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I have been using Wibbi as the home exercise program software for our physical therapy practice since 2010 (when it was still called Physiotec), and it has been a game-changer. It looks professional, saves our therapists time, and best of all, our patients love using the Wibbi home exercise program app. Here’s why I think it can do the same for you. In this article: Massive exercise library (plus you can add your own ones) Time-saving hacks Our patients love it Wibbi’s customer support is on the ball Excellent value for money I've also made a video about it: You can try out Wibbi for free for 30 days with no further obligation if you use this link , and if you then subscribe, you will get a 50% discount on the first three months. Yes, we will earn a commission, but don’t let this deter you from reading on. 👉 I only recommend products that I use, genuinely believe in, and love. Wibbi has all the basic features you would expect from home exercise prescription software, and they provide free training when you sign up, so I am not going to dig into the basics today. Instead, I want to highlight why they have managed to win over and keep me as a customer for over 14 years!   1. Massive exercise library (plus you can add your own ones)   With more than 20,000 exercise demo videos, Wibbi has one of the most comprehensive libraries to select exercises from, and they are constantly adding to it. It is divided into 18 modules, and you only subscribe to the ones you want (it costs very little to add more – see last section).   🌟 My favorite feature:  You can add your own exercise videos and pics!   You know how sometimes you have to adapt an exercise in a special way for just one patient? With Wibbi, you can film it and upload it so that it is right there in the patient’s plan with their other exercises (and it’s available if you want to use it again for someone else). You can also make it available to the rest of your team. This video gives you an idea of what the exercise library looks like: If an exercise you use regularly is not in the library, you can send Wibbi a video with your exact instructions and they’ll film and add it for you.  I’ve done this several times, and the turnaround time has been really quick; it is only when special equipment is needed that it can take a bit longer, but I just upload my own home video for my patients while I wait.   2. Time-saving hacks   Writing notes and creating tailored exercise programs can be sooooo time consuming and really lengthen your working day. Wibbi has several features that makes the process of creating and sending out home exercise programs quick and easy. These are my Top 4:   Create templates If you see a lot of patients with a specific injury (we treat many Achilles tendon injuries, for instance) you can group together your favorite exercises for the various rehab phases in templates – basically creating targeted, relevant exercise pools from which you can quickly select.   This does not mean that you prescribe the same exercises to everyone! It just makes finding the right ones so much quicker ; you can then delete the ones that are not relevant and maybe add one or two additional ones if necessary.   Also, this way you can save your desired instructions, sets and reps, and so on, not having to repeatedly enter the same info – just maybe edit it for that specific patient if necessary. Save your own exercise instructions (even outside of templates) All the exercises in Wibbi come with default exercise instructions, but these are often not exactly the way I want them. Fortunately, you can edit the instructions and save your version for future use.   🙌 And the really nifty bit about this is – it only saves it for you! So, every therapist in the clinic can have their own favorite instructions. If you do want to save it for the whole clinic, a template is the best place to do that.   Integrate Wibbi with your electronic notes system Wibbi integrates with many of the top EMR (electronic medical records) systems out there. We use Cliniko for our notes ( read our review of Cliniko here ). Every time we create a new patient in Cliniko, they are automatically added to Wibbi, which cuts down on admin time.   Once we’ve created the patient’s exercise plan, we simply click “Send to EMR”, and a PDF of the plan is added to their notes in Cliniko. This means we don’t have to go and write out each exercise with sets and reps, etc. So, the patient’s notes are complete from a legal perspective, and if another therapist has to see the patient, they can quickly check what exercises have been prescribed and what the exact instructions were without having to log into Wibbi.   Add info sheets You can add info sheets about specific conditions to a patient’s account, so it’s available if they want to review it, and it doesn’t get lost in emails. Wibbi has many info sheets to choose from, but you can also upload your own ones that can be made available to the whole clinic for future use.   Quickly complete outcome measures Wibbi has a range of standardized outcome measures that you can attach to your patient’s account. You can then ask your patient to complete it (they simply tick boxes) at specific intervals. The scores are saved in one place. Test Wibbi free for a month and get 50% off the next three months if you subscribe - click on the image to get started. 3. Our patients love it   The top things about Wibbi that our patients mention in their reviews of our practice include: How convenient it is to access their exercises via the Wibbi App. The tracking feature helps them stay motivated ; it allows them to mark exercises as completed, add the sets, reps, and weights they used, and whether they had pain, etc. How much they appreciate the clear video and text instructions. The therapist can review the patient’s exercise log and notes in the tracker at any time. So, you can monitor their rehab on an ongoing basis and get a good idea of how diligently they’ve followed the plan and whether there are exercises that appear to be problematic.    4. Wibbi’s customer support is on the ball   I have always had quick and friendly support from the Wibbi team whenever I needed help. Even when a technical issue was clearly caused by something on my end, they would take time to help me figure it out.   They also offer free training for any new physios who join our team.   5. Excellent value for money   Wibbi’s price structure is very reasonable. At the time of writing, they were charging a flat fee of around £21, which gives you access to the basic exercise prescription software and one exercise module. Each extra module we want to activate adds £3.50 per month, and each extra user adds £3.50 to our monthly bill.   It has always been quick and frictionless for us to add and remove users and modules. So, why not try out Wibbi's home exercise program software for free and see what it can do for your practice and your patients. Test Wibbi free for a month and get 50% off the next three months if you subscribe - click on the image to get started. 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 .

Patients sometimes ask me “Will TB-500 help my injury to heal quicker?” and then I have to explain to them that it is not a clever idea to self-medicate with a horse-doping substance. So I decided to write this article to clarify what TB-500 is all about. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What is TB-500? What are the claims about TB-500? Research on about TB-500 and thymosin beta-4 Are TB-500 and thymosin beta-4 legal? Injured? We can help We've also made a video about this: 👉 We don't have total control over what ads are being shown on this page. If you see ads selling TB-500 here, follow the advice in this article and ignore them. What is TB-500? TB-500 is a lab-produced peptide. Peptides occur naturally in our bodies (and in those of other mammals) and have various functions. TB-500 mimics a section of the natural peptide thymosin beta-4 (TB4) , which is involved in producing growth hormones. These growth hormones, in turn, help with things like muscle growth and tissue repair. TB-500 was originally developed for veterinary purposes. Soon it was used to enhance the performance of race horses and was duly banned in the horse racing industry . What does TB-500 do? Nowadays, humans can buy TB-500 online to use on themselves. The people who sell TB-500 for human use claim that it enhances sports performance. The thinking is that it helps athletes’ muscles and tendons to recover quicker from training and that they can therefore get more training done without risking overtraining. The other claim, aimed at people who want to look ripped without much effort, is that it will give you bigger muscles and help you to lose fat. But are these claims valid? Research on TB-500 and thymosin beta-4 Medical purposes The research on thymosin beta-4 as a drug for medical purposes for humans has not gone beyond Phase 2 clinical trials . These trials have focused on treating people with dry eye syndrome (a condition that affects the cornea) and treating people with epidermolysis bullosa, a rare disease that causes tears and sores on the skin when it bumps or rubs against something. It should be noted that the thymosin beta-4 in these trials were applied externally to the problem areas, so it didn't affect other areas of the body. People using thymosin beta-4 and TB-500 on themselves, however, mostly take it as a nasal spray, powder, or an injection. A drug has to make it past Phase 3 clinical trials to be considered safe for humans and for approval by the USA’s Food and Drug Administration (FDA) and similar bodies elsewhere. There have also been studies on animals that suggest that thymosin beta-4 might be useful for repairing damage to the heart muscle, and it has been shown to have anti-inflammatory properties. So, given the state of research on thymosin beta-4, we don’t know yet whether it’s effective and, more importantly, whether it’s safe for humans to use. Sports performance Neither TB-500 nor thymosin beta-4 has been researched for their effect on any aspect of sports performance, as far as I could ascertain. However, scientists have been scratching their heads about how to detect TB-500 and thymosin beta-4 use in sportspeople. Which brings us neatly to our next topic. Are TB-500 and thymosin beta-4 legal? Thymosin beta-4 is registered with the FDA as a drug still undergoing clinical trials. So, it is not an approved drug in the USA (and elsewhere) and cannot be prescribed by medical doctors. TB-500, which has the same properties as thymosin beta-4 , is also not approved for use. TB-500 as well as thymosin beta-4 are banned by the World Anti-Doping Agency . Despite the lack of research, it is considered a performance-enhancing drug, likely due to what was observed in horse racing As far back as 2015, Australia’s Department of Health, in a submission to the Therapeutic Goods Administration  (the Aussie version of the FDA), pointed out how easy it was to get hold of TM-500 and thymosin beta-4. They expressed their concern about its misuse in sport, especially by “sub-elite athletes … due to the highly competitive nature of their events, the perceived advantage provided by these substances and the less stringent doping scrutiny to which they are subject.” In 2016, in a case that went all the way to the Court of Arbitration for Sport , in Switzerland, 32 players of the Australian Football League club Essendon were banned from the sport for two years after having used thymosin beta-4 as part of the sports supplements regime they were prescribed. And now, almost ten years later, not much has changed. The Internet is still awash with websites and YouTube, Instagram, and TikTok videos touting TB-500 as a safe and legal way of getting bigger muscles and losing fat. Regulatory bodies don’t seem to do much about it. A search for “TB-500” on the FDA’s website produced one result: It is a warning letter  written in June 2023 to the owner of a website that sold TB-500 (injections and nasal spray) as well as SARMs and other illegal drugs. My take on TB-500 We’re not horses. We don’t know whether it is safe to use in humans nor do we know the long-term effect it might have on your health. Like other banned substances, it might turn out to have detrimental effects on your kidneys, liver, or other organs. I would stick to proven treatments. Injured? 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 Court of Arbitration for Sport (2016) “World Anti-Doping Agency vs. Thomas Bellchambers et al., Australian Football League, Australian Sports Anti-Doping Authority" Emmie N.M. Ho et al. (2012) "Doping control analysis of TB-500, a synthetic version of an active region of thymosin β4, in equine urine and plasma by liquid chromatography–mass spectrometry” Journal of Chromatography A 1265: 57-69. McGill University (2023) “The Human Lab Rats Injecting Themselves with Peptides” National Library of Medicine (2015) “Safety and Efficacy of Thymosin Beta 4 Ophthalmic Solution in Patients With Dry Eye” Thevis M et al. (2024) “Annual banned-substance review 16th edition—Analytical approaches in human sports drug testing 2022/2023” Drug Test Anal. 16(1): 5-29. U.S. Food & Drug Administration (2023) “WARNING LETTER – Warrior Labz SARMS – MARCS-CMS 655280 – June 12, 2023”  World Anti-Doping Agency (2013) “Investigation of in vitro/ex vivo TB-500 metabolism, synthesis of relevant metabolites and detection limits in urine and plasma”

