Peter O' Grady Orthopaedic and Soft Tissue Therapist

04/08/2026

We insure our clubhouses. We insure our pitches. We insure our equipment... so why don't we invest the same way in our young athletes?

Every year, clubs spend thousands maintaining facilities, buying equipment and developing players.

But one investment is still missing in many clubs.

Regular access to sports medicine expertise.

Not when a serious injury happens.

Not just for the senior team.

From the very beginning of an athlete's journey.

As clinicians, we often see young players only after months of pain. By then, they've already missed training, lost confidence, altered the way they move, or developed compensations that affect other parts of the body.

The question is...

What if we had seen them six months earlier?

Could that ankle sprain have been rehabilitated properly before it became a recurring problem?

Could that knee pain have been recognised as a growth-related issue before the athlete started changing the way they ran?

Could that hip or lower back pain have been addressed before it began affecting performance?

In many cases, the answer is yes.

Sports medicine isn't just about treating injuries.

It's about educating young athletes on recovery, helping coaches recognise early warning signs, identifying movement restrictions before they become performance limitations, and ensuring players continue to enjoy the sport they love.

The best clubs don't simply produce talented athletes.

They produce athletes who stay healthy enough to fulfil their potential.

Imagine if every underage player had someone monitoring movement, managing small problems early and helping them understand their own body.

How many careers could that protect?

How many players would still be playing five or ten years later?

The future of your club isn't just built by great coaching.

It's built by keeping your young athletes healthy enough to keep developing.

Because prevention will always be more valuable than rehabilitation.

03/08/2026

Why do we wait until athletes reach senior level before giving them proper sports medicine support?

It's something I've questioned for years.

Many clubs invest in medical support for their senior teams, but what about the underage players?

Surely they're the athletes who need it most.

These are the years when bodies are changing rapidly. Bones grow faster than muscles can adapt. Training loads increase. Competition becomes more intense. Some young athletes begin specialising in one sport, while others are trying to balance multiple sports, school and recovery.

This is also when we begin seeing:

Osgood-Schlatter disease

Sever's disease

Patellar tendon pain

Hip and groin pain

Lower back pain

Recurrent ankle sprains

Growth-related muscle injuries

Overuse injuries

Most of these problems don't appear overnight. They develop gradually.

The earlier they're identified, the easier they are to manage.

So why are we waiting until players reach senior level before giving them regular access to a sports medicine professional?

Imagine if every underage squad had someone assessing movement, identifying injury risk factors, managing small problems before they became major ones, educating players and coaches, and helping young athletes develop stronger, healthier movement patterns.

How many injuries could be prevented?

How many talented players might stay involved in sport instead of dropping out through persistent pain?

How many future senior players could reach their potential because somebody recognised a problem early rather than reacting once it became serious?

To me, investing in youth isn't just about better coaching.

It's about better healthcare, better education and better long-term athlete development.

The future of every club is standing on the training pitch tonight.

The question is...

Are we giving them the same level of care as the players we hope they'll become?

03/08/2026

How many teams are losing games before the first whistle?

Not because they lack talent.

Not because they aren't fit enough.

But because they're carrying players who are competing at 85-90% of their physical potential.

Every season I watch athletes being labelled as:

Injury prone.

Tight.

Weak.

Slow.

Lacking mobility.

Unable to reach top speed.

Constantly picking up niggles.

The question I always ask is...

Why?

The human body doesn't suddenly decide to stop performing.

There is almost always a reason.

Over the years I've found restricted joints limiting force production, nerves that weren't gliding properly, scar tissue affecting movement, muscles compensating for years, and movement patterns that had never been properly assessed.

The athlete kept training.

The coach kept coaching.

The strength coach kept loading.

But nobody had identified what the body was actually compensating for.

That's the difference an Orthopaedic and Soft Tissue Therapist can bring.

We're not just treating sore muscles after training.

We're looking for the reason performance changed in the first place.

Imagine if your fastest player could accelerate without restriction.

Imagine if your midfielder recovered better between matches.

Imagine if recurring "tight hamstrings" were actually solved instead of stretched every week.

Sometimes the difference between winning and losing isn't a new tactic.

It's keeping your best players moving exactly as they were designed to.

The best teams don't just invest in better athletes.

They invest in keeping those athletes performing at their absolute best.

That's where real performance gains are found.

02/08/2026

Part 2: Is Your Medical Team Missing a Piece of the Puzzle?

Following on from my last post, I want to make one thing clear.

This isn't about saying one profession is better than another.

It's about asking whether many sports teams are missing a valuable specialist.

In many clubs, the physiotherapist is expected to do everything.

Assess injuries. Diagnose. Provide hands-on treatment. Deliver rehabilitation. Manage return-to-play. Cover training. Cover matches. Communicate with coaches. Keep medical records. Prevent injuries. Support athletes who all need attention at the same time.

