Search Results

We take a look at an interesting research study that suggests an improvement of between 4% and 5% in multi-day races and that provides some clues on how much caffeine to take. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.   Some of the links in this article are to pages where you can buy products discussed or mentioned here. We might earn a small commission on sales at no extra cost to you. In this article: Caffeine for running and other endurance sports What the researchers did Results: Effects of caffeine on performance during multi-day events My recommendation How we can help Caffeine for running and other endurance sports Caffeine has been shown to have positive effects on performance in cycling, running, cross-country skiing, and rowing, for short as well as long-duration events. All of these studies have, however, looked at one-day events. ❓ The question that a team of researchers in Norway wanted to answer was: Would the improved performance due to caffeine supplements on the first day have a negative effect on the following day’s performance, if one assumes that you would have increased muscle damage due to the greater effort on the first day? What the researchers did To test this, the researchers took eight elite cross-country skiers and made them do a series of exercise bouts on a skiing ergometer (think of it as a treadmill for endurance skiers that also involves the arms). Each exercise bout consisted of a 10 minutes at 75% effort, followed by 5 minutes at 80% effort, and then an all-out effort for 10 minutes. They did this on two consecutive days, waited six days, then two more such exercise days, waited another six days, followed by the final two exercise days. Each skier had to take one of three drinks 75 minutes before each session without knowing which type they got. The drinks contained either: 3 mg of caffeine per kilogram of body weight 4.5 mg of caffeine per kilogram of body weight no caffeine (a placebo). 👉 To put the dosages into perspective: for someone weighing 70 kg this would mean either 210 mg or 315 mg of caffeine, respectively. Results: Effects of caffeine on performance during multi-day events The results were very interesting. The skiers who took caffeine (both dosage sizes) performed significantly better on both days than those who drank the placebo (no caffeine). Those who took the 3 mg/kg dosage of caffeine "skied" 4% further on Day 1 and 5% further on Day 2 than those who took the placebo. Those who took 4.5mg/kg skied 4% and 5.1% further than the placebo group. This was despite the caffeine group reporting more muscles soreness and blood tests confirming that they had more muscle damage than the placebo group after the first day's session. 💡 So, the answer to the research question is: Yes , caffeine supplements can lead to greater muscle damage due to an increased effort BUT it can still enhance subsequent performance despite the greater muscle damage. My recommendation It is important to note that the results might be different for other sports. Also, the study was done on elite athletes and the caffeine-vs.-muscle-damage equation might look different for recreational athletes. Lastly, this study only looked at short-duration exercise and the effect on performance on longer distance multi-day events has not been studied. Having said that, there's no harm in trying it as long as you stay within a safe daily dosage , which is a maximum of 5.7 mg per kilogram of bodyweight for healthy adults who are not pregnant (so, 400 mg of caffeine for someone weighing 70 kg). For pregnant women, the recommended dosage is half of this. I find caffeine gummies or chewing gum more convenient than drinks because your hydration schedule might look different than your caffeine schedule during a race, so here's a variety of flavours and dosages: How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call  for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate , Facebook , Twitter , and Instagram . References Stadheim, H. K., M. Spencer, et al. (2014). "Caffeine and Performance over Consecutive Days of Simulated Competition." Medicine & Science in Sports & Exercise 46(9): 1787-1796 . EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2015) "Scientific Opinion on the safety of caffeine" EFSA Journal 13(5): 4102 .

One of running’s worst-kept secrets is that caffeine boosts your performance. What is less well-known is how much caffeine to take, when, and in what form. Here’s our guide on how to get the most out of this wonderful substance for races over various distances. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: This is how caffeine improves your running How much caffeine to take and how – General guidelines 5K race 10K race Half marathon Marathon Single-day ultramarathon (50–100K) Multi-day ultramarathon This is how caffeine improves your running The question with caffeine is not whether it improves running performance, but by how much – unlike with some other, more controversial supplements that might or might not improve your performance. The International Olympic Committee  and the International Society of Sports Nutrition agree that caffeine (taken within a certain dosage range - see below) enables runners to run faster at shorter distances and to run for longer before fatigue sets in in longer races. How does it work? Caffeine’s main effect is on the central nervous system. It blocks the receptors of adenosine, a chemical that causes drowsiness and fatigue, making your brain think that you’re less tired than you actually are. On a physiological level, it increases the release of calcium ions, which helps your muscles to produce more force and also delays fatigue later in a race. Caffeine makes you feel less tired by blocking the chemical that causes drowsiness. It also helps your muscles contract more forcefully and improves endurance by enhancing calcium ion release. Dozens of studies  have shown that caffeine improves endurance performance on average by 2% to 4%. For context – this might shave up to 10 minutes off the time of a 4-hour marathoner. Note that these are average results – the effects of caffeine will vary between individuals due to factors such as genetics and training status. While caffeine is useful for increasing performance in races as short as 5 km, its beneficial effects increase with longer events. This is mostly because mental alertness becomes more important the further you run. A study  on sleep-deprived athletes found that strategically using caffeine to counteract drowsiness gave them about a 14% improvement in endurance. What about side effects? Side effects of caffeine  include: increased heart rate headache (for people not used to caffeine, but also for habitual caffeine users who haven’t had their “fix”) insomnia anxiety dehydration “gastro-intestinal distress” (i.e. you’d better factor in a visit the Portaloo before the race). However, these side-effects are mostly dose-dependent, so if you stick to the correct dosage (see below), you should be all right. 💡 Caffeine might have serious side effects if you have a heart condition or are prone to arrhythmia – it’s better to stay away from it if that’s the case. How much caffeine to take and how – General guidelines How much The people in the white lab coats agree  that between 3 mg and 6 mg of caffeine per kilogram of body weight per day is the “sweet spot”. Much less than that, and you don’t get an effect. Much more than that, and you don’t see any further increase in performance, but you run the risk of unwanted side effects kicking in. So, for a runner weighing in at 70 kg (154 lbs) this means between 210 mg and 420 mg of caffeine per day. In practical terms, this would be anything from two to four cups of regular coffee at 240 ml (8 oz) per cup. 💡 Take care not to confuse milligrams and grams – it might lead to an overdose. I would advise people who are not used to caffeine and/or doing shorter races to start off at the lower end of this range. Runners who are used to caffeine and/or doing longer races can likely take the higher suggested dose. Keep track of your overall caffeine intake from all sources. For example, if you had a coffee at breakfast (100 mg) and an energy gel before the race (50 mg), and then you sip an energy drink during the race (say 100 mg), those add up. And note the US Federal Drug Administration’s guideline of a maximum of 400 mg of caffeine per day for adults. The effects of caffeine can start within a wide time window, depending on how you take it. If you swallow the caffeine in some or other form (e.g. coffee or an energy drink), it is mostly absorbed in the stomach and small intestine and might take up to an hour to take effect. If you chew it (e.g. gummies or chewing gum), it already starts to get absorbed in your mouth, via your saliva, and its effects can take as little as 10 minutes to kick in. Chewing gum or sweets typically allows caffeine to kick in quicker. The running benefits of caffeine can last from 2 to 4 hours after they have taken effect , after which it starts to taper off. When your caffeine boost starts and ends is obviously important when timing your intake (either before and/or during a race) so that you reach peak performance when you most need it, so let’s look at the various ways to take it before we move on to race-distance specific advice. How to take caffeine for running Coffee The way most of us take our caffeine when it’s not race day. 👍 Pros: It’s cheap and widely available, and it can be a calming and familiar morning ritual before a race. 👎 Cons: Coffee’s acidity and volume can sometimes cause stomach upset or acid reflux, especially if you have it black and/or on an empty stomach. The caffeine content in coffee can vary depending on the brew strength, beans, etc. – if you need a precise dose, you might prefer other methods. Tea Most types of tea have less caffeine than coffee – standard black tea has about 40–50 mg of caffeine per cup. 👍 Pros: A good option if you want a gentler caffeine boost. It’s less likely to cause jitters compared to coffee or energy drinks. 👎 Cons: You have to drink quite a lot of it to reach an effective dose for running performance. Energy drinks Depending on the brand, it will be sweetened with either sugar or artificial sweetener – check this if you want to be on top of your total energy intake before and during the race. 👍 Pros: Easy to find. The caffeine content is usually listed on the container, so you know the dosage. 👎 Cons: A high sugar content might cause a blood sugar spike-and-crash or stomach issues during a run, and the carbonation in many energy drinks can lead to burping or bloating while running. Bulky to carry during a race.   Gummies and chewing gum Candy-like caffeinated gummies or caffeinated chewing gum. 👍 Pros: They are available in smaller doses of caffeine per unit, ranging from 25 mg to 125 mg, so you can spread out your caffeine intake strategically during longer races (see below). The caffeine kicks in fairly quickly because you chew them. Easier to carry with you than energy drinks or gels. No liquids involved. 👎 Cons: Chewing something while running hard isn’t for everyone. With chewing gum, you might not be able to extract the full dosage. Here is a range of dosage examples available on Amazon – click through to see more flavours if these make your mouth pucker. Caffeinated energy gels A typical caffeine-infused energy gel packet contains about 20 mg to 50 mg of caffeine. 👍 Pros: Easy to carry. You can ingest caffeine alongside carbohydrates for energy in one go. Precise and small dosing if necessary. 👎 Cons: Doesn’t kick in as quickly as gummies or chewing gum. Some runners find that gels (with their thick, sugary consistency) can cause nausea, so practice in training. Some runners need liquids with which to wash down the gel. Again, here's a range of dosages. If you click through, not all the flavour choices are necessarily caffeinated, so check for that. Tablets These are available over the counter (typically 100 mg or 200 mg of caffeine per tablet). 👍 Pros: Precise dosing – caffeine in pill form has been used in many research studies because it’s easy to standardise. 👎 Cons: Doesn’t kick in as quickly as gummies or chewing gum. Be very careful with pure caffeine powders or multiple pills, as it’s easy to overshoot the dose. Avoid sketchy “stimulant” combo products – some might also contain banned substances. So, let’s take a look at how best to put these options to work in races over various distances. 5K race When to take caffeine: 30–45 minutes before the race How much to take: 2–3 mg/kg (140–210 mg for a 70 kg runner) Best delivery methods: Caffeinated chews/gummies (fast acting) Caffeine chewing gum (fast acting) Caffeine tablets (precise dosing) Why this works: In a short, high-intensity race like a 5K, you want the caffeine to peak right at race time . Gum and dissolvable chews are perfect: they’re absorbed quickly through the mouth and cause less digestive distress  than coffee. For experienced users who want precision, a tablet can work well too. 10K race When to take caffeine: 30–45 minutes before the race How much to take: 3–4 mg/kg (210–280 mg for a 70 kg runner) Best delivery methods: Caffeinated chews/gummies Caffeine tablets Coffee (if tolerated) Why this works: A 10K requires sustained effort, and you want caffeine to kick in during the middle and late stages . Fast-absorbing methods like chews give a clean pre-race boost without excess fluid. Chews also combine fast absorption with slightly slower release , helping carry you through the full 40–60 minutes. Studies have shown that caffeine improves endurance performance on average by 2% to 4%. Half marathon When to take caffeine: Main dose:  45–60 minutes pre-race Optional booster:  60 minutes into race How much to take: Pre-race:  3–4 mg/kg (210–280 mg for a 70 kg runner) Mid-race:  50–100 mg Best delivery methods: Pre-race:  Tablet or coffee Mid-race:  Caffeinated gel, chew, or gum Why this works: You’ll be running for 1.5–2+ hours. The initial dose helps you settle into race pace with energy, while the booster prevents late-race fade . Chews and gum are compact, fast acting , and easy on the stomach , making them ideal during a hard run. Marathon When to take caffeine: Main dose:  45–60 min before start Boosters:  Every 90–120 min How much to take: Pre-race:  3–4 mg/kg (210–280 mg for a 70 kg runner) During:  50–100 mg each booster Total limit:  400 mg/day Best delivery methods: Pre-race:  Tablet or coffee During:  Caffeinated gels, chews, or gum Why this works: Marathons demand stamina and mental endurance . Use a solid pre-load plus mid-race caffeine to stay focused, especially around the "wall" (~30 km). Chews and gum kick in quickly  and are easy to carry , while gels combine caffeine and carbs . Single-day ultramarathon (50–100K) When to take caffeine: Skip at race start unless you're groggy Begin small, regular doses around hour 2–3 Continue every 1–2 hours as needed How much to take: Per dose:  50–100 mg Total daily max:  400 mg Best delivery methods: Early/mid-race:  Caffeinated chews or gels Late in race:  Chew or gum for fast relief, or tablet if major fatigue Why this works: In ultras, it's smarter to delay caffeine  until fatigue or low energy sets in. Frequent small doses  help maintain focus and stave off crashes. Chews and gum let you fine-tune the timing, while tablets are best saved for when you need a powerful wake-up . Multi-day ultramarathon When to take caffeine: Avoid caffeine during Day 1 / early stages Use sparingly in late hours or overnight Prioritize caffeine during critical decision periods  or sleep-deprived moments How much to take: 50–100 mg doses Stay under 400 mg per day Best delivery methods: Morning:  Coffee or tablet During:  Chews, gum Emergency alertness:  Strong chew or strong gum Why this works: Over days, sleep and recovery matter more than quick boosts . You’re not looking for constant stimulation. Instead, treat caffeine like a tool : use chews or gum  to stay alert during night sections or when sleep deprived. Save tablets  for intense fatigue or final efforts. Finally, there was an interesting study done on multi-day cross-country skiers that showed that caffeine taken over more than one day in endurance events leads to more muscle damage (due to the increased effort it enables) but still increases overall performance. About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Maughan R.J. et al. (2018) “IOC consensus statement: dietary supplements and the high-performance athlete” British Journal of Sports Medicine (52): 439-455. Guest, N.S. et al. (2021) “International society of sports nutrition position stand: caffeine and exercise performance” J Int Soc Sports Nutr 18:   1. Azevedo, R. et al. (2016) “Effects of caffeine ingestion on endurance performance in mentally fatigued individuals” Eur J Appl Physiol 116: 2293-2303. Bäcker, M.H. and Jaitner, T. (2023) “Effects of caffeine-containing energy drinks on endurance performance and side effects: a randomized cross-over study” Dtsch Z Sportmed 74: 214-218.

