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The best treatment for abdominal tendinopathy is a carefully graded rehab programme that is pitched at the right intensity to allow the tendons to calm down and regain the strength they've lost due to the injury. In this article I'll explain how to design such a plan and also what other factors you should keep in mind when doing your rehab. 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 and symptoms of abdominal tendinopathy Causes of abdominal tendinopathy Treatment for abdominal tendinopathy Recovery days are important How we can help The anatomy and symptoms of abdominal tendinopathy Anatomy The pictures above of the abdominal wall and the pelvis show where the rectus abdominis muscles (your six-pack) are attached to the pubic bone. It also indicate where the adductor muscles (the inner thigh muscles) attach to the pubic bone. This is important, because the tendons of these two sets of muscles are actually attached to each other via a thick layer of fascia that crosses over the pubic bone. They work together as you do sports, and if one of them gets injured it often affects the other as well. This is why you may end up getting adductor tendon injuries if you neglect abdominal tendinopathy or vice versa. Another bit of anatomy to take note of is the pubic symphysis, indicated by that little gap in the middle of the pubic bone, because osteitis pubis , which affects this area, is often also associated with tendinopathies of the abdominal and/or the adductor muscles. Symptoms Pain caused by abdominal tendinopathy usually starts on one side of the body where the tendons attach to the pubic bone and pubic symphysis. In severe cases, it then crosses over and both sides become painful. The pain can also refer up into the abdominal wall, or down into the adductor muscles, and into the genital area (front groin). However, there can be many other causes of pain in these areas, so it is important to have it checked out by your doctor to see whether it might actually be something like a bladder infection or a hernia. If you want to be sure about your diagnosis, the best thing to do is to get either an ultrasound scan or an MRI scan. An MRI scan, if you have access to that, would be my preference, because then you can also see the state of your pubic symphysis as well as your adductor tendons. As mentioned above, injuries in these three areas often go together. Causes of abdominal tendinopathy Abdominal tendinopathy is an overuse injury that can either develop suddenly (because you do a very hard training session) or slowly over time (because you don't allow enough recovery time between sessions). One would think that the main cause of abdominal tendinopathy would be overdoing it in the gym with sit-ups and crunches, and yes, that is one way to get it. But, surprisingly, this injury is also quite common in running sports - especially ones that involve a lot of twisting and turning, such as football/soccer, and hockey. This is because your abdominal muscles are active and working whenever you're upright and moving. Long-distance runners are also known to develop abdominal tendinopathy, but for them it is often a secondary injury as a result of an injury to the adductor tendons or osteitis pubis. Another common cause of abdominal tendinopathy that is not linked to sport is giving birth, as this process obviously puts a lot of strain on that area. Treatment for abdominal tendinopathy The most important treatment for abdominal tendinopathy is a combination of relative rest and strength training . The relative rest allows the pain and sensitivity to settle down while the strength training is needed to restore the strength that was lost due to the injury. Relative rest/load management Once injured, the abdominal tendons lose some of their strength. This means that they are now not strong enough to cope with the forces and loads put through them by your sport. So, if you continue to do your sport as usual and you don't dial it down a bit, you will just keep on making it worse. You also won't see results from your rehab, because you're trying to strengthen the tendons on top of the load that your usual sport activities put through it. This is why relative rest or load management is important. Initially, you have to reduce the amount and maybe even the type of sport you do to a level that doesn't aggravate your injury. By how much you should reduce it will depend on your type of sport and how severe your injury is. The aim with this is to establish a baseline of sport that you can do that does not cause an increase in your symptoms. For instance, if you're a footballer, it will very likely mean that you need to cut out high intensity sessions like matches and movements where you twist and turn. So, it will likely mean a break from football for a while, but you may still be able to run to maintain some of your fitness. However, if even running hurts, you'll have to replace it with something else. Runners may have to reduce their speed and distance. However, for some people, even that doesn't work. If it's really sensitive, you may have to stop all running for a while and just do some cycling or cross-training until it's recovered and strengthened enough to cope with running again. Weight lifters will likely have to reduce the weights they lift and try to find a level that doesn't aggravate their pain. Top tip: Keep in mind that a tendon might only tell you the next day if you’ve overdone it, so if your abdominal tendons complain first thing in the morning, think about what you did the previous day that might have upset them. Strength training That part of your abdominal tendon that's injured is now weaker than what it should be to absorb the forces during your normal sport, so you have to strengthen it. It's important to remember that this is an overuse injury. So, you have to be quite mindful of how you introduce exercise and strength training. If you go and do lots of heavy strength training immediately, you will just over-strain it and it will feel worse. Also, you have to keep in mind what else you've got going on. So, for instance, if you've got osteitis pubis as well, then you want to avoid anything that puts a big rotational/torsion force through that pubic symphysis area in the initial stages of rehab – you want to keep exercises nice and symmetrical at first. You can take a look at the detailed videos we’ve made about the treatment of osteitis pubis and of adductor tendinopathy . These two things need to be addressed if you've got them at the same time as your abdominal tendinopathy. Low load isometric contractions (like an isometric crunch), where you tense your muscles without moving, tend to work really well for abdominal tendinopathies, especially in the early rehab stages. The specific movements and the dos and don’ts of the exercises that I prescribe for my patients are best demonstrated in the video below, from 09:50 onwards. The first few exercises are nice and symmetric, so people who also have osteitis pubis can get started with those without flaring up their condition. Top tip: It's important to increase the exercise intensity and complexity gradually over time. What exercises you should progress to and what level of intensity you should work up to will depend on your sport and your individual goals. Recovery days are important One of the most common mistakes people make when recovering from abdominal tendinopathy is that they overdo their rehab. They are so desperate to get better that they fall into the trap of thinking that if they do their exercises every day, they'll recover quicker. But the opposite is actually true. Whenever you exercise, your body sustains microdamage. This is normal. Your body then repairs this microdamage and that's how you grow stronger over time. However, if you don't allow enough recovery/repair time between your training sessions, the microdamage accumulates and causes overuse injuries like abdominal tendinopathy. Tendons take much longer than muscles to recover after exercise (about 42 to 72 hours). So you have to allow enough time between your rehab sessions for this to take place, otherwise you'll just end up overtraining it again. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon) Cook, J. and S. Docking (2015). "“Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians." British Journal of Sports Medicine 49(23): 1484-1485. 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. McAleer, S. S., et al. (2015). "Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy." Physical Therapy in Sport 16(3): 285-299.

