I recently came across an interesting newsletter item from "Building the Elite" about the relative importance of training volume versus intensity.

The argument—made by someone preparing candidates for special forces selection—was that volume is the primary training variable to manage. This is because it has the greatest impact on the training programme's effectiveness, while intensity determines the type of adaptation you're targeting.

This struck me as highly relevant to neurological rehabilitation. Let's see if you agree.

The terms get used interchangeably in clinical practice. Pressure reduction. Offloading. Heel protection. Redistribution. But they are not the same thing. And the distinction matters to clinical outcomes —particularly at the heel, where anatomy conspires against us.

The 2025 International Pressure Injury Guideline makes this explicit. For heels, the recommendation is unambiguous: heels should be "fully free from contact with the support surface." Not reduced pressure. Not redistributed pressure. Zero contact.

This article explains the biomechanical difference between pressure reduction and complete offloading, why it matters specifically at the heel, and what the evidence shows. Let's be clear about definitions first.

Spasticity is common after spinal cord injury, and while medication can help, it isn’t always the best or only option. This article explores alternative ways to manage spasticity when medication isn’t effective or suitable. It looks at why symptoms can vary, what triggers may make spasticity worse, and the importance of an individualised approach. From rehabilitation strategies to practical day-to-day management, it provides a helpful overview for improving comfort, function, and quality of life.

Standing can offer more than simply being upright - especially after spinal cord injury (SCI). This article explores the wider benefits of regular standing, including support for circulation, joint and muscle health, digestion, bone density, and overall wellbeing. It also explains why upright time can be a valuable part of rehabilitation and long-term health management. A useful overview for anyone considering standing programmes or looking to understand how consistent upright time may support comfort, function, and quality of life after SCI.

Wondering how long it takes to notice benefits from FES cycling? This article breaks down what to expect in the first few sessions and over the following weeks, from early improvements in muscle activation and comfort to longer-term gains in strength, endurance, and performance. It explains why consistency matters, how individual factors can affect progress, and what milestones may indicate you’re on the right track. A helpful overview for anyone starting FES cycling and wanting a realistic timeline for results.

Recent NHS pathway updates include important changes to pressure ulcer prevention guidance, particularly around heel protection and offloading. This article explains the key updates, how they align with current evidence, and the practical implications for services reviewing prevention strategies. It also clarifies the difference between products that reduce pressure and those that fully offload the heel.