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The Rehab Engine

@therehabengine

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Physical Therapy x Sports Rehab x CSCS
🏹 Weaponizing Athletic Potential.
🧬 Bridging the Rehab-Performance Gap.

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ACSM’s 2026 strength guidelines mark a major shift from the 2009 rules.

The 2009 Position Stand gave detailed progressions (e.g. sequence big-to-small muscles, novices lift 8–12RM, advance to 1–6RM over time, and tiered frequencies up to 4–5×/week).

By contrast, the 2026 update (an umbrella review of 137 studies) centers on consistency and simplicity. Its core message: any resistance training is better than none. Training all major muscle groups ≥2× weekly is now the priority.

Crucially, the new guidance relaxes some old “must-dos.”

Techniques like training to failure, special machines, or complicated periodization did not give extra benefits for the average adult. Instead, programs should be personalized and sustainable.

For example: for strength, use heavier loads (≈≥80%1RM, 2–3 sets); for hypertrophy, aim for ~10 sets/muscle/week; for power, lift moderate loads (30–70%1RM) quickly. And remember, you don’t need a fancy gym – bodyweight, bands or home workouts all drive results.

In summary, ACSM’s 2026 stance shifts from rigid step-by-step programs to a flexible, evidence-based approach. The updated guidelines underscore that getting started and sticking with it is what really builds long-term strength and fitness.

Comment ‘Update’ to download the complete research article and to read the summary of what changed.

[strength training guidelines 2026, ACSM resistance training, new strength training rules, resistance training science, how to build muscle, strength training for beginners, muscle hypertrophy training, evidence based fitness, progressive overload, best strength training programme, how many sets to build muscle, training frequency for muscle growth, home workout muscle building] by @therehabengine

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6 months ago

Your physio banned leg extensions after ACL surgery. Your surgeon scheduled reconstruction before you left the consultation room. Both decisions made with confidence. Both worth questioning.

Here’s what Noyes’ research actually found — the squat loads the ACL more than the leg extension at certain angles. Adding just 7 pounds at the ankle doubles the quadriceps force. And above 60° of flexion, the “banned” exercise produces zero ACL strain.

The rule was never the exercise. It was always the angle.

Then there’s the surgery conversation nobody is having. Around 50% of ACL-deficient knees remain stable with structured conservative management alone. The re-rupture rate after reconstruction in young athletes sits at 25%. Surgery doesn’t reduce osteoarthritis risk — the rates are similar either way.

And in 2023, Filbay et al. published data showing 90% MRI-confirmed ACL healing with the Cross Bracing Protocol. Brace at 90° flexion. No surgery. The ACL can heal — it just needed the right conditions and someone willing to try.

The problem was never the exercise. The default was never justified. Start asking better questions.

📌 Save this. Send it to someone facing ACL surgery or stuck in rehab.

Reference: Noyes FR — Scientific Basis of ACL Rehabilitation · Beynnon et al. in vivo ACL strain studies · Filbay SR et al. BJSM 2023 · Grindem et al. conservative ACL outcomes

#aclrehab #aclreconstruction #kneerehab #sportsphysio #aclrecovery by @therehabengine

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5 months ago

They’re pushing the knee deeper into the bend.

More pressure.
More stretching.
More force into the range.

And on the surface, it makes sense.
If the knee won’t bend…
you push it until it does.

But here’s the question most people don’t stop to ask:

What if the fastest way to bend your knee… is to try to straighten it first?”

Confused? Because the solution sounds backward.

But this is where Muscle Energy Technique (MET) comes in — a concept extensively popularised by Leon Chaitow.

And it changes the entire strategy.

Most people try to force mobility.
Push the stretch.
Hold the position longer.
Fight the resistance.

But early after Anterior Cruciate Ligament Reconstruction, limited knee flexion is rarely a tissue problem.

It’s a protection problem.

The quadriceps stay on guard after surgery.
As the knee approaches deeper flexion, the nervous system increases quad tone to stabilize the joint.

So every time the athlete tries to bend the knee further…
the quadriceps quietly apply the brakes.

No matter how much stretching you add.

MET works differently.

Instead of fighting the muscle, you use it.

