Rheumatology.Physio Podcast

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,Another Webinar in the bank and I particularly enjoyed this one. It is a hybrid creation of some Spondyloarthritis content and sports content which makes for a really nice trip through tendons.This is slightly different to my usual content where we look primarily at tendons THEN at systemic inflammatory factors not the oth…

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,I have a case study that illustrates the challenges outside of secondary care with Rheumatology when there is clinical uncertainty. When I teach this regularly comes up and we talk through the case with its uncertainty and exactly what I did to try to help the person move forwards. I think this is a really useful example to help you in clinical practice.While you are here, if you register for Physio Matters Advanced Practice you will unlock this post AND our upcoming webinar with the legend that is Liz Bayley!

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,Part of our Physio Matters Advanced Practice subscription is monthly webinars and this was Septembers offering presented by myself!Full access is available by subscribing here or as a Physio Matters Advanced Practice Member HERE.Paid subscribers look below for slide deck as wellCheck out my new Spondyloarthritis 1 Page Screen (its free)

Welcome Back Rheumatology Fans,Ooof this is going to rattle some cages. Synopsis below but the best of this is watching the video.A recent news report about a woman with rheumatoid arthritis who was convicted of benefit fraud caught my attention. The case involved footage of her participating in activities including gym classes and running events despite having previously reported substantial limitations in her day-to-day function.I don’t know enough about the individual circumstances to comment on whether the judgement was appropriate. In fact, the reported offence appears to relate specifically to failing to notify the Department for Work and Pensions of a change in circumstances. But the story raises a broader issue that is highly relevant to people living with inflammatory arthritis and the clinicians treating them.Being physically active does not necessarily mean someone is not disabled.Rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis and other long-term inflammatory diseases can be enormously variable. Symptoms may fluctuate over time, treatments can substantially improve function, and limitations in one activity do not necessarily predict someone’s ability to perform another.Exercise also forms an important part of rehabilitation.I might see someone who currently cannot run, play tennis or golf because their inflammatory arthritis is poorly controlled. Following improvements in medication and a structured rehabilitation programme, one of our explicit treatment goals might be to return them to those activities.For another person, the goal might simply be getting upstairs more comfortably. To achieve that, we may use relatively demanding strengthening exercises in a gym. Seeing that person performing a squat or leg press tells you very little, in isolation, about how easily they can negotiate their stairs later that day.That distinction matters.We should not create an environment where people receiving appropriate financial support become frightened of exercising because they worry that being seen in a gym, lifting weights or participating in sport could somehow be interpreted as evidence that they are no longer disabled.From a clinical perspective, I want people with inflammatory arthritis to be as active as their condition, preferences and circumstances allow. Where possible, that includes meeting general physical activity recommendations and incorporating cardiovascular and resistance exercise.There are good reasons for doing so. Maintaining physical activity can help protect muscle and bone, improve cardiovascular health and support broader long-term health outcomes. For some patients, returning to demanding exercise is itself a major marker of successful treatment.None of this means that changes in someone’s circumstances should not be reported where required. That is a separate issue.The important point is that exercise capacity and disability are not opposites. A person can exercise and still experience meaningful restrictions from inflammatory disease. They can also improve dramatically with treatment while continuing to have limitations elsewhere.As clinicians, we should be encouraging people towards greater function—not inadvertently giving them another reason to be afraid of achieving it. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit rheumatologyphysio.substack.com/subscribe

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,I recorded a webinar that I ended up not using for a variety of reasons… I have cut out the best parts of it for your interest. Its a really good version of my slide on the Biopsychosocial model in Rheumatology and decision making in exercise prescription.Check it out and I would be really interested in your thoughts and f…

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,The case study series is back and explores an important challenge encountered in clinical practice: what should we do when a patient’s existing rheumatology diagnosis no longer fully explains their symptoms?The case follows a patient with an 18-month history of inflammatory arthritis who had responded well to biologic therapy but continued to experience persistent insertional heel pain and fatigue. Rather than focusing on treatment techniques, this discussion examines the clinical reasoning behind recognising when new symptoms may indicate an incomplete diagnosis rather than a simple flare or mechanical musculoskeletal problem.