That's a huge workload for one person, regardless of how experienced they are.

Now imagine adding an Orthopaedic and Soft Tissue Therapist to that environment.

One clinician can focus on restoring movement, reducing soft tissue restrictions, improving joint mobility, addressing muscle and fascial dysfunction, and helping athletes recover between training sessions.

The physiotherapist can then dedicate more time to rehabilitation planning, exercise progression, clinical decision-making, return-to-play testing and the wider medical management of the athlete.

Instead of one person trying to cover every aspect of care, each professional spends more time doing what they do best.

Professional sport has become incredibly specialised.

We have strength and conditioning coaches, sports psychologists, performance nutritionists, analysts, sports scientists and doctors because each discipline contributes something different.

So why shouldn't musculoskeletal care be just as collaborative?

In my experience, many recurring injuries aren't simply a strength problem or a mobility problem—they're often a combination of movement restrictions, tissue loading, biomechanics, training load and rehabilitation. Rarely does one profession hold every answer.

The best results I've seen have always come from professionals sharing ideas, challenging each other's thinking and working towards the same goal.

The question shouldn't be:

"Do we need a physiotherapist or an Orthopaedic and Soft Tissue Therapist?"

The better question is:

"How much more could our athletes benefit if we had both?"

Because when different expertise comes together, athletes receive more comprehensive care—and that's what every team should be aiming for.

01/08/2026

"One question I'm asked all the time..."

"If you're an Orthopaedic and Soft Tissue Therapist, why do most sports teams seem to hire physiotherapists instead?"

It's a fair question, and one I genuinely enjoy answering.

The truth is, I don't think it should be an 'either-or' decision. I believe the best environment for an athlete is one where both professions work together, each contributing their own expertise.

Physiotherapists are highly skilled in rehabilitation, exercise prescription, return-to-play planning and managing complex medical conditions. They play an essential role in modern sport.

Orthopaedic and Soft Tissue Therapists bring a different, but equally valuable, skill set. Our focus is often on detailed musculoskeletal assessment, identifying movement restrictions, hands-on treatment of muscles, tendons, fascia and joints, restoring movement, reducing pain, and helping athletes move more efficiently.

These approaches aren't competitors—they're complementary.

If an athlete has a hamstring strain, for example, why wouldn't you want someone whose primary focus is restoring tissue quality, reducing mechanical restrictions and improving movement working alongside someone guiding the rehabilitation, strength progression and return-to-play process?

The athlete benefits from both perspectives.

Over the past 14 years, I've seen countless clients who had excellent rehabilitation programmes but still couldn't understand why they weren't progressing. Often, they weren't weak—they were simply moving around restrictions that had never been identified or addressed.

Likewise, manual therapy alone isn't enough. Once movement is restored, the body needs to be strengthened, conditioned and exposed to sport-specific loading so the improvement lasts.

That's why I believe the future of sports medicine isn't about deciding which profession is "better."

It's about building multidisciplinary teams that recognise every profession has strengths.

At the end of the day, athletes don't care about job titles.

They care about one thing...

"Can you get me back performing at my best?"

That's the question every profession should be working together to answer.

I'd love to see more professional and amateur sports teams embracing a collaborative model, where physiotherapists, Orthopaedic and Soft Tissue Therapists, Strength & Conditioning coaches, sports doctors and other healthcare professionals work side by side.

Because when professionals collaborate instead of compete, the athlete always wins.

01/08/2026

You’ve Been Sitting in Hip Flexion All Day—Is More Squatting Really What Your Body Needs?

Squats are regularly prescribed as the answer to almost every lower-body problem. But should someone who sits at a desk for eight or ten hours automatically be given more squats?

Not necessarily.

To be clear, sitting is not technically the same as performing a squat. During a squat, the quadriceps, gluteal muscles, hamstrings, calves and trunk muscles actively control the body against gravity. When sitting in a chair, the seat supports most of the body weight and muscular activity is considerably lower.

However, both positions involve prolonged or repeated hip and knee flexion. That matters when deciding what an individual’s body needs from exercise.

Someone who sits throughout the working day may already spend many hours with:

The hips maintained in a flexed position

The knees held at approximately 90 degrees

Minimal gluteal contraction

Limited hip extension

Reduced ankle and spinal movement

Low overall muscular activity

Research has found an association between prolonged sitting, physical inactivity and reduced passive hip extension, possibly reflecting adaptations in tissue stiffness around the front of the hip. Prolonged slumped sitting has also been shown to increase trunk-muscle fatigue and discomfort.

So why would we automatically take that person into the gym and prescribe a programme dominated by more hip and knee flexion?

The problem is not that squats are a “bad” exercise. Squats can improve strength, bone health, coordination and the ability to sit down, stand up, lift and perform sport. They can also produce meaningful gluteal activation when performed correctly.