Is taking creatine for running and other endurance sports worth it? Sports physio and runner Maryke Louw takes a look at the research into creatine for endurance events and finds that it does improve performance for certain types, but that there are tricky trade-offs to be made for runners. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: What does creatine do? Creatine for endurance running and other endurance sports Are creatine supplements safe and legal? My recommendations on creatine supplements How much creatine to take and when Injured? How we can help What does creatine do?   Natural creatine Creatine occurs naturally in our bodies. It helps to supply energy to various cells , in particular muscle cells.   We “use up” approximately 1% to 2% of the creatine in our muscles every day, and we need between 1 gram and 3 grams of new creatine per day to maintain our natural levels.   A diet that includes foods such as meat, fish, seafood, and milk  would supply about half of this, and the other half is manufactured in the liver, kidneys, and pancreas.   The research  indicates that a vegetarian or a vegan diet  would reduce the creatine in one’s muscles, and a vegan diet would not supply any external creatine. It is recommended that athletes on these diets use a vegan creatine supplement . Creatine as a sports supplement Creatine monohydrate (one of various types of creatine supplement) has been used as a performance enhancing supplement in sports since the early 1990s.   There is a vast body of research that backs up its benefits for certain sportspeople. These include: Enhancing single or repeated bursts of explosive power or speed for short time periods – so, anaerobic (non-endurance) efforts. Think of activities such as the sprint events in track running, track cycling, and swimming, high jump, football (both kinds), rugby, and weightlifting. Helping muscles to recover faster after intense training or competition – when taken with sufficient carbohydrates and protein. Aiding the muscle healing process after injury. Creatine has been shown to improve performance in sports that require explosive power and speed. Effects that may or may not be a benefit , depending on the type of sport and the situation, are: “Loading up” on creatine in the days leading up to an event causes water retention , which adds to your body weight. This effect disappears after the loading phase. (The dosage guidelines below explain how to avoid this effect). It increases your muscle mass, especially when the creatine supplementation is combined with strength training, which leads to an overall increase in body weight . 👉 Both of these effects sound as if they could be detrimental to endurance runners, but what does the research show? Do the seemingly negative effects outweigh the positive ones? Creatine for running and other endurance sports   More recently, researchers began looking into the possible benefits of creatine supplementation for athletes competing in endurance sports .   In 2023, a group of ten researchers published the results of their review of all the available studies on creatine supplementation and endurance performance in the Journal of the International Society of Sports Nutrition . What follows is mostly a summary of their findings and recommendations.   Creatine helps for certain types of endurance sport Creatine supplementation works best for endurance sports that require multiple speed surges and/or a final “kick” or “spurt” to cross the finish line. These might be required due to e.g. the nature of the course (very hilly) or race tactics (either your own or those of other competitors). This is not surprising, given that creatine has long been used to enhance single or multiple short-term bursts of power or speed, as we discussed above. Creatine might give you the edge to outrun your opponents at the end of an endurance race. Think of a triathlon , where cyclists would benefit from the effects of creatine supplementation during climbs, when initiating or chasing a breakaway, and in the running sprint for the finish line. Creatine might also be of benefit if you need a surge at the end of e.g. a marathon.   Other examples mentioned in the research are: Tactical 5000-metre track races Road cycling races, e.g. the Tour de France Mountain biking Rowing Kayaking Cross-country skiing.   The researchers found that these benefits apply to elite and recreational endurance athletes.   What about creatine for endurance runners? Weight gain The 2023 research review found a significant difference between non-weight-bearing endurance sports (such as cycling and rowing) and weight-bearing endurance sports (such as running).   They point to several studies that assessed whether the added body weight caused by creatine supplementation (due to added muscle mass and/or water retention) cancelled out or reduced its benefits. The studies found that this added body weight did not affect the benefits in non-weight-bearing activities but that it nullified the benefits in weight-bearing activities or even made things worse overall.   VO2max In addition to causing weight gain, it seems that creatine supplementation has a negative effect on VO2max – the maximum amount of oxygen your body can absorb during exercise or when racing, which is quite important for endurance runners.   A research review into creatine and VO2max, published in the journal Critical Reviews in Food Science and Nutrition , analysed the results of 19 high-quality studies involving 424 people.   The studies all took a similar approach: Some people were put on a creatine supplementation regime while others were given a placebo, and most of them were put through an exercise programme. Afterwards, their VO2max was measured.   The VO2max of both types of group increased, but the increase of the creatine groups was smaller than that of the placebo groups. The slower increase in VO2 max might be offset by the increase in ventilatory threshold. Ventilatory threshold Interestingly, the ventilatory threshold of the creatine group improved compared to the placebo group.   Ventilatory threshold refers to the point during exercise at which breathing increases significantly, and it is usually triggered by an accumulation of lactate. The ventilatory threshold occurs at a higher VO2max in well-trained endurance athletes and has been shown to predict endurance performance, regardless of the level of training. So, it seems that the creatine supplementation somehow (researchers a not yet sure how) led a decreased need for oxygen and better exercise efficiency in these athletes. 👉 This might mean that the slower increase in VO2max during training may be offset by an improvement in ventilatory threshold. Creatine – unanswered questions There are some aspects of creatine supplementation and endurance sports that have not yet been studied properly. Among these are: Does creatine supplementation affect men and women differently? Women have more natural creatine in their muscles, and the researchers speculate that creatine supplementation might therefore have a lesser effect on women. They also mention that creatine supplementation might influence women differently across their menstrual cycle . Research has shown that creatine supplementation causes a bigger improvement in strength in vegetarians (with lower muscle creatine levels to start with) than in omnivores. However, it is not known whether this will be the same for endurance. There is also a lack of evidence on the impact of creatine on the endurance performance of children and adolescents . Athletes who consume a plant-based or vegetarian diet will likely benefit more from creatine supplements than omnivores. Are creatine supplements safe and legal?   Unlike some other performance enhancing supplements such as TB-500  and SARMS , creatine is not prohibited in sports . This may provide a clue as to how much of a difference it really makes. According to the U.S. Anti-Doping Agency (USADA), “creatine can have a small effect on performance, [but] the effects are not guaranteed and the specific training program remains most influential.”   USADA does, however, warn athletes that some creatine supplements that are contaminated with banned substances do make it into stores.   On a health level, a daily adult dose of 3 to 5 grams is safe , according to the Harvard Medical School . Unlike some other sports supplements, creatine is not an anabolic steroid, and it will not increase your testosterone levels. But they do point out the following: The USA’s FDA [and similar bodies elsewhere] does not regulate supplements, so there may be less or more creatine than is stated on the label, and there might be other harmful stuff in there. People with kidney disease should consult a doctor before taking it. Some people will initially gain some weight due to water retention, but this isn’t a long-term issue. My recommendations on creatine supplements   It will benefit you more if you are doing shorter races , e.g. track, 5 Ks and 10 Ks, which require a very hard effort and rely more on your anaerobic system. If you're a competitive triathlete , you might also benefit from it. The biggest benefit of creatine supplementation for a runner lies in leg strength, so be sure also to follow a solid leg strength training programme . As noted above, runners who follow a vegetarian or vegan diet might benefit from taking a creatine supplement, because your natural creatine intake via food and drink would be less than that of an omnivorous runner. Make sure your training plan is optimal. Low-quality training with supplements will never beat high-quality training without supplements. How much creatine to take and when   If you are going to take a creatine supplement, please note that it is usually taken together with higher amounts of carbohydrates , because creatine on its own does not provide energy; it facilitates the process in which carbohydrates are converted into kinetic energy.   It seems that taking creatine directly after a strength workout  is more beneficial than taking it before the workout.   The authors of the 2023 research review recommend the following dosages:   👉 For weight-bearing activities (e.g. running): To avoid the water retention and weight gain caused by “loading up”, take 3 to 5 grams (depending on your body mass) per day for 28 days to reach creatine saturation. Thereafter, take a maintenance dose of 0.03 grams per kilogram of body mass per day. Some creatine supplement options available on Amazon:   👉 For non-weight-bearing activities (e.g. cycling): First, to load up so that your muscles become saturated with creatine, take 20 grams in four equal portions per day for 5 to 7 days. Thereafter the same maintenance dosage as above.   Taking more than these dosages will not add any benefits and might be bad for your kidneys.   The authors advise that athletes practise with creatine supplementation during the off-season , because people react in various ways due to differences such as their starting creatine levels, muscle fibre distribution, and genetics. Injured? How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Forbes, S.C. et al. (2023) “Creatine supplementation and endurance performance: surges and sprints to win the race” Journal of the International Society of Sports Nutrition 20(1): 2204071. LeWine, H.E. (2024) “What is creatine? Potential benefits and risks of this popular supplement” Harvard Health Publishing, Harvard Medical School. Fernández-Landa, J. et al. (2023) “Effects of Creatine Monohydrate on Endurance Performance in a Trained Population: A Systematic Review and Meta-analysis” Sports Med 53: 1017-1027. Wax, B. et al. (2021) "Creatine for Exercise and Sports Performance, with Recovery Considerations for Healthy Populations" Nutrients 13(6): 1915. Gras, D. et al. (2021) “Creatine supplementation and VO2max: a systematic review and meta-analysis” Critical Reviews in Food Science and Nutrition 63(21): 4855-4866. Pashayee-Khamene, F. et al. (2024) “Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis” Journal of the International Society of Sports Nutrition 21(1): 2380058. U.S. Anti-Doping Agency (2021) “What Do Athletes Need to Know About Creatine?” Rogerson, D. (2017) “Vegan diets: practical advice for athletes and exercisers” Journal of the International Society of Sports Nutrition, 14(1). Antonio, J. and Ciccone, V. (2013) “The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength” J Int Soc Sports Nutr 10(36).

Tibialis posterior tendonitis (also known as posterior tibial tendonitis) is, in my experience, one of the trickier tendon injuries to treat. This article explains what causes tibialis posterior tendonitis, how to figure out whether your foot pain is indeed caused by this injury, and the best treatment approach for it. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call . This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles. In this article: Tibialis posterior tendon anatomy Posterior tibial tendonitis causes Posterior tibial tendonitis symptoms and tests Posterior tibial tendonitis treatment Posterior tibial tendonitis recovery time How we can help I also made a video that focuses specifically on the diagnosis and treatment of tibialis posterior tendonitis: Tibialis posterior tendon anatomy The tibialis posterior (tib post) muscle sits deep inside your calf, and the tib post tendon runs from this muscle down the inside of your ankle (behind the ankle bone) and attaches to the navicular bone on the inside of your foot as well as to several other bones underneath your foot. The main jobs of the muscle and the tendon are to support your foot arch so that it doesn’t collapse and to prevent your foot from tilting inwards (pronating) too much when you run or walk. In addition to this supportive role, they also help to point your foot downwards (plantar flexion) and then tilting it outwards (so that the sole of your foot points inwards, i.e. supination). We’ll get back to these movements later on when we discuss rehab exercises. Your tibialis posterior tendon supports your foot arch when you stand and walk and helps to tilt your foot onto its outer edge (supination) and point it down. Posterior tibial tendonitis causes The main injuring movement is when the foot tilts inwards (pronates) excessively – either too quickly and forcefully in one single incident, or too many times repeatedly. Pronation is part of the normal gait cycle (how we run and walk), so we’re talking about excessive pronation here. Excessive pronation forces the tib post tendon to work a lot harder than it normally does and also compresses it too tightly against the foot bones that it wraps around, and this then injures it. Below are some of the more common activities and situations that can cause your foot to pronate excessively. There are also some related tips on how to prevent tibialis posterior tendonitis in the first place. 1. Poor stability This can be due to weakness in the foot muscles, but also in the leg muscles, right up to the glutes. The glutes come into play when they cannot keep your knees aligned properly when you walk or run; so, when your knee turns inwards excessively each time you take a step, this causes the lower leg to tilt inwards, which causes over-pronation. How to fix this: Do exercises that strengthen your feet as well as the rest of your legs (more on this later). 2. Flexible feet in unsupportive shoes People with rigid feet can usually get away with wearing very flexible shoes (e.g. with memory foam or wobbly, soft foam soles) or flat shoes (like flip-flops) that offer little support, but if your feet are quite flexible (like mine), shoes that are too flexible or offer no support can cause you to over-pronate. Unsupportive shoes can predispose you to getting tibialis posterior tendonitis. What shoes are best for very flexible feet? Supportive walking or running shoes that lace up and don't make you wobble when you wear them. Asics and Hoka are two brands that are good, but you can also test your shoe by twisting it (like wringing water out of a towel) – if you can twist it nearly all the way around it is too flexible. As for sandals, Fit Flops , Megnya , and Powerstep are among the brands that make sandals with arch support. 3. Poor form going down hills If you’re not used to walking or running downhill and overdo it, or you do it towards the end of a long run when you’re tired and can’t maintain good running form, it can cause your feet to pronate excessively. Top prevention tip: Try to keep your steps light when you walk or run down hills. The harder you plonk your feet down, the more force goes through your body, potentially increasing pronation. If you're really tired on a run and have to go down a steep incline, rather walk 4. Running or walking on a camber for too long The foot at the higher end of a camber has to pronate more than usual to accommodate the angle of the surface you’re running or walking on. Top tip: If possible, vary the camber or avoid it during your walk or run. For example, on an out-and-back run, run back on the same side of the road that you did the out part. 5. Having a stiff ankle joint or tight calves If your lower leg can’t tilt forwards far enough on your foot (dorsiflex) to accommodate your walking or running strides, your foot has to pronate more to compensate for this lack of flexibility as you push off. This may happen if you have very tight calves, or some people’s ankle bones are simply shaped in a way that limits their dorsiflexion. Top tip for tight calves: If your calves are the problem, doing calf stretches may help. But please don't do these while your tib post tendon is injured, as it usually makes it worse (see below). Top tip for stiff ankle joints: If you have a high foot arch and your foot bones are restricting your movement, wearing a shoe with a higher heel-to-toe drop can help; the angle reduces the amount of dorsiflexion necessary for walking or running. Posterior tibial tendonitis symptoms and tests What tib post tendonitis feels like Tib post tendonitis usually causes pain around the inside of the foot and ankle, but in severe cases it can also cause an intense ache or burn a bit higher up the ankle. It may also cause swelling over the inner side of the ankle and foot. Where you typically feel the pain from posterior tibial tendonitis. The pain typically sets in gradually over the course of a day or a training session. Sometimes you may not notice it at the time, but wake up with pain the morning after an activity. If your injury started with you feeling a sudden pain when you took a step, or if you felt something snap, you may have torn your tib post tendon and need to get it checked immediately. Things that can increase the pain from tibialis posterior tendonitis include: Standing for long periods. Walking long distances. Although, if your tendon is very irritated, walking short distances may also hurt. Running or jumping will likely hurt. Often, the pain is most pronounced at the start of a run or training session, then it eases off as the tendon warms up, but returns worse than before towards the end of the session or several hours after. In severe cases, the pain may be present throughout the training session or even stop you from running and jumping. Walking or running in unsupportive shoes is usually worse. Wearing shoes or insoles that press directly onto the tib post tendon can irritate it. Calf stretches may feel good in the moment, but usually causes increased pain later because the calf stretch position also causes your tib post tendon to pull tight and compress around your ankle bones. Walking either uphill (because it stretches the tendon) or downhill (because it increases the work on the tendon) may hurt. Walking with the injured foot at the bottom of a camber may reduce your pain, whilst walking with it on the top usually increases it. Standing for long periods usually increases your pain when you have tibialis posterior tendonitis. Posterior tibial tendonitis tests Your physiotherapist will likely use the following tests to check whether you have posterior tibial tendonitis: Pressing on the tendon – The pain has to be located on the tib post tendon. If this is not the case, you likely have a different injury. We guide our online patients on how to do this themselves during our video consultations. Stretching the tendon – An injured tib post tendon usually hurts when you stretch it. You can stretch the tendon through movements that combine dorsiflexion (pulling toes up to the shin) with pronation (turning the foot in). If your tendon isn’t very irritated, this test may not hurt. Working the tendon – Forcing the tib post tendon to work when it is injured usually also reproduces the pain. If your tendon is very irritated, even light work (like when it helps you balance on one leg) may make it hurt. If your tendon is less irritated, your physio may have to test it through more loaded exercises (like calf raises or hopping). Your physio will select the best movement test depending on the rest of the information they gather during your consultation. Scans – Most cases can be diagnosed without scans. However, a scan is needed if your physiotherapist suspects a more serious injury, your symptoms don’t fit the typical pattern for tibialis posterior tendonitis, or you’re not recovering as expected. MRI or ultrasound scans are best. X-rays do not show tendons, but may be appropriate if your physio suspects that you may also have injured a bone. Posterior tibial tendonitis treatment First, we’ll look at ways to give your injured posterior tibial tendon a break to allow the pain to calm down, and then we’ll look at exercises to strengthen the tendon back up to its former state as well