Exercises are an important part of treating meniscus tears . For an exercise plan to be effective, it has to start at the correct intensity that matches the severity of your symptoms and then progress until you regain full strength and control. In this article, we demonstrate 23 exercises and stretches that are typically prescribed for meniscus tear rehab. It explains why these types of exercise are important, how to do them properly, and how to safely make them more challenging as you improve. 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: Read this first Early-stage rehab exercises for meniscus tears Later-stage rehab exercises for meniscus tears Read this first Before we get to what exercises you can do for your meniscus tear rehab, there are a few things that are important to understand. Have your injury assessed These exercises may not be right for you, and you should only do them if a physiotherapist has assessed you and confirmed that they are right for you. Pain It is usually OK to feel a bit of discomfort while doing the exercises, but they should not cause pain, and your knee should not feel more painful or be more swollen after you’ve done them. Check also for a delayed symptom response. Sometimes, an exercise session may feel absolutely fine while you’re doing it, but then it can cause your knee to feel worse several hours later or the next day. If this happens, it is usually a sign that the exercises (type, repetitions, or weights) were not right for you, and they have to be adjusted. Repetitions The number of repetitions and recommendations for how often the exercises should be done are only guidelines. Everyone’s meniscus injury is different, and your rehab plan should be tailored to you. Never strain to complete an exercise. If you find an exercise hard, do what you can while maintaining good technique without discomfort, and then gradually increase the repetitions when it starts to feel easy after a few sessions. Frequency People often make the mistake of thinking that the more they do their exercises, the quicker they will recover. This is NOT how it works. Your body needs a period of rest to recover and rebuild itself after each exercise session. If you do your rehab exercises too often, your body won’t be able to adapt quickly enough, and it can end up making your injury worse. It is usually OK to do low-load exercises daily. Higher-load exercises (like squats) should only be done every other day and maximum three times a week. Regaining range of motion Initially, your knee may not be able to move through its full range of motion (straightening and bending fully), and it can take up to four weeks to regain this. Don’t try and force the movement. Just keep doing your exercises in your comfortable range, and it will improve as your meniscus recovers and the swelling reduces. Early-stage rehab exercises for meniscus tears These exercises are usually appropriate when your knee is newly injured and still quite painful and swollen. They can help you to: Regain full range of motion Decrease pain and swelling Activate and strengthen the muscles that control your knee and leg in positions that don’t place too much strain on your injured meniscus Relax your leg muscles. I demonstrate some of the exercises that are usually prescribed during this stage in the video. Below that, I have provided quick-reference suggestions for sets and reps. Knee flexion-extension on bed Main benefits: The repetitive action helps to feed your joint Improves both bending and straightening range of motion Activates hamstring (back of thigh) muscles 📽️ Video demo Frequency: Twice a day Repetitions: 10 Rest: 30 seconds to 1 minute between sets Sets: 3 End-of-range knee extension Main benefits: Improves extension range of motion Activates your quadriceps (front of thigh) muscles 📽️ Video demo Frequency: Once a day Hold for: 10 seconds Rest for: 10 seconds Repetitions: 10 End-of-range knee extension over foam roller or towel Main benefits: Improves extension range of motion Strengthens your quadriceps muscles in the last few degrees of knee extension. It is in this range of motion that our quads have to work hardest to stabilise our legs when we walk. 📽️ Video demo Frequency: Once a day Hold for: 10 seconds Rest for: 10 seconds Repetitions: 10 Knee extension sitting in chair Main benefits: Improves extension range of motion Strengthens the quadriceps muscles through full range 📽️ Video demo Frequency: Once a day Hold for: 10 seconds Rest for: 10 seconds Repetitions: 10 Standing hamstring curls Main benefits: Improves bending range of motion Strengthens your hamstring muscles 📽️ Video demo Frequency: Once a day Hold for: 10 seconds Rest for: 10 seconds Repetitions: 10 Calf raises Main benefits: Strengthens your calf muscles 📽️ Video demo Frequency: 3 times a week – you can do them daily if you find them easy Repetitions: 15 Rest: 1 minute Sets: 3 Gentle hamstring stretch Main benefits: Reduces tension and discomfort in your hamstring muscles Improves knee extension range of motion 📽️ Video demo Frequency: 3 times a week. You can do it daily if needed. Hold for: 30 seconds Rest for: 30 seconds Repetitions: 3 Calf stretch Main benefits: Reduces tension and discomfort in your calf muscles Improves knee extension range of motion 📽️ Video demo Frequency: 3 times a week. You can do it daily if needed. Hold for: 30 seconds Rest for: 30 seconds Repetitions: 3 Later-stage rehab exercises for meniscus tears When to start with these exercises You can usually start with these exercises once you are able to: Fully extend your knee with only mild discomfort, Bend your knee nearly all the way (about 95% of normal), And can walk short distances with only mild discomfort. Remember, these exercises may not be right for you, so please check with your physio before you start doing any of them. Benefits of these exercises for meniscus tears These exercises are designed to: Gradually get your meniscus used to carrying weight again. Strengthen the muscles that support and control your knee and leg (gluteal muscles, hamstrings, quads, and calf muscles). Develop