One of the most common questions runners ask me is, how can they optimise running recovery? Most runners know to take recovery days, but the best thing you can do is to also build recovery weeks into your training. This article explains how recovery weeks can help you to train smarter and avoid injuries, using my current training programme as an example. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: Running recovery days are not always enough What does a recovery week look like? Maintaining training gains during your recovery week How we can help I've also made a video about this: Running recovery days are not always enough Whenever you go for a run or do any other type of workout, various parts of your body, including your muscles, accumulate micro-damage. This is normal, and it's part of the process by which your body grows stronger. The micro-damage sends a signal to your brain that this needs to be repaired to a somewhat stronger state than before the exercise session. This is how we become better, stronger runners with consistent training. Our bodies need sufficient time between training sessions to repair the micro-damage to a stronger state than before, and this is where the well-known training principle of recovery days comes into play. However, there isn’t always enough time available for full recovery before the next run, especially if you’re pushing your training to the limits. For instance, I'm currently trying to improve my 5K time. I'm following an eight-week programme where I'm adding lots of tempo runs, speedwork, and interval sessions, as well as longer runs. Last week was my third week of the programme, and I could really feel I was pushing those sprint intervals to the limit. And if I had done any more reps than I did, I think I might have pulled a quad muscle. So this week, my fourth week, is a recovery week. And what a recovery week does is, it helps your body to catch up on that repair that it didn't fully get to during recovery days, when you were pushing your training hard for a few consecutive weeks. Therefore, a recovery week buys you some insurance against getting overuse/overtraining injuries. What does a recovery week look like? The idea is to reduce your training load by about 20% to 30%. Training load doesn't just refer to the distance you're running, it's also how fast you're running. So, if you do an interval session where you run short distances but really fast, that training load can be equal to that of a very long run. Other factors can play a role as well. I’m in Bali as I’m writing this, and it's super humid and really hot. When I do my runs after eight in the morning, I sometimes feel like it’s just too hot to continue. And this means that the training load is higher. For instance, this morning I went for the first run of my recovery week. Last week I did 3 x 600 metre sprint intervals, and I did it when it was already quite hot. So today I only did 3 x 400 metres, and I went out before seven, when it was still relatively cool. I still felt that I worked hard, but I wasn't at all near my limits. Maintaining training gains during your recovery week So, why am I not just doing easy runs the whole recovery week? Because my aim is to increase my speed, and I don't want to lose the gains that I've made in the preceding weeks. If you’re doing a training programme where speed is your focus and getting the intensity up is your focus, then instead of stopping all high intensity in your recovery week, you just reduce the intensity sessions to short, sharp ones. You can maintain your speed during recovery weeks by doing short, sharp sessions that don't push you into complete fatigue. So, you're keeping that speed, keeping that intensity, having that stimulus, but you’re not pushing yourself to the extreme, and you’re stopping long before you’re really exhausted. As for the easy runs, I will just reduce the distance to be somewhat shorter than it was in the last three weeks. For my tempo run, I will maintain the same pace as before, but go a shorter distance as well. And then next week is Week 5, and I can push my speed, push my tempo runs again so that I can continue to improve. 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 .

When we exercise, our bodies sustain micro-damage. This is normal and needed, but also the reason why recovery after training is so important. If you get it right, your body will repair itself stronger than before. If you keep on pushing your training and don’t implement good recovery habits, all of this micro-trauma will add up and cause an injury. In this article: What happens in the hours after exercise? What is needed for a good recovery? Summary of useful recovery techniques Injured? We can help Here's the video of the livestream I did on this topic: What happens in the hours after exercise? As mentioned before, exercise causes micro-trauma in your bones, ligaments, muscles, tendons and joints. This micro-trauma is the trigger that tells your brain to repair your body stronger. In order for your body to repair it has to: get rid of all the damaged cells and waste products that was formed during your exercise session and replace the damaged cells with new, stronger ones that can cope with more exercise than before. The end result is a body that is now stronger than before you did your last training session! What is needed for a good recovery after training? Inflammation Inflammation is an important part of your healing process . Your body uses inflammation to get rid of all the damaged cells. I’ve often heard of people taking anti-inflammatory drugs e.g. ibuprofen after exercise to take the muscle soreness away and allow them to train again. There are several reasons why this is a bad idea: By decreasing your inflammatory response, you may be blunting your body’s response to exercise. This means that you may not get the same strength gains from a training session as you would have done without taking the tablets! If you have to take pain medication in order to train, it’s a clear sign that your body has not repaired the damage from your previous session. You will give yourself an over-use injury if you do this often. This type of drug can affect your kidney function if you use it too often. Cold water immersion, e.g. ice baths , is also a popular method that athletes use to recover from exercise, but it’s important to understand that they aren’t always the best choice. They too can decrease your inflammatory response. There’s research that shows that if you take an ice bath regularly after every strength training session you do, you may actually blunt your body’s ability to build muscle. But at the same time there’s evidence that shows that if you take an ice bath after a hard training or competition session, it allows you to perform better the next day. So what should you do? The current advice is to use ice baths when you need them. If it’s important to perform well the next day (e.g. multi-day races), take one. If you’re looking for more long term gains from training, don’t take them too regularly. Ice baths should also not be too cold. Between 11 and 15 degrees centigrade seems to be the optimal temperature . Circulation Your blood carries nutrients and oxygen to your cells and it’s quite obvious that good circulation is important for recovery after exercise. Compression socks helps to improve your circulation by helping your blood flow back up your legs to your heart. They have been shown to decrease fatigue as well as the amount of muscle soreness you feel after exercise (DOMS). Athletes who use compression socks have also been shown to recover their strength, power and endurance quicker than athletes who don’t wear them. An active recovery (e.g. jogging or gentle cycling) is often advocated after training as it is thought to improve you circulation and help you get rid of things like lactic acid. The research has found that it does help your lungs and heart recover more quickly, but that it doesn’t have any effect on things like lactic acid or DOMS. Lymph drainage Your lymphatic system is a network of “veins” that run through your body, but instead of blood it has lymph fluid running in it. All the waste products that your cells produce during normal life and exercise are removed via your lymph system. Compression socks have also been shown to improve your lymph drainage. Wearing them can speed up your recovery because it helps you get rid of the waste products from exercise more quickly. There is strong evidence that both massage and foam rolling after exercise can decrease the pain you feel from DOMS. It’s not quite clear why this work but some researchers think that it is due to increased lymph drainage. Food Your body can only repair the damage caused by exercise if you provide it with the building blocks it needs. These include protein, carbohydrates, fat, minerals and vitamins. Exercise nutrition is a complex field and there is no one-size-fits-all. What you need and when you need it will all depend on your own body, the type of exercise you do and what your aims are. For that reason I’ve decided to only provide a few basic principles that should benefit most people. You should already be getting all your minerals and vitamins if you’re eating a balanced diet that includes all the main food groups and stay away from processed food. Your total calorie consumption is very important, but not for the reasons you may think. People tend to associate calorie counting with weight loss, but there is strong evidence to suggest that you can cause yourself injuries like stress fractures if you train very hard and (on a regular basis) don’t replace the energy (calories) you use. This is often most relevant for athletes who do high volumes of training e.g. endurance athletes and triathletes. Protein is the main building block for muscles. The current research suggests that you’ll gain the most from eating protein if you can do it within the 2 hours following an exercise bout. Did you know that protein can also help endurance? Research has found that eating protein after exercise increases your mitochondrial proteins in your cells. Your mitochondria are the batteries of the cells and they have a direct impact on how well your muscles can use the oxygen that’s available to them. Read more about how to best use protein here . Athletes who consume high protein diets also seem to have better immune systems than ones that