Consistency is What Makes Running (and Rehab) Feel Easier

2025 was the year I decided to get back into running seriously. I had run cross country all through my younger and teenage years, but stopped due to university. There were a couple of times when I tried to get back into running, but it never felt great. Reflecting back, I realized I had been approaching my return to running all wrong. I learned that I needed to be consistent if I wanted to feel better running. Once I applied that, everything about running started to feel easier.

Why Consistency Matters for Running and Rehab

Things usually don’t feel great whenever we try to start a new activity or restart something we once did years ago. That doesn’t mean something is wrong. It often just means you haven’t been consistent long enough for your body to adapt. That applies whether you’re getting back into running, dealing with an injury, or trying anything new. As an athletic therapist for almost nine years now, that was something I learned from working with my patients and taking courses that I now needed to apply to myself.

Whenever I had attempted running again, I was always trying to do a distance that was too long. The issue wasn’t running itself, but that I was starting at too high of an entry point. One time I even tried to start again on what ended up being the hottest day of the year, and subsequently developed mild shin splints. Instead of adjusting the distance and focusing on consistency, I would just chalk it up to being older and out of shape and moving on.

What Changed: A More Consistent Approach

With this in mind, my approach in 2025 was different. I knew I had to start smaller, and I had to stick with it. I started with something I had never tried before: run-walks. By running for 5 minutes, walking for 5 minutes and running again for another 5 minutes, this would be a way to get some mileage without overdoing it. I stuck with this for every other day for two weeks before trying for 10 minutes straight. Nothing fancy; just consistent, manageable progress. After that, I would add two and a half minutes every 3-4 runs depending on how I felt. I went by time until I found an app to track distance that I liked; I switched to adding half a kilometre every 3-4 runs.

After a few months of consistent, gradual running, my body was starting to feel good again; not like when I was 17 or 18 and in my prime, but I was never expecting that. Even when I developed some shin pain, I still maintained some running consistency - I had to scale down my volume a bit, but only to the point where I was comfortable with the pain and not aggravating it. I calmed it down, stayed consistent, and then built it back up.

When I did get inconsistent with my running, that’s when problems developed again. I experienced some knee pain over the winter; while travel, sickness and stress certainly played a major role, I was also inconsistent with my running and strength training, and didn’t adjust my running volume to account for this. This resulted in me starting right back to square one with run-walks, but it was just another lesson learned. I’ve been locked in since and have been feeling great.

Consistency is what creates the outcome.

Getting back into baseball this year, my first few training sessions felt weird at first and my shoulder would be sore immediately after. But after a few weeks of throwing, my arm was feeling strong and smooth again. We see this in rehab too. After an injury, exercises can feel awkward or even painful. But when they’re done consistently and progressed appropriately, the body adapts.

The biggest difference in my running this time around was my mindset. I decided I would not wait for things to feel right before I committed. Rather, I decided to be consistent in order to feel right. It involved a step back further than I thought I needed, but it ended up being the right entry point for me to say, “I can keep doing this.” I had always told patients that, despite my younger days of running, I never could see myself running a marathon. But that was based on how I had always approached running. I remember running along the coast of Bantry Bay thinking, a marathon seems possible now.

Most things don’t feel easy at the start - running, rehab, or getting back into any activity. It’s not because something is wrong; it’s because you haven’t been consistent with it yet. Consistency is what makes things feel easier.

Throwing With Arm Pain: Should You Stop or Keep Throwing?

Now that baseball and softball games have started all across Ireland, it’s not uncommon for arm pain to show up with the sudden increase in throwing. The big question is: “Should I keep throwing?” The answer isn’t as simple as stopping completely or pushing through. Rest can lower your tolerance and set you back when you return, while pushing through can make things worse. Like most things, the answer lies somewhere in the middle, and there are a few key things to consider to help you make the right decision.

Should You Keep Throwing With Arm Pain? A Simple Checklist.

Instead of guessing, here are some simple questions to help you decide whether to keep throwing or pull back. Think of this less like a yes/no decision, and more like a checklist.

How Did It Start?
A sudden, sharp onset of pain during one throw is more concerning. A gradual build-up with no clear moment usually points toward a load or sensitivity issue.

Where Is It?
If you can point to one specific spot, that is something to pay attention to. More general soreness or tightness is more likely load- or volume-related.

What Happens When You Throw?
Monitor how your arm feels as you throw. Pain that gets worse as you continue to throw is a concern. Pain that stays the same or improves as you warm up tells a different story.

