Dose,
measure,
adjust.
A plan of about 12 weeks to dose and monitor load in rehabilitation. Three modules share one rules engine: Achilles tendinopathy, hamstring injury and chronic low back pain. Each phase produces open, reviewable results.
- DosePrescribe the load: exercise, sets, repetitions, intensity, tempo and frequency.
- MeasurePain during and after the load, the 24 h response, a validated questionnaire (Arabic VISA-A) and strength.
- AdjustProgress, hold or regress. Each decision shows the rule applied and the source behind it.
Dose load with explicit rules
The aim is to apply the dose, measure and adjust cycle in rehabilitation with explicit rules, and to leave each step as public, reviewable evidence.
What is done
Translate clinical trials into explicit progression rules: how much load to prescribe, what to measure after each session, and when to progress, hold or regress.
Use measures with known properties. For example, on the Arabic VISA-A the individual minimum detectable change is 28.4 points (Alghamdi 2026): a smaller change in one patient cannot be told apart from measurement error.
What is produced
A documented rules engine, with a citation for each rule. A reproducible analysis of the TEAch dataset. A prototype calculator. 2 to 3 anonymised clinical cases. All published openly on GitHub.
Three modules, one rules engine
The engine is shared: inputs (prescribed load, pain, 24 h response, questionnaire, strength), rules with their source, and an output (progress, hold or regress). The rules and thresholds change by region.
Achilles tendinopathy
This is the first module because it has load trials with explicit protocols, an open participant level dataset, and measures validated in Arabic with published measurement error.
| Piece | What it adds | Source |
|---|---|---|
| Pain monitoring | Randomised trial with 38 patients: continuing to run and jump with a pain monitoring model did not worsen outcomes compared with 6 weeks of active rest. The exact thresholds of the model are not in the abstract; they will be taken from the full text before they are coded. abstract | Silbernagel 2007, Am J Sports Med |
| Strength progression | 58 patients, 12 weeks: heavy slow resistance (HSR) and eccentric training gave equally good and lasting results; HSR tended toward higher satisfaction at 12 weeks, not at 52. abstract | Beyer 2015, Am J Sports Med |
| Exercise order | Open dataset (CC BY 4.0) on exercise progression to load the Achilles tendon incrementally. It is used to order exercises by load. as stated in the record title | Baxter et al. 2020, Zenodo |
| Data to analyse | TEAch, University of Iowa, 2022, ODC-By licence: a trial of pain science education plus exercise in tendinopathy (NCT04059146). n = 66 participants (actual enrolment according to ClinicalTrials.gov). | Dao, Mosby, Hall et al., Iowa Research Online |
| Saudi context | 283 cyclists from the Eastern Province were analysed; about 10% reported Achilles tendon pain. abstract | Althunyan 2021, J Family Community Med |
| VISA-A in Arabic (1) | 45 patients and 36 controls; ICC 0.985. Only 28 of 45 patients (62%) repeated the questionnaire: 38% loss at retest. | Alshewaier 2024, Orthop J Sports Med |
| VISA-A in Arabic (2) | King Saud University with Silbernagel (University of Delaware): 139 participants, 32 with tendinopathy; standard error of measurement 10.3 and an individual minimum detectable change of 28.4 points. | Alghamdi et al. 2026, Orthop J Sports Med |
| Dose by intensity and time under tension | LOADIT: a factorial feasibility trial with 48 men in Melbourne (6 RM versus 18 RM; 2 s versus 6 s per repetition). Recruitment 76% and retention 90%. The first author is also listed as affiliated with the Security Forces Hospital in Riyadh. | Hasani et al. 2021, BMC Sports Sci Med Rehabil |
Correct framing: Saudi studies on the Achilles tendon already exist (prevalence and questionnaire validation), so a new study would not be the first Achilles study here. It would be, according to the search performed (not systematic), the first load intervention study in Achilles tendinopathy in Saudi Arabia.
Hamstring injury
Local relevance: in the Saudi Professional League 2015 to 2016 (10 clubs, 300 players) hamstring strains were 11.8% of injuries (Muaidi 2019).
Rehabilitation rules: the lengthening protocol reduced return to training from 51 to 28 days on average in 75 Swedish footballers (Askling 2013). Prevention with the Nordic exercise: 3.8 versus 13.1 injuries per 100 player seasons in 942 players (Petersen 2011); 579 amateur players with 25 sessions in 13 weeks (van der Horst 2015).
Open data: physical load and hamstring injuries in elite football (Zenodo 10231709, CC BY 4.0), LaLiga injuries (figshare, CC0) and biomechanical deficits after injury (Ménard, figshare, CC BY 4.0). None is a rehabilitation progression dataset: there is no open rehabilitation data, so the rules will come from the trials and be checked against the project's own cases.
