https://pocketphysio.app/blog/ PocketPhysio is a home exercise program (HEP) app for physiotherapists and physical therapists: 1,500+ filmed exercise videos with a voice guide for each, patient assessment, and programs sent to patients by link, SMS, email, the patient app or WhatsApp. en Thu, 01 Oct 2026 00:00:00 +0000 https://pocketphysio.app/blog/are-barefoot-shoes-good-for-your-feet/ https://pocketphysio.app/blog/are-barefoot-shoes-good-for-your-feet/ A barefoot or minimalist shoe changes three measurable things: the heel to toe drop, the stack height under the foot, and the width of the toe box, usually with a more flexible sole and no motion control. The evidence cuts both ways, and both halves are real: feet do get stronger, and in 22 young adults who wore a minimal shoe for most of their shod time for six months, foot strength measured on a laboratory rig rose by an average of 57.4%, with no change in 24 controls, and a 2025 review of 7 studies in 213 mostly athletic participants found increases in foot muscle size, although most of those studies mixed minimal footwear with an exercise program or tested barefoot exercise rather than footwear, so the shoe cannot be separated from the training. Injuries also show up when people change fast: in 36 recreational runners given a 10 week transition, 10 of the 19 in minimal shoes developed new bone marrow swelling in at least one foot bone, and a review of 20 transition studies recommends taking no less than 4 to 8 weeks and cutting your running volume in the first two weeks. Be careful or get advice first if you have diabetes or reduced feeling in your feet, if you have current plantar heel or Achilles pain, if you have fallen in the past year, or if your feet are structurally different from the young athletic ones in these studies. No study here set out to measure knee pain or back pain, so the claims you see about those are not coming from this research, and the one trial that recorded knee symptoms found more knee and calf pain in the minimal footwear group. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/blood-flow-restriction-training/ https://pocketphysio.app/blog/blood-flow-restriction-training/ Blood flow restriction training means exercising a limb with light loads while a cuff around the top of it restricts the blood returning from the muscle, which lets a small load produce some of the adaptation a heavy one normally would. Its main use is the part of rehabilitation where heavy loading is not allowed or not tolerated, whether that is the weeks after knee surgery or pain that stops someone loading a limb properly, and that is where the evidence sits: a 2026 meta-analysis of 9 randomized trials in 372 people after ACL reconstruction found quadriceps peak torque favored the cuff groups at moderate certainty on GRADE, with knee function scores favoring them at low certainty and no difference in pain or range of motion. The list of people who should not use it without medical clearance is long and specific: the absolute list, at evidence level 1b with a grade A recommendation, includes high blood pressure, a history of blood clots or a high thrombosis risk, peripheral arterial disease, pregnancy, kidney insufficiency, lymphatic disorders, and broken or infected skin where the cuff would sit. A second list, graded lower at level 2b and grade B, adds severe osteoporosis, a recent fracture, clotting disorders, diabetes with nerve damage, a badly swollen limb or a joint full of fluid, and anyone who cannot tolerate the cuff; a separate risk stratification paper adds recent heart events and poorly controlled heart conditions. This page carries no cuff pressures on purpose, because pressure is set by a trained clinician on a measured limb and not from an article. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/do-joint-supplements-work/ https://pocketphysio.app/blog/do-joint-supplements-work/ For glucosamine and chondroitin the answer is now unusually clear. The American College of Rheumatology osteoarthritis guideline summary approved in September 2026 states, "In people with knee, hip, and hand OA, we strongly recommend against glucosamine, chondroitin, and combination preparations of glucosamine and chondroitin." That recommendation is graded strong, with low certainty of evidence for glucosamine alone and moderate certainty for the combination, and the document marks it as a change in direction since 2019, when chondroitin was conditionally recommended for hand osteoarthritis. The UK position is older and blunter: NICE guideline NG226 says "Do not offer glucosamine or strong opioids to people to manage osteoarthritis", and the NHS adds that "GPs no longer prescribe chondroitin and glucosamine on the NHS because there's no strong evidence that they are effective as a treatment." Collagen sits somewhere else: the evidence is a pooled analysis of three small trials, all of them at high risk of bias, plus a guideline summary that does not mention collagen anywhere, which leaves it unsettled rather than ruled out. No supplement on this page has been shown to rebuild cartilage, and the X-ray studies of joint structure contradict each other. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/exercise-snacks/ https://pocketphysio.app/blog/exercise-snacks/ An exercise snack is one to two minutes of effort done a few times a day instead of in one session, and the honest summary is that it is a way of getting movement to happen rather than a program that replaces strength work. A 2024 scoping review in Sports Medicine gathered 32 studies and found that exercise snacks were feasible and appeared safe, that the trial evidence showed modest improvements in cardiorespiratory fitness, and that effects on physical function, mood and quality of life were equivocal. The three observational studies in that review linked short bursts of vigorous daily activity with lower death rates, which is an association found in people already doing them rather than proof that adding them does the same. A pilot randomized trial in 42 adults near retirement ran a 12 week version and reported more daily activity and a longer six minute walk distance, while stating plainly that no statistical tests were done because a pilot is not designed to detect effects. Where this idea earns its keep is a home exercise program that is not getting done, because three one minute blocks attached to things you already do each day is usually the difference between some and none. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/glp-1-medicines-and-knee-arthritis/ https://pocketphysio.app/blog/glp-1-medicines-and-knee-arthritis/ Two different questions get typed into the same search box, and they have different answers. If your joints ache while you are taking a GLP-1 medicine, joint pain is not on the patient information the NHS or MedlinePlus publish for semaglutide or tirzepatide, although the NHS says those lists are not complete. A 2026 meta-analysis of 43 randomized trials in 100,488 people found no rise in the six reported musculoskeletal categories it counted, and joint ache as a symptom was not one of them, so an ache still deserves an explanation of its own. Tell your prescriber about any new symptom that started after you began the medicine. If you are asking whether one of these medicines helps an arthritic knee, the American College of Rheumatology guideline summary approved on 8 September 2026 conditionally recommends the use of a GLP-1 receptor agonist in people who have knee osteoarthritis and obesity, to help achieve the best weight for the person, in combination with diet and exercise, and the diet and exercise are part of that recommendation rather than an optional extra. The trial behind it, STEP 9, randomized 407 adults with obesity and knee osteoarthritis and measured body weight and pain, not cartilage. Every question about whether a medicine is right for you, or about a dose, belongs with the prescriber who holds your history, and the strength work still has to happen either way. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/grip-strength-test-at-home/ https://pocketphysio.app/blog/grip-strength-test-at-home/ A handheld dynamometer is the only way to get a grip strength number you can compare with anything, because every published cut-off and every reference chart was built from dynamometer readings in kilograms. The revised European consensus on sarcopenia, EWGSOP2, sets low grip strength at less than 27 kg (60 lb) for men and less than 16 kg (35 lb) for women, measured on a calibrated handheld dynamometer under defined conditions, and in that consensus a low reading means sarcopenia is probable, which is a reason to be assessed properly rather than a diagnosis you can give yourself. Normative data pooled from 12 British studies put the median maximum grip at 48 kg (106 lb) for men and 29 kg (64 lb) for women at age 50, and at 32 kg (71 lb) and 19 kg (42 lb) by age 80. Readings also differ between types of dynamometer, so a number is only comparable with another number taken the same way. We looked for a published validation of the squeeze-a-bathroom-scale method and found none, so that version gives you something to beat, not a result you can read against any chart. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/hyrox-injuries/ https://pocketphysio.app/blog/hyrox-injuries/ Hyrox injuries are mostly gradual, mostly below the waist, and mostly knee and tendon problems, not the dramatic single moments the sleds suggest. In the first prospective study of the sport, 89 athletes logged 12 weeks of their own training and reported 63 new injury episodes across 4,376 hours, an overall rate of 14.4 per 1,000 hours for every complaint and 6.4 per 1,000 hours for the ones that cost at least a day of training. Overuse accounted for 73% of them, the knee was the most affected region at 22%, and 35 of the 63 cost no training time at all. The most reported mechanism was not a station but running, named in 43% of the 30 episodes where a mechanism was recorded. Set against the comparator rates those authors quote for recreational and novice runners and for high-intensity functional training, this looks like a demanding sport sitting in the same territory as its neighbors rather than above them, with the caveat that the injury definitions behind the comparison are not the same. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/ice-baths-and-saunas-after-training/ https://pocketphysio.app/blog/ice-baths-and-saunas-after-training/ Cold water straight after a resistance training session blunts the muscle growth from that session. A 2024 meta-analysis pooled 8 interventions with 116 participants between them and found cooling within 15 minutes of the last set came out behind training alone, at a comparative standardized mean difference of -0.22 (95% credible interval -0.47 to 0.04), with the probability of any reduction put at 0.957. The same cold plunge is a reasonable choice when tomorrow matters more than today's adaptation, because a separate meta-analysis of 52 trials found better next-day power and better perceived recovery after high-intensity exercise. Heat answers a different question and the answer is not in: a 2025 systematic review of 14 studies in 194 participants could not pool its data and said no firm conclusion is possible. So the goal decides this, not the trend: with a heart condition neither end of the thermometer starts without your doctor's go-ahead, and blood pressure that is not under control is a reason to leave the cold water until it is controlled. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/massage-guns/ https://pocketphysio.app/blog/massage-guns/ A massage gun drives a small head into muscle many times a second, and the reviews that have tested it agree on a narrow result: it can change how far a joint moves for a short while, and it does not make a muscle stronger. The newest meta-analysis, 12 randomized trials in 393 people, found no benefit for recovering maximum strength after hard exercise at moderate certainty, and no reduction in muscle soreness at very low certainty. Two earlier systematic reviews, one of 13 studies in 255 adults and one of 11 studies in 281 adults, pooled nothing at all, and inside the first of them one small trial found a plain static stretch as effective as a single treatment for calf flexibility. No trial of a massage gun for sciatica, for a trapped nerve or for plantar fasciitis was found while this page was written, so it is not a treatment for any of them. The part that matters most is where not to put it: not over a calf or thigh that might have a clot, not on a recent fracture or thin bones, not on skin that cannot feel properly, and not on the neck, head or eyes, where published case reports describe a torn artery, a dislocated lens and glaucoma. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/prp-and-stem-cell-injections-for-knee-arthritis/ https://pocketphysio.app/blog/prp-and-stem-cell-injections-for-knee-arthritis/ The newest rheumatology guideline recommends against both platelet-rich plasma (PRP) and stem cell injections for an arthritic knee: the American College of Rheumatology guideline summary approved on 8 September 2026 says, in one line each, that in people with knee and hip osteoarthritis it strongly recommends against PRP treatment, graded strong with low certainty of evidence, and strongly recommends against stem cell injections, graded strong with moderate certainty. Its strong recommendations for those joints include exercise, and weight loss for people who meet criteria for overweight or obesity, both at moderate certainty. A double-blind, placebo-controlled trial of PRP in knee osteoarthritis randomized 288 adults and found no difference from a saline injection, in pain or in cartilage thinning, after 12 months. Stem cell injections have no trial of that size and design: in a 2023 systematic review of 12 studies, only one compared the injection with a placebo injection, and that one had 13 knees in each arm; the US Food and Drug Administration states that no stem cell product is approved for any orthopedic condition. The American Academy of Orthopaedic Surgeons reads the PRP evidence differently, grading it at Limited strength, so two clinicians can give you two honest and opposite answers, and that disagreement is worth knowing about first. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/red-light-therapy-for-joint-pain/ https://pocketphysio.app/blog/red-light-therapy-for-joint-pain/ Red light therapy is the shop-counter name for what researchers call photobiomodulation, and what they called low level laser therapy before that, so the trials you are looking for are filed under names nobody searches. In knee osteoarthritis the better evidence points one way: added to exercise, it reduces pain in the short term, and it does not improve range of motion, muscle strength or function. A systematic review of 22 placebo-controlled trials, 1,063 participants in all, found pain 14.23 mm lower on a 100 mm scale at the end of treatment, pooled from the 816 of them who had that measurement, and the doses used across those trials varied more than a hundredfold, which is why the dose argument matters more than the yes or no. Nothing in that literature measured cartilage, joint space or how the arthritis progressed, so no part of it says a joint is repaired. Treat it as something that may take the edge off pain while you do the strengthening work, and not as a replacement for it. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/rucking-and-weighted-vest-walking/ https://pocketphysio.app/blog/rucking-and-weighted-vest-walking/ Rucking is walking with weight on your back, and weighted vest walking is the same idea with the load held against your trunk. Adding load raises the force going through your knees, and it rises with the weight: in 24 adults walking at a fixed speed, peak knee joint contact force increased directly with loads of 15% and then 30% of body weight. That makes it useful training for legs that tolerate load, and a poor choice for a joint that already complains at walking pace. Nobody has studied recreational rucking, so there is no tested starting weight and no injury rate for people doing it by choice. Every figure on this page comes from military or laboratory load carriage research, most of it in small groups of young men, and it describes what was measured rather than what will happen to you. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/shockwave-therapy-for-plantar-fasciitis/ https://pocketphysio.app/blog/shockwave-therapy-for-plantar-fasciitis/ Shockwave therapy sends pressure waves into the sore part of your heel through a head held against the skin, and it is used for heel pain that has not settled with loading work and footwear changes, not as the first thing you try. How good the evidence is depends on which synthesis you read: a 2023 systematic review that included 40 plantar fasciitis studies pooled 13 of them against a placebo and reported a large effect on pain and function at moderate to high certainty, while a 2025 network meta-analysis of 22 trials in 2,299 people found every intensity better than placebo on success rate, no intensity better on function, and graded the certainty of the whole body of evidence low to very low. NICE guidance HTG200 says the evidence on efficacy is inconsistent, that the procedure should only be used with special arrangements for clinical governance, consent and audit or research, and that clinicians should make sure patients understand that uncertainty and give them clear written information about it; it was published in 2009 and has not been reappraised. A 2021 best practice guide in the British Journal of Sports Medicine treats shockwave as an add-on after about 4 to 6 weeks of stretching the plantar fascia, low dye taping and education matched to the person. A course in the trials ran from 2 to 6 sessions, most often 3, roughly a week apart, with settings varying so much that there is no standard course to quote, and it does not replace the calf and foot loading work, which carries on alongside it. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/tens-machines-for-back-pain/ https://pocketphysio.app/blog/tens-machines-for-back-pain/ A TENS machine changes how pain is felt while it is switched on, and it does not treat whatever is causing your back pain. The UK guideline is blunt about it: recommendation 1.2.11 of NICE guideline NG59 reads "Do not offer transcutaneous electrical nerve simulation (TENS) for managing low back pain with or without sciatica", it is dated 2016, it survived the guideline's update of 29 July 2026, and NICE publishes no strength or certainty grading beside its recommendations; the World Health Organization's 2023 guideline says the same thing with a grading attached, that TENS should not be used as part of routine care, a conditional recommendation against use on very low certainty evidence. For long-standing back pain the trial evidence is weak and inconsistent: a Cochrane review of 4 high-quality trials in 585 patients could not pool them at all, found conflicting results on pain intensity, and found consistent evidence in two of those trials, covering 410 patients, that back-specific function did not improve; a Cochrane overview of TENS for chronic pain, drawing on 51 trials and 2,895 participants from eight reviews, rated the evidence very low quality throughout and could not say whether TENS is beneficial or harmful. The largest meta-analysis across all kinds of pain, 381 trials in 24,532 people, found pain lower during or immediately after TENS than with placebo, pooled from 91 trials and 4,841 people at moderate certainty, which is the shape of the honest answer: something that may help while it is on. So two guideline bodies advise against it, the trials say it may take the edge off while it runs, and anyone with a pacemaker or another implanted electrical device should not use one at all. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team) https://pocketphysio.app/blog/wall-pilates/ https://pocketphysio.app/blog/wall-pilates/ Wall pilates is mat pilates done with a wall used as a support and a feedback surface, and the wall is not new: physios and pilates teachers have used it that way for decades. No study of wall pilates specifically could be found while this page was written, so every number you see attached to it online has come from research on mat or equipment pilates, which is a different thing done in a studio under supervision. What it is genuinely good for is control, position sense and a low-threat way back into movement, which makes it a reasonable first two or three weeks for someone who has not exercised in a while. What it cannot do is load a muscle enough to keep building strength past that early stage, because a wall mostly makes a movement easier instead of harder, and that limit is the honest ceiling on it. If your back or neck is sore, the moves worth skipping are the repeated fast roll-downs, the double leg lowers, anything with your hands pulling behind your head, and long holds you push to failure while holding your breath. Thu, 01 Oct 2026 00:00:00 +0000 noreply@pocketphysio.app (PocketPhysio editorial team)