don’t. Carbohydrate intake during and after sports has become a hotly debated subject over the last few years with some athletes preferring to follow very low carb and high fat diets while others are sticking to more traditional higher carb diets. From what I could find by looking at the current research it still looks as if the quickest way to restore your muscle energy stores is still by eating a carbohydrate rich meal after exercise. How much do you need? That will vary depending on your body size, training session and ultimate goals. In general I'll advise that you steer clear of any refined carbohydrates unless you have to compete again in a couple of hours. In summary: Make sure that you eat a balanced diet and time at least one of your meals within 2 hours after your training session. Rest It should be clear by now that your body needs rest after exercise in order to restore itself. Plan your days. It’s not a good idea to go walking around town for several hours if you’ve just completed a long run. Several studies in the last few years have shown that getting enough quality sleep is a very important part of recovery. This is the time that your body uses to repair. Not only does a lack of sleep affect your mood and brain function, but some studies have shown direct links between lack of sleep and an increased risk of getting injured. Most adults need between 7 and 9 hours of sleep. The problem is that hard training can affect the quality of your sleep. There are plenty of things that could help you sleep better e.g. limiting screen time, watching how much caffeine you use, not eating too late at night etc. Summary of useful techniques for recovery after training Rest & Sleep: This is very important. Compression socks: They can help recovery by improving circulation and lymph drainage. Ice baths: Yes and No. These can be useful depending on your specific goals for that day. Food: Eating a balanced meal within 2 hours of exercise will give you best recovery results. How much you need of what will depend on your body, training type and goals. Massage/foam rolling: Can reduce the amount of DOMS you experience in the days following exercise. Active recovery: This can help your lungs and heart recover quicker. Stretching: This can help you regain your flexibility and range of motion. It does not have any effect on DOMS. Injured? 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 Burke LM, Hawley JA, Wong SH, et al. Carbohydrates for training and competition. Journal of sports sciences 2011;29(sup1):S17-S27. Diet And Stress Fractures In Male Athletes – Has The Research Finally Caught Up? https://www.sports-injury-physio.com/blog/diet-stress-fractures Do compression socks work? https://sports-injury-physio.com/blog/do-compression-socks-work/ Dupuy O, Douzi W, Theurot D, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue and inflammation: a systematic review with meta-analysis. Frontiers in physiology 2018;9:403. How to use protein to boost running, training and recovery https://www.sports-injury-physio.com/blog/how-to-use-protein-supplements Ice Baths for Recovery- Black, white or somewhere in between? http://www.mysportscience.com/single-post/2016/06/16/Ice-Baths-for-Recovery-Black-white-or-somewhere-in-between Is your spiky ball or foam roller as effective as a sports massage? https://www.sports-injury-physio.com/blog/foam-roller-massage/ Simpson, N. S., Gibbs, E. L. and Matheson, G. O. (2017), Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports, 27: 266-274.

During the various stages of the menopause, women experience a dramatic drop in oestrogen levels. Oestrogen has been shown to play an important role in maintaining strong and healthy bones, muscles, tendons, and joints. In this article, we’ll discuss how the drop in oestrogen during the menopause can negatively affect a woman’s musculoskeletal system and what female runners can do to get the most out of their training and prevent injuries. In this article: The different stages of the menopause Effect on Bone Effect on Muscle Effect on Tendons Effect on Joints Should I consider HRT? Here's the video recording of the livestream Maryke did on this topic. The different stages of the menopause Perimenopause: This is the period during which a woman is making the transition to the menopause. It can start around 10 years before the menopause and is basically the period during which your oestrogen levels start to drop. This is when you start observing symptoms like changes to your periods, sleep, mood, weight, hot flushes, decreased sex drive, painful joints etc. Menopause: You are classed as being in the menopause when you’ve not menstruated for a full 12 month cycle. The symptoms are very similar to those of the perimenopause but usually just more severe. Postmenopause: This refers to the years after the menopause. Most woman’s bodies will get used to the new lower levels of oestrogen and you may find that the menopause symptoms slowly decreases. Image from the Cleveland Clinic https://my.clevelandclinic.org/ Effect on Bone Oestrogen plays an important role in building the structure of bone as well as maintaining bone density. One of the most widely known effects of the menopause is that a woman becomes more prone to bone loss that can lead to osteoporosis and in extreme cases fractures. The good news is that weight bearing exercise can help you build new bone, even when your oestrogen levels are low. Running is a great way to stimulate bone growth in your legs and pelvis and can slow the rate of bone loss due to the menopause. There is some evidence that you get an even better response if you combine weight bearing exercise with hormone replacement therapy (HRT). Top tip: Don’t forget about your arms and spine. Running only stimulates the bones in your legs, pelvis and maybe lower back. Weight training has been shown to be an effective way of stimulating bone growth in arms and backs – a good reason to schedule in a couple of strength training sessions in your week. Effects on Muscle Low oestrogen levels appear to affect muscles in 4 ways: 1. It causes a decrease in muscle mass (how much muscle you have). One study found that strength training as well as HRT could reverse some this loss. This study did not show any added benefit if you combined HRT with strength training, BUT the participants in this study weren’t people who regularly trained. So it may be that runners who train regularly may find benefit from combining HRT and strength training. A lot more research is needed in this area before any definitive guidelines can be published. Top tip: This is another good reason to include strength training in your regular programme! Diet also affects your ability to build muscle so make sure that you eat enough protein. 2. It causes a drop in muscle strength and power unrelated to the loss in muscle mass. One study, where they used twins to test the effect of HRT on muscle function (one twin used HRT and the other didn’t) over a 7 year period, found that the higher levels of oestrogen enabled muscles to contract better and that the muscles contained more Type 1 (fast twitch) fibres. Top tip: Make sure you also include exercises that will stimulate fast twitch muscle fibre production and develop muscle power (like plyometrics, sprints and hill reps). 3. Oestrogen protects against muscle damage. This means that low oestrogen levels may mean that you get more muscle damage from doing the same exercise when you’re in the menopause than when you were younger. Top tip: Adjust your training as you go through the menopause to allow your muscles to recover fully and reduce your risk of injury. 4 . Women are better at using fat as an energy source for muscle cells. This is one of the reasons why females have better endurance than men during low intensity exercise. This superior fat-utilisation unfortunately changes with the menopause. There are some studies that suggest that HRT can improve women’s ability to break fats down, but this has not been specifically tested. Effect on Tendons Menopausal women seem to be more susceptible to tendon injuries like Achilles tendinopathy , gluteal tendinopathy and De Quervain's tenosynovitis. When we exercise our tendons, ligaments, muscles etc. all sustain micro-trauma. This is normal. The body uses the rest period after exercise to rebuild these structures so that they’re stronger than before you did the exercise. Tendons are extremely strong structures and are mostly built from collagen fibres. Research has shown that low oestrogen levels lead to an increase in the breakdown of tendon collagen fibres and also a much slower production of new fibres. Tendons change also seem to change their composition to having less collagen and more elastin and aggrecan in reaction to low oestrogen. This means that a woman in her menopause may sustain more micro-damage in her tendons when she trains and they will likely take longer than before to recover from the training. Top tip: Make sure that you vary your training to include high and low load days and that you allow enough recovery time after hard sessions. Tendons react very well to high load resistance training that’s performed at a slow speed, so yet another reason to schedule in some strength training. Effect on Joints Most of our joints in our bodies are synovial joints. Synovial joints are formed where two bones come together. The bones’ endings are covered in cartilage and are held together by ligaments and a strong capsule that surrounds the whole joint. The space inside the joint is filled with synovial fluid. This fluid is produced by the synovial membrane that lines the capsule. Joints don’t have arteries and veins going into them – they get all their nutrients and oxygen from the synovial fluid. There is strong evidence that the drop in oestrogen during the peri-menopause and menopause can also increase the rate at which osteoarthritis develops. Increasing oestrogen in women with signs of osteoarthritis has been shown to have a positive effect on joint cartilage, bone and muscle and decrease the inflammation in their joints. Top tip: Strength training and impact activity can also increase your bone density and muscle strength. Diet can have a big impact on chronic inflammation in the body and you can decrease it by staying away from foods that are processed and high in sugar and trans fats. Should I consider HRT? We don’t know. The truth is that there’s still a massive gap in the research when it comes to this topic with very few studies investigating women who exercise on a regular basis. Oestrogen’s also not the only hormone that’s affected by the menopause. But the early signs are that HRT may be beneficial to help you maintain a strong body for longer. HRT is not for everyone and you may not be able to take it for health reasons. There’s also a lack of research into more natural sources that can help to balance your body and attenuate the effects of the menopause. We would suggest that you discuss it with your GP or find a doctor who has a special interest in it. But in the meantime, take some time to review your training schedule and see how you can adjust it to compensate for the changes your body is experiencing. As mentioned before, diet also plays an important role in inflammation and building muscle and bones so it may also be worth visiting a dietitian/nutritionist – again look for someone with a special interest in the menopause and exercise. Need more 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 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate . References: Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16. Nedergaard A, Henriksen K, Karsdal MA, et al. Menopause, estrogens and frailty. Gynecological Endocrinology 2013;29(5):418-23. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58. Xiao Y-P, Tian F-M, Dai M-W, et al. Are estrogen-related drugs new alternatives for the management of osteoarthritis? Arthritis research & therapy 2016;18(1):151.