as strengthening exercises for other muscles to avoid injuring the tendon again. How to reduce posterior tibial tendonitis pain Limit the time you spend on your feet We’re not even talking about running or other sports in the initial stages of recovery – it’s all about giving your injured tendon a break by paying attention to things like standing and walking. Our patients often find that standing for prolonged periods of time really aggravates this injury – often more so than walking or gentle jogging! Remember that the tib post tendon’s main function is to support your foot arch, so it works non-stop when you’re standing. So, at every opportunity, sit down rather than stand. At work, look at what tasks you can do sitting down, or maybe perched on a high chair or barstool. Whenever possible, sit rather than stand. When I had posterior tibial tendonitis in both feet, I was working a 12-hour shift on Thursdays. I would get my tendons to calm down through the week, and then that one shift would set them back so far that I realised I needed to do something. There were types of treatment that I didn't have to do standing up, so I would administer them sitting down. Every time I had to chat to a colleague, I would perch on something. If I found myself waiting for the bus, I would sit down, and if I couldn't sit down, I would try and lean on my arms to take some weight off my feet. Measures like these are just temporary, to allow your tendon pain to calm down. You’ll be able to gradually revert to standing as much as you like once your tendon has recovered. And in the meantime you can still do things like swimming and cycling. Get orthotics that support your foot arches Like limiting time on your feet, orthotics (insoles) that support your foot arches give your injured tib post tendon(s) a bit of a rest so that they can recover. It’s like a little mini-crutch in your shoe. Supportive insoles can reduce the load on your tib post tendon. You can have orthotics made for you by a podiatrist, and this may be advisable if you have very flat feet, but most of our patients do just fine with off-the-shelf orthotics. Don’t get ones that are too hard or with very high arches, because they will press on the tendon and aggravate it further. People with normal foot arches should be able to wean themselves off their orthotics eventually, but if, like me, you have very flexible/flat feet, it may be a good idea to wear them even after you’ve recovered from your injury. These orthotics, available on Amazon, would work well for supporting your foot arches: Correct shoes for posterior tibial tendonitis Good shoes go hand-in-hand with orthotics. Shoes that are too flexible won’t give your foot enough support, which means that your injured tendon will have to work harder. However, don’t tie your shoes too tightly in an effort to increase the support for your feet; the shoes may press on the tendon and aggravate it further. Here are examples from Amazon of supportive shoes that work well for standing, walking and running: So, see if you can get away with wearing shoes that's supportive but don't cause too much pressure over that area. At the beginning, you may find that it helps to tie your shoes really loosely. Later on, of course, you need to tie them properly so that you can get the necessary support. If any type of closed shoe hurts, then a sandal with arch support may help. Here are some examples from Amazon: Stretches – be careful! Injured tendons tend to feel stiff at times – this is due to excess fluid build-up inside the tendon. In the case of posterior tibial tendonitis, you will probably feel the stiffness in your calf and inner ankle, and some treatment programmes prescribe calf stretches and even soleus stretches that you do with a bent knee. I want you to be careful with these, especially if you've got a fresh injury and have just aggravated your tib post tendon. Any stretches where your foot moves closer to your shin (like with calf stretches) cause the tib post tendon to compress tightly onto the bones of the ankle and foot. More often than not, I have found that patients actually flare themselves up with those at the beginning. Any stretch where your toes move closer to your shin will likely irritate your tendon and increase your pain. If you've had your tendon pain for a while and you want to try some gentle stretches, go for it, but don't stretch it too hard at the beginning. Ease into it, and check how your tendon reacts in the next 24 hours, because tendons often only tell you the next morning that you've overdone it. Massage for posterior tibial tendonitis For dealing with stiffness, massage or foam rolling are safer options than stretching. However, don’t massage directly on the painful tendon, even though it may feel good in the short term. Again, compression on the injured tendon usually makes it worse. Rather massage your calf muscles and avoid the painful areas, using a massage ball or foam roller. Posterior tibial tendonitis taping The purpose of the taping is to stop over-pronation. This can be especially useful if you want to ease back into running and you’re not sure whether your recovering or recovered tendon is ready to handle it. A show-and-tell video is more useful for demonstrating how the taping is done, and my colleague Steph Davies has made an excellent video about this. You should remove the tape immediately if your skin has an allergic reaction (red, itchy, or blisters) to it. Posterior tibial tendonitis exercises None of the treatment options above, on its own or in combination, will get your tendon to recover totally. All tendons and tendinopathies need to be strengthened up afterwards to regain their full strength. The tib post tendon can be quite fickle when you try to strengthen it. We usually ask our patients to avoid exercises that target the tib post muscles and tendon until the injury has calmed down quite significantly. But while the tendon calms down, it is possible to get going with some exercises to strengthen other muscles. Strengthening the muscles around your ankle and foot has been shown to help people recover from tib post tendinopathy, but you must also strengthen the rest of your leg. Weak glute and core muscles can cause your leg to turn in when you run and walk, placing extra strain on your tib post muscle and tendon. Exercises that strengthen the tibialis posterior muscle and tendon Once your tib post tendon has calmed down somewhat, it is advisable to start off with an isometric exercise – which means that the foot and ankle don’t move – using an elastic exercise band. Keeping the foot in a neutral position avoids compressing the tendon, which may still be quite sensitive at this stage, against the foot bones. I demonstrate this isometric exercise in this video: When your tendon has calmed down some more, you can progress to doing the exercise with the full range of motion of your ankle and foot, i.e. pulling on the exercise band by moving your ankle and foot. Your physio will guide you on when you're ready to start these. Some exercise bands available on Amazon: Or you can go to the TheraBand Store for more options . Exercises that strengthen other muscles You should be able to start with these exercises even while your injured tib post tendon is recovering from the worst of the pain. They help reduce the strain on the tib post tendon by improving the strength and control around your hips and core. Choose exercises that you can do lying down or sitting, e.g.: Clams Side leg lifts Bridges Crunches Russian twist Cross-training options If you can’t run while you recover from your tib post tendonitis, there are other ways to keep fit. Swimming is usually a good option – kicking off the wall can sometimes hurt, so avoid that. Riding a bike with posterior tibial tendonitis can sometimes irritate the tendon more because of the position of your foot on the pedal (dorsiflexion). But this is not true for everyone, so test a gentle bike ride and observe how your tendon responds in the 24 hours after the ride. Riding a bike with posterior tibial tendonitis can sometimes make it worse due to the position your foot is in. Last-resort treatment options Sometimes, even when our patients are really good and follow the treatment recommendations above, their tib post tendonitis still doesn’t want to get better. In such cases, I would say people should seriously consider investing in going to see a sports physician. Why a sports physician and not a GP? Because sports physicians specialise in sports injuries, including tendon problems. They can usually do an ultrasound scan there and then to see what’s going on. And that's important, because other things can feel like a tib post tendinopathy and then actually not be it. For instance, you can have a tear in your tendon, which can feel very similar, but it will need a different approach. They also have quite a variety of other types of treatment they can add for you. Some patients react really well to shockwave therapy to calm the tendon pain down and allow them to resume their rehab exercises. For others, an injection may be useful. Now, we don't want cortisone near tendons , but sometimes the tendon sheath is inflamed or there are bursas involved, and they can tell that with ultrasound. In extreme cases I have seen people have cortisone injections for this; you just have to treat it very carefully afterwards – they’re usually immobilised in a boot for ten days or so to protect that tendon. And then, very slow-level rehab after that. But note that none of these treatments will heal your tendon; they may only reduce the pain. Afterwards, you will still have to do the strength exercises. So you may as well give the pain management methods and exercises I described earlier a proper go before considering any of these treatments. Posterior tibial tendonitis recovery time In our experience, recovery times for tibialis posterior tendonitis depend on: For how long your tendon has been painful before you started with the correct treatments. What type of sport or activity you want to get back to – it takes longer to get back to high-impact sports that involve running and jumping. Other factors, like the menopause and being older can also increase recovery times. In most cases, you can expect the following recovery times: 8 to 12 weeks if your tendon pain only started in the last couple of weeks and you’re able to rest it and apply the correct treatments immediately, 4 to 9 months if you’ve had your pain for more than a month before starting the correct treatment, more than 12 months if you’ve had your pain for several months. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Bowring B, Chockalingam N. Conservative treatment of tibialis posterior tendon dysfunction—A review. The Foot 2010;20(1):18-26. Kulig K, Pomrantz AB, Burnfield JM, et al. Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]. BMC Musculoskeletal Disorders 2006;7(1):1. Ross MH, Smith MD, Mellor R, et al. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport & Exercise Medicine 2018;4(1):e000430.

We explain why the middle of your back hurts when you’re sitting and how to address these issues. This includes demos of five stretches and two strength exercises. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Causes of middle back pain from sitting Removing the cause of your back pain Exercises and stretches for middle back pain How we can help We’ve also made a video about this: Causes of middle back pain from sitting   The main reasons why you can get middle back pain from sitting are: that you either bend forward too much , that you’re trying to sit upright without proper support , or that you’re simply sitting for too long .   When you bend your spine forward while sitting for extended periods of time, it can cause your muscles, ligaments, and discs to overstretch and become irritated .   Conversely, if you try to keep a good posture by sitting nice and upright, but without proper back support, your muscles can get tired after a while and go into spasm , resulting in back pain. Sitting with "good" posture but no support can also make your back hurt. Our bodies are built for movement. When we don’t move, the circulation to different parts of our body, including our backs, decreases. So, even with the perfect posture, you may still end up with back pain if you remain in one position for too long. Removing the cause of your back pain   Ergonomic chair-desk-computer setup Things that might cause you to bend forward too far and for too long are: Your chair is too far away from your desk. This can especially be the case if your armrests prevent you from getting your chair close enough to your desk. Your computer screen is too low. You can even get back pain from standing for long times and having to bend forward to work on a computer or do other stuff on a surface that’s too low.   Here is our article with much more detail on the best ergonomic chair-desk-computer setup to avoid neck pain  – the advice in there also applies to middle back pain from sitting. The top of your screen should be at about eye level when you sit or stand and work. Proper back support for sitting upright To sit relaxed, your lower back is the most important area that has to be supported.   If the back of your chair doesn’t support your lower back by itself when you’re sitting upright, stick a cushion or pillow in there for support so that your muscles can get a break from having to keep you upright.   I demonstrate the difference this makes in this part of my video on middle back pain from sitting .   Here are some options to help you with lower back support: Middle back pain from sitting on the floor? Teachers often ask me, “My back really hurts when I sit on the floor. What can I do about this?”   The same principles about bending forward and sitting upright without support apply to sitting on the floor. This is especially tricky when you have to work with small children, either as a teacher or with your own.   The best solution is to get up off the floor and use a chair with proper support. If you have a child on your lap, e.g. when you’re reading them a story, take care to lean backwards a bit against something – either the chair back or something else – that can support your back.   There’s always a way to adapt things; it's just that we’re sometimes stuck in the traditional way of thinking about it. So, try to think outside the box and adapt your position. Climbing a flight of stairs is a great active-break option. Move! Taking regular breaks (e.g. every hour) to get some movement going can make a massive difference to back pain. This is the simplest solution of them all, but often the hardest one to implement!   If you struggle to take breaks during the day, another solution is doing some exercise before and after work. Stretches and exercises for middle back pain from sitting   So, you've adapted your position so that you're starting to get those structures to relax, and you're not irritating it any further. What stretches and exercises can you do?   Stretches for middle back pain It’s often tempting to go all out when you’re stretching something that’s painful and uncomfortable, because it feels good in the moment. However, if you are too aggressive with your stretches and it's not a muscle spasm causing your pain but actually an irritated disc or ligament, you can irritate those things even more.   So please be gentle and careful with the following stretches; and especially at the start, just politely ask your back whether it wants to do a particular movement, so that you can learn what it likes and what it dislikes.   1. Back extension stretch You can do this one right there in your chair. 📽️ Video demo   Instructions Place your hands behind your head. Lean backward. Don’t tilt your head backwards; you have to arch your back and push out your chest. Return to the starting position. Do this 10 to 20 times.   Top tip Dynamic stretching, where you move in and out of the position several times and hold a stretch position for just a second or so before letting go, is better than static stretching, where you hold the stretch for a long time, because the former gets your circulation going.   2. Mid-back rotations This one can also be done in a chair. 📽️ Video demo   Instructions Either fold your arms across your chest or put your hands behind your head. The latter will give you a bit more spine extension and result in a stronger stretch. Rotate your upper body side-to-side. Do this 10 to 20 times.   Top tips Rotate gently – don’t use momentum to twist your body as far as possible. If your back is really sore, drop your arms to your side – the movement should be easier. Don’t push into pain.   3. Side flexion stretch You can do this standing or sitting, but standing will be easier if your chair has arm rests. 📽️ Video demo   Instructions Straighten your left arm out to the side, palm of your hand facing forwards, and then slowly raise your arm so that your hand is pointing upwards. At the same time, have your right arm by your side and lower it down by dropping your right shoulder. Hold for 10 seconds, then repeat on the other side. Do this 5 to 10 times.   Top tip Try to bend to the side by curving your spine, as opposed to leaning sideways from your hips.   4. Standing curl-down This is one of my favourites, because you get lovely traction in the spine. 📽️ Video demo   Instructions Stand with your feet hip-distance apart and your knees slightly bent. Put your chin on your chest and tighten up your tummy muscles. Roll your upper body down, upper back first and then the middle back, until you hang from your hips. Inhale slowly and deeply, and then exhale slowly – you’ll feel the traction effect in your back even more – and slowly come back up. Do this 3 to 5 times.   Top tips You don’t have to go as far down as I do in the video – just go to where it’s comfortable. Fold your arms at the bottom for a bit of extra traction.   5. Arm opener stretch This can be really satisfying, but it is quite a strong stretch; so, don’t do it if your upper back is very painful – rather start with the other ones. This one is more appropriate for a stiff or mildly uncomfortable back. 📽️ Video demo   Instructions Lie on your side with your arms straight out in front of you and your hips and knees bent 90 degrees. Lift the top arm up until it is right over your head and then keep going so that it drops down behind you, all while following your arm with your head. Drop your arm only as far as gravity will take it; don’t force it further. As you become more flexible, it will drop down further. Keep your arm level with your shoulder; don’t drop it down nearer to your hips. Keep your hips vertical; don’t tilt them backwards. Inhale deeply and slowly (this will move your ribs and therefore also your spine) and then exhale, relaxing into the stretch. Slowly bring your arm back to the front. Do this 3 to 5 times on each side.   Top tip Place a cushion or pillow under your head if your neck is uncomfortable. Strength exercises for middle back pain In addition to the obvious benefits of strengthening your back muscles, this also improves the circulation in your back, which will contribute to reducing your pain.   1. Rows An added benefit of rows is that they strengthen your core in addition to your back muscles – if you keep your back nice and straight while doing them. You can do this sitting or standing, and with an exercise band or on the rowing machine in the gym. These instructions are for seated rows with an exercise band.   📽️ Video demo   Instructions Tie the exercise band at about hip height to something sturdy. Sit upright (imaging trying to “grow tall”, with the top of your head reaching for the ceiling) and grip the ends of the exercise band with your hands and elbows shoulder-width apart. Pull the two ends of the exercise band towards you while maintaining shoulder width with your hands and elbows. Go until your elbows have gone past your sides. Don’t just bend your arms; your shoulders should move backwards, and your shoulder blades should move towards each other. Slowly bring your arms back to their starting position. Do 3 sets of 10 to 15 reps with 1 minute rest between sets.   Top tip The exercise band should already have some tension in it in the starting position, otherwise the start of the movement is too easy.   Here is a selection of exercise bands available on Amazon. You can also visit the TheraBand Store  for more options.   2. Back extensions – Prone salute This is a good one if you don’t have exercise bands or access to a rowing machine. It strengthens your back and neck extensor muscles. 📽️ Video demo   Instructions Lie on your front with your forehead on the floor and your palms facing downwards, in line with your head, shoulder-width apart. Tense your stomach muscles and keep them gently contracted throughout the exercise. Lift your head and shoulders off the floor; use your back muscles, don’t push with your arms. Hold for 5 to 10 seconds before coming down slowly. Rest between repetitions for as long you’ve been holding it. Do 10 repetitions.   Progressions (making the exercise more difficult) Place your hands, palms facing downwards, under your forehead. Once you’ve lifted off the floor, lift one arm, hold for a while, drop it down, and then do the same with the other arm. As above, but lift both arms simultaneously and hold them there.   Top tips If your lower back doesn’t like it when you lie in this position, place a cushion or pillow under your stomach and make sure to contract your stomach muscles. Don’t strain to lift as high as you can; just to where you can feel your back muscles tensing. How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate .

This article explains the clamshell exercise’s benefits as well as progressions, e.g. with exercise bands, to make it more difficult. Does the clamshell exercise hurt? We explain why this might be and what you can do instead. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Clamshell exercise benefits The basic clamshell Clamshell exercise progressions - How to make them more challenging Why the clamshell exercise may hurt Clamshell exercise variation How we can help I demonstrate the clamshell exercises described below in this video: Clamshell exercise benefits You may have heard some trainers and physiotherapists say, “The clamshell exercise is a waste of time; it's not a functional exercise; you want to be doing functional exercises.” But that's a bit short-sighted, because there are situations in which the clamshell exercise can be valuable.   1. It targets the gluteal muscles When we do a squat, we use our gluteal muscles in our hips to prevent our knees from collapsing inwards and to keep them nicely in line with our feet. However, this is quite difficult for people whose gluteal muscles are weak or untrained. Or people simply don’t understand how to do that corrective movement using their glutes. In these cases, the clamshell is an effective way to teach you how to create the turning out movement using your glutes and to strengthen up those gluteal muscles to be able to do proper squats later on.   Also, if you have a hip injury, the clamshell is a good way to compare the strength of your glutes on the injured side to those on the uninjured side, and then to strengthen up those weak muscles until they are on par with the uninjured side. You may not be able to do functional exercises while you're injured, so the clamshell exercise can help you to maintain your glute strength. 2. When an injury prevents you from doing other exercises When you have an injury, e.g. to your knee or foot, that prevents you from doing more functional exercises, such as squats, the clamshell can be a good substitute for strengthening the glutes until other exercises are possible again. 3. Core control The clamshell exercise teaches you to move your leg without moving the rest of your body. This is an important skill to master for controlling your core. The basic clamshell exercise 📽️ Video demo   Instructions Lie on your side. Make sure your hips are vertical; so, the top one should not be leaning forwards or backwards. Your thighs can be anywhere from a 30-degree angle to a 60-degree angle to your hips – whatever is comfortable. Your top foot should be on top of the bottom foot. Tighten your tummy muscles gently. Lift your top knee, rotating it backward as far as is comfortable while keeping your feet together and your hips vertical. Bring the knee back down slowly.   Top tips If you can't get down to the floor because you've got a knee injury, or your hip just doesn't like lying on a hard surface, do it on a bed or anywhere you're comfortable. Later, when you get better, you can move to the floor or use a nice, thick mat. If your head is hanging uncomfortably, put your hand or arm or a pillow under it. You can place the top hand on the floor in front of you for more stability in the beginning. Clamshell exercise progressions – How to make them more challenging   When you can do three sets of 15 of a specific type of clamshell exercise, you’ve reached the limit of its benefits because you’re now strong enough for it. So now it’s time to make things somewhat harder.   Clamshell exercise with band 📽️ Video demo   Instructions Put or tie an exercise band around your thighs, just above the knee. Do the basic clamshell exercise as described above. Make sure to lower your leg very slowly against the resistance – if you allow the exercise band to drag your leg down quickly, you’ll lose the benefit of the exercise.   Top tips Tie the band so that your legs are close together; you want resistance from the moment that you lift your top leg. Start with a low-resistance band (usually the yellow one) so that you get the full range of motion, but it’s just a bit tougher than without the band. Rest for about a minute when you switch sides so that your muscles are well-rested each time you start.   Progress to an exercise band with more resistance as soon as you can do three sets of 15. Here is a selection of exercise bands available on Amazon. You can also visit the TheraBand Store  for more options. Clamshell exercise with unsupported foot If you don't have an exercise band, you can make the clamshell exercise more difficult by lifting the top foot slightly, so that it doesn’t rest on the bottom one. 📽️ Video demo   Instructions Position yourself on the mat as if you're going to do the classic clamshell exercise. Lift your top foot, so it hovers about 5 cm to 10 cm above your other foot. Now, rotate your top knee up and back. Try to keep your foot still and hovering in the same spot. Then reverse the movement, slowly lowering your knee until your knees touch.   Top tip Use your stomach muscles to stabilise yourself. Because your top foot is no longer resting on your bottom foot, this version of the clamshell becomes as much a stability exercise as a strength exercise.   Clamshell exercise with feet lifted 📽️ Video demo Instructions Assume the classic clam starting position. Then, lift both feet up off the floor – they must remain in this position throughout the exercise. Perform the classic clamshell movement, slowly turning the top knee up and out. Complete all your repetitions before lowering your feet to the floor.   Top tip You will feel that your bottom glutes are now also working (as an isometric clamshell, to keep the bottom foot up off the floor), so make sure you rest well between repetitions. Why the clamshell exercise may hurt   1. Range of motion too big When you try to open your legs wider than their current range of motion and you strain to lift the top knee quite high, it can cause things to pinch or cramp when you’re at the top.   2. Legs at wrong angle Also, not everybody's hips have the same range of motion. So, sometimes it doesn't like the angle you place your legs at, and you can then get a pinching in the groin when you do the clamshell movement. So, don't force anything; adjust your leg position if it’s uncomfortable.   3. Not stabilising properly If you allow your hips to lean backwards and things move in an uncontrolled way, it might put strain on your back, especially if you have a back injury or your back muscles are not strong enough.   4. Injuries that can be aggravated by the clamshell exercise In my experience, the clam exercise usually makes the following injuries feel worse.   Gluteal tendinopathy and/or hip bursitis I couldn’t find any research to explain why this happens. Here’s what I think: There is evidence that when you do the clam, it also activates the tensor fasciae latae. This muscle runs over your hip, where the bursa is. So, when you do the clamshell, the tensor fasciae latae rubs over the gluteal tendons and/or bursae which are already irritated. But I think it possibly also pinches the injured tendons when you’re at the top of the movement.   When you have gluteal tendinopathy, there are better exercises to do than the clamshell – here’s an article about that .   High hamstring tendinopathy Same as with gluteal tendinopathy, I think it's about how the high hamstring tendons attach to the sit bone, and there's something about the clamshell exercise action that just irritates them when you open and close the legs.   Piriformis syndrome Some people do the clamshell action to try and strengthen the piriformis. First, you don't actually strengthen the piriformis that well in the clam position; it works more when your legs are a bit straighter. But also, when you have piriformis syndrome, your sciatic nerve is often irritated. If you think of the sciatic nerve running either under the piriformis or often through it, doing an action like the clamshell can really irritate it more.   Clamshell exercise alternative   When it really hurts your bottom hip when you lie on your side, or your neck just doesn’t like that position, you can do “clamshells” on your back with an exercise band instead of gravity providing the resistance.   📽️ Video demo   Instructions Lie on your back with the exercise band around your thighs just above the knee. Keep one leg steady while moving the other leg outwards and downwards. Slowly bring back the leg that you moved; don’t allow the exercise band to let it snap back.   Top tips Put a pillow under your head if you feel that your neck needs it. You can do up to 15 repetitions with one leg at a time, or you can alternate the legs as you go along. When you do this version of the exercise, both your legs are working (the one to stabilize and the other to create the movement). So, you must rest between sets to allow both legs to fully recover. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Reiman, M. P., Bolgla, L. A., & Loudon, J. K. (2012). “A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises” Physiotherapy Theory and Practice 28(4), 257-268 . Moore, D., Semciw, A. I., & Pizzari, T. (2020). “A systematic review and meta-analysis of common therapeutic exercises that generate highest muscle activity in the gluteus medius and gluteus minimus segments” International Journal of Sports Physical Therapy 15(6), 856-881 . Giphart, J. E., Stull, J. D., LaPrade, R. F., Wahoff, M. S., & Philippon, M. J. (2012). “Recruitment and activity of the pectineus and piriformis muscles during hip rehabilitation exercises: an electromyography study” The American Journal of Sports Medicine 40(7), 1654-1663 . Sidorkewicz, N., Cambridge, E. D., & McGill, S. M. (2014). “Examining the effects of altering hip orientation on gluteus medius and tensor fascae latae interplay during common non-weight-bearing hip rehabilitation exercises” Clinical Biomechanics 29(9), 971-976 .