your position sense and balance. Position sense refers to your brain’s ability to know exactly where your knee is and to control it properly without you actually having to look at it. Position sense is often decreased when you get injured, and restoring your position sense can help you to avoid strains and sprains. What exercises to do The list of exercises you could do during this stage of rehab is endless. For this article, I have demonstrated three of the most important types of movements (squats, bridges, balancing), plus suggestions for how to progress them (make them more challenging as you improve). How often to do the exercises These exercises work your knee and muscles much harder than those in the previous section, and your body will need a recovery period of at least 48 hours after each session. My general advice is: Do them two to three times a week, And never on consecutive days. Please check with your physio what is right for you. How to progress them A typical rehab plan for a meniscus tear will start with low-load exercises done in stable positions (usually supported on two legs). As your knee recovers, these will then be progressed to exercises that gradually place more load through your knee and increasingly challenge your balance and control (usually single-leg exercises on unstable surfaces). Once you’ve regained your full strength and control, it is then important to ease back into your sport. How do you know when you’ve regained full strength and control? This will be different for every person and depends on the sport or activity you want to do. A physiotherapist can help you to determine this. I demonstrate the exercises discussed lower down in this video: Squat exercise progression examples Start with: Wall sits 📽️ Video demo Hold: 10 seconds Rest: 10 seconds Repetitions: 10 Build up to 30sec hold x 3 When to progress: When you can do this exercise without effort and less than two out of ten (2/10) discomfort. Progression 1: High box squats 📽️ Video demo Repetitions: 15 Rest: 1 minute Sets: 3 When to progress: Once you are comfortable doing the full recommended dose using a high surface, you should gradually lower the surface until you can comfortably do them to the level of a regular dining table chair (knees bent about 90 degrees). Only then can you usually safely move on to the next exercise. Progression 2: Free squats 📽️ Video demo Repetitions: 15 Rest: 1 minute Sets: 3 When to progress: When you can do the full recommended dose of this exercise with minimal effort and without pain. Progression 2: Squats with weight 📽️ Video demo Weight: Use a weight that makes you tired within 10 repetitions. Repetitions: 10 Rest: 1 to 2 minutes Sets: 3 When to progress: Train at this intensity for at least two to four weeks before attempting the next progression. Progression 4: Single-leg box squat 📽️ Video demo Repetitions: 10 Rest: 1 minute Sets: 3 When to progress: When you can do the full recommended dose of this exercise with minimum effort and no pain. The next step would be more dynamic, plyometric, and sport-specific exercises. Bridge progression examples Start with: Double-leg floor bridge, knees 90 degrees 📽️ Video demo Hold: 20 seconds Rest: 20 seconds Repetitions: 5 When to progress: When you can do the full recommended dose of this exercise with minimal effort and without pain. Progression 1: Double-leg floor bridge, knees 45 degrees 📽️ Video demo Hold: 20 seconds Rest: 20 seconds Repetitions: 5 When to progress: When you can do the full recommended dose of this exercise with minimal effort and without pain. Progression 2: Double-leg high bridge 📽️ Video demo Hold: 20 seconds Rest: 20 seconds Repetitions: 5 When to progress: When you can do the full recommended dose of this exercise with minimal effort and without pain. Progression 3: Marching high bridge 📽️ Video demo Repetitions: 16 Rest: 1 minute Sets: 3 When to progress: When you can do the full recommended dose of this exercise with minimal effort and without pain. Progression 4: Single-leg high bridge 📽️ Video demo Repetitions: 15 Rest: 1 minute Sets: 3 When to progress: When you can do the full recommended dose of this exercise with minimum effort and no pain. The next step would be more dynamic, plyometric, and sport-specific exercises. Balance progression examples Start with: Balance with progressively less support 📽️ Video demo Hold: Build up to holding for 30 seconds. Initially, you can stabilise yourself by placing a finger against a wall, but you should aim to be able to complete this exercise without holding on. Rest: 30 seconds, or rest one leg while you do the other Repetitions: 3 times each leg When to progress: When you can do the full recommended dose of this exercise without holding on for support, with minimal effort, and no pain. Progression 1: Balance while moving head 📽️ Video demo Hold: 30 seconds Rest: 30 seconds, or rest one leg while you do the other Repetitions: 3 times each leg When to progress: When you can do the full recommended dose of this exercise with minimal effort, good control, and no pain. Progression 2: Single-leg deadlift with knee bent 📽️ Video demo Repetitions: 10 slow repetitions Rest: 60 seconds Sets: 3 sets each leg When to progress: When you can do the full recommended dose of this exercise with minimal effort, good control, and no pain. Progression 3: Single-leg deadlift with knee straight 📽️ Video demo Repetitions: 10 slow repetitions Rest: 60 seconds Sets: 3 sets each leg When to progress: When you can do the full recommended dose of this exercise with minimal effort, good control, and no pain. Progression 4: Balance on unstable surface 📽️ Video demo Repetitions and sets depends on the type of exercise you choose to do. When to progress: When you can do the full recommended dose of this exercise with minimal effort, good control, and no pain. The next step would be more dynamic, plyometric, and sport-specific exercises. 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: Hutchinson, M., et al. (2016). BRUKNER & KHAN'S CLINICAL SPORTS MEDICINE: INJURIES, VOL. 1, McGraw-Hill Education.