Here’s what we did:

We brought the knee to the first flexion barrier.
Then the athlete performed a gentle quadriceps contraction— trying to extend the knee — while I resisted the movement.

Just 10 seconds of effort.

Then he relaxed.

And the moment the quadriceps switched off, the knee moved further into flexion.

No forcing.
No aggressive pushing.
Just a different signal to the nervous system.

Within three cycles, his knee moved from 70° to 90°.

Same knee.
Same tissues.

Different strategy.

This is the part many rehab conversations miss.

Mobility isn’t always about lengthening tissue.
Often it’s about removing the nervous system’s reason to resist the movement.

When you change that signal, the joint often gives you the range it was protecting all along.

In performance rehab, the goal isn’t to force range.

It’s to restore the system’s confidence to allow it.

#aclrehab #sportsphysio #kneerehabilitation #performancerehab #muscleenergytechnique by @therehabengine

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7 months ago

The outside of his knee hurt every time he ran.

So the obvious answer would seem to be:
“Stretch the IT band.”

But that’s not where we started.

We first looked at how he was moving while running.

Biomechanical observations associated with iliotibial band syndrome include increased hip adduction, increased knee internal rotation, increased knee flexion at heel strike, increased velocity of knee internal rotation and increased maximal foot inversion.

That’s a long list.

And that’s exactly why simply looking at one movement and saying:

“That’s causing your ITBS.”
isn’t enough.

A biomechanical observation is a starting point for assessment, not a diagnosis.

So instead of asking:
“How do we release the IT band?”

we asked:
“What is this runner actually doing, and is any of it relevant to his symptoms?”

We watched him run.
We assessed the movement characteristics we thought might be relevant.

Then we formed a hypothesis.

And rather than changing everything at once, we tested one targeted modification.

That’s an important part of clinical reasoning.

If the runner changes their movement and their symptoms improve, we’ve learned something.

If nothing changes?

We don’t keep forcing the same explanation.
We reassess.

Because the goal isn’t to make someone’s running form look like a textbook.

And it isn’t to eliminate every degree of hip adduction, knee rotation or foot movement.

Those movements exist in normal running.

The question is whether a particular movement strategy is relevant to this athlete, under this load, at this point in time.

That’s why we don’t treat every painful IT band the same way.

Pain tells us where the problem is being experienced.
Assessment helps us decide what to investigate.

And the intervention should follow the assessment.
Not the other way around.

Don’t just stretch the structure that hurts.
Understand why it might be getting irritated in the first place.

Follow@therehabengine for evidence-informed running injury breakdowns, biomechanics and performance.

#itbandsyndrome #kneepain #runningbiomechanics #runninginjury by @therehabengine

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4 days ago

Your running shoe may have been chosen the wrong way. 👟

Ask most runners how they picked their shoes and the answer is “they checked my arch.” Flat foot gets a stability shoe, high arch gets cushioning. It sounds logical. It’s the shop default.

But when this was tested in military recruits, shoes assigned by arch type didn’t reduce injuries compared with giving everyone the same standard shoe. Injury rates were similar.

So what should we go by instead?

Fit: a thumb’s width in front of the longest toe, heel locked, no pressure points.

Comfort: within a category, the shoe that feels most comfortable on your foot is the best guide we have. This is a proposed idea, not settled proof.

Rotation: in one cohort, runners who used more than one pair had roughly 39% lower injury risk. Observational data, so promising rather than proven.

And here’s the part that matters most: a great shoe can’t rescue a bad build-up. Too much, too soon is one of the most commonly proposed causes of running injuries. Get the weekly load right first, then let the shoe help at the margins.

Shoes are like friends. They can support you, or take you down. 🤝

Send this to someone buying marathon shoes.

📚 References

1. Knapik JJ et al. Injury-reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training. Am J Sports Med. 2010.
2. Knapik JJ et al. Injury reduction effectiveness of selecting running shoes based on plantar shape. J Strength Cond Res. 2009.
3. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: “preferred movement path” and “comfort filter.” Br J Sports Med. 2015.
4. Malisoux L et al. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015.

📌 Save this for your next shoe purchase.