What Happens After You Throw?
How you feel after throwing is just as important as when you’re throwing. If pain lingers or worsens into the next day, take note. If it settles quickly, you’re likely in a better spot.

What’s The Trend Over Days?
Think in patterns, not moments. If the pain is getting worse each session (more severe and/or comes on quicker), that’s a red flag. Stable or improving pain is more manageable.

Does Your Performance Change?
A drop in velocity or accuracy is more concerning than no change at all.

Does It Change How You Throw?
Are you altering your mechanics to avoid pain? Even if tolerable, compensations can shift stress elsewhere and make things worse.

Does It Affect You Outside of Throwing?
If pain carries into daily activities like reaching overhead or carrying, that’s worth paying attention to.

How Confident Do You Feel Throwing?
Do you trust your arm, or are you hesitant with every throw? We sometimes need a bit of encouragement to push through mental barriers, but we’re also pretty good at sensing when something isn’t right. Avoiding certain throws or holding back effort is something to flag.

None of these on their own are an automatic stop sign. But when multiple red flags show up, it’s time to pull back—or pause—and get assessed by someone who understands throwing injuries. If most of these are green flags, it’s usually safe to keep throwing. But that doesn’t mean ignore it—it means adjust. Reduce volume or intensity, monitor your response, and build back up with a plan.

One bad throw doesn’t mean you need to stop, but one pain-free session doesn’t mean you’re in the clear either. You don’t have to choose between shutting it down completely or pushing through pain. The goal is to make better decisions based on how your arm responds over time. If you’re unsure, that’s where a proper assessment matters—not just to tell you what’s wrong, but to give you a clear plan for what to do next. That’s exactly what we do at Bend Without Breaking Athletic Therapy.

You’re Focusing on the Wrong Things for Recovery

When people think about recovery from training or rehab, they usually think about what they need to add. Some of the common things I see are stretching, foam rolling or other myofascial release tools, massage guns, saunas, ice baths, or even recovery sessions consisting of low-intensity exercises. The goal always seems to be flushing things out or speeding up healing. But if your recovery routine is built around tools, you’re probably missing the point. You don’t need more recovery tools - you need better habits.

What Recovery Actually Is

Recovery is what allows you to adapt to training. After a session, your body needs time to repair and adjust to the stress you’ve placed on it. When that process goes well, you come back stronger. When it doesn’t, performance drops, fatigue builds, and injury risk increases. Your ability to adapt comes down to the balance between the load you place on your body and your ability to tolerate it. Recovery is not what you do after training - it’s your body’s ability to handle and adapt to stress.

What Actually Drives Muscle Recovery and Performance

This is where things often get off track. Recovery tools get the most attention because they’re visible, easy to use, and feel productive. But the biggest drivers are far less exciting:

• Adequate sleep. This is where your body does most of its repair work. Poor sleep directly impacts performance and recovery.

• Adequate nutrition. You need enough total calories to match your physical activity, and in the right balance: protein for muscle repair and growth, carbs for fuel, and fats to support cellular processes.

• Adequate hydration. Often overlooked, but even just small levels of dehydration can negatively affect performance.

• Stress management. Chronic stress can interfere with recovery and adaptation across the board.

These aren’t optional. They’re the foundation.

What About Recovery Sessions?

Many people also include “recovery sessions” - low-intensity workouts meant to help the body recover. But this is often misunderstood. If your goal is recovery, adding more load, even low intensity, is still adding load. A 5km “easy run” is still 5km of running volume. These sessions can be worked into your overall training and load management, but they are not a substitute for recovery.

Where Recovery Tools Fit In

This isn’t to say that recovery tools are useless. Foam rolling, massage guns ice baths - if you enjoy them and they help you feel better, they can be part of your routine. But they are accessories. They support recovery; they don’t drive it. No amount of foam rolling or ice baths will make up for poor sleep or under-fuelling.

What Good Recovery Actually Looks Like

Recovery is simple, but it’s not always easy. It looks like:

• Eating enough at the right proportions to support your training

• Staying hydrated throughout the day

• Getting consistent, quality sleep

• Giving yourself time between hard sessions

• Doing things that help you relax and unwind

It doesn’t need to be complicated. There’s nothing wrong with lying in bed, watching something you enjoy, and calling that recovery.