Many women (and medical practitioners) don’t realise that women who are going through the menopause are at a higher-than-normal risk of developing gluteal tendinopathy, which is one of the typical causes of greater trochanteric pain syndrome, also known as outside hip pain or lateral hip pain. This article explains how the menopause can cause gluteal tendinopathy, how to avoid this during menopause, and what the best treatment approach for gluteal tendinopathy is. Remember, if you need more help with an injury, you're welcome to consult our team of sports physios online via video call. Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you. In this article: The anatomy of the gluteal tendons How we develop gluteal tendinopathy The menopause and gluteal tendinopathy How to avoid gluteal tendinopathy during menopause Best treatment for gluteal tendinopathy during menopause How we can help via video call The anatomy of the gluteal tendons One of the most common causes of pain round the outside (lateral side) of the hip is gluteal tendinopathy, which is when the tendons that attach your gluteal muscles to the top of your femur, where it protrudes from your hip socket, get injured or irritated due to overuse. Picture credit: Wikimedia More often than not, it is the gluteus medius tendon that is the culprit, but it can also be the gluteus maximus (your main buttock muscle) or the gluteus minimus. If you were to look at a healthy tendon under a microscope, you would see that it consists of many collagen fibres running parallel to each other. Zoom out a bit, and you would see that these fibres are grouped in bundles, also in parallel. This is what makes a tendon so strong and resilient. We all know that it is easy to snap a single piece of thread. But put ten pieces of thread together in parallel, and this is not so easy anymore. How we develop gluteal tendinopathy When we exercise, our tendon fibres (as well as our muscles, joints, and bones) sustain micro-damage, which is quite normal. The natural processes in our bodies then repair that micro-damage by removing the damaged tissue and, in the case of tendons, replacing this with healthy new collagen fibres that are more robust than the previous ones, so that the tendon is now a bit stronger than before the exercise session. That is why over a period of time, our muscles can get bigger, our collagen fibres get stronger in our tendons, or even our cartilage in our joints gets nice and healthy thanks to that repeated cycle of micro-damage and repair. We develop gluteal tendinopathy when we don’t allow our bodies enough time to repair the tendon fibres properly between exercise sessions or if we suddenly overload our tendons in a major way, such as running a marathon on a whim without training for it. The menopause and gluteal tendinopathy So, what role does the menopause play in gluteal tendinopathy, or any other tendinopathy, for that matter? The stages of the menopause For some women the perimenopause can start as early as in their late 30s, but normally it's around about the mid-40s, and it can last up to 10 years. During this stage your hormone levels (predominantly oestrogen and progesterone) start to drop. This is the time where you are starting to get some symptoms of the menopause, and those common symptoms may have nothing to do with tendons whatsoever. These are typically hot flushes, not being able to sleep properly, and maybe putting on a little bit of weight around your waist. We then move on to the actual menopause, which is when your body stabilises at a new lower "normal" hormone level. It's defined as having not had a menstrual cycle or a period for 12 months. So, once you've hit that 12 months, you're then known to have gone through menopause. Hormones and gluteal tendinopathy Oestrogen plays an important part in the process of collagen replacement in our tendons, which means that once the perimenopause starts, the cycle of NORMAL tendon repair takes a little bit longer than previously. So, if you continue with exactly the same exercise regime as previously, or even ramp it up or start with new types of exercise that your body isn’t used to, you run the risk of exercising with tendons that haven’t fully recovered yet from previous exercise, which can then develop into a tendinopathy. How to avoid gluteal tendinopathy during menopause However, it’s not all doom and gloom. If women are aware of the role of the menopause in how tendons get repaired after exercise, we can mitigate against developing a tendinopathy. We can start listening to our bodies while realising that what we can do at this stage in our lives compared to what we could do previously might need a little bit more thought. We might need to realise that a harder session would necessitate a longer recovery time. And to do that, we can listen to the signs and symptoms that we might be having in our body. Do we feel tired and fatigued? Do we have niggles anywhere? Can we rest a little bit longer in between? This doesn’t mean that we can’t do any other exercise in between training sessions. According to the ‘relative rest’ approach, it means that we can switch over to cross-training that doesn't put so much pressure on that gluteal tendon. It could be things like cycling or gentle walking on the flat, or it could be doing high interval intensity training (HIIT) exercises for the upper body that don't necessarily involve your lower limbs. It's about looking at whether we experience pain (anything more than a niggle) during exercise and in the 24 hours following an exercise session. So, for women who have started or gone through the menopause, it's really important that we start planning ahead and start thinking about what exercise sessions we are going to put into our week. How can we better schedule it to allow enough recovery? Best treatment for gluteal tendinopathy during menopause If you have overdone it and you already have gluteal tendinopathy, the best treatment, as with any tendinopathy, is strength training for the tendons and the associated muscles. But you will just have to be more careful with how you approach this and your treatment plan should be adjusted according to how your body responds. For instance, the latest research has shown that doing fewer repetitions of an exercise, slowly and with high weight, produces better results than high volumes of fast repetitions with little or no weight. But what is "heavy" for your painful tendon may be a lot lighter than what you think, so it's important to first establish what your tendon's current strength and tolerance is. It's also important that you allow enough recovery time between rehab sessions. We teach our patients to monitor their 24 hour pain/symptoms response and use that to find the perfect schedule for training. You can find more information about exercises for gluteal tendinopathy in this article. How we can help via video call 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 Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn , Facebook , Instagram or Twitter . References Brukner, P, et. al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management." Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management." Sports Medicine 45(8): 1107-1119. Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial." British Journal of Sports Medicine 52(22): 1464-1472. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58.

Yes, walking can be an important part of your rehab and recovery from gluteal tendinopathy, but there are some factors to consider. If you overdo it, it can actually make things worse. In this article we’ll look at how you should adapt your walking to aid your recovery. 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 or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you. In this article: Why walking can cause pain How can you get your tendons strong enough for walking? Tips for walking with gluteal tendinopathy How we can help We also made a video about this: Why walking can cause pain When we walk, our gluteal (or buttock) muscles have to absorb and generate quite a lot of force. These forces are also transferred through the tendons that attach our glute muscles (glute max, glute med, and glute min) to the hip bone. When you have gluteal tendinopathy, your gluteal tendons lose some of their strength. This means that they no longer have the capacity (endurance and strength) to cope with all the force created during your normal daily walking. Depending on how irritated or sore your tendons are, even short walks may cause them to become painful. It’s important to understand that experiencing lots of pain does not mean you have a really badly injured tendon. Even mildly injured tendons can be very painful. How can you get your tendons strong enough for walking? You have to use a combination of relative rest and strength training. Relative rest is different from complete rest. Relative rest means that you remain active, but you reduce the volume (how far you walk) and/or intensity (speed, hills, and so on) of your activities to levels that do not aggravate your pain. In other words, you reduce your activity levels so that your current (injured) tendon capacity is sufficient to cope with it. This then allows the tendon to calm down so that you can get on with your rehab. Strength training is the most effective way of stimulating your tendons to regain the strength and endurance they need to cope with all the activities you want to be doing in a day. We’ve discussed what exercises work best for gluteal tendinopathy in a previous article. Walking can also be used to restore tendon capacity, but this has to be alongside your strength training programme, not as the only activity. Tips for walking with gluteal tendinopathy 1. Establish your current walking baseline/capacity What distance can you currently walk without causing a significant increase in your pain, either during the walk or in the 24 hours after? This distance is known as your baseline and represents what your tendons are currently able to cope with. It’s OK to have a little bit of discomfort for a short while after your walk, but it should settle down fully within the next 24 hours. If it was very painful, kept you awake at night, or you struggle significantly more for a few days after the walk, then that distance and/or intensity were too much. It may require a bit of trial-and-error to figure this out. We usually advise our patients to start with a very short distance. If it doesn’t increase the pain, they can then up the distance by a bit. But if it causes the pain to flare up, it is usually not as severe as if they had gone for a long walk, and they now know to walk even less the next time. 2. Keep it slow Fast walking creates larger forces on the gluteal tendons and means that they will reach their maximum capacity sooner than when you walk slowly. So, keep it at a stroll or even a saunter to start with. 3. Avoid hills and uneven terrain Hills, soft sand, and uneven terrain will also cause your glutes to work harder and can cause flare-ups during the early stages of rehab. 4. Total time on your feet matters Your gluteal tendons work even when you’re just standing still. So, when you plan your walks or activities, consider the total time that you’ll be spending on your feet that day. For example, if you’re going to spend quite some time on your feet while baking or cooking, it may not be a good idea to also go for a walk that day, as the total load (standing + walking) may exceed your tendon’s current capacity. This is why we take extra time during our assessments to get a good understanding of all the activities and tasks our patients do in a typical day. We then use that information to create an optimal schedule so that they can fit in their strength training and walking around their regular life without causing tendon overload. 5. Respect recovery days Injured tendons take a bit longer to recover from exercise. This is why it’s usually not a good idea to push your tendons to their limit on several subsequent days. It is often best to alternate what we call “high load” and “low load” days. High load days for gluteal tendons are days when you do your exercises (although we also split these into high and low load) or when you do more walking and standing. Low load days may be days where you don’t spend a lot of time on your feet or go swimming or cycling instead of walking. Your physio should help you to figure out the optimal schedule for you. This is not an exact science and also takes a bit of trial-and-error. This is why we ask our patients for regular feedback to ensure that we adapt their programmes in a timely manner if needed. 6. Don’t rush it! It’s normal to experience a small increase in discomfort when you start new exercises or walking. It is really important to get fully used to that load and to allow your body enough time to adapt to it before increasing your walking distance or intensity. And when you do increase it, do it by small amounts, e.g., 5 or 10 minutes rather than 20 or 30 minutes. However, this advice may vary depending on the specific case. 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 15 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) Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management" Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management" Sports Medicine 45(8): 1107-1119. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial" British Journal of Sports Medicine 52(22): 1464-1472.

