Your patient's MRI shows a degenerated disc. Does that explain their pain? A 2023 open-access review (Jha et al., Journal of Clinical Medicine) says: not by itself. Degeneration without new nerves is silent. The chain: inflammation draws blood vessels into the disc, nerves follow the vessels into territory that was never innervated, then those nerves get sensitized — heat receptors, sodium channels, acid sensors — so normal mechanical load produces amplified pain. Pathological innervation is the biggest differentiator between a degenerated disc that hurts and one that doesn't. And the MRI grade doesn't track it: Pfirrmann grade and Modic changes don't correlate with pain severity. Also covered: the Cutibacterium acnes infection story (watch, not act) and anti-NGF / intradiscal methylene blue on the horizon. Do: explain the mechanism to patients; stop blaming the Pfirrmann grade; watch intradiscal biologics.
17 Oct 2026
The Pain Switch That Wasn't
The isometric analgesia claim in tendinopathy, stress-tested. Rio 2015's crossover trial in six volleyball players found five 45-second isometric holds cut tendon pain during a single-leg decline squat from 7/10 to near zero — and clinics built stage one of rehab around it. Bigger, tougher replications mostly failed: no analgesic edge in a 2019 patellar tendinopathy trial, and a Dutch trial in 91 patients with chronic midportion Achilles tendinopathy found no pain advantage for isometrics over isotonics or rest. Two systematic reviews agree. Verdict: isometrics are a fine, tolerated entry point for irritable tendons — but the "pain switch" story doesn't hold. Stop selling analgesia; start loading.
30 Sept 2026
Acute Low Back Pain Guideline, Part 2: Treatment
Part 2 of 2 on the new 2026 AAPM acute low back pain guideline: what to start with, what to add at 1-2 weeks, radiculopathy options, and where opioids fit.
30 Sept 2026
Acute Low Back Pain Guideline, Part 1: Assessment
Part 1 of 2 on the new 2026 AAPM acute low back pain guideline: which red flags actually matter, the yellow flags that predict chronicity, and when to image.
29 Sept 2026
Overloader, Underloader, Oscillator: A New Model for Tendinopathy
Nasser, Hopes and Grimaldi's 2026 BJSM editorial proposes the Tendon Investment Framework: three investor types, and why the same rehab plan fails all three differently.
25 Sept 2026
Don't Hide What Matters: Should Physios Name the Diagnosis?
A 3-minute review of Perron et al.'s 2026 JOSPT editorial on pathoanatomical vs functional diagnostic labels in physical therapy.
25 Sept 2026
Neck Pain or Something Worse? Red Flags for Vertebral Artery Dissection
A scoping review in the Journal of Manual and Manipulative Therapy maps what neck pain from vertebral artery dissection actually looks like — and why vigilance matters more than any checklist.
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