Chronic low back pain
Everything collected on the chronic low back pain pages for Saudi Arabia (ES, AR): the 2026 Saudi guideline, international guidelines, dose evidence and gaps.
The rule set concept is already sketched there in seven rules, each with its source.
Two pieces of work planned: an analysis of the cognitive functional therapy trial dataset (CFT, Zenodo 6760585) and a study of adherence to the Saudi guideline among physiotherapists, continuing the line of Moslem 2022 and Alshehri 2020.
Why the three regions are not crossed with public data
The idea of relating the ankle, the hamstrings and the lumbar region in the same person is attractive, but it cannot be answered with open data today.
No open dataset found covers the three regions in the same people.
FinnGen publishes aggregate results; individual data are not openly available, so it does not allow following the same patient across regions.
Causal evidence for a kinetic chain between these regions is weak; a cross with aggregate data would only show correlations.
Hypothesis: load decisions with the evidence in view
A tool that works on a phone alone, in Arabic, English and Spanish, that decides to progress, hold or regress and cites the evidence for each decision.
| Competitor | General approach | Does it decide the load and cite the source? |
|---|---|---|
| Physitrack | Remote exercise programmes and follow up for clinicians | To be checked with a demo |
| VALD | Force and performance measurement systems with associated software | To be checked with a demo |
| Kinvent | Connected force and mobility sensors with an app | To be checked with a demo |
| Kitman Labs | Performance and health data platform for teams | To be checked with a demo |
| TeamBuildr | Strength training programming for teams | To be checked with a demo |
The general approach is a short description, not verified in this review. It is not claimed that any competitor lacks the feature until their demos are reviewed. The proposed difference is the combination: phone only, three languages including Arabic, an explicit decision and a citation per decision.
About 12 weeks for the first module
The Achilles module first, complete and published. Then hamstrings and lumbar on the same engine.
Full text reading of Silbernagel, Beyer, LOADIT and the Arabic validations. A glossary of dose variables and of measures with their error.
Rules for the Achilles module, each with its citation. Reproducible analysis of the TEAch dataset in a public notebook.
A mobile web prototype in AR, EN and ES that returns progress, hold or regress with the rule and the source.
2 to 3 anonymised clinical cases with consent. Open publication on GitHub.
Requirements for a dedicated study in Riyadh
What is needed to move from clinical cases to a study with ethics approval, and what earlier Saudi studies show.
Before working with patients
Interventions are carried out by professionals with a current licence from the Saudi Commission for Health Specialties (SCFHS).
A protocol approved by an ethics committee, informed consent and study registration before recruitment.
Approval precedents
Ministry of Health committee: 20-194E (Alshabanat 2022) and 20-192E (Alshewaier 2024).
King Saud University committee: E-19-4315 (Alghamdi 2026).
Recruitment lessons
| Study | What happened | Lesson |
|---|---|---|
| Alshabanat 2022 Arabic VISA-P, patellar tendinopathy | Outpatient clinics, October to December 2020: 129 recruited, 111 included, 53 patients in about 3 months. Only 37 of 53 repeated the questionnaire (30% loss), attributed to COVID 19 restrictions. Only 5 of the 53 patients were women. | Plan for loss to follow up and for recruitment of women from the start. |
| Alshewaier 2024 Arabic VISA-A | Physiotherapy clinics: 45 patients; 38% did not complete the retest at 7 days. | Reminders and a retest in the same visit or by phone. |
| Alghamdi 2026 Arabic VISA-A, King Saud | Clinical diagnosis: localised tendon pain, tenderness on palpation and pain with load, confirmed by a physician with 5 or more years or a physiotherapist with 3 or more years of experience. | Use the same criteria so the data are comparable. |
Proposed material
A phone with the calculator, the Arabic VISA-A, a 0 to 10 numeric pain scale, a step and a weight for heel raises, a metronome for tempo and, if possible, a handheld dynamometer or a load cell. An initial proposal, to be adjusted with the study team.
Earlier research in Saudi Arabia
Arabic validation of the VISA-A at King Saud University (Alghamdi 2026), the LOADIT feasibility trial on intensity and time under tension (Hasani 2021) and the Saudi low back pain guideline (Aldera 2026).
Risks and limitations
There is no open data on rehabilitation progression; TEAch is not a dosing trial. The rules rest on small trials and on abstracts until the full texts are read.
With an individual minimum detectable change of 28.4 points on the Arabic VISA-A, many week to week decisions cannot rest on that questionnaire alone.
Losses of 30% and 38% in earlier Saudi studies, and few women recruited in at least one of them.
A tool that recommends loads could be regulated as health software: confirm this with the competent authority before using it with patients.
Three modules are a lot for one person. Mitigation: finish and publish the Achilles module before opening the others.
Arabic texts need native review. Competitors may already have similar features: their demos need review.
References
Links checked on 25 October 2026. Notes show what was verified only in the abstract or could not be verified.
- Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897-906. https://doi.org/10.1177/0363546506298279 (verified in the abstract)
- Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704-1711. https://doi.org/10.1177/0363546515584760 (verified in the abstract)
- Baxter JR, Corrigan P, Hullfish TJ, O'Rourke P, et al. DataSet: Exercise progression to incrementally load the Achilles tendon. Zenodo, 2020, CC BY 4.0. https://doi.org/10.5281/zenodo.3967532 [the Zenodo website returns 403 to automated checkers; the record exists per its API]
- Dao M, Mosby H, Hall MM, de Cesar Netto C, et al. TEAch Primary Aims dataset. University of Iowa, 2022, ODC-By 1.0. https://doi.org/10.25820/data.006166 (n = 66 according to ClinicalTrials.gov, NCT04059146)
- Althunyan AK, Darwish MA, Sabra AA, et al. Factors associated with Achilles tendon pain in cyclists in eastern province of Saudi Arabia. J Family Community Med. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC7927966/
- Alshewaier SA, Alotaibi RM, Alshabanat AS, Alkathiry AA. Cross-cultural adaptation, translation, and validation of the VISA-A questionnaire for Arabic speakers. Orthop J Sports Med. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11151768/
- Alghamdi NH, ALMohiza M, Alghamdi RA, Grävare Silbernagel K, et al. Translational cross-cultural adaptation and validation of the VISA-A questionnaire for Arabic-speaking patients with Achilles tendinopathy. Orthop J Sports Med. 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC13009985/
- Hasani F, Haines T, Munteanu SE, Schoch P, Vicenzino B, Malliaras P. LOAD-intensity and time-under-tension of exercises for men who have Achilles tendinopathy (the LOADIT trial): a randomised feasibility trial. BMC Sports Sci Med Rehabil. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8152048/
- Alshabanat AS, Alshewaier SA, Alotaibi RM, Alkathiry AA. Arabic translation and cross-cultural adaptation of the VISA questionnaire for patellar tendinopathy. Orthop J Sports Med. 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9720810/
- Muaidi QI. Saudi Professional League: a prospective study of the injuries and illnesses sustained by professional soccer players during the 2015-2016 season. Asian J Sports Med. 2019;10(1):e79930. https://brieflands.com/journals/asjsm/articles/79930
- Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med. 2013;47(15):953-959. https://doi.org/10.1136/bjsports-2013-092165 (verified in the abstract)
- Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med. 2011;39(11):2296-2303. https://doi.org/10.1177/0363546511419277 (verified in the abstract)
- van der Horst N, Smits DW, Petersen J, Goedhart EA, Backx FJ. The preventive effect of the Nordic hamstring exercise on hamstring injuries in amateur soccer players: a randomized controlled trial. Am J Sports Med. 2015;43(6):1316-1323. https://doi.org/10.1177/0363546515574057 (verified in the abstract)
- Felipe JL, et al. BBDD: Association between physical load in different time windows and hamstring injuries in elite football players. Zenodo, 2023, CC BY 4.0. https://doi.org/10.5281/zenodo.10231709 [the Zenodo website returns 403 to automated checkers; the record exists per its API]; n not verified
- Nieto Torrejón L, Martínez Serrano A, et al. Injuries database (LaLiga). figshare, 2024, CC0. https://doi.org/10.6084/m9.figshare.24998822
- Ménard M, Sorel A, Boumpoutou R, et al. Persistent biomechanical deficits observed in professional soccer players with a history of hamstring injury during a reactive functional test. figshare, 2020, CC BY 4.0. https://doi.org/10.6084/m9.figshare.13285817
- O'Keeffe M. CFT trial dataset (cognitive functional therapy vs group exercise, participant level). Zenodo, 2022, CC BY 4.0. https://zenodo.org/records/6760585 [the Zenodo website returns 403 to automated checkers; the record exists per its API]
- Aldera M, Alturkistany A, Al Rayes H, et al., Alshehri MA. Saudi Clinical Practice Guideline for the Assessment and Management of Low Back Pain and Sciatica in Adults. J Clin Med. 2026;15(2):528. https://pmc.ncbi.nlm.nih.gov/articles/PMC12842004/
- Moslem WM, Alrwaily M, Almarwani MM. Adherence to low back pain clinical practice guidelines by Saudi physical therapists: a cross-sectional study. Physiother Theory Pract. 2022;38(7):938-951. https://pubmed.ncbi.nlm.nih.gov/32838639/ (abstract only)
- Alshehri MA, Alzahrani H, Alotaibi M, Alhowimel A, Khoja O. Physiotherapists' pain attitudes and beliefs towards chronic low back pain and their association with treatment selection. BMJ Open. 2020;10(6):e037159. https://pmc.ncbi.nlm.nih.gov/articles/PMC7311013/
- Project pages: Chronic low back pain in Saudi Arabia (EN) · ES · AR, with their own source list.