Recovery isn’t tools - it’s habits. The basics aren’t exciting, but they’re what actually work. When tools start replacing sleep, nutrition, hydration, and stress management, that’s when recovery - and performance - start to suffer. Recovery isn’t what you do after training. It’s what allows your training to work.

Pain Does Not Always Mean Damage, and Why That Matters for Injury and Recovery

Whenever we feel pain, we usually assume we have caused some sort of tissue damage. But this isn’t always the case. Pain is not a direct measure of injury, and it’s often a poor indicator of how much damage is actually present. A more useful way to understand pain is to think of it as a reflection of tissue sensitivity rather than damage. This shift in perspective can have a major impact on how you approach recovery and whether you stay stuck or start making progress.

What is Pain, Really?

Pain can be hard to define, but at its core, pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. This definition is important because it highlights that pain is real, but it’s also influenced by more than just what’s happening in our tissues.

Pain Does Not Always Reflect Tissue Damage

Paper cuts are a great example of how a very minor cut to the skin can be quite painful at the moment. On the other hand, the occurrence and progression of rotator cuff muscle tears increase with age, yet around 50% of people are asymptomatic. These two examples highlight just how varied our experience of pain can be. If pain always meant damage, then paper cuts wouldn’t hurt as much as they do, all shoulders would become progressively more painful as we age, and serious injuries would always be extremely painful. This is exactly why pain isn’t a reliable measure of damage.

We have this varied experience because pain is influenced by many factors. While we have sensory receptors that pick up painful sensations, pain itself is the brain’s interpretation and output of this information. Factors like stress, sleep, previous pain experiences, and even how you think about your injury can all turn the volume of pain up or down. When pain changes day to day, it doesn’t mean tissues are repeatedly being damaged and healed - it often reflects changes in sensitivity.

Pain is Influenced by More Than Just Tissue Damage

This matters because how we interpret pain influences how we respond to it. Many people become fearful of moving a painful area because they assume they’re causing more damage. While understandable, this avoidance can lead to under-loading and delayed recovery. On the other end, completely ignoring pain can lead to overload and further injury. Viewing pain as sensitivity, not just damage, allows you to move and load an area with more confidence while still respecting your limits.

When Pain is Helpful, and When It Isn’t

While unpleasant, pain can be helpful in certain circumstances. Following an acute injury, like rolling your ankle, it is the sensation of pain that tells us to stop the activity to avoid further injury and let it heal. We can use pain as a guide to know if activity is too much for us right now. However, pain can persist beyond normal healing timelines. The longer pain sticks around, the more sensitive the system can become, and the less reliable pain can be.

I liken this to a smoke detector that starts beeping when you’ve just burnt a piece of toast. There’s no fire or even visible smoke, but that smoke alarm is highly sensitive, and it lets you know something is going on. Our brains can work the same way - pain can show up even when there’s no ongoing damage, acting like an overprotective alarm rather than a warning sign of harm.

Why This Matters for Injury and Rehab

Instead of asking “is this damage?”, a better question is: “what can I handle right now?” In some cases, it is okay to be active and exercise even if we have pain. Other times, it’s appropriate to take a step back and allow things to settle. When we view pain as more about sensitivity than damage, it becomes easier to keep moving and loading an area without unnecessary fear.

We can then scale activity to match that level of sensitivity - working within a tolerable range, adjusting when needed, and using pain as a guide rather than a stop sign. If pain is acting like that sensitive smoke detector, the goal isn’t to shut it off completely, but to gradually build tolerance so it becomes less reactive. From there, the focus shifts to what actually drives recovery: strength, mobility, movement quality, and confidence.

Pain is real, but it’s not always reliable. The fact that pain can vary from person to person with similar injuries, and that pain can be influenced by many things should tell us that not all pain is damage. Rather, it might be more useful to view pain as more about sensitivity, as this allows us to move and use an injured area while still respecting what we are experiencing. Pain is part of the picture, but it’s not the whole picture, and it’s not always a reliable measure of damage.

There’s No “Best” Rehab Exercise - Only the Right One For You

If you’ve ever had an injury, you’ve probably been given a list of exercises to do to help you recover. Or maybe you’ve searched for exercises online and found a handful of the “best” or “number 1” exercise for your injury. The problem is that even good exercises don’t work if they don’t fit into your life. That’s where most rehab plans fall apart. It’s easy to get caught up trying to find the perfect exercise, but the reality is the best exercise is the one that actually works for you. Many people don’t fail rehab because the exercises are wrong or because they lack motivation. They fail because the plan doesn’t stick.

