show any signs of cartilage loss really. Still the rehab has been quite slow and when he was nearly fully recovered, 4 months post op, his knee flared up again after a walk in the woods... Still an ongoing story. Would a hemiarthroplasty have been a better choice here? Or should he continued conservative to 12+months? Who knows really.

My two cents $.01: patient has a painful condition that is not well visualized with a CT scan, like a radiculopathy, nerve entrapment, post herpetic neuralgia, endometriosis, etc $0.02: Patient has a mental health condition, like OCD or GAD and needs to be confronted with this once other modalities and proper clinical reasoning has ruled out somatic causes.

I suspect quad tendon grafts need a dedicated protocol to do as well as hammie graft. BPTB might need some dextrose prolo or such if they develop patellar tendon pain.

This mirrors my belief about some modic changes. As of 2026 we don't really have a good way of treating them, probably not even to diagnose which ones that might be due to infection vs bone stress. Basivertebral nerve ablation is probably the way to go until we have intra discal injections approved.

For suspected bone stress injuries at low risk sites I let the patients self pace return to running within a framework like point 2, while doing cross training preferably. No x-rays unless something goes awry. For high risk sites I unload as much as needed for pain free ambulation and get a x-ray within 1-2 weeks with a follow up appointment as the x-ray is completed, then we start working from there according to response to unloading and the radiographic findings. International guidelines needs to be adapted to your local constraints. I work in public funded healthcare and need to try to be responsible with our resources. I also can not refer to MRI for these injuries, only refer to Ortho who then orders MRI, obvious doctor's delay. So no reason to refer low risk injuries, while high risk injuries need proper care while waiting to see Ortho (if they have a fracture line, lower grade BSI even at high risk sites can mostly be managed in primary care as long as the patient is progressing). I have not found any really useful Swedish guidelines for managing bone stress injuries. This is simply a pragmatic model l that I have semi-consciously developed.

Riding without a power meter is diabolic though

It's a combination of muscle damage and hypoglycemia. You don't only need a good enough lactate threshold, you need a lot of miles to toughen you up and a well rehearsed nutrition plan with at least 150g of carbs and enough water to maintain sweat rate if it's hot.

The saddest story I can remember re all this is when I saw an ICU nurse, about my age (35) maybe 3 months post microdiscectomy. He had developed sciatica+foot drop and went to Ortho colleague very early, just walked there after a shift to get input. They had advised him to wait and see, maybe do physio, take some pain meds and try to live as normal as possible. 6 weeks later no improvement and bad pain so he opted for surgery. When his foot drop failed to improve they told him to go do physio. He was very motivated so I threw lots of stuff on the poor dorsiflexor; NMES, different nerve slides, all neuro rehab facilitation tricks I could remember, isolated and compound movements etc etc but the improvements were all quite modest. So for this poor dude he will have a lifetime of dorsiflexion weakness and his healthcare utilization was way increased vs early intervention.

I like to refer and refer more patients than most other physios where I work. The thing with specialist referrals is that nobody will force the patient to do something they don't want or need to do, and if the patient improves with conservative measures everyone will be happy. If they don't and you've waited a window of opportunity might have closed and outcomes might be way worse.

Two years ago I was in absolutely horrible shape following a pneumonia and a few years of resistance training rather than cardio. However, I bought myself a cargo bike in a town 100 km away. I brought 2L of chocolate milk and rode it home, took 5h. Wore a HR strap for fun, averaged like 155 which is mid Z3. I was hungry but not very tired when I got home. Years of triathlon training has given me very good endurance when when untrained. However, I was and still am quite slow compared to when I was good at it. Going fast is the challenge.

I had a classmate from year 6-9. Bright, shy girl. Did very well on all tests. I vividly remember when we were taking turns reading aloud and she was so darn slow, made a lot of mistakes etc. She then started the same collage as the girl I dated at the time. She got diagnosed with dyslexia at 16-17 years old. She told my ex that "I just thought letters was a kind of bad concept, like the best we had but just kind of hard for everyone but still better than runes or hieroglyphs". She is a medical doctor now. Probably doing just fine, as she's very smart in spite of her dyslexia. I think it's probably pretty close to dyspraxia. Some people don't have a nervous system that's good at precise, deliberate movements. Others have a nervous system that struggle with the specific pattern recognition that reading and writing requires. With practice you can become a lot better ofc, but never world class. I was quite shit at school. However I'm very intrigued by written language. Read all the Harry Potter books by myself, starting with the chamber of secrets at about 8-9 years old and when The Order of the Phoenix was released I read it in english, I was 12 or 13 at the time. Hugely helpful for my english development. Maybe I'm more towards the hyperlexic side.

Before I became a physio I was a network techie (some Cisco certifications) and this is pretty true, nobody understood networks so we could make shit up 😆