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,This is a new series of explainer videos (where I literally explain) a variety of things. Essentially me explaining topics as if I was in front of a patient. This is the first one where I go through a disease explaination for Rheumatoid Arthritis.The full video is available to paid subscribers, online course enrollees and …

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,In 2025 I recorded a Bone Health Module for my online course. It wasn’t something I particularly planned on but a series of events meant that the material was all but written and it seemed a sensible move. Fast forward to now and it has rather smashed it to be honest, I have had some really great feedback so I thought I would share with you the intoductory part of the module. For my paid subscribers, scroll down and you will find a second part entitled “Factors Affecting Bone Mass”.If anyone would like to enroll in the full module it is HERE. Available as a standalone option or as an add-on to the full Rheumatology.Physio online course which is the best value in my opinion :)Also check out this webinar we have coming up with the legend that is Adam Dobson:

Welcome Back Rheumatology Fans,Recently we explored high-intensity exercise in Rheumatological Diseases with insights from Jean-Pascal Grenier. The conversation challenged a belief that has lingered in rheumatology forever That people with inflammatory arthritis should exercise gently.Moderate exercise? Yes. Gentle strengthening? Of course. Hydrotherapy? Yes Please!But high intensity? Long duration? Pushing physiological limits? This has been where clinicians have become nervous. It is natural of course, an assumption that utilising inflamed joints will cause that inflammation to increase or an acceleration of joint damage leads to caution. Especially if there is also an associated increase in pain levels.Which is why it is worth talking about Natalie Dau - Follow her Instagram here.Natalie is an ultrarunner who holds the Guinness World Record for crossing Peninsular Malaysia on foot. In the process she ran roughly 700 km in just over eight days as part of a 1,000 km endurance project from Thailand to Singapore. (I once got a train from London to Edinburgh and thats 630km and I was absolutely exhausted).Natalie Dau has Rheumatoid Arthritis.For many clinicians trained even 10–15 years ago, that combination of facts would have sounded contradictory. RA was traditionally framed through the lens of protection: protect the joints, protect the energy envelope, protect against flare.And yet here we have someone running the equivalent of two marathons a day.Now, before anyone concludes that this is a prescription rather than an observation, it’s worth being clear: Natalie’s story is not an argument that everyone with RA should become an ultramarathon runner. But her story is useful because it forces us to interrogate our assumptions.One of the themes Jean-Pascal raised was that the human body – even with inflammatory disease – is often far more adaptable than we think. With appropriate training progression, recovery, and load management, people can tolerate much higher intensities than traditional guidance might imply.Graded individualised exposure, consistency, individualised adaptation and a good amount of reassurance. This can enable people to achieve a lot more than they thought they might be able to.I used to run a version of this for people newly diagnosed with RA in the NHS, they were offered to attend an exercise group and we started every session with static bike. The person had control, I gave them the instruction to bike at a 5-6/10 on an effort scale. The difference between session 1 and session 2 was STAGGERING. I tracked their settings in super none-vigorous manner and they increased their settings a lot more than you would anticipate. So to conclude, no you can’t exercise “too much” with Rheumatoid Arthritis, the amount you SHOULD exercise is variably individual but a good starting point is to aim for 150 minutes of moderate intensity per week. Some is better than none, more is usually better and enjoying it is probably the most important ingredient. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit rheumatologyphysio.substack.com/subscribe

This is a free preview of a paid episode. To hear more, visit rheumatologyphysio.substack.comWelcome Back Rheumatology Fans,You can get access to this article but upgrading your subscription, enrolling in my online course or becoming a member of Physio Matters Advanced PracticeWe got ANOTHER media request, I am starting to wonder who is giving out my email address, if it is you then can you tell them I would like paying next time… haaaaaa.Ok, so back to being serious, this request was advice for returning to tennis or squash when arthritis had stopped the person from playing. This was actually a new one for me so here we are with an expansion on my responses. You can get access to this article but upgrading your subscription, enrolling in my online course or becoming a member of Physio Matters Advanced Practice