Consent✅ Another personal trainer - Deep buttock pain with... referred symptoms into hamstring & below the knee to pain - sitting, hinge based movements, yoga etc Lumbar spine & hip clear including imaging Typical symptoms brought on by - 1. Neural tension testing, seated piriformis stretch test & active contraction test 2. Palpation through deep gluteal space & on Tinel's test into sciatic nerve (SN) with US probe localisation....most provocative just inferior to piriformis Ultrasound image - annotated SN (longitudinal) as passes deep to piriformis - nerve calibre changes - can also see prominent adjacent vessels (fibrovascular adhesions a common cause of SN compression) US video - hydrodissection of SN longitudinally - can see inejctate pass along tissue plane proximally & distally (through piriformis) Immediate pain relief of typical sitting symptoms & under contractile loadshow more

Consent ✅ Ballet dancer - deep seated R buttock... pain on single leg activities, attitude derriere (see pic), arabesque, pigeon stretch Positive ischiofemoral impingement test (side lying hip ext & adduction) MRI - oedema in quadratus femoris Not improving despite offload & rehab - therefore US guided CSI & LA both diagnostically & therapeutically (see video - avoiding sciatic nerve on central / left of screen adjacent to the ischial tuberosity) I've inverted the MRI image so marries up with injection video orientation.....show more

Consent ✅ The thing I enjoy most in my... job is collaboration with expert physiotherapists on complex cases, especially in elite sportsmen & women It’s a symbiotic relationship – there is mutual learning & professional growth - and the patient gets the best of both worlds I had the privilege of assessing a professional ballet dancer who flew in from Budapest alongside the amazing Liz Bayley recently I thought I’d summarise our joint knee assessment for those interested (get a cup of tea! 😆) 2 months ago, sharp pain in the medial knee after sitting with legs crossed for 30 minutes ‘Instability’ during Swan Lake rehearsals, with pinching pain and fear of knee buckling – had one fall on stage during a performance One episode woke up one morning with local swelling, ‘pressure’ in the joint, and diffuse anteromedial knee pain - unable to walk or fully extend / flex the knee Currently experiencing sensation of pain, ‘swelling’ & fullness, particularly anteromedial patella - burning, prickly sensation Warms up with activity – latent post exercise pain Aggs - Grand plie in first position, squatting, bridges with hip adduction, transferring weight in turned-out position, down stairs Reviewed MRI in Hungary – Normal menisci, Hoffa's fat pad & articular cartilage – but report missed adductor magnus distal tendinopathy! (see sagittal image) – always check the images yourself Exam- Hip joint & lumbar spine clear Full squat sore especially with R leg bias Tender medial aspect of the knee, particularly in the region of the pes anserinus Fat pad compression test negative Mild awareness PFJ compression Knee flexion pain at end range but other meniscal tests negative Adductor loading / stretch tests (including adductor magnus bias) negative Prone knee bend neural tension test with saphenous nerve bias – minimally provocative DDs: · Patellofemoral pain – ‘common things are common’ · Pes anserine bursitis with associated infrapatella branch of saphenous nerve irritation? · Distal adductor magnus tendinopathy with associated saphenous nerve irritation? (AM forms floor of Hunter’s canal) POCUS in clinic – Great for tracing saphenous nerve & distal branches reliably; no nerve pathology seen or pain reproduction on systematic Tinel’s test using probe. Adductor magnus tendinopathy confirmed – but on further review of MRI, the inflamed adductor magnus tendon seems some distance from saphenous nerve (see axial image), so symptoms less convincing related to secondary nerve irritation However, pes anserine fluid noted vs contralateral side & correlates with her typical pain US guided local anaesthetic injection (video) significantly improves symptoms on comprehensive testing in gym & pilates studio P - Liz Bayley refined a Ballet specific rehabilitation plan now we have more diagnostic confidence - so cool watching her piece this together! Observe how symptoms respond over 6-8 weeks If no improvement, consider definitive injections to pes & / or PFJ – but need to exercise caution especially around tendons that are placed under huge athletic demandshow more

Exercises to help relieve sciatic nerve pain, relieve compression... and improves spine-hip movementshow more

Exercises to help relieve sciatic nerve pain, relax muscles... and improve movement of the spine - hip joint.show more

