Patient: 31M, sustained a right 4th finger fracture (metacarpophalangeal joint) five weeks ago, currently under clinic care. Reports minimal pain and continues training, focusing on non-hand-dominant exercises.

Differential Diagnosis:

• Delayed union or non-union of fracture

• Joint stiffness due to immobilisation

• Muscle atrophy or grip weakness

• Secondary compensatory movement patterns affecting training

Management Focus: Gradual reintroduction of gripping through isometric loading, progressing towards functional strength work while avoiding excessive stress on the fractured site.

Patient: 32M, struggles with front rack due to left-sided thoracic rotation limitation. Bar does not rest comfortably on the clavicle.

Differential Diagnosis:

• Thoracic mobility restriction (possible segmental stiffness)

• Scapulothoracic dysfunction affecting shoulder positioning

• Glenohumeral joint stiffness or soft tissue restriction

• Left rotator cuff imbalances

Management Focus: Single-arm rowing variations with rotational bias to improve thoracic mobility and strengthen supporting musculature.

Patient: 35F, long-standing ankle mobility limitations improving, but still struggles with squatting – heels lift, and compensates by leaning forward.

Differential Diagnosis:

• Insufficient ankle dorsiflexion (soft tissue or bony restriction)

• Weakness in lower traps/rhomboids affecting thoracic positioning

• Limited hip mobility contributing to altered squat pattern

Management Focus: Addressing thoracic strength and mobility to support a more upright squat while continuing dorsiflexion-focused mobility drills.

Patient: 41F with hypermobility and autoimmune history, experiencing right knee pain and swelling after squats. Seeing another physio but seeking additional advice.

Differential Diagnosis:

• Patellar tendinopathy

• Hoffa’s fat pad irritation

• Synovitis due to systemic inflammatory response

• Underlying joint instability related to hypermobility

Management Focus: Isometric knee strengthening (e.g., wall sits), isolated lower limb strengthening for joint control.

Patient: 33M, developed right shoulder pain after sleeping awkwardly in a camper van. Struggles with overhead movements, particularly when loaded.

Differential Diagnosis:

• Rotator cuff-related shoulder pain (RCRSP)

• Subacromial impingement

• AC joint irritation

• Scapular dyskinesis affecting overhead positioning

Management Focus: Strengthening within open-packed positions using banded resistance to restore stability and reduce pain.

Patient: 46M, fell off a Lime bike, experiencing hip and knee pain. MRI pending, X-ray ruled out fracture. Reports posterior knee pain across horizontally and anterior patellar pain.

Differential Diagnosis:

• Meniscal tear (though not classic pattern)

• Distal hamstring strain (attachment site irritation)

• Patellofemoral pain syndrome

• Posterior capsule strain

Management Focus: Await MRI for definitive diagnosis, rule out soft tissue hamstring injury, consider progressive knee loading strategies.

Patient: 31M, struggling with squat mechanics, reports poor left leg drive.

Differential Diagnosis:

• Hip or knee strength asymmetry

• Unilateral glute weakness

• Neural involvement (sciatic or femoral nerve irritation)

Management Focus: Unilateral hip-dominant strength exercises to correct imbalances and restore drive in left leg.

Patient: 26F, recently started Olympic lifting, experiencing knee discomfort.

Differential Diagnosis:

• Quadriceps dominance leading to patellar overload

• Poor posterior chain activation

• Limited hip mobility affecting squat pattern

Management Focus: Education on posterior chain activation, targeted hip and glute strengthening.

Patient: 44F, experiencing back pain related to performance limitations, possibly due to height-related mechanics.

Differential Diagnosis:

• Lumbar extension-related pain

• Insufficient posterior chain engagement

• Core instability affecting spinal positioning

Management Focus: Hip-dominant strengthening with posterior chain emphasis to reduce spinal compensation.

Patient: 32F, diagnosed with a right knee stress fracture (August 2023), treated early 2024. Muscle asymmetry between right and left leg noted.

Differential Diagnosis:

• Ongoing bone stress reaction

• Muscle atrophy post-injury

• Compensatory gait adaptations affecting mechanics

Management Focus: Progressive calf and quad strengthening to restore muscle symmetry and prevent reinjury.

Patient: 28F, newly diagnosed PCOS, keen to compete in Olympic lifting. History of labral tear and hip issues. Reports deep groin pain radiating down the inner leg.

Differential Diagnosis:

• Hip impingement (FAI)

• Labral pathology

• Adductor-related groin pain

• Femoral stress reaction

Management Focus: Strengthening hip stabilisers, controlled internal rotation/adduction movements, and loading strategies to support training.

Patient: 50F, attending an entry-level barbell class, experiencing knee and lower back pain. Lunges aggravated her symptoms, making it difficult to progress.

Differential Diagnosis:

• Knee osteoarthritis with movement intolerance

• Lumbar facet joint irritation due to poor movement control

• Quad dominance leading to excessive knee load

Management Focus:

• Programme modification: Replaced lunges with single-leg step-downs to maintain unilateral strength while reducing knee stress.

• Slow eccentric control: Encouraged neuromuscular control and gradual loading without exacerbating pain.

• Gradual exposure: Adjusted range of motion and monitored symptoms to safely reintroduce lunges over time.

Patient: 35M, experiencing wrist pain when receiving snatches. No history of trauma, but symptoms worsened with training volume.

Differential Diagnosis:

• Overload-related wrist flexor strain

• Wrist joint compression sensitivity (possible early cartilage irritation)

• Soft tissue irritation from repetitive impact

Management Focus:

• Isotonic wrist strengthening: Loaded wrist flexors in a stretched position to improve tolerance under load.

• Taping for support: Applied supportive taping, which allowed him to continue lifting pain-free during the session.

• Load management: Advised adjustments to training intensity and recovery strategies to prevent recurrence.