#runninginjuries #marathontraining #sportsphysio #footwear #therehabengine by @therehabengine

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4 days ago

Most marathon runners learn these 10 habits the hard way…usually mid-race or inside a clinic.

If you want to stay healthy, run faster, and actually reach the finish line strong, save this checklist for your next training block:

1. Strength train year-round — Not just in the off-season.
2. Don’t increase everything simultaneously — Pick volume OR intensity, never both.
3. Track symptoms, not just mileage — Early warnings save months of bench time.
4. Practice race nutrition — Never test a new gel on race day.
5. Don’t ignore recurring pain — Niggles are early warnings, not badges of honor.
6. Respect the taper — Trust the work you’ve already put in.
7. Sleep like it’s part of training — Recovery is where adaptation happens.
8. Keep easy runs easy — Slow down to speed up.
9. Don’t change your gear on race day — Stick with proven shoes and kit.
10. Don’t wait for injury before doing rehab — Prehab is performance enhancement.

Which habit are you currently ignoring in your training block? Drop the number below 👇

#marathontraining #bengalurumarathon #injuryprevention #berlinmarathon #halfmarathontraining by @therehabengine

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8 days ago

27 cm vs 37 cm. But does that automatically mean one runner is overstriding? 👀

In this episode of our marathon series, we’re comparing two runners side by side: an elite runner and a recreational runner.

Using Kinovea, we measured the horizontal distance between the centre of mass (COM) and the foot at initial contact.

The recreational runner lands approximately 37 cm ahead of the COM, compared to 27 cm in the elite runner.

That’s a 10 cm difference.

But here’s where things get interesting.

Overstriding isn’t simply about how far the foot lands in front of the body.

We also need to consider:
Shank angle: How far forward or backward is the tibia inclined at initial contact?

Running speed: The distance between the foot and COM can change with running velocity.

Cadence and step length: How do these factors influence the overall landing pattern?

The runner’s individual context: Training history, symptoms, running demands, and the rest of the gait cycle matter.

And one more thing: a larger foot-to-COM distance doesn’t automatically mean a runner is injured or that their technique needs correcting.

This is exactly why we shouldn’t blindly copy an elite runner’s mechanics or label every recreational runner’s stride as a problem.

The goal isn’t to make everyone run the same way. It’s to understand what we’re actually seeing.

A more forward-leaning shank angle at initial contact generally indicates that the lower leg is tilted further forward, which may be associated with the foot landing farther ahead of the body.

In the next episode, we’ll look into the research on overstriding and injury.

Follow @therehabengine for more evidence-informed running biomechanics and marathon analysis.

DM “Tune” for a running gait analysis.

#runningbiomechanics #overstriding #runninganalysis #marathontraining #sportsphysiotherapy by @therehabengine

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7 days ago

They studied 630 million people to figure out how often Achilles tendons rupture.

(And forgot to ask Africa, Latin America, and most of Asia.!)

18 of the 28 studies came out of Europe. Sweden alone practically wrote the “global” number. So when you see headlines quoting “15.7 per 100,000 — the global incidence of Achilles rupture,” what you’re actually reading is: middle-aged men in countries with great injury registries and a soft spot for badminton.

Here’s the part that still holds up, though, bias and all: the trend is real. Ruptures have climbed almost every decade since 1979 — 6.1 back then to 31.1 now. And the danger zone isn’t the athlete you’d expect. It’s the 30–49 crowd going back into sport on a tendon that hasn’t been asked to work hard in years. That’s not conditioning. That’s a car being floored straight off the driveway with no warm-up, no service check.

Most people don’t find out their tendon couldn’t handle that load until it’s already torn.

👉 Comment “ATR” below and we’ll send the research article straight to your DMs.

Swipe through the breakdown first ⬆️

#achillestendon #tendonhealth #returntosport #runninginjury #physiotherapy by @therehabengine

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7 days ago

44 years. That’s how long India waited for another Asian games Marathon medal.

Remember when we asked why India is still 12 minutes behind the marathon world record? 🇮🇳

When we made that reel, the question wasn’t just about the numbers on a stopwatch. It was about understanding what separates Indian distance running from the best in the world.

