South Hills Orthopaedics Sports Medicine & Physical Therapy

08/17/2026

We had a wonderful company picnic yesterday and we all finally got to meet Penny. As Ashley handed her to me she blurted out “remember the safe word!!” and let me know she has 2+ months of jabs at me all built up. Was a great day and well planned and executed party. We all still talk about our first Xmas party, especially those of us who came from a PT chain business. There we could close for an hour and have a little Xmas party, where we supplied our own food. They didn’t even cough up some cash for a few pizzas. Now we get catered lunch weekly for all of December, and Xmas Eve and NY Eve off. -Duffy

08/16/2026

And not just compression, but shear forces as well. Years back a great analysis was done showing the lateral meniscus can move more than 11mm during full flexion of the knee....that's over 1cm...that's a lot of movement. The medial not so much. But this large amount of movement could be either an agitant, but shearing strain on a torn or deranged menisci...or help by permitting movement. Either way, if a meniscal injury is suspected, I always tell people avoid deep squatting and twisting on the planted foot....until it becomes asymptomatic. The tear will pretty much always be there, one just needs to reduce the sensitization and avoid....as I always say....poking the bear. -Duffy

08/15/2026

This is an abject failure of our medical system. And my own profession has some dirty hands in this whole thing (I deleted a rant about that here). We need to educate the young generation and prevent the old ideas and patterns from being renewed. Teach them about what pain is, and isn't.....benefits of exercise, and I mean ALL the benefits...and examples of what their life may look like if they don't take the advise. -Duffy

08/13/2026

For roughly half of what I see every day, not exercising, or not doing enough exercise is the cause or a co-factor in their need for PT. It's my obligation to encourage and suggest doing some...preferably joining a gym. But frustratingly, one would think I was asking them to mow an 18-hole golf course with cuticle scissors. Gyms are cheap, one can get in and out quick if they focus, very very low risk but very high reward. I've seen $50-75 PER VISIT co pays...heck that would buy a few months minimum at most gyms. -Duffy

08/11/2026

A person in a sling can significantly reduce the degree of strength loss if they perform exercises on the opposite limb Not a new idea, and in the past I have posted on a study where the person with the immobilized joint who just IMAGINES doing the exercises, retains more muscle and strength. Just imagine doing both? I was taught this idea as the Raimiste technique, way back...possibly in school....so it's the reason I have had many of you do things on both sides...such as after your total hip/knee, or when I am using neuromuscular electrical stimulation. Neat stuff -Duffy

Limb immobilization leads to a rapid and pronounced loss of muscle strength and size. Cross-education, contralateral resistance training of the nonimmobilized limb, has emerged as a resistance training strategy to mitigate deficit in the immobilization limb. A systematic review and three-level hiera...

08/09/2026

UGH ! Has YOUR newsfeed come up with some news story about protiein, and less being better for some reason? Pay no attention to it...read Stuarts discussion about it, and find out why media hype and clickbait are often used to generate revenue regardles of the quality of the material in the first place -Duffy

Eat less protein to live longer? A new review says maybe. The human data says otherwise.

The paper is impressive, but almost all its "lives longer" results come from mice, rats, and flies. The second it gets to actual people, the goalposts move. We stop talking about lifespan and start talking about six-week blood sugar readings. The authors even admit the effect on human lifespan is "unknown."

So what do the big human studies actually show? Look at the table below. Across hundreds of thousands of people:

Total protein and dying early? Basically no link.
Protein and heart disease death? Neutral. Plant protein looks slightly protective.
Protein and cancer death? No convincing harm.

And here's the kicker for anyone over 65. In older adults, eating too LITTLE protein is the real risk. More frailty, more falls, higher mortality. The very group being told to cut back is the group that does worse when they do.

Fair caveat: this is mostly observational data, so hold it loosely. But that cuts both ways.

Bottom line. Restricting protein does interesting things in a mouse. Telling a 75-year-old to eat less of it? The evidence isn't there. If anything, it points the other way.

08/08/2026

I've always owed it to my patients (and students) to explain things that are supported by the current evidence and research. Most buy into it (albeit incredulous at first)...some don't buy into it, but go along since they are improving (see how that works?)...other need to be told things that are just way out of line with facts...I can't bring myself to lie to them....tell them I'm repositioning their C6 vertebrae, putting their disc back in etc. If I did, it would probably help them overall, but is that fair or proper? -Duffy

08/02/2026

I've taken slack over the years for not doing dedicated "cardio" exercise....but my workouts via resistance training have been shown to also improve cardiovascular status....and I super set when I can, like I did this morning....one set of chest, straight to a set of arms, straight to set of quads, and back to the beginning....my heart rate was up, I was huffing. It turns out according to this research, mixing resistance training and cardio in the same session yielded the best cardio improvements. But this all makes sense, and using research and evidence along with "making sense" worked out for me......again. I take a bow. -Duffy

https://www.facebook.com/share/p/1BbttbiPEq/

Most people default to cardio for blood pressure. The best research on this doesn't back that up.

A 2026 analysis pooled 105 clinical trials and directly compared seven types of exercise, head to head, in people with high or borderline blood pressure. The type that won wasn't cardio. It was combined training, meaning a workout that mixes strength work with cardio in the same session. It dropped systolic blood pressure (the top number) by 12 points. Interval training, short bursts of hard effort mixed with rest, came in a close second at 11 points. Cardio alone, done by itself, landed in the weakest group, alongside plain strength training and static holds.

That 12-point drop is worth focusing on -;It's roughly what a first blood-pressure medication achieves on its own. That doesn't make exercise a replacement for medication, but it shows the ceiling on what movement alone can do is much higher than people assume, if it's the right kind.
There's a second finding that changes the "more is better" instinct too. Benefit went up with more weekly exercise, but only up to a point, then flattened out. Past a moderate weekly volume, doing more didn't add more benefit. The relationship curves, it doesn't climb forever.

This is a pooled analysis of many different studies, not one single trial, so it smooths over real differences in who was tested and how. The two winning categories are broad, "combined training" and "intervals" cover a range of specific workouts, not one exact protocol. And the precise numbers were only clearly reported for the top two types; the rest are ranked by tier, not exact figures.
The takeaway: if blood pressure is the goal, mixing strength and cardio, or doing intervals, beats steady cardio done alone. And more isn't always better, there's a sweet spot.

Xin et al., Journal of the American Heart Association, 2026.

08/01/2026

Add this info on to the material I posted the other day, and you will have a much better idea of how your body may respond to the world around you and why, and in the process save you from lost of anxiety and wasted time ! I will admit that I do get frustrated with the pain science world....there are different factions, all trying to nail down "pain" and help others...but some don't play nice and can be real jagoffs....which doesn't help anyone. -Duffy