Why There’s No “Best” Rehab Exercise

There is no universal “best” rehab exercise. The same exercise that works well for one person might feel frustrating, confusing, or unrealistic for someone else. This is because not only do injuries differ, but because people differ as well. Your time, experience, goals, and day-to-day life all shape what will actually work for you. Research often shows that different exercise approaches lead to similar outcomes. This tells us something important: there usually isn’t just one right way to rehab an injury. You have more good options than you think.

Why “Perfect” Exercises Often Don’t Work

That “perfect” exercise you saw online might not work for you because:

• It’s too much for where you’re at right now.

• It takes longer to set up or complete than you have time for.

• It needs equipment you don’t have.

• It looks impressive, but doesn’t actually relate to what you need.

What Makes a Rehab Exercise Actually Work

But here’s the important part: any exercise can be the right one for you, if it fits. An exercise is more likely to work when it:

• Fits your life. You have the time, space, and equipment to actually do it consistently.

• Makes sense to you. You understand what you’re doing and why you’re doing it.

• Can be adjusted. It can be progressed, regressed, or modified depending on how you’re feeling.

• Builds confidence. You feel like you’re moving forward, not second-guessing every rep.

The best exercise for you is one that checks these boxes. If an exercise misses even one of them, it becomes harder to stick with. We know from behaviour change research that people are more likely to stick with something when it feels manageable, it fits into their routine, and they understand why they’re doing it. Rehab is no different.

Why People Struggle to Stick With Rehab

This can be why people will bounce from exercise to exercise - not because nothing works, but because nothing works for them. It’s easy to find an exercise that’s touted as the solution to your pain, but if it doesn’t fit your situation, or you don’t feel like it’s helping you move forward, then it’s not the solution to your problem - and that’s okay.

The Real Goal of Rehab

There’s no perfect rehab exercise. Just one that fits your life, makes sense to you, and actually moves you forward. The more you realize there are multiple ways to get there, the easier it becomes to stop chasing the “best” exercise and start making real progress. The perfect exercise doesn’t exist in isolation - it only exists in the context of you. If the exercise doesn’t fit your life, it won’t fix your problem.

Why Your Arm Is Sore After Throwing (What’s Normal and When to Worry)

It’s common for baseball and softball players, especially pitchers, to experience arm soreness after throwing. Even when you’ve built up properly, your arm can still feel fatigued or achy after a game or bullpen session. This type of soreness is different from injury-related pain. It reflects the physical demands of throwing, not necessarily a problem. Understanding why your arm gets sore can help you manage it properly and recognize when something more serious might be going on.

Why Throwing Is So Stressful on the Arm

Even with good mechanics, strength, conditioning and recovery, pitching is still stressful on the arm. This is due to the speed and forces generated during the throwing motion, particularly in the later phases. At ball release, the arm experiences a strong pulling (distractive) force, often exceeding body weight, that the shoulder muscles must control. Repeating this over the course of a game places a significant demand on the arm, even in well-conditioned athletes.

What Causes Arm Soreness After Throwing? (DOMS Explained)

Delayed onset muscle soreness is the stiffness and aching you feel after a new activity or a significant increase in workload. While we don’t fully understand it, the leading theory is that it results from small amounts of muscle damage and the body’s inflammatory response. Eccentric muscle actions, where muscles work to slow movement, are a major contributor. In throwing, the muscles of the shoulder girdle and arm work eccentrically to decelerate the arm after ball release. Over the course of an outing, this repeated demand can lead to soreness.

Does Lactic Acid Cause Arm Soreness?

Lactic acid is often blamed for muscle soreness, but this idea is outdated. Lactate (the correct term) does not cause the fatigue or burning sensation during activity, and it doesn’t explain soreness the next day. Lactate is cleared from the body relatively quickly. In pitching, the amount produced during a single throw is minimal and is typically cleared before the next pitch.

When Arm Soreness Is Normal (and When It’s Not)

It is normal for your shoulder and arm to be sore following pitching, and even into the next day. This is usually a general, fatigued soreness that improves within a day or two. Pay closer attention if you notice sharp or pinpoint pain, pain during throwing, loss of velocity or control, or soreness that continues to worsen over time. Soreness doesn’t mean something is wrong- it means your body was challenged, and this happens every time you step on the mound. But if that challenge exceeds what you’re prepared for, that’s when problems can develop.