Consent ✅ Female Cross fitter with bilateral quite focal... anterior knee pain superolateral to patella Onset after ramp up in training volume & weight esp squats, cleans Function inhibiting catching symptoms at predictable knee flexion angle POCUS - thickened lateral quadriceps fat pad seen to impinge under quads expansion & over trochlea on active knee flexion ➡️ extension - correlates with palpable painful click felt under probe US guided injection today removed click & pain on squat testingshow more

Secrets For Pain Relief And Better Movement💯🧘‍♀️ These Powerful... exercises can help relieve: - Lower back pain - General back tension - Poor posture - Sciatic nerve discomfort - Knee & joint pain💯 Take a few minutes each day to stretch - your body will thank you 👍show more

Struggling with sciatic nerve pain⁉ 😬 Do these to... find relief 👇👇show more

Consent✅ - this is a beauty 🤓 Elite runner... Crampy, aching lateral knee pain - onset at around 20-30 mins Seen multiple clinicians - had numerous injections including ITB plus extensive rehabilitation - refractory Almost 'claudicant' in nature - settles quickly on cessation of exercise - spreads both proximal & distal to lateral joint line No spinal symptoms & LSp assessment clear No lateral compartment pathology eg meniscal tear Had popliteus tendinopathy on US, but minimal response to my initial diagnostic injection POCUS video - The inferolateral genicular neurovascular bundle ('pepper pot' structure) is seen compressed under the distal ITB on active knee flexion : terminal extension Patient localises pain in this area with probe pressure Injection - hydrodissection (CSI, LA) - fluid seen separating plane just superficial to NV bundle 100% pain relief on extended treadmill test beyond 45 mins 👍 I wonder how many recalcitrant 'ITB' cases are actually neurovascular in aetiology? 🧐 Plan - considering angiography, MR neurography & possible distal ITB release at Gerdy's tubercle if not responsive to injectionshow more

Piriformis sendromu.

Ultrasound quiz Level: Basic Chronic knee pain with recurrent... effusions and secondary osteoarthritis of the knee 10 years after partial meniscectomy What can you see on this video?show more

Consent ✅ L anterior elbow pain in bodybuilder POCUS... - shows distal biceps tendinopathy & paratendinitis with fluid in sheath US guided injection - seems there is an occult intra-substance tear that is only visualised with the injectate in-situ Lateral to medial approach to avoid vessels medial to tendon - also be wary of radial nerve / branches bottom right of screen Injection can also be done in cobra position - here paratendinitis an easy target so injection undertaken proximallyshow more

Exercises can be aimed at providing short-term relief (plantar... fascia stretch) or improving long-term function (heel raises). Whether someone decides to do 1, 2, or all 6 of the movements depends on their symptoms, goals, time availability, etc. Learn more:show more

5 exercises to relieve sciatic pain, restore mobility, and... reduce nerve irritation: 1.show more

Positive knee to wall FHL test in this gymnast... with posteromedial ankle pain. Difference of 4cms with the big toe extended. No change on uninjured side. Michelson et al (2021) say this test isn’t sensitive enough to pick up a tight FHL… Continued 1/2 🦶🏼show more

MOTION IS LOTION - Some morning movement exploring tension... and rotation in the hips and the spine. - Seated Hip Pry - Single Leg Hinge to Hip Flexor Reach - T-Spine Rotations - Hamstring to Hip Flexor Run through each for 6-8 reps for 2 sets and see how you feel. Keep Exploringshow more

Kalçadan Bacağa Vuran Ağrı Piriformis Sendromu 📌Siyatik sinirin piriformis... kası altında baskı altında kalmasıyla kalça ve bacak arkasına ayağa yayılan uyuşma, karıncalanma belirtileri ortaya çıkabilir.show more

Consent ✅ Female 50s, osteopaenic Runner, hiking, recent increase... volume plus a 10K on unfamiliar hilly terrain & different trainers L groin pain radiating into medial thigh Referred as ‘groin strain’ (what’s a groin strain?!) Video - Hop Testshow more

Fan video of the Pidcock crash sent to us... by a follower. You can clearly see he lands in a very deep rut, which launches him into the bannersshow more