In more than six years of running an online physiotherapy practice, we have learned through trial-and-error what combination of practice management software works best for us. If you're wondering how to start a physiotherapy practice, whether it's virtual or face-to-face, read on to see how the right software can help you and your team to spend less time "running the business" and more time ensuring that your patients are satisfied. This article contains affiliate links. We may earn a reward or commission on sales at no extra cost to you. In this article: Wix - How we run our websites Acuity Scheduling - Managing patient appointments Square and PayPal - How we get paid Zoom - Our virtual consulting room Cliniko - Clinical notes Wibbi (formerly Physiotec) - Physiotherapy exercise software Typeform - Keeping track of patient satisfaction FreeAgent - Staying on top of our finances Notion - The ultimate back office task wrangler Putting it all together Below is a flowchart with the various pieces of physical therapy practice management software that we use for our online physio practice. Some are unique to physiotherapy, others are suited to any private practice, and others are aimed specifically at small businesses. While there's always room for improvement, the pieces of software are integrated to a large extent, "talking" to each other and saving us and our team time and effort on the non-clinical work so that we can focus on keeping our patients satisfied before, during, and after consultations. The rest of the article is dedicated to reviewing the pros and cons of each piece of software. Wix – How we run our websites As a 100% online physiotherapy practice, our websites are our only shop windows, so they had better look good and function well. At first, we commissioned a website that was built from scratch by a web designer. Please don’t do that. It looked very pretty, but after we signed off on the final product and paid their last invoice, we found that we constantly needed to make changes as the business evolved, and each time we wanted to do this, we had to cough up to get it done. So, we bit the bullet and decided to become self-sufficient by starting all over again on a web design platform. We had some previous experience on WordPress, but decided to go with Wix in the end because of its easy drag-and-drop functionalities and the fact that you don’t need separate plug-ins that have to be updated and maintained separately for added functionalities such as online payments. None of us is a techie, and we were pleasantly surprised by how easy it was to build the websites (at first https://www.sports-injury-physio.com/ and later https://www.treatmyachilles.com/ ) and how easy it now is to maintain and update them. We’re also impressed with Wix’s focus on search engine optimisation, because we rely to a large extent on our online articles to be found in search results to get new patients booking in with us. Why we recommend Wix for your physio website: Easy drag and drop function to build with Websites load fast and are mobile optimised They offer integrated booking and payment systems although we decided to go with a different option (see below) Good security with 2-factor authentication Quick and friendly support when needed You can set it up to be both HIPAA and GDPR compliant Acuity Scheduling – Managing patient appointments There are many online appointment calendars for medical practices out there, some of which are integrated with medical note keeping software (like Cliniko discussed below), but we prefer Acuity Scheduling because it allows patients to cancel and reschedule their own appointments. Ours is a lean operation – we don’t have a “receptionist” or other admin person to cancel or reschedule appointments on behalf of patients. We also don’t want our patients and our physios to have to send lots of emails back and forth just to get an appointment moved (this is frustrating, even with admin staff doing the heavy lifting). Acuity’s booking system is embedded into our websites so that patients don’t have to leave the site to book an appointment. It also integrates with our one payment platform (see below) to make the booking-and-payment experience a seamless one for the majority of our patients. Top reasons why we recommend Acuity Scheduling for bookings: Patients can reschedule and move their own appointments. You can set a minimum time limit to not allow bookings, rescheduling or cancellations within X number of hours or days before an appointment starts. The booking system automatically converts the available times to different time zones – useful if you also see international patients. Each physiotherapist can manage their own diaries and availability, or you can choose to limit their access. You can set up individual products or packages. It supports discount codes. You can set it up to be both HIPAA and GDPR compliant. It is super easy to refund appointments or issue partial refunds – one click of a button takes us directly to the transaction in our payment system. Drawbacks: It doesn’t automatically refund cancelled appointments (although you may view this as a good thing if you want total control over refunds). It doesn’t integrate with any clinical notes system. Square and PayPal – How we get paid Sign up with Square via this link and save on card processing fees for up to £1,000 in sales within the first 180 days. Why two payment platforms? In case one goes down, mainly, and this does happen from time to time. Also, the transaction fee structures of both these payment platforms are quite complicated and depend to a certain extent on where in the world your online physio clinic is registered and where the payment is made. We find that, in our case, the fee on a Square transaction is usually less than on a similar transaction on PayPal. But we have to have PayPal because that’s the way many people prefer to pay online for stuff. About two-thirds of our revenue comes in through Square, and the rest is via PayPal. On both platforms you can choose how often it should transfer money to your business bank account. PayPal integrates with FreeAgent, our accounting software, so our PayPal transactions show up there on a daily basis. Square transactions are exported into a spreadsheet and then imported into FreeAgent – we do this once a week, and it takes about 5 minutes. If you run a face-to-face physiotherapy clinic, you’d be happy to learn that both Square and PayPal provide point-of-sale card