Recovery Principles

There’s no magic cure for DOMS. The best approach is good, basic recovery: adequate sleep, nutrition and hydration, and appropriate spacing between throwing sessions. Lght physical activity can sometimes provide some temporary relief, but adding more work to an already fatigued arm usually just adds more stress. Recovery should support the system, not further stress it.

Some arm and shoulder soreness after throwing is completely normal. It reflects the high demands placed on the arm, even when you’re prepared well. Being sore isn’t a requirement for a good outing, and it’s not something to chase or avoid entirely. The key is understanding the difference between normal soreness and warning signs of overload. With proper training, recovery and monitoring, post-throwing soreness is simply part of the process, not a problem to fix.

Back Outside? Why Baseball Players Get Hurt Early in the Season (and How to Avoid It)

It’s that time of year again. The days are getting longer, the weather is improving, and baseball and softball teams across Ireland are starting to move from indoor sessions back outside. And with that comes a pretty common pattern. You’re throwing a bit harder, taking more swings, and running a bit more; it feels good to be back on a full field again. For the most part, nothing feels wrong in the moment. But then the next day, or a few sessions later, you start to notice a little bit of soreness, maybe something more specific, or something that lingers and starts to affect how you play. If that’s you, you haven’t done anything wrong, but your body is telling you something - it’s just not always obvious what.

Why Injuries Happen Early in a Baseball Season

The start of the baseball and softball season is one of the most common times for injuries to show up. Even at the professional level, a large portion of injuries happen during spring training and early in the season. This is because the demands of the game change quickly. Indoor training has its place, but it comes with less space, lower intensity, and more controlled movement. When you move outside, everything ramps up at once - throwing distance increases, effort increases, volume often increases, and the overall unpredictability of the game comes back. Even if you’ve been training all winter, this is still a jump that happens all at once, and your body has to deal with all of it at the same time.

It’s Not Damage- It’s a Load Problem

A lot of these early-season issues get labelled as “overuse injuries”, which can make it sound like something is worn out or damaged. Most of the time, though, that is not what is happening. A better way to think about it is this: your body is dealing with a mismatch between what you’re asking of it and what it’s currently prepared for. Your body adapts to the loads you put through it, which is the purpose of training. However, these adaptations take time. When your throwing, hitting, and running all increase at once, your body just hasn’t caught up yet. It becomes a matter of “too much, too soon.”

Why This Happens Even If You Trained All Winter

It can be frustrating when you have been training consistently, doing some throwing and hitting, and still have something flare up. Even if you’ve been doing baseball activities indoors, it’s more about what you are preparing for. Indoor work doesn’t fully prepare you for full-distance throws, game-speed effort and repeated high-intensity movements. So when these show up all at once, the jump in demand can be enough to tip things over.

Soreness vs. Injury: What’s Normal?

Some soreness early in the season is completely normal. That general, slightly stiff feeling a day or two after training is just your body responding to something new. When talking about overuse injuries though, it tends to feel a bit different:

• More specific to one area

• More noticeable with certain movements

• Sharper and/or more painful

• Something that builds over a few sessions

Even with these symptoms, it still doesn’t necessarily mean a tissue is damaged. In a lot of cases, it’s better to think of this as a sensitive or irritated area, rather than a broken one.

How to Avoid the ‘Too Much, Too Soon’ Trap

This is where things get tricky, because no one is counting every throw or swing, and there is no perfect formula for how much is “too much.” But there are a few principles that go a long way:

• You want to build, not spike. That means letting your throwing, hitting, and running increase gradually instead of all at once.

• The point at which you’re starting to feel some soreness or fatigue in a body part is usually a good time to start to wind down from activities for that session. It’s usually better to nip things in the bud.

• It’s tempting to go all out in those first few outdoor sessions, especially when you’re feeling good. But maxing out early is an easy way to create that mismatch between load and tolerance.

• Early on, consistency matters more than intensity. Getting regular exposure to the demands of the game is what helps your body adapt.

• Adding some basic strength work alongside your training can help build tolerance over time (especially if you’ve had issues in the past), but it doesn’t need to be complicated.

• It’s worth expecting some soreness. Trying to avoid it completely usually leads to doing too little, which doesn’t help your preparation either.

