What’s the hardest part for you when talking to patients about their conditions and pain?

What’s your least favorite part of prep? One specific thing? And what’s your favorite?

Side topic, it’s so weird that in my regular gym the stacks must me light because the weights at planet fitness are humbling the shit out of me!!

Effectiveness of eccentric calf muscle exercise therapy in patients with chronic midportion Achilles tendinopathy: a randomized controlled trial The paper on eccentric heel raises for Achilles tendon issues. It looked at people for 12 weeks, most were in their 50s and had this issue for 60-70 weeks. They broke them up into a group that did bicep curls and a group that did eccentric heel raises. It would have been nice to see a control group where they didn’t do anything or just had appointments with the research team at similar intervals as the other groups. This would help see if natural history or just having attention resulted in improvements. Yes the body is weird and sometimes when you just have any kind of appointment for an issue people experience improvements. It’s always easy to break down a study and say what it didn’t do after the fact than it is to actually put something together. Truly phenomenal papers with minimal limitations are hard to come by. This paper does add some understanding of chronic issues. One could postulate a lot of what we do is always somewhat a song and dance and it’s more about having options that resonate with the person in front of you and allow them to do something and gain systemic benefits of exercise. There are some objective measures that would have been nice to know but that also gets tricky. The more you test the more you’re likely to find something positive. And is it a true effect or just because we measured a heck of a lot of things? It would have been nice to see an actual measurement of performance vs just a self report. Right now I’d just say this was an interesting finding but wouldn’t change my practice patterns because of this vs the big trends in the research. Most of the trends still are showing: load management is a key important piece for rehab, progressive overload to the area of concern, exercise needs to be specific enough to help someone persist with it, a program should be first designed with adherence in mind, education that’s open about the issue, monitor for avoidance behaviors, fear and reduced self efficacy, work on someone’s health habits in areas that can be most significantly changed. Yes there are entire body effects from exericse, sometimes these can result in significant improvements like walking programs have been shown to improve shoulder, neck, back and knee pain. But I wouldn’t put a ton of stock in this paper changing my practice patterns just set

Which exercise do you think would be more beneficial for Achilles pain?