Lower hamstring tendonitis, also known as distal hamstring tendinopathy, usually creates pain in the back of the knee. However, there are many other conditions that feel similar; this article explains the causes and symptoms. It also describes three of the best lower hamstring tendonitis exercises and explains why recovery times can range from a few weeks to more than a year. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: Anatomy of the hamstrings What do the hamstring muscles do? Causes of lower hamstring tendonitis What does lower hamstring tendonitis feel like? Other conditions that cause pain in the same area Diagnosis of lower hamstring tendonitis How long to recover? Treatment for lower hamstring tendonitis How we can help We've also made a video about this: Anatomy of the hamstrings Your hamstrings are the muscles that run down the back of our thigh, and together they comprise three muscles: semitendinosus, semimembranosus, and biceps femoris. The biceps femoris has a long head and a short head. The semitendinosus and semimembranosus muscles are attached to your sit-bone (ischial tuberosity) and run down the inner part of the back of the thigh to attach via the distal (lower) tendons to the inner back corner of the knee (semimembranosus) as well as towards the front inner side of the knee (semitendinosus). The long head of the biceps femoris originates at the sit-bone and the short head a little bit lower down on the thigh bone (femur). Both of their lower tendons attach to the outer back corner of the knee as well as to the side of the knee onto the head of the fibula. Where the hamstring tendons cross the knee joint, you also find several bursae. A bursa is a small fluid-filled sac that is meant to reduce friction between tendons or between tendons and bones. The lower hamstring tendons compress more against the other tendons and your knee joint when your knee is straight compared to when it is bent. This is why it is often more comfortable to start your rehab exercises in positions that avoid the last 30 degrees of straightening your knee. What do the hamstring muscles do? At the hip Your hamstrings help to extend your hip and stabilise your pelvis when you walk, run, and jump. At the knee They are the main muscles responsible for bending your knee (flexion). But they also support the anterior cruciate ligament and help it to stabilise your knee, preventing your shin bone from sliding forward on your thigh bone. Finally, it also prevents your knee from overextending (going past its normal straight position) when you walk and run. When we walk and run When we run and walk, we kick our legs forward and our knees straighten out. But we don’t really want our knees to lock fully straight with every step we take. This is where the hamstrings come in. As your knee approaches full extension, your hamstrings contract and slow that movement down. They do this through an eccentric contraction, which means they actually have to lengthen while they contract. You have to keep this in mind when you choose what exercises to do during your rehab. Causes of lower hamstring tendonitis Lower hamstring tendonitis is caused by overuse. It can be divided into primary and secondary tendonitis, depending on how the overuse happened. Causes of primary low hamstring tendonitis Primary low hamstring tendonitis can develop when you overuse your tendons by doing a single training session, race, or match that works them much harder than what they are used to. But it can also develop gradually if you don’t allow your tendons enough recovery time in between challenging sessions. Your body requires a certain amount of time to restore and rebuild the micro-damage (which is normal) caused by exercise. If you allow it enough recovery time, it not only repairs your tendons, muscles, and bones but actually makes them stronger than before. However, if you train again before the repair process has been completed, the micro-damage accumulates and eventually causes overuse injuries like tendonitis or tendinopathy. Common training errors that can lead to primary tendon overload include: A sudden increase in the intensity, frequency, and/or duration of training sessions, races, or matches Not enough recovery time Doing a new sport too intensely right from the start. Lower hamstring tendonitis is more common in sports or activities that require repetitive flexion and extension of the knee, especially when it is done with high force, e.g.: Race walking Running (fast as well as long distance) Cycling Triathlon Weightlifting Causes of secondary low hamstring tendonitis Secondary lower hamstring tendonitis develops when another condition or injury increases the strain on the lower hamstring tendons. Research has shown that the following conditions or factors may cause low hamstring tendonitis: Knee replacement surgery Osteoarthritis Anterior cruciate ligament tears MCL injuries Excessive foot pronation Bursitis It is quite common for the bursae under the lower hamstring tendons to get injured by the same activity or condition that caused the injury in the lower hamstring tendons. If you have such a bursitis, your treatment plan has to be adapted to accommodate this. Keeping your knees more bent during your exercises may be better since that reduces the amount of compression on the bursae. What does lower hamstring tendonitis feel like? Where you feel the pain will depend on which of the lower hamstring tendons are injured. You can have tendonitis in any or all of them. The main symptoms of lower hamstring tendinopathy are pain (an achy feeling) and stiffness. Some people will just have pain, others just stiffness, while others will experience both. The symptoms usually set in gradually during a session, or you may feel it only several hours afterwards. With lower biceps femoris tendonitis, the discomfort is mainly located over the outside of the knee. It can be more to the front, in the area where the tendons attach to the fibular head, or in the outside back corner of the knee. Lower semitendinosus and semimembranosus tendonitis cause pain and/or stiffness at the inside back corner of the knee. Pressing on the affected hamstring tendons in that area usually reproduces the pain. It usually hurts to bend your knee against resistance. The pain is often aggravated by prolonged jogging, fast running, cycling, climbing, or lifting weights. The pain may be most noticeable at the start of a training session, then ease off, only to increase again towards the end of the session or several hours later. It is usually possible to train through the discomfort and pain during the early stages of having the injury, but if you continue to aggravate it, the tendons usually become really irritated, causing more constant pain that may stop you from doing sport. It can often feel very stiff first thing in the morning or after sitting still for long periods. This is due to fluid and chemicals produced by the injury process accumulating when you don’t move. Once you get up and move a bit, your circulation usually increases, which helps get rid of these irritants and your knee starts to feel more comfortable. Your hamstring muscles may feel weak or as if they don’t want to work properly. Sometimes it may cause your knee to feel a bit unstable. The main pain is located in the back or sides of the knee, but it can refer into the calf or the back of the thigh. Other conditions that cause pain in the same area Other conditions that can cause pain that may be confused with distal hamstring tendonitis include: Lower hamstring tendon tears – if you felt a “pop” or a sudden, sharp pain when you injured your knee, you’ve likely torn something. Bursitis in any of the bursae that lie under the semimembranosus, semitendinosus, or biceps femoris tendons (this often occurs in combination with low hamstring tendonitis). Osteoarthritis Bone bruising Baker’s cysts Calf muscle injuries Popliteal muscle injuries Referred pain from the lower back Conditions specific to inner knee pain: MCL strains or tears Medial meniscus tears Pes anserine bursitis Lower adductor tendonitis or bursitis Conditions specific to outer knee pain: Lateral collateral ligament strains or tears Lateral meniscus tears Iliotibial band syndrome Diagnosis of lower hamstring tendonitis An experienced sports physiotherapist or doctor will be able to diagnose lower hamstring tendonitis through taking a thorough history of how your injury developed, how it is currently reacting to various activities, and making you do some movement tests. MRI scans are usually best to confirm the diagnosis of lower hamstring tendonitis and to exclude other injuries. Ultrasound scans can show tendon injuries, but it does not show what is going on inside the joint, so it can’t rule out any injuries there. X-rays only show bone injuries and are not very useful in this case. How long to recover? Understanding what happens inside the tendons will help you to understand why specific treatments are prescribed. It also explains why some cases can recover within a few weeks while others can take up to 18 months. Tendonitis or tendinopathy can be divided into three stages that often overlap. Acute or reactive stage: This is when your tendon first becomes injured. It usually feels pretty sore, sensitive, and sometimes even a bit swollen, but it usually hasn’t lost much strength and has not yet undergone any structural changes. If it is provided with the correct mix of rest and exercise, it can usually recover within a few weeks. Dysrepair stage: At this point, the pain and symptoms have been grumbling for a few weeks or more, and it worsens or improves depending on the activity it is being subjected to. A tendon injury enters this stage when it doesn’t receive the correct treatment to allow it to heal. Instead of healing, the injured part of the tendon now starts to change its structure and it loses some of its strength and endurance. If a tendon has entered the dysrepair stage, recovery usually takes about four to nine months. Degenerative stage: A tendon is usually in the degenerative stage if the symptoms have been present on and off for several months. In this stage, the tendon’s structure has changed significantly, causing it to lose quite a lot of strength and endurance. Tendons that have entered the degenerative stage usually recover within 12 to 18 months of starting the correct treatment plan Treatment for lower hamstring tendonitis There is very little research available that looks specifically at the treatment for lower hamstring tendonitis, so the advice in section also gleans from the research done on tendon injuries in other areas of the body and my own experience. The current research shows that the most effective treatment for any type of tendonitis or tendinopathy is a combination or relative rest and a graded strength training plan. But you also need a good dose of patience, because this type of injury recovers very slowly. Relative rest The research shows that people tend to recover better from tendonitis or tendinopathy when they avoid resting for prolonged periods of time. But this doesn’t mean that you can just ignore your injury and train through it. To allow your pain to settle down and your tendons to heal, you do have to reduce or adapt your activities to a level that doesn’t irritate your tendons. This is called relative rest. How do you know if you’re doing it right? The rule with rehab and exercise is usually that an activity is OK to do as long as: It only causes slight discomfort while doing it (you may be aware of it, but it doesn’t go above a slight sensation or discomfort), AND It does not cause an increase in your daily levels of pain and stiffness that lasts for more than 24 hours. So, if your tendons feel quite a lot more sensitive or stiff several hours after you’ve done a specific activity (including your rehab), it may have been too much. You should try avoiding or modifying that activity or, if it was a rehab session that’s to blame, try an easier rehab session next time. Strength exercises for distal hamstring tendonitis Strength exercises can help to restore the strength and endurance in the injured part of your tendon and restore its ability to cope with the load placed on it by your sport. They do this by stimulating your tendons to produce new and stronger collagen fibres (the main building block of tendons). What exercises you do during your recovery should match your tendons’ current strength and sensitivity; it should also change as your injury heals. During the early stages, the aim is to allow your tendon pain to settle down, to allow the tendons to start their own healing process, and to maintain their current strength. Next, the aim gradually shifts to regaining your lost strength and restoring your tendons’ capacity to safely do your sport. A common mistake I see is that people are often too motivated to get better, and then they overdo their rehab, either doing the exercises too often or just doing too much. As a result, their tendons remain painful and sore, and they don’t really progress. Allowing your tendons enough recovery time is just as important as doing your exercises. Your body can only rebuild and repair itself if you give it enough time to do so. A well-rounded rehab plan for lower hamstring tendonitis should: Be designed to match the individual’s goals – the rehab plan for someone who just wants to walk will look very different from that of someone who wants to run, jump, or cycle hard. Not cause a significant or lingering increase in your pain – use the pain monitoring guideline provided under relative rest (see above) to gauge this. Contain a mix of higher load days (where your tendons work a bit harder) and low-load or recovery days where they get to rest, rebuild and strengthen themselves in response to the high-load days. How many recovery days you need or what exercises you do on which day will depend on your specific case. Only increase in intensity once your tendons are fully adapted to the current load. Avoid sudden or large increases in weight, reps, or how often you do the exercises. Gradually increase the amount of load (how much work they have to do) the hamstring tendons have to tolerate until it matches the loads created by your sport or the activities you want to do. Gradually get the tendons used to being compressed against the bones and other tendons around the knee joint. Gradually get the tendons used to working in positions that stretch them, until they can work through their full range of motion. There are several types of exercise you can use. For this article, I’ll focus on the three most commonly used ones that can be performed using simple pieces of equipment and that can restore the main functions of the hamstring tendons: Bridges – Mainly develop static control at the knee and hip extension strength. Hamstring curls – Eccentric hamstring action and dynamic control at the knee similar to what we use during walking and running. Deadlifts – Eccentric hamstring action and control at the pelvis but also static control at the knee. Bridges During the early stage of recovery, the lower hamstring tendons often don’t react well to exercises that create a lot of movement around the knee joint. So isometric bridges (where you just hold the position) are often a good starter exercise. Whether you choose isometric bridges or bridges where you repetitively move up and down, the same principles of progression apply. There are several ways in which you can adapt the bridge exercise to suit your tendon’s current capacity: Angle of the knee – The straighter your knees are, the harder the hamstrings have to work, and the more compression the lower hamstring tendons have to absorb around the knee joint. Hold time – The longer you hold it for, the harder your hamstring have to work. Repetitions and sets – The more repetitions or sets you do, the harder it works. Double leg vs. single leg – Doing the bridge supported on one leg is harder work than doing it on two. Lifting your feet onto a chair – This usually makes the hamstring work harder, especially if you push with your heel down onto the chair as opposed to placing the sole of your foot against the edge. Resting a weight across your lower stomach or pelvis. Basic floor bridge with knees bent to 90 degrees. A good starter exercise for anyone with a sensitive lower hamstring tendon is therefore: A floor bridge with their knees bent about 90 degrees or more Supported on two legs Without extra weight And held for short intervals, e.g. 10 seconds hold, rest for 10 seconds, and repeat 6 to 10 times This can usually be done daily because it is a low-load exercise, but in some cases only every other day. This high bridge position loads the hamstrings more but avoids strong compression or stretch at the knee. This can then be progressed by: Holding the bridge for longer, e.g. 30 seconds hold, 30 seconds rest, repeat 5 times Or placing your feet a bit further away so your knees are a bit straighter Or adding weight Or switching to single-leg support Or placing your feet on a step. Or placing your feet on a ball. Having your knees straighter increases the work for the hamstrings and compression on the lower tendons. Placing your feet on an unstable surface makes your hamstrings work even harder. To avoid overloading your tendon when you progress the exercises, it is best to increase one variable at a time. I usually advise my patients to first increase the hold times until they can tolerate a decent amount of time (e.g. 30 to 60 seconds x 4). Then I might get them to move their feet slightly further out, so their knees are straighter, but at the same time start with shorter holds again. If their pain response to this new position is OK, then they can gradually increase the hold time again. Only once they can tolerate long holds with their knees straighter do I get them to test single-leg support, again starting with their foot close to their bottom. Doing a single-leg bridge with your knee almost straight, supported on an unstable surface, is very hard work for the hamstrings. The hardest type of isometric bridge I get my patients to work towards is: With their heel pressing into a low bench Their knee only slightly bent – to about 10 degrees Supported on one leg only Held for between 30 and 60 seconds x 3 to 4 repetitions, with 60 seconds rest between repetitions. And sometimes with extra weight resting on their pelvis. But I would only go to this level if this is the level of strength and endurance required by their sport. Hamstring curls My patients often get the best results if they can use a hamstring curl machine in the gym, but you can also use resistance bands. A drawback of the bands is that they don’t provide uniform resistance through the full range of movement, and you can’t really get to a very high resistance. For my patients who can’t get to a gym, I tend to switch them to doing curls with a large ball once they are ready to move on from the bands. As mentioned earlier, your hamstrings have to contract eccentrically when you walk and run. Hamstring curls are one of the best ways to retrain your hamstrings’ eccentric action, but you may want to restrict the range of motion initially to reduce the amount of stretch and compression your lower hamstring tendons have to deal with. Prone hamstring curls that avoid the last 30 degrees of knee extension produce the least amount of stretch and compression in the lower hamstring tendons. I usually start my patients off with: Prone hamstring curls – This reduces the stretch on the hamstrings because the hip is not flexed. Restricting the range of motion so they stop about 30 degrees short of full extension or stick to their own pain-free range if this is uncomfortable. Building good strength, using double legs first if using a machine, or a light band if using resistance bands. Switching to isometrics (holding still in one position) if the repetitive bending and straightening irritates their tendons. If they are using a machine, some of the obvious progressions are: Increasing the weight Switching to single leg curls Switching from using the prone curl machine to a seated curl machine which increases the compression and stretch in the lower hamstring tendons. Doing seated hamstring curls increases the amount of stretch and compression on the lower tendons and resembles how they work when your run and walk. If they use resistance bands, I usually progress them by: Using stronger bands Switching to slow ball curls using both legs – often starting by not extending the knees past halfway and gradually working to get full range Finally switching to single-leg ball curls. Ball curls is a good high-load alternative to using the leg curl machine in the gym. Some resistance bands available on Amazon: Or you can go to the TheraBand Store for more options . Romanian deadlifts Romanian deadlifts also develop the eccentric action of the hamstrings but in a slightly different way; the movement now happens mainly at the pelvis. It has the added benefit of improving your balance and control when you progress to doing them on one leg. It's often best to start by simply doing the movement without any extra weight. I usually start my patients off with: Double leg deadlifts I may restrict how far down they go initially if the full position aggravates their pain; the lower you, go the more stretched the hamstrings are. I progress them by: Increasing weight Getting them to work towards achieving full range of movement. I often use a mix of double-leg and single-leg deadlifts depending on what we want to achieve. If we are looking for pure strength gains, I would add weight to the double-leg deadlifts