Tennis elbow (also called lateral epicondylitis or lateral elbow tendinopathy) is an overuse injury and the most common cause of pain on the outside (lateral) elbow. We explain tennis elbow’s causes and how to know whether you have tennis elbow, including three simple tests you can do yourself. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What causes tennis elbow? Why tennis elbow isn’t the best name for this injury The stages of tennis elbow (and why this matters) Pain is no indicator of the severity of your tennis elbow How to know whether you have tennis elbow How we can help We've also made a video about this: What causes tennis elbow?   Tennis elbow develops in the tendons that attach the muscles in your outer forearm to your outer elbow. These muscles work together to extend your wrist (bend it backwards). The most commonly affected muscles are the extensor carpi radialis brevis and extensor digitorum. The natural cycle of tissue breakdown and repair Tendons are made up mostly of collagen fibres, packed tightly in parallel. It is this parallel structure that makes them so strong. When we exercise or do activities that use our muscles and tendons, they naturally sustain micro-injuries. These injuries are normal and signals to the brain that it needs to make these areas stronger.   👍 If you allow enough recovery time between bouts of work or exercise, the body repairs these small injuries so that the tissues grow stronger and stronger over time. This is why someone who has been doing a physical job or specific exercise for a long time can do so much more than someone who is just starting out. Where things go wrong 👎 If you don’t allow enough recovery time between hard bouts of work or exercise, or you ramp up the intensity or volume too quickly, the body doesn’t have enough time to repair all these micro-injuries. When they accumulate, they can cause overuse injuries like tennis elbow.   Typical activities that cause tennis elbow Any activity or action that overworks the wrist extensor muscles will also cause excessive force on the tendons and their attachments into the outer elbow and can cause tennis elbow.   Typical activities that can cause tennis elbow include: Typing Using a computer mouse DYI, e.g. using a screwdriver, painting, and bricklaying (especially if you’re not used to it) Gardening Knitting Carrying shopping bags for long distances Gripping, pushing, and pulling heavy weights Sports like tennis, squash, or gymnastics.   None of these activities have to be a problem – it is only when you do them excessively or you suddenly ramp up how much you do that the injury might develop. Why tennis elbow isn’t the best name for this injury   “Tennis elbow” is not the best name for this injury, since it’s rarely caused by playing tennis. (When it is caused by playing tennis, it’s mostly the backhand that’s the culprit.)   The medical term is lateral elbow tendinopathy. However, I’ll continue to use the terms tennis elbow and lateral elbow tendinopathy interchangeably, as the former is what most people know and understand.   Why not lateral epicondylitis or tendinitis? Medical terms that end in “itis” imply that inflammation plays a major part in the injury process, and this is simply not the case for overuse tendon injuries such a tennis elbow, as you’ll see in the next section. The stages of tennis elbow (and why this matters)   You tennis elbow will be in a specific stage of healing or injury depending on how long you’ve had it for. This matters, because the best treatments in the various stages differ quite a bit.   The three stages of tennis elbow (and other overuse tendon injuries) are:   1. Reactive tendinopathy This is typically the stage your tendon is in when you first injure it, e.g. your tendon pain and stiffness only started a few days ago.   What scans show:  When you scan the tendon, it typically shows an accumulation of fluid between the collagen fibres, but without any major structural changes or injuries to the collagen fibres. There may be a few inflammatory cells, but researchers seem to agree that inflammation is not the main cause of the injury. Impact on recovery:  The good news is, if you apply the correct treatment during the reactive stage, the tendon can fully recover without suffering permanent structural changes.   The best ways to deal with tennis elbow during this stage are rest, load management, and treatments that will help it settle. The worst thing you can do during this stage is strength training exercises (more on this in our treatment article). 2. Tendon dysrepair If you don’t allow the tendon to rest and calm down and you continue to irritate it while it’s in the reactive stage (either through too much physical activity or perhaps by applying the wrong treatments), it might enter the dysrepair stage. Instead of healing, the injury gets a bit worse.   What scans show:  During the dysrepair stage, in addition to tendon swelling, you start seeing the collagen fibres moving away from each other and starting to lose their nice, strong parallel structure. It’s worth noting that this tends to affect only a small portion of the tendon – the rest of the tendon is usually still strong and healthy. There are usually also small blood vessels growing into the tendon, which are normally absent, and there are no signs of inflammation.   Impact on recovery:  Recovery tends to take a bit longer than in the reactive stage. There is evidence that the tendon structure can mostly revert to normal with the correct mix of load management and careful loading (learn more about this in our treatment article).   3. Degenerative tendinopathy Your tendon might have entered this stage if the tennis elbow injury has dragged on for several months.   What scans show:  The injured area of the tendon (remember, this is usually only a small part ) now show signs that the collagen fibres have been damaged and have totally lost their parallel structure. You also see many blood vessels growing into the area. There is no inflammation. Impact on recovery:  You can still restore full pain-free function in your tendon, but the injured area will likely not be normal again. Recovery now depends on getting the rest of the tendon (the uninjured part) to grow stronger and to take over the work of the injured part.   The best treatments  for tennis elbow during this period should focus on reducing pain and increasing the tendon’s strength with a training plan that gradually becomes more challenging. Pain is no indicator of the severity of your tennis elbow   The pain people experience when they have lateral elbow tendinopathy can vary dramatically. Some people may feel only a bit of discomfort or only have pain with activities that really load the tendon, e.g. carrying a heavy bag or gripping something strongly, while others may have lots of pain even when the tendon is not working.   It’s important to understand that pain is not linked to how severe your tennis elbow is . There's evidence that your tendon might show only a minor injury on scans, but your pain can be very intense, and vice versa.   Research has shown that the level of pain can be amplified when you’ve had your injury for longer than three months, are under a lot of stress (work or otherwise), don’t sleep well, and believe that the injury won’t get better. So, in addition to treating the tennis elbow itself, these are all factors worth addressing if your pain persists or is very intense. How to know whether you have tennis elbow   Tennis elbow symptoms The best way to diagnose tennis elbow is to combine information from: What the symptoms feel like:  The main symptoms of tennis elbow are pain and stiffness. 💡If you’re getting tingling, funny sensations or numbness, it might mean that you’ve injured a nerve; this can be in addition to or instead of having tennis elbow. Location of the symptoms: The pain is mainly in the tendons of the wrist extensors or where they attach to the outer elbow. In ongoing cases, you may get some stiffness and pain going into your forearm or upper arm. 💡If you’re getting neck, shoulder, or wrist pain, it might be worth getting it checked by a physiotherapist, as you may have a different injury. How the symptoms started: Tennis elbow symptoms usually start gradually during an activity, several hours after the activity, or you may even wake up with the pain and stiffness the day after an activity. 💡If your symptoms started when you felt a sudden, sharp pain while doing something, it might be a tear rather than tennis elbow. How the symptoms react to activities:  You usually experience pain with activities that require extending the wrist or gripping, pulling, pushing, or turning things. Some people may only feel mild discomfort, while others may get intense pain when they do something as simple as lifting a cup of tea. 💡If your pain is mainly aggravated when you move your elbow (without involving the hand) you might have an injury inside your elbow joint rather than tennis elbow. Tests for tennis elbow You can further hone the diagnosis with three simple tests:   Important:  You might not experience pain in all of these tests. If your symptoms fit the above descriptions and you have at least one positive test, you might have tennis elbow.   Cozen’s test The aim of this test is to strongly contract the wrist extensor muscles to see if it causes pain. The test focuses on the extensor carpi radialis brevis muscle, but all the other wrist extensor muscles also have to work. Sit with the arm to be tested straightened at the elbow. Turn your wrist so that your palm faces down and make a fist. Now, move your fist slightly inward (abduction) and up. Place your other hand on top of your fist. Now try to tilt your fist on the injured side upwards (extending your wrist) while pushing down on it with the other hand, creating a strong isometric contraction of the wrist extensor muscles – don’t allow it to move. If this causes pain over the outer elbow where the tendons run or attach, you might have tennis elbow.   Mill’s test The aim of this test is to stretch the wrist extensor muscles and their tendons to see whether it causes pain. Sit with your arm extended at the elbow. Turn your wrist so the palm is facing down and your hand is horizontal. Now use your other hand to push your hand downwards as far as it will do. If this causes pain over the outer elbow where the wrist extensor tendons run or attach, you might have tennis elbow. I often adapt this test – if it doesn’t cause pain at first – by getting the patient to make a fist with their hand before they push it downwards. This increases the stretch on the extensor digitorum and can sometimes cause pain if that is the tendon that is affected most.   