readers. Top reasons why we recommend Square for online payments: It integrates seamlessly with Acuity Scheduling. It is quick and easy to upload transactions to our accounting software. It is easy to manage refunds and to issue electronic invoices that patients can pay with the click of a button. It implements a high level of security. It accepts Mastercard and Visa. It is available in more countries than PayPal. Sign up with Square via this link and save on card processing fees for up to £1,000 in sales within the first 180 days. Top reasons why we recommend PayPal: Many people prefer to pay via PayPal. They process card payments without the user having to open a PayPal account. It is good to have a backup payment method in case a patient experiences problems with the other one. It automatically uploads transactions to our accounting software. It integrates seamlessly with Acuity Scheduling. It is easy to manage refunds and to issue electronic invoices that patients can pay with the click of a button. Zoom – Our virtual consulting room Top reasons why we recommend Zoom: If set up correctly, it is very secure and complies with data protection laws. Most people know how to use Zoom, especially after the COVID-19 pandemic. It integrates seamlessly with Acuity Scheduling and automatically creates and cancels appointment links when appointments are created or cancelled. Cliniko – Clinical notes Sign up with Cliniko via this link and get £30 credited to your account. We’ve tried several patient notes systems over the past 10 years, and Cliniko stands head and shoulders above the rest. It is by far the most user friendly and allows a lot more customisation than the others. It also offers an online booking system with an integrated video call function. We don’t use these because Cliniko doesn’t allow patients to cancel or reschedule by themselves – this has to be done by the clinic. This is a dealbreaker for us, because we don’t want to allocate resources to the cancelling and rescheduling of appointments. However, if you are happy for patients to contact you via email or by phone to change appointments, then Cliniko is the ideal all-in-one system to manage online bookings, video calls, and patient notes. Top reasons why we recommend Cliniko: It is very user friendly. You can customise and set up various templates for products as well as for patient notes and letters. You can email patient notes, letters, and invoices securely directly from Cliniko. Cliniko can be set up to satisfy data protection laws in most regions, including the United Kingdom, European Union, the USA, and Australia. You can use it as your booking system in regular physical practices as well as for online practices. It has video calls integrated. It integrates with the most popular online exercise software systems, including Physiotec, which cuts down on admin time since the physio doesn’t have to create accounts manually in the exercise software and can save a copy of the exercise programme in the patient’s notes with the click of a button. Sign up with Cliniko via this link and get £30 credited to your account. Drawbacks: It doesn’t integrate with Acuity Scheduling, so the physio has to transfer the patient’s details to Cliniko by hand. The online booking system doesn’t allow patients to cancel or reschedule their own appointments (which is why we don't use this functionality). Wibbi (formerly Physiotec) – Physiotherapy exercise software I’ve been using Wibbi for more than 10 years and counting, first in my regular physiotherapy clinics and later also in our online physio clinics. They have a massive library of exercise videos and images, and it is very easy to create exercise plans. You can also email them with videos of any exercises that you would like to be added, and they will film and add them in a timely manner. Our patients love Wibbi. Top reasons why we recommend Wibbi: They offer a wide variety of exercises, including physio rehab, vestibular rehab, neuro rehab, and general fitness. Physios: Very easy to use and create exercise programmes. Patients: Very easy to access their exercises. Physios can upload their own videos and instructions and make them available to patients. You can also ask Wibbi to film exercises and add them. They offer an app for patients. Patients can record and track their progress. The physio can view the patient’s log to see how their exercises have progressed. You can upload info pamphlets about various conditions, etc. You can customise the patient interface with your logo, etc. Their support is quick and friendly. They are very affordable. Drawbacks: I can’t think of any at the moment. Use this link to sign up for a free trial with Wibbi and to get a discount if you subscribe afterwards. Read a more detailed article about how we use Wibbi in our practice . Typeform – Keeping track of patient satisfaction Being a 100% virtual clinic, it is slightly trickier to get a sense of how satisfied our patients are with our service than when they physically walk in and out the door. After their first consultation with us, patients get an automated email via Acuity Scheduling with a link to a satisfaction survey that we set up in Typeform. It’s very user friendly, looks modern and sleek, and you can customise the form in many different ways. We access our Typeform dashboard regularly to check whether there are any issues to be dealt with. We export monthly reports with the aggregate scores out of five and the comments from the patients and send these to the physios. This helps us and our physios to improve our service and to highlight problem areas quickly. FreeAgent – Staying on top of our finances Sign up with FreeAgent via this link and get 10% off your subscription. Our company is based in the UK, so we’re using FreeAgent’s UK version. It also has a USA version. Please note that the version for use outside these two countries doesn’t include features such as VAT, payroll, Self Assessment, and Corporation Tax computations. Designed for small businesses Until a few years ago, we used a human accountant, but it was always a bit of a hassle to keep our fingers on the financial pulse of the business on a day-to-day basis. We used our own spreadsheets to try and keep up, but it took lots of time to keep things up to date, and inevitably, errors crept in. When we had to submit our annual financial statements to Companies House and our corporation tax return to HMRC, there was also a lot of back and forth between us and the