What To Do If Pain Starts to Show Up

If you do start to notice something more specific or limiting, the goal isn’t to ignore it - but it’s also not to shut everything down. Most of the time, the best approach is to adjust your activity rather than stop it. That might look like reducing how much you’re throwing or hitting, lowering the intensity or modifying what you’re doing for a short period. From there, you can gradually build things back up once it settles. It’s a simple idea, but an important one: settle things down first, then build them back up. If it’s not settling or is starting to affect how you’re able to play, that’s usually a good time to get it checked out by someone who understands baseball and softball.

You’re Not Broken

The start of the season is always a bit of a shock to the system. More volume, more intensity, more effort, all at once. This is a really common part of the early season, even for players who have done a lot of things right leading into it. If something flares up, it doesn’t mean you’re fragile or injury-prone, or you’ve done something wrong. More often than not, it just means your body hasn’t caught up to what you’re asking of it yet, and it needs a bit more time to get there.

If you’re not sure how to balance training and recovery, or something starts to feel off, that’s exactly what I help with - especially for baseball and softball athletes navigating the start of the season.

What Is Evidence-Based Practice? A Better Way to Understand Research, Experience, and Patient Care

Evidence-based practice (EBP) is a term that gets used a lot in healthcare and rehab, but what does it actually mean? It’s often described as the integration of best available research, clinical expertise, and patient values. While all three are important, they aren’t truly equal or separate in practice. A more useful way to understand evidence-based practice is as a funnel — where research provides the starting point, clinical reasoning refines it, and the patient ultimately determines what is appropriate.

The scientific process is the best method we have for determining what is likely to be true. Researchers ask questions, test hypotheses, collect and analyze data, and repeat the process. Over time this builds a body of evidence that helps guide how we treat patients. Of course, research is not perfect. Studies can be flawed, data can be manipulated, and tightly controlled experiments may not always reflect real-world conditions. Still, when done well, scientific research provides the best starting point for understanding which treatments are most likely to work.

Clinical experience and observation are also forms of evidence, but they are considered lower levels of evidence because they are more susceptible to bias and lack experimental control. A patient may feel better after a treatment, but it can be difficult to determine whether that improvement was caused by the treatment itself or by other factors such as natural recovery or contextual effects. At the same time, clinical experience has value. Clinicians work with real patients who have unique circumstances, goals, and constraints that are often not represented in research studies.

“The literature cannot refute what is seen in the clinic, but it can refute our explanations of those experiences.”

The final piece of the puzzle is the patient. Ultimately, patients provide consent and decide whether a treatment plan fits their goals, beliefs, and circumstances.

This is where the funnel analogy becomes useful. At the top of the funnel is the best available research. Clinicians should start with the totality of evidence when deciding how to approach a condition. From there, that information is filtered through clinical expertise and practical experience. Finally, it narrows down to the individual patient, who determines whether the proposed treatment aligns with their preferences and circumstances.

Let’s look at an example.

A patient presents with Achilles tendon pain related to running and is diagnosed with a tendinopathy. Current research suggests that tendons respond well to progressive loading. Based on both research and clinical experience, the therapist recommends a heavy, slow calf raise program as the primary treatment. The patient agrees, and the plan moves forward.

But what if the patient is uncomfortable with that approach? Maybe they are inexperienced with resistance training, have had negative experiences lifting heavy weights, or simply prefer higher-repetition exercises. Instead of abandoning evidence-based practice, this is where the funnel becomes useful. We return to the top and reconsider the available options. While heavy, slow loading may be a preferred strategy in the literature, loading itself is the key stimulus for tendon recovery. Using clinical reasoning, the therapist might adjust the program to higher repetitions with lighter weight, or even begin with isometric exercises if symptoms are particularly irritable. These options may not be the exact approach used in research studies, but they still respect the underlying principles supported by evidence.

What if a patient requests a treatment that goes against the best available evidence? Evidence-based practice doesn’t mean ignoring the patient. Instead, it means having an honest discussion about the proposed treatment—its benefits, risks, and what the research actually shows. The clinician can then return to the top of the funnel, review the available options, and help the patient make an informed decision. Sometimes there is little or no research on a particular treatment. In those cases, if the risks are low and the patient understands the uncertainty involved, choosing to proceed can still fall within the spirit of evidence-based practice.

Evidence-based practice isn’t about blindly following research, relying solely on experience, or simply doing what the patient prefers. It’s about integrating all three — starting with the best available evidence, filtering it through clinical reasoning, and applying it in a way that works for the individual in front of you. Thinking of EBP as a funnel rather than a balance helps clarify that process. It shifts the goal from finding the “perfect” treatment to finding the most appropriate one for that person, at that time.