And since then, we’ve seen Indian records fall.
Today, Sawan Barwal has given us another reason to revisit that conversation. Another national record. Another milestone. Another reminder that Indian distance running is moving forward.

Now, let’s be clear. Breaking a national record doesn’t automatically mean we’re closing the gap with the world’s best. The marathon world record is still a long way ahead, and there’s a lot that needs to change before Indian runners can consistently compete at that level.

But progress doesn’t happen overnight.
It happens when athletes get better training environments, when coaches have access to better resources, when sports science becomes part of everyday training, and when young runners get the support they need to reach their potential.

It happens when we stop looking at a record as the finish line and start asking what comes next.

Because the real question isn’t whether India can produce another record-breaking performance.

It’s whether we can build a system that makes performances like these more frequent.

Can we turn individual milestones into a sustained rise in Indian distance running?

Can we move from celebrating records to understanding what it takes to keep breaking them?

We don’t know how soon that 12-minute gap will begin to shrink.

But every new record gives us another reason to believe that the conversation is worth having.
And maybe, just maybe, we’re moving in the right direction.

Congratulations to Sawan Barwal. 🇮🇳
The records are falling. Now, let’s see how far we can go.

What do you think is holding Indian distance running back from competing with the world’s best?

👇 Drop your thoughts in the comments.

#sawanbarwal #indianathletics #marathonrunning #distancerunning #asiangames2026 by @therehabengine

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8 days ago

He came in with medial shin pain.
The first instinct might be to look at the painful area and ask:

“What is happening at the shin?”

But when we look at medial shin pain through a running-mechanics lens, the more useful question becomes:

“What characteristics of his movement could be contributing to the way load is being distributed?”

The literature highlights several characteristics that have been associated with medial shin pain / medial tibial stress syndrome (MTSS).
These include:
• Pronated foot type • Increased ankle plantarflexion • Supinated foot type • Decreased ankle dorsiflexion / ankle equinus • Decreased hip internal rotation

Notice something important here.
There isn’t a single foot position or a single joint movement that explains every case of medial shin pain.

A runner may present with a pronated foot type. Another may present with a supinated foot type. One may have limited ankle dorsiflexion. Another may demonstrate increased plantarflexion.

So the goal isn’t to look at a runner and immediately decide:
“This is the problem.”

Instead, these characteristics give us things to assess.

And once we identify the movement characteristics that are relevant to that particular runner, we can consider whether modifying running mechanics is appropriate.

Research suggests that strategies such as-
Increasing step rate (if cadence is on the lower limit), reducing overstride, landing softer and reducing excessive hip adduction and scissoring.
 has shown improvement in someone with medial shin pain.

The assessment comes first.
For example, if the relevant movement characteristic is overstride, a strategy aimed at reducing overstride makes sense.

If the relevant characteristic is excessive hip adduction or scissoring, the strategy needs to address that.

If the runner demonstrates a different mechanical characteristic, the same cue may not be appropriate.

There is no universally perfect running form.

There is only a specific runner, a specific presentation, a specific movement strategy, and a specific reason for choosing a cue.

Follow for more clinical insights on running biomechanics.

#mtss #shinpain by @therehabengine

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18 days ago

Why increase your running cadence by 5–10%?

A small increase in step rate can help shorten your stride, bring your foot closer to your body’s centre of mass, and reduce certain loads on your lower limbs.

A study by Heiderscheit et al. (2011) examined how changing step rate affects running mechanics and joint loading.

Research: Heiderscheit BC, et al. Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise. 2011;43(2):296–302.

Comment LINK to read the research article.

Try a 5% increase first. Use a metronome or count your steps, and let your body adapt gradually.

This is the same gait retraining approach we used in our thesis, exploring the effects of a 5–10% increase in running cadence….

#runningbiomechanics #runningtips #sportsphysiotherapy #gaitretraining #overstriding by @therehabengine

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9 days ago

how far is too far? 👀

measuring the distance from the foot to the com is a good starting point, but overstriding isn’t just about a number.

there’s more to the picture. 👀

next up: shank angle.

#running #runninganalysis #biomechanics #overstriding #sportsphysiotherapy by @therehabengine

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11 days ago