accountant. Switching to FreeAgent changed all that. None of us has an accounting qualification, but the software is so intuitive and user-friendly that it is actually difficult to make a mistake. And the few times that we did need help, FreeAgent’s helpdesk came to our aid quickly and efficiently. Not to mention the fact that our FreeAgent subscription costs us about half of what we had to pay the accountant. Integrates with bank accounts and payment platforms FreeAgent syncs with our business bank account daily and seamlessly. It “learns” how to allocate transactions (e.g. whether a payment was for our HCPC membership or our clinic’s web hosting) and asks you to confirm the details of a transaction when it is not sure. It also integrates with our two payment platforms, PayPal and Square. The PayPal integration is seamless, like with our bank account. For Square, we have to export a spreadsheet and then import it to FreeAgent, and we find that things don’t fall too far behind if we do this once a week. Daily reminders A feature that we find extremely useful is the Admin To-Do list on the FreeAgent dashboard. For example, its prompts us to confirm what certain transactions was about or that a tax deadline is approaching. Financial statements We keep track of the financial situation of our clinic by keeping an eye on the Profit-and-Loss Statement and the Cash Flow Statement, both of which are automatically updated every day. Other reports that we don’t really use are the Balance Sheet, Aged Debtors and Creditors, and Trial Balance. Payroll This function takes care of calculating PAYE and National Insurance contributions, and you can get it to send your payroll info to HMRC every month. Integrates with Companies House and HMRC Come year-end, FreeAgent generates the required annual financial statements for submission to the UK's Companies House. Once you’ve checked them, you can submit them directly from FreeAgent. Likewise, it also pre-fills the corporation tax self-assessment form that you need to send to the HMRC. Again, you can submit the form from within FreeAgent once you’ve checked it over. Sign up with FreeAgent via this link and get 10% off your subscription. Notion – The ultimate back office task wrangler We use Notion to juggle the various tasks we have to do to keep the business running – from producing and organizing regulatory documents (like data protection) to creating and publishing web content to onboarding new physios. It is a workspace that is a calendar, task manager, messaging system, and filing system all in one. No more faffing about between browser tabs, emails, spreadsheets, folders, and PDFs when you want to get something done. You can use it on your mobile phone and on your computer. The basic building block is a “Page", and you can have Pages within Pages within Pages. Or databases (think spreadsheets on steroids) that pull people, messages, tasks, dates, information, and files together in one place. On the other end of the scale, you can get an overview of the Pages filtered by person, date range, task status, task priority, and so on, and you can view this as a calendar, a task list, or in a customisable table. The permutations are endless, and we are barely scratching the surface of what Notion is capable of. Here are three examples of how we use it: 1. Producing content We have a dedicated calendar in Notion where we plan and schedule all our social media and blog content. So, these tasks don't get buried under our daily tasks in our regular Google calendar. Let’s say we want to create a blog post about the treatment of ankle sprains. You create a Page from a Notion blog post template that already has the checklist of what needs to be done. This page lives directly inside the calendar, so you don't have to search in various folders for it. You assign the Page to the people who need to work on it (this now shows up in their task lists). You add the planned publication date (this now shows up in the calendar of each of the people involved). As the work progresses, documents, images, web pages, and so on that will be used for creating the blog post are added. The people involved message each other in the Page. They also drag-and-drop the Page on their calendars to the days they are going to be working on the blog post. As the work progresses, the task status is changed from To do > In progress > In review > Completed. The status shows up in the overview that I mentioned above. 2. Onboarding a new physiotherapist Again, we made a Notion template for this, so all the documents, checklists, and training material (including embedded training videos) are already on the Page once it is created. And again, you can update the status of the process as you go along. If, for example, you need some input from the person who manages the payroll, you tag them on the Page and leave a message to tell them what to do – the Page then pops up in their task list. You can also (if you want to) assign a priority to the task to have it ranked against other task priorities in the task overview. 3. Annual cyber security audit A reminder pops up in your Notion calendar that the annual cyber security audit is due. (Grrrr!!!) You click on the reminder, and the relevant Page opens up with the documents that need to be filled out, as well as a checklist. Last year’s completed documents and checklist are also there. There is a note that you left for yourself a year ago about a certain cyber security policy change that the government was considering, with a link to the web page where you can check whether the change has been implemented by now. There’s also AI Notion has recently started to add AI to its suite of services. Here’s a few of the things it was able do at the time of writing: Summarise meeting notes and create action points. Turn a list of bullet points (e.g. a job description) into a professional-looking piece of writing with full sentences. Conversely, it can create a bullet-point list of key insights/highlights from a document. Translate text. Putting it all together The Venn diagram below illustrates how the various integrated pieces of practice management software contribute to our triple goal of satisfied patients and a happy and productive team, all underpinned by running an efficient business. About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. She started the 100% online physiotherapy practice Sports Injury Physio in 2017 and added Treat My Achilles in 2019. Follow her on LinkedIn and ResearchGate .