References:
Meira, E. Understanding evidence-based medicine using a funnel analogy. SportRxiv, 10, December 2020.

When is Movement “Too Much” or “Not Enough”?

In rehab, we often label movement as “too much” or “not enough”, but how do we actually know when that’s true and relevant? If you’ve ever had an injury assessment, you might have heard terms like “over-pronation” or “under-pronation.” Maybe you have too much knee valgus when you squat, your low back is hypo-mobile, your pelvis is out of alignment, or maybe it’s poor posture. The problem with many of these descriptors is that they’re largely subjective - no therapist can actually measure joint movement simply by watching you. These terms are often used to explain pain or injury, but the relationship between movement and pain is far less clear than many people assume.

Much of this comes from the concept of an “ideal.” Ideal technique, ideal posture, ideal mechanics. Anything different gets labelled “dysfunction”. The implication is that every person should move a certain way, and if you don’t move in this “optimal” way, something must be wrong and needs fixing. These explanations are often used to justify specific corrective exercises. But this approach is overly simplistic and ignores the natural variability in human bodies and pain experiences. There is certainly more discussion to be had around movement when it comes to performance — efficiency, skill, and sport-specific technique — but here we’re focusing on injury and pain.

Even if we did hook someone up to a biomechanical analysis system and measure joint angles during movement, the question still remains: when does movement become too much or not enough? Textbooks provide average ranges of motion for joints, but that’s exactly what they are — averages. What we don’t have are clear standards for when variation becomes a problem. At extreme ranges there would probably be agreement that someone has “poor posture.” But posture exists on a spectrum. At what point does it actually become “poor”? And even then, we still have several steps before confidently saying that over-pronation is the cause of your foot pain and must be corrected for you to recover.

How Are Movement Dysfunctions Measured?

Often, we simply use our eyes when assessing how someone moves. I’m certainly guilty of this. It’s jokingly call it the “vomit test”: if watching someone move makes me want to vomit, I’ll take note. Very objective and scientific (sarcasm). In reality, this is more about noticing large movement differences rather than tiny variations. There are objective tools that can improve accuracy — a goniometer to measure joint angles, a dynamometer to measure force, or slow-motion video. But even with objective data, we still face the same question: how much is too much? We simply don’t have reliable, consistent data showing that a specific angle — say 25° — suddenly becomes “over-pronation.”

Do These Movements Dysfunctions Actually Cause Pain?

Many biomechanical explanations follow a common-sense logic. It seems reasonable that there would be an ideal way to move, and any deviation would be less ideal. It also seems reasonable that someone’s flat foot might contribute to pain while running because of increased stress on the bottom of the foot. These explanations pass the common-sense “sniff test,” which is likely why they persist. But plausible explanations are not always accurate, especially when dealing with complex human systems.

Do People With Pain Actually Show These Dysfunctions?

This is where things become less clear. Research often contradicts what seems intuitive. For example, it seems logical that poor posture would lead to back pain. But we see people with poor posture who have no pain, and others with excellent posture who do have pain. Sometimes the relationship may even run the other direction - pain can influence posture. Someone with disc-related back pain may shift their torso sideways simply because it reduces symptoms. In that case, the posture isn’t the cause of pain but a response to it.

Can These Movement Patterns Actually Be Changed?

Many treatment approaches focus on correcting these perceived dysfunctions through specific exercises. These are typically highly cued, low-load “motor control” exercises designed to help you feel and control certain movements or positions. The idea is that repeating these exercises will eventually correct the dysfunction and resolve the pain. But research often shows that these movement patterns don’t actually change — even when pain improves. So what caused the improvement? Was it the exercises themselves? General physical activity? Natural recovery? Expectations about the treatment? Pain and movement are complex systems, and rarely explained by a single factor.

Do You Need to Change Your Movement to Get Out of Pain?

This is the real question, and the heart of my position. Humans are highly individual in how they move. We naturally develop movement patterns that feel comfortable and efficient for us. Do we really want to change what is natural for every individual? Usain Bolt, the fastest man in the world, has noticeable scoliosis. Through training, he has adapted to it while setting world records in the 100 metres. If we tried to “correct” his scoliosis, would that make him faster — or slower? Many elite marathon runners display foot mechanics that many clinicians would label over-pronation (in fairness, I probably would too). Yet they perform at the highest level. Would it make sense to change the very mechanics that got them there? This situation occurs frequently in rehab. A runner develops knee pain, completes rehabilitation, and their pain resolves — yet they continue running exactly the same way as before. If they entered and exited pain without changing their running mechanics, can we really blame the mechanics? Sometimes we do temporarily change movement patterns, but not because the movement itself is faulty. Instead, the goal is to unload a sensitive structure. Once symptoms settle, we gradually build capacity again.