Maudsley’s test This test targets the extensor digitorum muscle further by getting it to contract against resistance. Sit with your injured arm straight out in front of you and your palm facing down. Extend your fingers so that they form a straight line with your arm. Use your other hand to press down on your middle finger but resist the downward pressure by pushing back up with your finger; in other words, don’t allow your finger to be pressed down. If this causes pain over your outer elbow, you may have tennis elbow.   What about scans for tennis elbow? The best scans for diagnosing tennis elbow are ultrasound scans and MRI scans.   However, you usually don’t need a scan to diagnose tennis elbow. The few scenarios in which scans are useful are if your injury isn’t healing as expected or your doctor or physiotherapist suspect that you may actually have a different type of injury, e.g. a tendon tear or ligament injury.   Okay, so if you or your physio have figured out that you do have tennis elbow and in what stage of the injury it is, what do you do next? Here is our article on the best treatments for tennis elbow. 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 Cook, J. L. and C. R. Purdam (2009). "Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy." British Journal of Sports Medicine 43(6): 409-416. Cook, J. L., et al. (2016). "Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?" British Journal of Sports Medicine 50(19): 1187-1191. Coombes, B. K., et al. (2015). "Management of lateral elbow tendinopathy: one size does not fit all." Journal of Orthopaedic & Sports Physical Therapy 45(11): 938-949. Butler, D. and Mosely, L. (2013). Explain Pain. Noigroup Publications: Adelaide, South Australia.   Hanlon SL, Pohlig RT, Silbernagel KG. Beyond the Diagnosis: Using Patient Characteristics and Domains of Tendon Health to Identify Latent Subgroups of Achilles Tendinopathy. J Orthop Sports Phys Ther. 2021 Sep;51(9):440-448 Lai, W. C., et al. (2018). "Chronic lateral epicondylitis: challenges and solutions." Open Access J Sports Med: 243-251. Menon, N. A. (2024). "A Review of Lateral Epicondylitis Injection: Drugs Used, Injection Techniques and Guidance Method." Indian Journal of Physical Medicine & Rehabilitation 34(1): 21-26. Karanasios, S., et al. (2021). "Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials." Br J Sports Med 55(9): 477-485.

In this video, I demonstrate how to tape your ankle and foot with rigid zinc-oxide tape to reduce the load on your tibialis posterior tendon. It's not a long-term solution, but can provide good short-term pain relief when you have posterior tibial tendonitis. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. You can find more detailed advice about treatment for posterior tibial tendonitis in this article . If you find that this taping technique for posterior tibial tendonitis reduces your pain, it may mean that you would benefit from wearing supportive insoles in your shoes. Remember, if you skin turns red or itchy, it usually means that you're allergic to the tape and it's best to remove it immediately. 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 Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here , and she's also on LinkedIn .

We are often asked about running after a knee replacement. People are mostly concerned about two things: “Will I be able to run after a knee replacement?” and “Will I wear out my knee replacement if I run?” This article distils what the latest research tells us (and doesn’t tell us). It also has some advice on how to increase your chances of running after having your knee replaced. 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 or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you. In this article: What does a knee replacement involve? What does the research say about running after a knee replacement? Will I be able to run after a knee replacement? Will running wear out my knee replacement? How to increase your chances or running after your knee replacement Alternatives to running after a knee replacement How we can help We've also made a video about this: What does a knee replacement involve? A knee replacement, also called a knee arthroplasty, is a surgical procedure to resurface the weight bearing surfaces of a knee joint damaged by osteoarthritis. A surgeon caps the ends of the thigh bone and the shin bone, which form the knee joint, and sometimes also the kneecap, with metal or plastic parts. A partial knee replacement, also known as a unicondylar knee replacement, is when only one part of the knee joint is resurfaced. What does the research say about running after a knee replacement? Will I be able to run after a knee replacement? Yes, there are people who go back to running and appear to do so without any issues. A study of ultra marathon runners who took part in at least one of the five Ultra-Trail du Mont Blanc races in France from 2015 to 2017 (ranging from 55 km to 300 km) found that three of the four runners who ran with a knee replacement completed their race. This drop-out rate of 25% (admittedly from a tiny sample) compares favourably with the overall drop-out rate of 19.6% among the 3,171 surveyed runners who started a race. None of the four runners with a knee replacement reported adverse symptoms relating to the knee before, during, or after the race, whereas some of the runners who had had hip replacements did report such symptoms. Marco Konings and colleagues did a review of 19 research studies on a total of 4,074 knee replacement patients . They found that 23 out of a total of 131 runners in these studies had returned to running post-op. The above shows that it is possible to run after a knee replacement, for ultra runners and for mere mortals. However, in practice, not all runners who have had a knee replacement do go back to running, as is clear from the results of the Konings study. Several studies have found that the percentage of people who return to high-impact activities, such as running, after a knee replacement was much lower than that of people returning to lower-impact activities, such as cycling or swimming. It is not clear from any of these studies whether people who didn’t return to running were physically unable to run after their knee replacement and/or whether they were afraid of damaging or wearing out their new knee. This brings us to the next question. Will running wear out my knee replacement? We’re not sure. Expert opinion is that high-impact activities may wear out your replaced joint more quickly, but there is actually no strong research to back this up. There’s very little research that investigated the effect of physical activity on prosthesis wear. Mixed research results for general activity In a 2021 overview of research on patients with replaced knees, Martin Thaler and colleagues found conflicting results. Some studies showed that active people with replaced knees were more prone to needing their replaced knee replaced once again than inactive people, whereas other studies found that people who were inactive post-op were more likely to need a second new knee. They concluded that there is currently conflicting evidence with regards to the effect of general physical activity on the wear and tear of a replaced knee. We should keep in mind that the benefits of an active lifestyle for your general health (heart, preventing diabetes, improved bone density, etc.) may outweigh the risk that it poses to a replaced knee. What about high-intensity exercise? In a similar review of the research, Elena Zaballa and colleagues found only one paper that assessed post-operative “leisure time physical activity” (i.e. also sport) in relation to the risk of damage to your replaced knee. It showed no increased risk in participants doing "high-intensity" leisure activities. Unfortunately, they didn’t specify whether these high-intensity activities were "high-impact", such as running, or low-impact, e.g. interval cycling. So, these results can’t produce a definitive answer. All it tells us is that you can likely do high-intensity exercise without increasing your risk of having to go for knee surgery once again but not what type of exercise is best. What about high-impact activities (like running)? We could not find any studies with empirical findings about the risk of damaging a replaced knee by running or doing other high-impact activities. A research review conducted earlier this year on hip replacements showed that the degree of wear and tear depended not only on the amount of physical activity but also on the mechanical loading of the joint. This in turn depended on body weight, type of physical activity, and technique (whether you are an experienced or a newbie athlete), where high-impact activity and poor motor control increased the risk. These results suggest that high-impact activities may increase the risk of damaging a hip replacement, but it was one of many factors. Research for knee replacements is still lacking. A recent survey of knee replacement experts showed that the majority say that patients can safely go back to jogging and running after knee replacements. Thaler et al. questioned 120 knee surgeons from 31 countries, and 68% agreed that patients could go back to jogging after six months, 60% said they could jog on the road, 54% said that patients could run on a treadmill, and 51% said any type of running. They didn’t explain how they defined the difference between jogging and running, but I assume jogging would be easy running and running would be harder sessions. For some context, these experts agreed overwhelmingly that people who have had a knee replaced should never play squash again. What’s the verdict? A lack of research showing that running will wear out or damage your knee replacement should not be seen as evidence that running with a replaced knee is safe. It might increase your risk, but most experts these days feel that patients can resume jogging and running after six months. How to increase your chances or running after a knee replacement So, what can runners do to increase their chances of being able to hit the road or trails again after their knee replacement? Start before your surgery The research shows that knee replacement patients who stayed active until they had their surgery were more likely to return to their sport. Staying active means that your general health is better and that your legs have better blood supply. This will help your knee to heal more easily. Your muscles will also be stronger, so you will regain your strength more quickly. Yes, you may not be able to run soon after surgery, but try and find something you can do to stay active in the meantime. How about cycling, or swimming, or some gentle strength training? If you’re struggling to find something appropriate, a physiotherapist can help you to figure