This article tells you about the latest, updated research on how to treat a sprain – that is, an acute ankle sprain or any other soft tissue sprain – in the first few days after it has happened and thereafter. The recommended process can be remembered with the acronym ‘PEACE and LOVE’, and it deals with situations where you have sprained but not broken something. You may also find these articles useful: - Should I go to A&E with a sprained ankle? - How to avoid recurring ankle sprains In this article: A short history of acronyms for how to treat a sprain The updated research on how to treat a sprain – a two-stage process PEACE: The acute phase of treating a sprain LOVE: How to treat a sprain once the acute phase is over Need more help? A short history of acronyms for how to treat a sprain So, you’ve dodged a bullet and your sprain did not also involve a fracture. However, it is still important to apply the correct acute soft tissue injury management for your injured ankle or other joint that you’ve sprained to speed up your recovery and to avoid the injury recurring. Now, some of you may go ‘Well, years ago it used to be called ICE: ice, compress, elevate. Everyone knew it. It was easy to remember.' Then it became RICE: ‘rest, ice, compress, elevate’. This was followed by PRICE: ‘protect, rest, ice, compress, elevate’. And then, in about 2012, they decided to add in the O and the L to make it POLICE, which was ‘protect, optimally load, ice, compress, elevate’. Most recently, in the last couple of years, through more and more research , they've decided on the acronym ‘PEACE and LOVE’, which is clearly a lot longer. It's harder to remember what it stands for, but it is actually really good advice for soft tissue injuries. Steph also demonstrates and discusses the treatment mentioned below in more detail in this video: The updated research on how to treat a sprain – a two-stage process PEACE refers to the first three days, or the acute period after you have sustained a sprain. This is when you will probably experience the typical acute symptoms in the sprained joint, such as swelling, bruising, bleeding, and inflammation. LOVE refers to what you have to do once these acute symptoms have settled down. PEACE: The acute phase of treating a sprain P stands for ‘protect it’. So, you do need to rest your sprained joint and look after it. If you need to use crutches, use crutches. If you need to use a support, use a support. Protect the injury in the first few days. As in previous acronyms, E still means ‘elevate’. For instance, if it's your ankle that you have sprained, you want to put it up on a footstool or lie on your front with some pillows behind you, with your foot up behind you, so you can elevate it and help to reduce that swelling. A is a new one and stands for ‘avoid anti-inflammatories’. I still hear so many people say, ‘I have an injury, so I’ll take some ibuprofen.’ However, inflammation is the beginning of your healing process. It kickstarts your body into healing the injured tissue. You don't want to disrupt that in the first few days. If you take anti-inflammatories, it's going to dull down your own healing process. C is still ‘compress’. And the second E is ‘educate’. So, learn about what you're supposed to be doing for your injury to get it better. LOVE: How to treat a sprain once the acute phase is over The LOVE portion of this acronym is for the second group of things you do after that initial acute symptoms have calmed down, and you're ready to rehab it and try and get it better. L stands for ‘load’, and it’s so important to do the right load at the right time. This is the sort of thing we physios can help you with. We can look at your injury and your situation and decide whether you should be sticking initially to weight-bearing exercises with body weight only, or whether you're ready to move on to resistance exercises or weighted exercises, and also when you're ready to move on to impact exercises and jumping and running and changing direction. It all has to be done at the right time, in the right order, so that you can get your ankle nice and strong again and hopefully avoid any further injury. O is a strange and a new one. It stands for ‘optimism’. This is because they've done a lot of research, looking at people's attitude towards their injury, and they found that people who are more optimistic make a quicker and better recovery than those who are either really scared, really anxious, or what they call ‘catastrophise’ about their injury, as in think about it all the time and have it rule their lives. So, this is really about your attitude towards your recovery. V stands for ‘vascularisation’. It’s a bit of a tongue-twister, and I think it’s one of those that they phrased to fit with the acronym. It’s about the cardiovascular recovery you can do while you're still injured and perhaps not able to run yet. So, for instance, for your ankle it will be things like going swimming or, if you don't have too much swelling, doing cycling, so that you try and get your cardiovascular system going again. This will improve your fitness as such as well as improve your blood flow to the area and help your injury to recover quicker. And then, finally, E is for ‘exercise’. There's a lot of strong evidence to show that exercise, the right sort of strengthening, the right sort of balance exercises – static balance as well as dynamic balance – will really improve not only your recovery but improve your chances that this injury isn't going to happen again. Eventually you should also look at getting you back into your sport-specific movements that you need to do, but at the right time with the right amount of load. Need more help? If you need advice on any of the above, especially load management and exercises that are suited to your specific injury and your circumstances, please feel free to book a video consultation with one of our physios . 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 Dubois B, Esculier J Soft-tissue injuries simply need PEACE and LOVE British Journal of Sports Medicine 2020; 54: 72-73.