This is why I’m skeptical of the over/under and hyper/hypo labels for posture and movement. Often the measurement isn’t reliable, the link to pain isn’t clear and many of these “dysfunctions” either can’t be changed or don’t need to change for pain to improve. I understand the appeal of this idea: fix this dysfunction and you’ll fix your pain. It’s simple and reassuring, but it can also create misleading narratives. People start to believe their bodies are fragile. They worry that moving the wrong way will cause injury. Small aches lead to fear, avoidance, or compulsive corrective exercises. Ironically, letting go of the need to fix every perceived dysfunction often opens more options in rehab. It shifts the focus towards building strength, tolerance, and confidence in movement, rather than chasing perfect mechanics. This is usually what gets people back to doing what they enjoy.

(Credit goes to Greg Lehman’s Reconciling Biomechanics with Pain Science for the inspiration for this blog and this thought process that helped me develop into the therapist I am today.)

"What a Difference Some Exercise and Time Makes”

This recent case highlights how patient education, realistic expectations, and a clear rehab plan can shape recovery.

A 69-year-old retired male had been running casually for over 10 years, typically 6–10km every other day from spring through fall. In early November, he felt some lower right glute pain during a run but was able to finish. After resting a week, he attempted another run and developed sharper pain around 2km in, forcing him to walk home. Since then, he had been resting and stretching. He noticed his flexibility improved, but the pain persisted — particularly with a few attempts at running. In January, after a delayed four-hour flight, he developed more significant pain down the back of his right leg. Sitting aggravated it, and a long Christmas dinner was his worst day. The leg pain, and how long it was taking to improve despite doing nothing to aggravate it, were what concerned him the most.

Patient Education

Early on, the priority was providing an explanation for his leg pain. Clinically, this presentation was consistent with proximal hamstring tendinopathy: common in runners and often aggravated by sitting pressure. We discussed the possibility of an initial gluteal strain but questioned it given the relatively low-load nature of distance running. The key message wasn’t obsessing over the perfect label. It was explaining: why sitting hurt, why symptoms evolved, why rest alone hadn’t solved it, what tendons actually need to improve, and how we could tackle both pain points. That led directly into expectations.

Setting Expectations

He was used to minor “niggles” resolving in 1–2 weeks. The concern was this felt different; even different from his prolonged ITB pain years ago, which left him frustrated by unclear explanations and slow progress. With spring approaching, he felt pressure for this to “heal now.” We discussed that tendinopathies are notorious for slower timelines — often 2–8 months depending on duration and loading consistency. This timeframe is not because something is severely damaged, but because tendons adapt gradually. He didn’t love that timeline, but having one was better than uncertainty. Understanding what is typical often reduces anxiety more than promising quick fixes that don’t pan out.

Proper Loading

During his rest period, he had mainly been stretching. Stretching can feel good and reduce pain temporarily, but tendons respond best to progressive resistance training. We introduced three primary exercises: hip thrusts, Romanian deadlifts (RDLs), and floor-sliding hamstring curls. The focus was on progressive loading of the proximal hamstring and glute through hip extension and knee flexion. We also discussed getting creative with loading, since his available weights were light. With hip hinges especially, most people can tolerate going relatively heavy. We kept stretching in the plan since he found it helpful and it wasn’t interfering with recovery, but strengthening became the priority.

Two Weeks Later

At follow-up, the first thing he said was: “What a difference some exercise and time makes.” He reported several days completely free of leg pain; the glute discomfort was still present but improved. He also noticed continued flexibility gains despite doing less static stretching and more strengthening. We progressed his RDL to a split-stance variation to increase single-leg loading without needing heavier weights. Next steps will include further progression and building toward a structured return-to-run plan.

Why This Case Matters

Despite being a running-related injury, improvement didn’t require anything fancy. It required a clear explanation, realistic expectations and progressive loading. Education reduced uncertainty, expectations reduced anxiety, and loading gave the tissue a reason to adapt. This wasn’t about chasing symptoms; it was about rebuilding capacity. It was about restoring capacity. Nothing flashy. Just the sound rehab principles of clear communication, calming things down and building them back up.