it out. Don’t rush back into running The majority of knee surgeons advise that it is only safe to start jogging or running after six months. This is because the body takes a long time to heal. It’s not just about getting your muscles strong. The bone where the new knee surfaces were attached requires time to settle and stabilise as well. Build your base strength (and maintain it) The stronger your muscles are, the more shock they will absorb, and the less strain your new knee will have to deal with. I find the leg press to be a very good all-round strengthening exercise for knees , especially since it can be adapted for individual circumstances. But don’t just focus on the muscles close to your knee (quads, hamstrings, calves). You should also include exercises for your core and hip muscles, especially the glutes . The body works as a kinetic chain. It requires all the links to be strong and to take their share of the load. Make sure you maintain your strength once you resume running by doing regular strength training sessions. Balance and control As mentioned earlier, poor motor control has been implicated as a factor that may increase the wear on your new knee. Motor control refers to how well-coordinated your body moves. For runners, this also impacts their running form. You can retrain your motor control through exercises that challenge your balance . You should also focus on having good form when you do your regular strength training exercises, e.g. keeping your knees well aligned when you do squats. A good example of an exercise that develops strength and motor control is a single leg deadlift. Less is often more Many of my older patients who run find that they run better and get fewer injuries if they focus on doing only a few high-quality runs per week. They then top up their training week with lower-impact cross training sessions. Everyone is different, but you will likely find that there is an upper limit of running volume that your knee can cope with. This can be frustrating, but trying to force it to do more might just lead to trouble and even cut your running days short. Minimise the load on your new knee Minimise the load on your replaced knee when you run. Things that might help include: Cushioned running shoes - Hoka is a brand that provides good cushioning plus stability. Running on soft surfaces Working on good running form and not pushing into full exhaustion Keeping your body weight within a healthy range. But remember that restricting your calorie intake too severely can have a negative effect on your bone health, so don’t overdo a weight loss diet. Continuing your strength training and motor control exercises even after you go back to running. Alternatives to running after a knee replacement You should aim to incorporate a mix of activities into your week. Aerobic exercise Aerobic exercise promotes health in general. It keeps your heart and lungs healthy and helps to treat and prevent diseases like diabetes. If your knee won’t tolerate running or you want to switch to doing lower-impact activities anyway, you may find walking, incline walking on a treadmill, cycling, using the cross trainer, or swimming useful. The World Health Organization (WHO) recommends that we do 150–300 minutes of moderate or at least 75–150 minutes of vigorous aerobic physical activity, or an equivalent combination of moderate and vigorous activity per week. Strength and balance Regular strength training at the gym can work, but your physio can also suggest exercises that you can do at home. Pilates, Thai Chi, and yoga are examples of activities that tick this box. The WHO currently recommends that people above the age of 65 incorporate three or more such sessions into their week. 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 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Rochoy, M., et al. (2020). "Does hip or knee joint replacement decrease chances to complete an ultra-trail race? Study in participants at the Ultra-Trail du Mont Blanc®." Orthopaedics & Traumatology: Surgery & Research 106(8): 1539-1544 Konings, M. J., et al. (2020). "Effect of knee arthroplasty on sports participation and activity levels: a systematic review and meta-analysis." BMJ Open Sport & Exercise Medicine 6(1): e000729-e000729 Thaler, M., et al. (2021). "Twenty-one sports activities are recommended by the European Knee Associates (EKA) six months after total knee arthroplasty." Knee Surgery, Sports Traumatology, Arthroscopy 29(3): 694-709 Zaballa, E., et al. (2022). "Risk of revision arthroplasty surgery after exposure to physically demanding occupational or leisure activities: A systematic review." PLoS One 17(2): e0264487 Mooiweer, Y., et al. (2022). "Being active with a total hip or knee prosthesis: a systematic review into physical activity and sports recommendations and interventions to improve physical activity behavior." European Review of Aging and Physical Activity 19(1): 1-16 Ponzio DY, Chiu Y-F, Salvatore A, et al. (2018) "An analysis of the influence of physical activity level on total knee arthroplasty expectations, satisfaction, and outcomes: increased revision in active patients at five to ten years." J Bone Joint Surg Am 100:1539–1548

Hamstring injuries are extremely common, especially in sports involving running. In this article, we explain what puts you more at risk of a hamstring injury or re-injury and what you can do to avoid a hamstring strain. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. Here’s how the story often goes… You spent time, weeks perhaps, being ‘good’ and resting your hamstring muscle strain while you went stir crazy, enviously watching your friends continue to play sport and run races. Your hamstring finally felt better, so you euphorically went back to sport / running, and a while later ... it went again! Aaargh! Infuriating! Now what!? In this article: Anatomy of the hamstring Hamstring strain risk factors you can manage Hamstring strain risk factors you cannot control How we can help Anatomy of the hamstring The hamstrings are a big muscle group made up of the biceps femoris, the semimembranosus, and the semitendinosus. They all start at the sit bone (ischial tuberosity), at the bottom of the pelvis, and come down the back of the thigh and attach into the tibia, just below the knee. The biceps femoris attaches below the outside of the knee, and the semimembranosus and semitendinosus below the inside. One of the interesting things about hamstrings is that they cross both the hip joint and the knee joint, so they can extend the hip (take the leg backwards) AND flex (bend) the knee. When we run, one of the main jobs of the hamstrings during the swing phase of gait, i.e. when your foot is off the ground, is to lengthen in a controlled way (eccentrically) to manage at what speed and how far the powerful quadriceps muscles at the front of your thigh are straightening your leg. There is one point, when at maximum stride length when sprinting, that the hamstrings are not only working hard eccentrically but also on a stretch; this is one of the most common times for the muscle to get injured. As your leg starts to swing back and your foot makes contact with the ground, the hamstrings now produce a powerful concentric contraction (where the muscle shortens as it contracts) that helps to push you forward. The faster you run, the more forcefully your hamstrings contract. A hamstring ‘strain’, ‘tear’, or ‘sprain’ all mean the same thing, and the severity of muscle injury is now graded 0–4 (previously 1–3) depending on how much of the muscle has been injured. The higher the grade, the longer it will take to rebuild the injured muscle and regain full strength. So, now you have some background knowledge on how the hamstrings function, how does it apply to what you need to do to avoid injuring or re-injuring yours? Hamstring strain risk factors you can manage Let’s start with some of the ‘modifiable risk factors’ for hamstring strains or, in other words, stuff you can do something about to decrease the risk of it getting injured again. Strength We’ve already discussed how the hamstrings work eccentrically against the quadriceps when you run. If there is a deficit in the endurance or the eccentric strength in the hamstrings, particularly in comparison to the quadriceps (the hamstrings : quads ratio), then there is an increased risk of hamstring muscle injury, as it is easily overwhelmed by the strength of the quadriceps. How to fix this: Make sure that your rehab programme includes exercises that develop the eccentric hamstring action. This doesn’t mean that you should rush in and do Nordic curls right from the start. Eccentric contractions make the muscles work really hard, and you should first build your base strength with gentler exercises. Power How far can you hop on one leg? Is it the same on both sides? If you’re a runner, you may wonder why hopping on one leg concerns you. This is just a way to test your hamstrings’ ability to create powerful concentric contractions. A recent research review showed that returning to running/sport before recovery of full power can also increase your risk of hamstring muscle injury. How to fix this: Include plyometric (hopping and jumping) exercises in the later stages of your rehab. Core muscle control Research has also shown that poor trunk muscle stabilisation and control while running can increase the risk of hamstring muscle injury. It is therefore important to address not just the hamstring itself, but any underlying biomechanical factors around the pelvis or spine that might need strengthening or improving. How to fix this: Doing sit-ups and planks is not sufficient. You should include core exercises that require you to stabilise your pelvis while also moving your legs (this is what the core does when you run). An example of an early-stage exercise would be bridges with leg lifts. High-speed running exposure / training error It makes sense that if there is an increased mechanical risk in hamstring injury with sprinting, then the overall risk is increased the more you sprint. There is also evidence that sudden increases in sprinting volumes in the past 7 to 14 days from what you are used to doing before also increase the risk of injury. However, a gradual increase or build up can be beneficial in conditioning the muscle to that load. Gradual conditioning may in fact contribute to a decreased risk of re-injuring your hamstring. There is conflicting evidence about whether decreased recovery times between matches or races will increase the risk of hamstring injury – some studies say it does and others say it doesn’t; it probably depends on what your body is used to. How to fix this: Plan your training carefully and avoid sudden increases in the frequency of your high intensity (fast