The problem arises when squats are used without assessing the person first.

If somebody already has restricted hip extension, poor ankle mobility, weak or poorly recruited gluteal muscles and a tendency to dominate movements with the quadriceps or lower back, repeatedly loading a squat pattern may reinforce their existing strategy.

They may complete every repetition by:

Driving excessively through the quadriceps

Allowing the knees to dominate the movement

Flexing or overextending through the lumbar spine

Failing to achieve proper hip extension at the top

Using the hamstrings and spinal muscles to compensate for poor gluteal contribution

In that situation, the individual may become stronger at performing their compensation rather than correcting it.

Evidence suggests that prolonged sitting may be associated with reduced gluteal function and greater reliance on secondary hip extensors such as the hamstrings and adductors. Restricted hip-flexor length has also been associated with reduced gluteus maximus activation during a squat. However, these relationships are not absolute, and sitting alone does not prove that someone has “switched-off” glutes.

This is why exercise selection should balance the positions and demands of everyday life.

For a desk-based worker, a programme may need to include:

Hip-extension exercises such as bridges, hip thrusts and carefully controlled hinges.

Single-leg training to improve pelvic control, balance and side-to-side differences.

Hip and ankle mobility where genuine restrictions are present.

Posterior-chain strengthening to develop the glutes, hamstrings and spinal stabilisers.

Walking and regular movement breaks to interrupt long periods of static sitting.

Squat training in an appropriate dose, with attention to depth, control, foot pressure, spinal position and gluteal contribution.

The body does not simply require more exercise. It requires the right movement, in the right dose, for the right person.

Squatting may form part of the solution—but prescribing large volumes of squats to every desk-based worker without assessing how they move makes very little sense.

Do not simply strengthen the position a person spends all day in. Restore the movements their working day has taken away.

31/07/2026

"Menopause was the real diagnosis... the heel pain was just the symptom."

A recent client attended the clinic with pain in both heels, particularly during the first few steps in the morning and after periods of rest. Like many people, she assumed it was simply plantar fasciitis.

However, the assessment told a different story.

While there was tenderness around the plantar fascia, there were no significant mechanical findings that would normally explain pain affecting both feet to this extent. Her walking pattern, ankle mobility and lower limb mechanics didn't fully account for her symptoms.

During the consultation, another important piece of the puzzle emerged: she was going through menopause.

Many people don't realise that hormonal changes during menopause can affect the musculoskeletal system. As oestrogen levels decline, collagen production and tissue repair also change. Tendons, ligaments and fascia become less resilient, recover more slowly, and can become more sensitive to everyday loading. Research also suggests that declining oestrogen can influence pain sensitivity and inflammatory responses, increasing the likelihood of tendon pain, plantar heel pain, joint stiffness, and general musculoskeletal aches.

Treatment focused on reducing the sensitivity of the plantar fascia and calf complex using targeted soft tissue therapy, improving ankle and foot mobility, restoring tissue flexibility where appropriate, and prescribing a progressive loading programme to improve the capacity of the tissues over time. We also discussed the role of menopause in musculoskeletal health and the importance of seeking appropriate medical advice if hormonal symptoms were affecting her quality of life.

This case is a reminder that the source of pain isn't always where you think it is. Sometimes the underlying cause is mechanical. Sometimes it's hormonal. Often, it's a combination of both.

As therapists, our role isn't just to treat painful tissues—it's to identify why those tissues became painful in the first place.

When you treat the underlying cause, the results are often far better than simply treating the symptoms.

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30/07/2026

"It wasn't her groin at all..."

A client recently came to the clinic with persistent groin pain that had been limiting everyday movement and exercise. Naturally, the first thought is often a groin strain or adductor injury.

But after a detailed orthopaedic assessment, that diagnosis didn't fit.

Her hip joint, adductors, abdominal wall and other local structures all tested well. Instead, the assessment pointed towards irritation originating from the lumbar spine, with symptoms being referred into the groin.

This is why assessment matters.

The upper lumbar nerve roots (most commonly L1-L3) can refer pain into the groin, front of the hip and upper thigh. If the source of the problem is the lower back, repeatedly treating the groin itself may provide little or only temporary relief.

Treatment focused on restoring normal movement and reducing irritation around the lumbar spine rather than chasing the painful area. This included releasing restricted soft tissues surrounding the lumbar paraspinal muscles and thoracolumbar fascia, reducing adhesions that had developed around the affected tissues, improving mobility of the lumbar segments, and using targeted soft tissue techniques to decrease mechanical irritation affecting the involved nerve pathways.

Once the source of the irritation was addressed, the groin symptoms began to settle.

Pain isn't always where the problem is.

This is why a thorough assessment should always come before treatment. Identifying the true source of pain allows treatment to be directed where it is actually needed, rather than simply where it hurts.

Treat the cause, not just the symptom.

27/07/2026