because you can’t really do that safely with single-leg ones. If you want to lift heavy for maximum strength gains, double-leg deadlifts usually work best. But if control is more important or I really want to ensure that they are using the injured leg and not compensating with their uninjured one, I may get them to add in single-leg deadlifts with or without weight. If your main goal is to improve control, single-leg deadlifts may be best. Exercises for the rest of the body Our bodies work as kinetic chains, with every part of it affecting the next. So you can reduce the work your hamstrings and their tendons have to do by ensuring that the muscles in the rest of your body are as strong as they should be. A well-rounded rehab plan for lower hamstring tendonitis should therefore include exercises for your calves, quads (front thigh muscles), and core. Avoid hamstring stretches at the start Your hamstrings usually feel very tight and uncomfortable when you have lower hamstring tendonitis, which naturally makes people want to stretch them. Or you may even have been told that it is due to having tight hamstrings that you got the injury in the first place (the research does not support this claim). In my experience, doing hamstring stretches during the early stages usually just ends up irritating the tendons. Typically, doing hamstring stretches can feel really good while you’re doing them, but they then cause an increase in pain several hours later. Often when I ask people to stop stretching their hamstrings the pain that has been niggling them for months finally starts to calm down. Hamstring stretches can often irritate the lower hamstring tendons further. The reason your hamstrings feel tight when you have distal hamstring tendonitis is because the irritated tendons also irritate the muscles, causing them to tighten up. The stiffness usually disappears as the tendons recover. A better option than stretching may be to use a foam roller; avoid the tendons and target the muscle bellies of the hamstrings. Foam rolling your hamstrings may be a better option than stretching. Of course, this will not be true for everyone. Some people may find that hamstring stretches truly help them. But if your hamstring pain is not really settling down and you’ve been doing hamstring stretches, see what happens if you stop them for a couple of weeks and foam roll your hamstrings instead. Also, if you have increased neural tension , doing hamstring stretches or neural sliders may be very useful, but you should always monitor how they affect your symptoms. Neural tension Your sciatic nerve is a thick nerve that runs down the back of your leg. It runs close to the hamstrings and splits into several branches. One of these branches curl around the knee in the same area your biceps femoris tendon runs. When we move our legs, our nerves are meant to slide and move with it. If our nerves are prevented from sliding (e.g. a muscle holds on to them or perhaps you have a lower back injury), they can become irritated and cause pain. We then say a person has increased neural tension. Physios and doctors can easily test for increased neural tension by getting you to perform specific movement tests, e.g. the slump test for the sciatic nerve. The slump test assesses neural tension in your sciatic nerve. Increased neural tension in the sciatic nerve can either mimic lower hamstring pain or it can develop as a result of having long-standing hamstring pain. If your physio finds that you have increased neural tension, they will usually include exercises to address this. Correcting overpronation Some researchers argue that excessive pronation at the foot and ankle (turning in) can increase the strain on the inner knee and may contribute to semimembranosus and semitendinosus tendonitis. These patients may benefit from shoes and/or shoe inserts that stop their feet rolling in so much, and exercises that strengthen their ankles and feet. Shockwave The research on the usefulness of shockwave for tendon recovery is still inconclusive; sometimes it works and other times it doesn’t. If you’re stuck and not making progress, it may be worth trying since it is seen as a low-risk intervention. Injections There is currently very little to no research that looks specifically at injections for lower hamstring tendonitis. If we look at the research for tendonitis in general, there is evidence that PRP injections may be of use. Corticosteroid injections into or close to the tendons should usually be avoided since this may actually negatively impact healing or cause ruptures. The exception is for cases where there is a chronic lower hamstring bursitis contributing to the pain. In those cases an ultrasound guided corticosteroid injection into the bursa (not the tendon) may be beneficial. Surgery If you’ve tried a carefully graded rehab plan, shockwave, and injections without any real progress, surgery may be an option. It is worth noting that tendons take a very long time to recover, so it is advisable to do your rehab for at least 12 months before considering surgery. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon) Chan, W., et al. (2016). "Calcific tendinitis of biceps femoris: an unusual site and cause for lateral knee pain." Case Reports 2016: bcr2016215745. Sederberg, M., et al. (2022). "Distal semimembranosus tendinopathy: A narrative review." PM&R 14(8): 1010-1017. Oyasato, T. (2021). "Lower Extremity Strengthening, Neuromuscular Re-Education And Graded Activity For A Runner With Distal Hamstring Tendinopathy: A Case Report.” Akhtar, M. A., et al. (2020). "A rare case of calcific tendinitis of biceps femoris presenting with lateral knee pain." Journal of Clinical Orthopaedics and Trauma 11: S660-S662. Manning, B. T., et al. (2015). "Diagnosis and management of extra-articular causes of pain after total knee arthroplasty." Instr Course Lect 64: 381-388. Yoon, M. A., et al. (2014). "High prevalence of abnormal MR findings of the distal semimembranosus tendon: contributing factors based on demographic, radiographic, and MR features." American Journal of Roentgenology 202(5): 1087-1093. Bylund, W. E. and K. de Weber (2010). "Semimembranosus tendinopathy: one cause of chronic posteromedial knee pain." Sports Health 2(5): 380-384. Krishna Sayana, M. and N. Maffulli (2006). "Tendon injuries." Football Traumatology: Current Concepts: from Prevention to Treatment: 165-182.

Do you get knee pain during your core and glute exercises? Sports physio Maryke Louw demonstrates eight core and glute exercises that are easy on your knees. She also gives some tips on how to adapt or replace each of these exercises if your knees are still complaining. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: How to gain the most from these core and glute exercises Isometric crunches Isometric curl-downs Russian twists Ball rotations Prone leg lifts Side leg lifts Clams Glute bridges How we can help We’ve also made a video about this, and the article has links to the video clips that demo each of the exercises: How to gain the most from these core and glute exercises Before we start, a few things to help you get the maximum benefit from these exercises. I’ll be demonstrating eight exercises – four that target mostly the core and four that target mostly the glutes but also some core. You don’t have to do them all. Some of them work the same muscle group, just in different positions and with different techniques. The idea is to pick the ones that work best for you and your knees. You know the mantra “No pain, no gain”? That is a silly and dangerous approach. If an exercise causes you pain – in the knees or elsewhere; while you’re doing it or in the 24 hours afterwards – it either has to be adapted, or you’ll have to ditch that specific exercise and try another one from the options I’ve provided here. The exercises do not have to be done on an exercise mat on the floor. If it hurts you knees to get down on the floor, it’s fine to do them on your bed. When the instructions below say, “gradually increase” or “work your way up to”, it means over the course of several weeks (or however long it takes) , not within one exercise session. 💡These exercises are safe for most people. But if you have a serious knee injury or a chronic health condition, they may not be right for you – check with your doctor or a physio before you try them. Isometric crunches Targets: Your core. 📽️ Video demo Instructions Lie on your back, feet flat on the floor, knees bent about 90 degrees. Tighten your tummy muscles and push your lower back into the floor by tilting your pelvis backwards. Slowly lift your head, then your neck, then your upper back off the floor. Hold the position for 5 to 10 seconds. Come back down: upper back first, then neck, then head. Rest for as long as you held the position. How many? Gradually increase the duration of your holds until you reach anything from 30 to 60 seconds. Again, rest for as long as you’re holding it. Once you can do 4x30 sec or 3x60 sec holds with good control and form, you can move on to making it more difficult. How to make it more difficult Do movements with your arms while you’re holding the position, e.g. side-to-side movements, “marching” movements. You could hold light weights or do the arm movements with resistance bands to make it even more challenging. 💡 Top tips If your knees aren’t comfortable at 90 degrees , straighten them somewhat. You could also put some cushions under the back of your knees. If your neck isn’t comfortable , support it by putting your hands behind your head. Alternatively, isometric curl-downs (see below) may be a better exercise for you. Isometric curl-downs Targets: Your core. 📽️ Video demo Instructions Sit up straight, feet flat on the floor, knees bent about 90 degrees. You can hook your feet under something sturdy like a couch/sofa if you want, but make sure you use your stomach muscles for this exercise and not your hip flexors (at the front of your hips). Tighten your tummy muscles and lower yourself backwards a little by curling your spine at your lower back. Make sure not to “hinge” back at the hips with a straight spine (that is also an exercise, but it’s not the one you’re meant to be doing here). Hold the position for 5 to 10 seconds. Slowly come back into the upright position. Rest for as long as you held the position. How many? Gradually increase the duration of your holds until you reach anything from 30 to 60 seconds. Again, rest for as long as you’re holding it. Once you can do 4x30 sec or 3x60 sec holds with good control and form, you can move on to making it more difficult. How to make it more difficult Go down lower and then hold it. Have a weight on your chest. Do movements with your arms while you’re holding the position, e.g. side-to-side movements, “marching” movements. You could hold light weights or do the arm movements with resistance bands to make it even more challenging. 💡 Top tips If you have lower back issues, this exercise might not be the best for you – rather do the isometric crunches. Like with the isometric crunches, adjust the angle of your knees so that they’re comfortable. If your feet aren’t hooked under something sturdy and they lift off the floor when you go down, it's because you are not controlling the movement properly with your tummy muscles; practice the movement in a shallower position first and concentrate on the balance in your body. Russian twists Targets:  Your core and especially your oblique (side) stomach muscles. 📽️ Video demo Instructions Start in the same seated position as for the isometric curl-downs. You can hook your feet under something sturdy, but you will get better practice at controlling the movement properly if you don’t. Same curl-down as for the isometric curl-downs. Hold the position and slowly twist your torso from side-to-side. Don’t force the movement – go only as far as is comfortable. Keep your tummy muscles tight and your lower back rounded – don’t arch your back. Slowly come back into the upright position. How many? Work your way up to 3 sets of 10 to 12 repetitions (side-to-side twists) each. Rest 1 minute between sets. How to make it more difficult Hold a weight in your hands. Once you can twist far enough with a weight and with good control, you can place the weight on the floor at the end of the twist and then pick it up again before twisting to the other side. 💡 Top tips If you have back issues , the ball rotation exercise (see below) might be better for targeting your oblique muscles. Like with the exercises above, adjust your knee position if necessary, so that they’re comfortable. Ball rotations Targets: Your core and especially your oblique (side) stomach muscles. 📽️ Video demo Instructions Lie on your back with and exercise ball against the back of your thighs and your calves resting on it. Place your arms on the floor, out to the sides, to stabilise your upper body. Tighten your tummy muscles and lift your bum and lower back slightly off the floor. Using your tummy muscles (not your leg muscles), slowly rotate your hips and legs first to one side, then to the other side, making the ball follow your movements. Control during the whole movement is important – don’t let gravity do the work for you when your legs go down to the side. This exercise ball comes with a pump and in various sizes and colours: How many? Work your way up to 3 sets of 10 to 12 repetitions (side-to-side rotations) each. Rest 1 minute between sets. How to make it more difficult Increase how far you rotate once you can do the above with good control. 💡 Top tips Use an exercise ball with a diameter that is at least the same as the length of your thighs ; this will make for a more comfortable position. The one I used in the video is a bit small for me; the Amazon one above comes in various sizes. Adjust your knee position for more comfort if necessary. Prone leg lifts Targets: Glutes and lower back. 📽️ Video demo Instructions Lie on your stomach, with your forearms on the floor in front of you and your forehead resting on your hands. Have one leg flat on the floor and the other one bent 90 degrees (sole of your foot pointing to the ceiling). Tighten your tummy muscles (this is to keep your back and hips horizontal) and lift the bent leg as far as it will go without your back and hips tilting out of their horizontal position. Concentrate on using your glute muscles, not the muscles in your back. Lower your leg slowly back down. How many? Start with 5 leg lifts one side, rest 30 seconds, then 5 leg lifts the other side, and work your way up to: 10 to 12 lifts one side. Rest 30 seconds. Same for the other side. 3 sets of these with 30 seconds rest between sets (giving each side about a minute’s rest at a time – 30 seconds total rest, and about 30 seconds while the other side is working). How to make it more difficult Straighten the leg that you’re lifting. 💡 Top tips If the prone position hurts your back, see whether putting a cushion under your stomach helps; if not, choose from the other three glute-targeting exercises below. Side leg lifts I like this one because you can really target the glutes and, while it starts off easy, you can really make it quite difficult as your strength and control improve. Targets:  Mainly your glutes, but also some core. 📽️ Video demo Instructions Lie on your side, with your head supported by either your bottom arm or a cushion. Your top hand can rest on your hip. Have your bottom leg slightly forwards and bent at a comfortable angle – this is to help stabilize you. Your top leg should be straight. Ensure that your hips are stacked/vertical (so, not tilted backwards or forwards) throughout the exercise. Tighten your tummy muscles to control this. Slowly lift your top leg as far as it will go without having to tilt your hips backwards. Slowly lower your leg back down. If you have to move your hips to lower your leg far enough for your foot to touch the floor, don’t lower your leg that far – foot in the air in the bottom position is fine. How many? Work your way up towards: 10 to 15 lifts one side. Rest 30 seconds. Same for the other side. 3 sets of these with 30 seconds rest between sets (giving each side about a minute’s rest at a time – 30 seconds total rest, and 30 about seconds while the other side is working). How to make it more difficult Have an exercise/resistance band around your legs. For this, the bottom leg has to be straight as well, so make sure you have good core control with the easy version before you attempt this. There should be no slack on the band with the top leg in the lowered position, so that you get resistance right from the start when you lift your leg. Exercise bands are available in sets (of usually three or five), with each band having a different resistance. So, you can start with the least resistance and gradually work your way up to heavier resistance. If existing knee pain is a problem, put the band around your thighs, just above the knees, and not around the knees. Here is a selection of exercise bands available on Amazon. You can also visit the TheraBand Store  for more options. 💡 Top tips If you find this exercise difficult at first , you can flex your top foot (moving your toes towards your shin); this engages your leg muscles and locks your knee, which makes it easier to lift your leg. With your leg lifted, if it hurts around your top hip/glutes, you’ve lifted it too far. With your leg lifted, if you feel it in your quads , your leg is too far forward – bring it back so that your hip is straight and you can't see your foot. Likewise, if you can see your foot when the leg is lifted , your leg is too far forward – bring it back slightly so you can see your toes at most. (This tip obviously doesn't work if the size of your tummy affects your view, e.g. if you’re heavily pregnant.) Clams Targets: Mainly your glutes, but also some core. 📽️ Video demo Instructions Lie on your side, with your head supported by either your bottom arm or a cushion. Your top hand can rest on your hip. Have your legs slightly bent at the hips (about 60 degrees) and the knees (about 90 degrees). Ensure that your hips are stacked/vertical (so, not tilted backwards or forwards) throughout the exercise. Tighten your tummy muscles to control this. Keeping your feet together, slowly lift your top knee as far as it will go without your hips tilting backwards. Slowly lower your knee back down. How many? Work your way up towards: 10 to 15 clams one side. Rest 30 seconds. Same for the other side. 3 sets of these with 30 seconds rest between sets (giving each side about a minute’s rest at a time – 30 seconds total rest, and about 30 seconds while the other side is working). How to make it more difficult Have an exercise/resistance band around your legs. There should be no slack on the band with the top leg in the lowered position, so that you get resistance right from the start when you lift your leg. Exercise bands are available in sets (of usually three or five), with each band having a different resistance. So, you can start with the least resistance and gradually work your way up to heavier resistance. Put the band around your thighs, just above the knees, and not around the knees. 💡 Top tips If being bent 90 degrees hurts your knee(s) , straighten your knees somewhat and do the clam by lifting your whole top leg (i.e. don’t keep your feet together). A common mistake is to try to lift your knee to high, and then things get squashed around the glute muscles, which might be painful. Keep the movement within a comfortable range. If you experience any problems when doing the clam or simply want an alternative – check out this article on our website . Glute bridges Targets: Mainly the glutes (of course!) but also the lower back, core, and hamstrings. A good all-round exercise, but of all the glute exercises in this article, this one is most likely to irritate an already painful knee. 📽️ Video demo Instructions Lie on your back with your knees bent about 90 degrees and your feet flat on the floor. (See Top tips below for the pros and cons of having your feet closer to or further away from your bum.) Tighten your tummy muscles. Squeeze your glute muscles and, using them, not your back muscles, lift your hips up towards the ceiling as far as they will comfortably go. Hold the position for 10 seconds, still making sure that you’re using your glute muscles to keep you up there. (You might feel that your hamstrings and lower back are working a little bit – this is fine. If your back is arched, you are probably mainly using the back muscles.) Lower yourself down slowly. How many? Work your way up to 3x30-second holds before making the bridges more challenging. Remember to rest for as long as you hold the position. How to make it more difficult Do the bridges with weight on your tummy or over your hips. If you want to progress to more challenging variations on the glute bridge, check out this article on our website . 💡 Top tips If holding the position hurts your knees , going up and down (slowly) without holding the position might be kinder to them. If this works for you, work towards 3 sets of 15 repetitions, and then add weight to make it more challenging. The closer your feet are to your bum, the less your hamstrings work and the easier the exercise. But if you have knee pain, especially towards the back of your knee, this position can be quite uncomfortable, so then you want your legs somewhat straighter. If only one knee is painful, it’s fine to have only that leg somewhat straighter. If you rest your feet only on your heels , it makes the exercise a bit more challenging, but this might be kinder to your knees. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate .

Resistance band exercises can be very useful for injury rehab, especially if you can’t or don’t want to go to a gym. However, the range of choices of resistance bands out there can be a bit bewildering. This article explains the various options when choosing resistance bands, how to safely attach them so you won’t topple a chair or grandfather clock while doing your exercises, and how to start and then progress your resistance band workouts. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Choosing resistance bands How to attach a resistance band How to start resistance band exercises for rehab How to progress your resistance band exercises How we can help We’ve also made a video about this: Choosing resistance bands If you go online, you’ll see that there’s a wide variety of resistance bands available. Probably the best-known brand is TheraBand, but there are many others out there as well. All those handles, straps, and loops! Some resistance bands are simple, long elastic bands, others are loops, and others come complete with handles and/or ankle straps and/or stuff to anchor them with. Some are round and some are flat. I prefer the plain, flat ones because they are light and take up very little space – ideal for when I travel. It’s easy to grip one end with your hand when you’re doing arm and certain upper body exercises. When your feet or legs are involved, you can tie one end to the other to form a loop, and simply stick the relevant limb(s)s through the loop. By tying the loop yourself, you can also decide what size the loop is. I’m not very fond of those shiny tube resistance bands, because to me it feels like they don’t offer the amount of resistance that the manufacturers claim they do. You may wonder how to attach your resistance bands to objects if they don’t come with anchoring equipment – I’ll tell you about a neat trick lower down. All those colours! Resistance band sets must be some of the most colourful products on the Internet, but there’s method to the madness. Different colours denote different resistance strengths, just like you would find dumbbells of different weights in a gym. Unfortunately, there’s no “industry standard” for which colour denotes which amount of resistance. TheraBands start with yellow for the least resistance, and then work their way through red, green, blue, black, silver, and lastly gold for the most resistance. Another brand might start with green, then on to blue and yellow, and so on. Unlike weights, the amount of resistance that a single band offers increases as it is stretched further and further. So, there’s quite a bit of versatility in terms of how you can use even a single band to produce various levels of resistance. This is also why you don’t necessarily have to splash out on a full set of seven bands. There are several packs of three or five resistance bands available that will probably meet your rehab needs for resistance band exercises. You can also double up and use two bands to increase resistance. Here’s a selection of various brands of resistance bands, or you can visit the TheraBand Store for more options: How to attach a resistance band Like many people, I used to tie my resistance bands to a piece of furniture. However, it can be difficult to find something to attach your resistance bands to that doesn’t move as you pull on the band, especially with leg exercises, where quite a strong force is sometimes exerted. Chairs and tables can easily move, and even beds have moved with some of my resistance band exercises! Then, one of my patients showed me a really clever trick with a door. You simply tie something like a sock or a sturdy spoon to one end of the resistance band, stick that end between the door and the door frame so that the “stopper” is on the other side, and close the door. Now your resistance band is anchored very securely. (I have since found out that you can also buy resistance band door anchors separately.) This also means you can attach the resistance band at exactly the correct height for your exercise – something you can’t always do when you’re relying on a piece of furniture. Here's the demo from the video: How to start resistance band exercises for rehab To start with, control is better than high resistance You have to start with a resistance that's light enough, that doesn't cause you pain, and allows you really good control of movement. If the resistance is so high that you can’t do your exercises in a slow, smooth, controlled way, you will risk re-injuring yourself. And the exercises themselves might be painful, which will lessen your motivation to keep up your rehab programme. Also, because the band’s resistance increases as it lengthens, a resistance that’s too tough may prevent you from moving through the full range of motion that your injury needs for proper rehab. Having said that, you should use a level of resistance where there is at least some resistance right from the start of your movement, so that you work against resistance through the whole movement. So, there should be no slack in the band when you start the movement. Aim for a resistance level that allows you to do 15 repetitions at a time. If you get so tired that you can’t finish 15 reps or have pain, the resistance is too high. If you don’t have a resistance band that is light enough for this, start with fewer repetitions. The release is as important as the pull These exercises are not about pulling at the resistance band and then letting it snap you back when you’ve reached the end of the pull movement. First, you may injure or re-injure yourself by letting it all snap back in an uncontrolled way. But most importantly, working your muscles and tendons by slowly easing back against the resistance of the band (an eccentric muscle contraction) gives you as much benefit as stretching the band out, if not more, especially in a rehab exercise situation. Control the movement properly and release the exercise band slowly. Functional exercises You can use resistance bands to mimic the movements of the sport that you’re aiming to get back to after your rehab. For instance, a right-handed tennis player with a shoulder injury can mimic their backhand stroke by fixing the resistance band at hip height to their left-hand side, reaching across with their right arm, gripping the band, and then pulling it back across to their right. Exercise bands are great for training functional movement patterns. Muscle activation Resistance bands are good for making sure that all the muscles that are supposed to participate during an exercise do so. For example, you can use resistance bands for squats to make sure that your glute meds are working. Loop the resistance band around your knees so that they have to pull outwards, using the glute meds, to stay in line with your feet and not buckle inwards when you do your squats. How and when to progress your resistance band exercises Your body grows stronger by having to deal with little bits of extra load that are added in gradual increments. If your exercises stay at the same level of difficulty for weeks and weeks, your body will eventually just go, “Yeah, I can do this. No need to grow any stronger.” So, when you get to the stage where 15 reps of a resistance band exercise feel way too easy, you should usually increase the resistance so that it is a bit of a challenge to get to 15 reps again. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate .

If you’ve been dealing with plantar fasciitis, chances are you’ve been told you must  wear supportive, cushioned shoes with good arch support – and that minimalist or barefoot-style shoes are a recipe for disaster. But recent research is starting to challenge that one-size-fits-all advice. In this guide, we’ll break down what the latest studies say about shoe types, how to figure out what might work best for your feet, and why you might want to rethink the notions of “always” and “never” when it comes to picking shoes for plantar fasciitis. Plus, we’ve tracked down some not-so-boring shoe options that are both foot-friendly and stylish (scroll down for pictures and links). Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: The classic advice: Cushioning + arch support What about minimalist shoes or going barefoot? Why shoe rotation might be the missing ingredient So, what types of shoe should you wear? Good news: Arch support doesn’t have to be boring Good shoes are usually not enough How we can help The classic advice: Cushioning + arch support There’s good reason why most podiatrists and physiotherapists (myself included) have been recommending cushioned shoes with arch support. Several high-quality studies have shown that these features can reduce heel pain and improve function: A 2015 clinical trial  found that contoured sandals (with built-in arch support and decent cushioning) worked just as well as custom-made orthotics to reduce plantar heel pain – and both were far more effective than flat, unsupportive sandals. Two research review studies ( 2018  and 2019 ) confirmed that using arch-supporting insoles can provide moderate pain relief in the short term, especially when compared to having no support at all. 💡 So yes – arch support still matters , and it might be the most important shoe feature for managing plantar fasciitis. But it turns out that that’s not the whole story. What about minimalist shoes or going barefoot? If you’ve been told to avoid anything flat or flexible at all costs, the following might surprise you. 👉 Recent studies suggest that some people with chronic plantar fasciitis may actually benefit from barefoot walking programmes or wearing minimalist shoes – as long as it’s done carefully and with proper support: A 2024 trial  found that people with long-term heel pain who followed a structured barefoot walking programme (compared to walking in shoes) had greater improvements in pain and function. It’s worth noting that they did the barefoot walking as a strength training session for their feet on a treadmill (so, a soft surface) and that they increased the time very gradually – they didn’t walk barefoot all day long or on hard surfaces. Another study  showed that flexible, minimalist shoes – especially when worn with arch-supporting insoles – significantly improved symptoms for women with plantar fasciitis. Again, these shoes were worn for no more than six hours per day. Unfortunately, quite a large number of people dropped out of the study; so, we shouldn’t view this as a definitive result, because not everyone’s data were analysed. 💡 The key takeaway here? Arch support is still helpful, even in minimalist shoes.  Yet minimalist shoes might not be as taboo as previously thought, while it should be noted that these studies used them in a restricted way for a strengthening regime. Incorporating barefoot walking sessions into your day might help to strengthen your feet and reduce plantar fasciitis pain in the long term. 🐟 What’s a bit fishy about these results is that neither study reported anyone saying their pain got worse due to the minimalist or barefoot walking. This sounds a bit too good to be true , because other studies found that people who wear non-cushioned shoes report higher pain levels. So, I think we should wait for more high-quality research to properly put this to the test before we start recommending it to everyone. This advice might also apply only to chronic cases (that has been present for several months). Acute (or recent onset) cases, in my experience, react much better to cushioned shoes with arch support. Why shoe rotation might be the missing ingredient Here’s the most interesting new insight (for me) from recent research. A small study  found that people who rotated between different types of shoe – instead of wearing the same pair every day – had slightly better outcomes than those using only orthotics or only doing physio. It makes sense when you think about it: Different shoes load your feet in different ways. Varying your footwear might help to reduce repetitive strain on the same structures (like your plantar fascia) and give certain tissues time to recover. 💡 So, maybe the magic isn’t just in which shoe you wear – but in switching things up regularly . However, it is worth pointing out that this was a small study and not a randomized controlled trial (so, not super strong evidence). Again, we need more research to know how effective this truly is. Varying your shoes might help to reduce repetitive strain. So, what types of shoe should you wear? Here’s the practical bottom line from the research: ✅  Look for shoes with arch support.  Whether you prefer sporty or stylish, arch support helps to reduce plantar fascia strain and is consistently linked to less pain. ✅  Cushioning likely helps.  Research shows that this probably matters, and it is also something I’ve observed in practice, especially if you’re having to stand or walk on hard surfaces. ✅  Minimalist shoes might have a role to play in some chronic cases. View this more as strength training and limit how long and on what surfaces you use them. ✅  Rotate your shoes.  Avoid wearing the same pair day in and day out. Mix things up with supportive sneakers, sandals with arch support, and even occasional barefoot time if appropriate for you. ✅  Replace worn-out shoes. Shoes, especially ones with soft foam soles, lose their support and change shape over time. They may still look pristine on the top but if your feet suddenly starts to hurt  in shoes that used to be comfortable, they likely need to be replaced. ✅  Consider adding orthotics.   Off-the-shelf arch-support insoles have been shown to work just as well  for most people as custom-made ones. So, don’t feel pressured to spend hundreds on custom insoles – there are excellent, affordable options available. Good news: Arch support doesn’t have to be boring I know that many of the “recommended” plantar fasciitis shoes can look a bit … uninspiring. That’s why I’ve gone onto Amazon and curated some modern, stylish, and comfortable shoe options that offer proper support without looking “orthopaedic”. Whether you’re into streetwear, sporty, or classic looks – there’s something here for you, and in most cases not only in the colours in the illustrative images below. Running shoes for plantar fasciitis Brooks has several models of running shoe with good arch support and cushioning. Those shown below have versions for men and women. HOKA and ASICS are two more runnings shoe brands with plantar fasciitis-friendly models. Again, these models come in men's as well as women's versions. Hitting the trails with plantar fasciitis? The ASICS Gel-Venture trail running shoe will provide your feet with good arch support. Sneakers / walking shoes Obviously the running shoes listed above can also work for walking, but here are more options for non-runners when they're out and about. Men Women Sandals and flip-flops First up, a few activewear sandal options with arch support. And now for something a bit more stylish and less sporty. 👉 Speaking of FitFlop – they're a company that specialises in women's footwear with arch support, so check out their other sandal and flip-flop styles and options here . Dress shoes / formal / everyday So many styles to choose from! I won't reveal my personal taste here by selecting pictures of shoes that I reckon are cool and stylish. Rather follow the links below and see what you like best. ⭐ Dansko is my top pick  for a shoe brand with a wide range of men's shoes  and women's shoes  for everyday wear that all provide arch support. For a good selection of comfortable men's dress shoes with arch support , head to OrthoComfoot's Amazon store . For women, FitFlop again has a big selection of formal and everyday offerings. Have a look at their range of boots on Amazon, and here are their options for flats . (💡I would steer clear of the ballet pumps and go for the more sturdy options.) And men and women such as nurses, chefs, and sales assistants who are on their feet all day could consider Dankso's range of clogs and mules for work . Slippers When you come home from work, kick off the work shoes and slip your feet into a pair of these. They all have good arch support and non-slip outer soles. Minimalist/zero-drop shoes All of the options below have removable arch support insoles. Please refer to our advice above on how best to use minimalist shoes for plantar fasciitis. Tennis and pickleball These Asics Gel-Resolution tennis and pickleball shoes provide good arch support and cushioning. There are many more colours available – from classic off-white to more colourful combinations. Good shoes are usually not enough Yes, the right shoes can help to reduce pain from plantar fasciitis – especially when they offer good arch support and you rotate between pairs. But shoes alone are not a cure . If you’re serious about getting rid of your plantar fasciitis for good, research shows that a more complete approach is needed. That means combining supportive footwear with treatments like strength training, stretching, and load management . I've put together some helpful guides to walk you through it: Causes and symptoms of plantar fasciitis Self-treatment – overview of all the treatment options   Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Vicenzino, B. et al. (2015) "Orthosis-shaped sandals are as efficacious as in-shoe orthoses and better than flat sandals for plantar heel pain: a randomized control trial" PLoS One 10(12): e0142789. Whittaker, G.A. et al. (2018) "Foot orthoses for plantar heel pain: a systematic review and meta-analysis" British Journal of Sports Medicine 52(5): 322-328. Schuitema, D. et al. (2019) "Effectiveness of mechanical treatment for plantar fasciitis: a systematic review" Journal of Sport Rehabilitation 29(5): 657-674. Reinstein, M. et al. (2024) "Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial" Annals of Physical and Rehabilitation Medicine 67(2): 101786. Ribeiro, A.P. and João, S.M.A. (2022) "The effect of short and long-term therapeutic treatment with insoles and shoes on pain, function, and plantar load parameters of women with plantar fasciitis: a randomized controlled trial" Medicina 58(11): 1546. Koo, S.-W. et al. (2024) "Effectiveness of Shoe Rotation in Managing Plantar Fasciitis in Patients" Journal of Clinical Medicine 13(16): 4624. Umar, H. et al. (2022) "Impact of routine footwear on foot health: A study on plantar fasciitis" Journal of Family Medicine and Primary Care 11(7): 3851-3855.

THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis Self-treatment – overview of the treatment options (this article) Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis Plantar fasciitis is a pesky, painful, and persistent problem, but the good news is that the majority of the most effective treatments identified in the research are all things you can do at home. No having to take time off work and forking out to go and see a physio! This article will give you a complete list of the most effective treatments for plantar fasciitis that you can apply yourself. We might earn a small commission on the sale of some of the products listed on this page at no extra cost to you. First, let’s get something out of the way: what you shouldn’t do when you’ve discovered that you have plantar fasciitis. Treatments that don't work for plantar fasciitis Your first instinct for treating very painful plantar fasciitis might be to reach for the anti-inflammatories. That will be of almost no use, especially if you’ve had the pain for a while. Other injuries usually start with inflammation before the regeneration phase of the injured tissue kicks in. Plantar fasciitis is different. It usually skips the inflammation and goes straight into a degeneration or breakdown phase. Anti-inflammatory medication does not work for plantar fasciitis. Physiotherapists sometimes mete out two other treatments that won’t relieve or fix your plantar fasciitis: ultrasound and electrotherapy. So, what to do about your pain? Plantar fasciitis treatment: What is the most effective? The treatment for plantar fasciitis has to be tailored to you. There will never be a single treatment to cure plantar fasciitis, simply because there can be so many different reasons why you develop heel pain . The plantar fasciitis treatments below can be roughly divided into treatments that reduce tension in the plantar fascia and treatments that strengthen the plantar fascia. The most effective treatments according to the research are: (see details under each section) Relative rest Stretching exercises Strengthening exercises Massage Taping the foot Foot orthotics or supportive insoles in shoes Specific shoes or rotating which shoes you wear Night splints TENS (transcutaneous nerve stimulation) Low-level laser therapy Weight loss Relative rest Once injured, your plantar fascia loses some of its strength and endurance. So now it struggles to cope with the load you place on it when you do your normal daily activities and sport. So, if you try and ignore the pain and just continue as normal, it usually just gets worse. Remember, your plantar fascia supports your foot's arch and has to work whenever you stand, walk, run, or jump. To allow it time to recover, you have to reduce these activities to a level that does not cause your pain to increase significantly. Complete rest is not needed nor is it useful, as it can cause your foot to lose more strength. You just have to limit the time you spend on your feet to what your foot can currently tolerate. So, observe how your pain reacts to the time you spend on your feet standing, walking, etc., and then temporarily limit your activities accordingly. Top tip: Wearing good shoes and orthotics can reduce the strain on your plantar fascia and help your foot tolerate more activity. I discuss what to look out for in these lower down. Stretching for plantar fasciitis The calf muscles are connected to the plantar fascia via a fascia extension from the Achilles tendon, and I always find that they are tight in my patients who complain of heel pain. Actually, all the muscles in the back of your leg are connected. This is why you should not only include stretches for the plantar fascia but also for the rest of the leg and back. A word of caution – you can make the symptoms worse if you over-stretch. Find a detailed explanation and demo of what stretches you should do for plantar fasciitis here. Stretching your calf muscles can help reduce the tension on your plantar fascia. Strengthening exercises for plantar fasciitis The shape of the foot is determined by a passive support system (bones, ligaments, plantar fascia) as well as an active one (muscles and tendons). The plantar fascia is put under extra strain if the muscles in your foot and lower leg are weak or they cannot control your foot properly. Strengthening your foot, ankle, and leg muscle can help to reduce the strain on your plantar fascia. Strengthening and proprioceptive exercises can be very effective in the treatment of plantar fasciitis, but it is important that you do them at the correct intensity for the stage of your recovery. If you would like help with your rehab exercises, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. 🎉 Discount Code: MARYKE Massage for plantar fasciitis It is easy to massage your plantar fascia as well as your calf using massage balls and foam rollers . The current research suggests that  foam roller massage  can be just as effective as a massage from a therapist when it comes to pain relief and increasing muscle length. Massage for plantar fasciitis should include all the muscles along the back of your legs – not just the plantar fascia. I've created a detailed article with demo videos of how to massage yourself for plantar fasciitis. Taping for plantar fasciitis There are several taping techniques that you can try. The one thing that they all have in common is that they try and off-load the plantar fascia through supporting the inside arch of the foot and preventing the foot from rolling inwards excessively when you step on it. One of the most commonly used is the Low Dye Taping technique. You can watch my variation of this technique below. Orthotics or supportive insoles for plantar fasciitis Foot orthotics come in various shapes and levels of support. I usually prescribe a medium density off-the-shelf orthotic that supports the inner arch of the foot. This reduces the load on the plantar fascia and gives it a chance to recover. Think of it as a "crutch" for the plantar fascia. Consult a podiatrist if you do lots of sport. I usually advise my patients to test arch-supporting inserts first, but if they find them uncomfortable, soft gel inserts may be useful. The gel inserts don't support the arch but some patients seem to benefit from the extra cushioning under the heel. There is some research that shows that people with plantar fasciitis often also have a thinner fat pad (so less cushioning) under their heel bone - the gel insert may help with this. I’ve selected the products below from Amazon, as they are similar to the ones we use in our clinic and appear to be good value for money. Shoe selection for plantar fasciitis Unsupportive and inflexible shoes provide very little arch support and put a much greater strain on the plantar fascia. Wear shoes with good cushioning and arch support. Here's our article on why it might be a good idea to mix up the types of supportive shoe you're wearing , why these shoes don't have to look boring and ugly, and how even minimalist shoes might play a role in your rehab. Night splints for plantar fasciitis Researchers suspect that the plantar fascia shortens during the night and that the sudden stretch when you stand on it in the morning injures it anew. The theory behind night splints is that they prevent your plantar fascia from shortening during the night, which reduces the pain in the morning as well as the chance of injury. I do find these effective in patients with persistent symptoms. Night splints come in various shapes and range from very rigid to soft. I prefer the  Strassburg sock  for comfort, but I’ve also included an example of a more rigid splint with an arch cushion below. TENS for plantar fasciitis TENS has been shown to reduce pain while you're hooked up to the TENS unit and maybe for a few hours afterwards. But there isn't convincing evidence that it is a treatment method that will speed up your healing. So, TENS can be useful to reduce intense plantar fasciitis pain to enable to you carry on with a treatment method that will eventually heal you. Read more about TENS treatment for plantar fasciitis. These three TENS units come with electrode pads small enough to stick securely even on small feet. Low-level laser therapy for plantar fasciitis Low-level laser may help to reduce pain, but the evidence to support this is not very strong. You will have to consult a physiotherapist for this treatment. Weight loss The less you weigh, the less force is transferred through your plantar fascia when you stand, walk, or run. As simple as that. I hope you found this overview of treatments for plantar fasciitis helpful. Like I said, I’ve written in more detail about how you can treat yourself with stretches and massage – just follow the links below. Read more about: Stretching for plantar fasciitis Massage for plantar fasciitis How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Morrissey D, Cotchett M, Said J'Bari A, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine 2021; 55: 1106-1118. Belhan, O., Kaya, M., & Gurger, M. (2019). The thickness of heel fat-pad in patients with plantar fasciitis. Acta orthopaedica et traumatologica turcica, 53(6), 463-467. McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290. Robroy L.M. et al., (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

People who proclaim (often quite vehemently) that arch-supporting insoles are bad for your feet because they weaken your muscles take too narrow a view of the subject. They’re ignoring that we have different bodies and genetics. Let’s look at what the research shows, why some people might need insoles more than others, and the various ways you can keep your feet and body strong while using them. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Foot control is not just about muscles Evidence from the research My advice regarding insoles How we can help Foot control is not just about muscles Our foot arches rely on passive support (from ligaments, plantar fascia, and the shape of our bones) and active support (from our muscles) to maintain their shape. You need both types of support to work together for good foot stability. The X-ray images below demonstrate how the shape of your bones influences your foot arch height – higher arches are usually more stable and rely less on ligaments and muscles for support. So yes, weak foot muscles can contribute to overpronation and foot pain. However, if your ligaments are very lax, strengthening the muscles is often not enough to prevent injuries or stop your foot arches from changing shape (flattening out). Your passive support system is especially important when your muscles are tired, e.g. after a long day on your feet or towards the end of a run.   💡  If you have very flexible feet, you may always need extra passive support during certain activities. Evidence from the research No research has been conducted that specifically looks at how supportive insoles affect intrinsic (the small muscles inside the foot) muscle strength. This is not surprising, because there’s no practical way of measuring the activity in those small muscles when someone is walking or running. There isn't any research available that specifically measured the impact of insoles on the small foot muscles. Several studies have looked at how foot orthoses (insoles) affect the muscles around the ankle and the rest of the leg – these are easier to monitor because you can simply stick an electrode over them. When researchers pool all the available data, the results sometimes show increased activity in muscles like the tibialis anterior  and peroneus longus , and other times less activity. So the evidence suggests that insoles affect different people differently. The available research looked only at the activity in the muscles around the ankle and higher up the leg. When researchers take a more focused approach and look at specific situations where feet might benefit from more support, they often report positive effects on muscle activity. For example, several studies have shown that people with chronic ankle instability experience delayed muscle activation around their ankles when they balance on one leg. Dingenen et al.  found that shoes and supportive insoles improved muscle activation in these people compared to balancing barefoot. 💡 The claim that insoles weaken your intrinsic foot muscles is based on opinion, not fact. Individual differences mean that some people need and benefit from insoles more than others – they might even help your muscles work better in certain cases. My advice regarding insoles 1. Not everyone needs insoles permanently Some people might just need insoles to help them get over an injury or until they’ve gained good control in their ankles and feet – this is usually true for people with a good passive support system (less flexible ligaments or high foot arches). However, if you have very flexible feet, can observe your foot arches changing shape, or regularly experience foot pain related to the tibialis posterior tendon or plantar fascia, you might benefit from them on a more permanent basis. A physiotherapist or podiatrist can help you understand what’s best in your case. 2. Insoles can protect your feet If you fall into the category of very flexible feet with collapsing arches, insoles can help protect your feet and prevent your arches from further collapsing or your tibialis posterior tendon from straining. 3. Foot strength is good, but whole-body strength is better Improving foot strength and control tends to benefit most people, regardless of whether they need orthotics for life or just as a temporary measure while recovering from an injury. However, strengthening your whole body works even better. Poor muscle strength and weak control higher up in your legs and core increase the strain on your feet. I find that an approach where you incorporate foot control with regular strength training exercises for your legs often produces better results than just focusing on the feet. Here’s a quick test to assess your hip control , and this video gives you some ideas for foot-strengthening exercises. (It says it’s for runners, but these exercises are useful for everyone.) 4. Vary your support as needed Even people with very flexible feet can often regain enough strength and control to walk barefoot or wear less supportive shoes at times, which, in turn, can help them to build even more strength. 💡 The key to doing this right lies in understanding what good foot posture and control feel like for you and paying attention when you move. Also, pick the right amount of passive support depending on the activity you’re about to do. For instance, I have very flexible feet, and I can see that my left arch is keen to change shape. But I’ve maintained my arches and foot health since my 20s through a combination of tailoring my footwear to my activities and strength training. I’ve built enough strength and control to walk around the house and shortish distances outside (a kilometre or two) without much support. But if I try to go for long walks, spend long days on my feet, or go running, I need my orthotics – my muscles simply don’t have the endurance to compensate for my rubbish ligaments when I get tired, and I usually end up with tibialis posterior pain if I push it. I always wear my orthotics when I know I’ll be on my feet for long periods, doing sport that is likely to exhaust me, or when my sport involves high-impact activities like changing direction or jumping. Some studies suggest that wearing minimalist shoes with some arch support for short periods during your day can help strengthen your feet and reduce symptoms of plantar fasciitis. These types of shoe might be a good stepping stone if you’re looking to experiment with reducing your support. 5. Don’t make sudden changes You can’t go from having a lot of support all the time to suddenly walking around or playing sport without any support. Building strength and endurance in your feet takes a long time. If you’re going to experiment with using less supportive footwear, make sure you first lay the foundations by building good strength and control. Then, start reducing your foot support during low-impact activities like walking, and start with short sessions. And finally, if your feet are happy with that, you can experiment with high-impact activities.   💡 Not everyone can wean themself off their insoles – and that’s OK. Insoles play a very important role in protecting your feet when your body’s passive support system can’t do it on its own. Bottom line: Whether insoles are “bad” for your feet depends entirely on your body, your goals, and how you use them. The key is to personalise your approach – use support when you need it, and strengthen your body and feet to improve your control. How we can help Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Reeves, J. et al. (2019) "A systematic review of the effect of footwear, foot orthoses and taping on lower limb muscle activity during walking and running" Prosthetics and Orthotics International 43(6): 576-596. Ribeiro, A.P. and João, S.M.A. (2022) "The effect of short and long-term therapeutic treatment with insoles and shoes on pain, function, and plantar load parameters of women with plantar fasciitis: a randomized controlled trial" Medicina 58(11): 1546. Murley, G.S. et al. (2009) "Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review" Gait & Posture 29(2): 172-187. Dingenen, B. et al. (2015) "Muscle-activation onset times with shoes and foot orthoses in participants with chronic ankle instability" Journal of Athletic Training 50(7): 688-696.