running) sessions. Flexibility The evidence on whether tight hamstrings increase your risk of an initial hamstring injury is also not clear. However, poor flexibility in the hamstrings may increase the risk of recurrent strains. How to fix this: Make sure that you regain your full range of motion after you’ve injured your hamstring. However, take your time, as you can actually re-injure your muscle if you stretch it too strongly early in your rehab. It’s often best to use eccentric exercises rather than passive stretches to regain the full range, as they strengthen the muscles as they lengthen them. Hamstring strain risk factors you cannot control Unfortunately, there are also a few ‘non-modifiable’ risk factors associated with hamstring muscle injury, i.e. things that increase the risk of injury that, well, you can’t really do much about. Previous hamstring injury When you’ve injured your hamstrings once, the risk of a recurring hamstring strain is 2.7 times higher than had you never injured it. This could be because of structural weakness and scar tissue being more vulnerable. That risk increases to 5 times higher if the hamstring was injured in the same competitive season; this probably accounts for people who try to return to sport too soon without completing a comprehensive rehab plan. How to limit this risk: Make sure that you follow a carefully graded and progressive strength training plan to restore your injured hamstring’s strength, power, and flexibility. A typical plan will start with gentle, low intensity exercises that avoid taking the hamstrings into too much stretch. As your injury recovers, these exercises should increase in intensity and include exercises that develop the eccentric muscle action as well as quick, powerful contractions. They should also strengthen the hamstrings through the full range it moves through when you run or play your sport. Age It’s a sad fact of life that injury risk increases as we get older. This could be due to a decrease in tissue quality or perhaps an increase in overall exposure to load. Either way, age is not something any of us can do much about! How to limit this risk: The good news is that research has shown that regular strength training can reduce your injury risk by up to 50% and also preserve your muscle mass and strength as you get older. You can read more about how to mitigate the effects of ageing on your running in this article . Previous Anterior Cruciate Ligament (ACL) injury Recent research has found that recurring hamstring strain risk is increased if there has been a previous ACL injury. This may be due to a part of the hamstrings having been used for an ACL reconstruction graft. It could also be due to ongoing knee instability, which increases the load on the hamstrings. How to limit this risk: The answer once more lies in the quality of your post ACL injury rehab. Take your time to build your function and strength, with particular focus on the hamstrings. Include lots of balancing work, as this can help to improve your knee control and stability. How we can help Our team of sports physiotherapists can help you with a full physio assessment to identify your modifiable risk factors and then put together a plan to address them, along with a graded strengthening and running conditioning build-up. You're welcome to get in touch if you would like some guidance with this. Otherwise, good luck! Go and get this sorted and get back out there! 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 Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here , and she's also on LinkedIn . References Green B, Bourne MN, van Dyk N , et al. “Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport” British Journal of Sports Medicine 2020; 54:1081-1088 Erickson LN, Sherry MA. “Rehabilitation and return to sport after hamstring strain injury” J Sport Health Sci. 2017 Sep; 6(3):262-270 Brukner P, Nealon A, Morgan C , et al. “Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme” British Journal of Sports Medicine 2014; 48: 929-938 Pollock N, James SLJ, Lee JC , et al. “British athletics muscle injury classification: a new grading system” British Journal of Sports Medicine 2014; 48: 1347-1351

Yes, absolutely! You just have to take things slow and listen to your body. The biggest mistake you can make is to try and follow someone else’s programme or pace. Here are some tips on how to start running safely after the menopause. And remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What are the benefits of running through or after the menopause? How to start running safely after the menopause How we can help We also made a video about this: What are the benefits of running through or after the menopause? We’ve previously discussed in detail how the drop in oestrogen during and after the menopause can negatively impact your bones, tendons, muscles, and joints . It also affects other aspects of your life, like mood and sleep. The research shows that exercise can help to reduce these negative effects. Running is a smart choice of exercise as it is weight bearing (so it helps to maintain your bone strength), builds strength in your tendons and muscles, and also has a positive effect on mood and sleep. How to start running safely after the menopause All new runners (regardless of their menopause status) are prone to injury if they overdo things. And when you’ve gone through the menopause, your body usually requires a bit of extra time to repair itself after exercise. You can manage this situation by using the following tips. 1. First, build your walking endurance This has two benefits. Firstly, it will allow you to observe your body’s response to exercise and to gauge how many recovery days you need between sessions. Secondly, it will build the base strength you need to transition safely to running. Top tip: You have to be able to walk comfortably for 30 minutes at a brisk pace two to three times a week before introducing some running into your exercise programme. 2. Then, start a run-walk programme Running requires a lot more energy and places your body under a lot more strain than walking does. So, it makes sense to mix up running with walking at first. An example would be to progress from walking briskly for 30 minutes to walking briskly for four minutes and then running for a minute, repeating this until you’ve done a total of 30 minutes. These short running intervals will work your body hard, but then you allow it a bit of rest and recovery through walking. It’s also much easier to focus on having good running form when you’re not too fatigued, which will help you to avoid injuries. As your fitness improves, you then gradually increase the amount of running and decrease the amount of walking until you can run continuously for 30 minutes. Top tip: A run-walk programme is the safest way to ease into full-on running. 3. Speed is relative I often hear new runners complain that they are so slow. But speed is relative to what you’ve done in the past. To increase your speed from just walking to a slow jog actually requires a big effort from your body. Fast running creates much stronger forces in your bones, muscles, tendons, and joints. And if you’re new to running, they simply won’t have the strength yet to produce or cope with strong forces. It will take several months and sometimes a few years of regular running for your body to build the capacity for running fast. Top tip: Allow your speed to naturally develop as your body grows stronger and fitter. Run at a pace that feels comfortable and allows you to breathe easily without having to stop. 4. Take your time The drop in oestrogen levels during the menopause means that your body can’t repair and rebuild itself as quickly between exercise sessions as before. This is why even experienced runners are more prone to injury after the menopause if they don’t adapt their training habits. There are plenty of run-walk programmes available. Make sure that you don’t slavishly follow the one you’ve chosen, because whoever created it can’t know how quickly your body will adapt and recover. Top tip: Have bigger gaps between your training sessions if your legs don’t feel as if they’ve fully recovered yet. Only increase the amount of running in your run-walk programme when you feel that you’re 100% used to the current mix of running and walking. If you’ve found your last session hard work, repeat it until it feels easy and only then move on. 5. Strength train (I don’t mean pumping iron in the gym) Strength training has been proven to help runners prevent injury. We also know that the menopause makes you lose muscle strength and control but that these losses can be delayed or prevented through strength training. The words “strength training” can often discourage women because it sounds aggressive, and not all of us want to go lift weights in a gym. Strength training comes in many forms. If you’re new to it, then you can get really good results just by doing simple exercises at home, using your bodyweight. This article has examples of simple strength training exercises you can do at home . You also don’t have to allocate massive amounts of time to it. Two sessions per week can be enough. If you find a clever physio, they should be able to give you 3 or 4 exercises that target all the main areas. Top tip: If you feel a bit overwhelmed when you think about strength training, speak to a physio who can guide you. How we can help Our team of physios are experts in injury prevention and treatment, and we can help you understand your body, help you understand what training intervals may be best for you, and advise on what strength training exercises you can do. You’re welcome to consult one of the team at SIP online via video call . 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 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References 1. Shimojo, G. L., et al. (2018). “ Combined aerobic and resistance exercise training improve hypertension associated with menopause ” Frontiers in Physiology 9: 1471. 2. El Mohtadi, M., et al. (2021). “ Estrogen deficiency - a central paradigm in age-related impaired healing? ” EXCLI Journal 20: 99-116. 3. Leblanc D, Schneider M, Angele P, et al. “The effect of estrogen on tendon and ligament metabolism and function” The Journal of Steroid Biochemistry and Molecular Biology 2017;172:106-16. 4. Nedergaard A, Henriksen K, Karsdal MA, et al. “Menopause, estrogens and frailty” Gynecological Endocrinology 2013;29(5):418-23. 5. Oliva F, Piccirilli E, Berardi AC, et al. “ Hormones and tendinopathies: the current evidence ” British Medical Bulletin 2016;117(1):39-58. 6. Xiao Y-P, Tian F-M, Dai M-W, et al. “Are estrogen-related drugs new alternatives for the management of osteoarthritis?” Arthritis Research & Therapy 2016;18(1):151.