Someone recently asked on Facebook: “Osteoarthritis in the knees and running on the treadmill... any hope of the discomfort and occasional pain to go away as I lose more weight and get stronger?” In this article, I’ll answer this question and give you some tips that may help your knees. In this article: Is it OK to run with arthritis in your knees? Tip 1: Start slow Tip 2: Do strength training Tip 3: Manage your volume Tip 4: Recovery, Recovery, Recovery Tip 5: Cross train Tip 6: Shoes are important Tip 7: Experiment with different running terrains Tip 8: Get to know your knees! Here's the video of a previous livestream that I did about this: It is OK to run with arthritis in your knees? Yes, absolutely. It’s a common misconception that running is bad for your knees. A recent study that followed participants with arthritis in their knees over a 4 year period found that running did not make their arthritis symptoms worse and it also didn’t increase the signs of arthritis seen on X-ray. In fact, the participants in the study found that running helped their knee pain. Another study that followed runners and non-runners over an 18 year period also found that the runners did not show more signs of arthritis in their knees compared to the control group of non-runners. This does not mean that everyone with arthritis will be able to run. All of us are built differently and our bodies react to exercise and running in very different ways, but take a look at the 8 tips below before you hang up your running shoes. Tip 1: Start slow If you’re new to running, you have to give your body enough time to adapt to the new load that goes through your joints, muscles and ligaments. This takes time, but every time you do a session it stimulates your cartilage and bones and muscles to grow stronger. The older you are, the longer this adaptation can take. Osteoarthritis is part of the normal aging process in the body. It’s very similar to getting wrinkles. How well our joints age are to a large extent affected by our genetics, diet and previous injuries that we may have sustained in the past. If you have a bit of arthritis in your knees, you will just have to take it much easier when you first start running because your joints may take longer to adapt. Following a run / walk programme can be a good idea. Tip 2: Do strength training The stronger the muscles in your legs are, the less force goes through your joints when you run, walk, climb stairs etc. Strength training has also been shown to prevent running injuries in runners of all ages. Make sure that you include exercises for your glutes, hamstrings, quads and calves. Tip 3: Manage your volume Yes, there is no arguing that osteoarthritis affects the structure of your knee joints. This may mean that they can’t quite handle the same volumes of running as they did when you were younger. If you try and pile too many miles on them, you may overwork them and make them hurt. So if you have arthritis in your knees, you have to pay close attention to what your knees are telling you. How much running will your knees allow you to do without making them hurt more? How much is too much? Tip 4: Recovery, Recovery, Recovery All runners need to have recovery days to allow their bodies to repair and adapt to the exercise they’ve done. The younger and fitter you are, the shorter the recovery period needed. As you get older the body naturally takes longer to repair itself. Check if you need to maybe give your knees more recovery days between your run days. Do your knees feel better if you just run twice a week, rather than 3 times? Tip 5: Cross-train I know this is an article about running and arthritis, but doing other activities like swimming or cycling in between your running sessions can actually help your knees recover better which will help your running. Tip 6: Shoes are important There are no specific guidelines for what running shoes you should use, but in general I would suggest that you throw out old trainers, get cushioned but supportive trainers, stay away from minimalist shoes. What the research has shown is that the best way to select a running shoe is by testing it and feeling that it’s comfortable, so try to find a running store that will allow you to test them on a treadmill or pavement. Tip 7: Experiment with different running terrains Again, there’s no specific terrain that has been shown to be better for runners with osteoarthritis in their knees. My patients usually have to test it for themselves. Some find that they are better when running on the flat, others prefer off road and some has to stick to running on a treadmill. Running down hills are usually harder work for knees and I tend to advise my patients with sensitive knees to limit the amount of downhill running they do. Running up hills doesn’t seem to be such a big problem. Experiment with this for yourself. See what your knees feel like when you run the same distance at the same speed on a variety of surfaces. Tip 8: Get to know your knees! To recap: running does not cause osteoarthritis in knees and it doesn’t make it worse. Because your joint’s ability to adapt and recover from exercise is affected by arthritis you may not be able to run at the volumes or intensities that you’d done previously. If you would like to continue running or start running, you will have to pay close attention to what your knees are telling you and choose your running intensity, volume and frequency accordingly. In that study that I mentioned earlier that showed that running doesn't cause arthritis and can help knee pain, the participants all adapted their running according to what they felt was right for them. I’m pretty sure that the study would have had a very different outcome if they’d forced the participants to run according to a programme set by someone else. Make sure that you experiment with all the things listed above and observe how it affect your knees! Let me know if you have any questions . Need more help with an injury? You can consult me online via video call for an assessment of your injury and a tailored treatment plan. Best wishes Maryke 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 , Facebook , Twitter or Instagram . References Chakravarty EF, Hubert HB, Lingala VB, et al. Long distance running and knee osteoarthritis: a prospective study. American Journal of Preventive Medicine 2008;35(2):133-38. Lo GH, Musa SM, Driban JB, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clinical Rheumatology:1-8.

It’s important to understand that pronation of your foot or ankle is a normal part of how we walk. It’s only when it’s excessive or not well controlled that it may cause injuries. In this article I explain what exercises I usually prescribe to help correct overpronation. In this article: What is an ideal foot posture? Practising the components Putting it all together Video demonstration of exercises to correct overpronation What is an ideal foot posture? Our feet all look different and there is truly no ideal shape. I was trying to think about how to describe what I look for in people’s feet but have come to the conclusion that it’s easier to explain it in a video (see below). In short, we’re looking for an arch under the middle of the foot. This arch can be high for some people and very low for others. The important thing is that your arch should allow your foot (the subtalar joint specifically) to sit in a neutral position so that the foot does not form a big angle with the tibia by rolling in excessively (pronation). If your foot does sit in a more pronated position it will cause the ligaments and tendons on the inside of the foot to strain and the ankle joint on the outside to compress causing Sinus Tarsi Syndrome . I often find this to be the case if patients struggle with ongoing pain over the outside of their feet after an ankle sprain . It may also cause injuries in your knee and hip. Sometimes your foot may have a good posture while you’re standing but then roll in excessively when you’re walking or running. Strengthening the muscles inside your foot as well the ones that control pronation can help to support your arch, restore your foot’s posture and help you to control pronation better when you walk and run. Practising the components When teaching foot correction exercises, I usually break it down to the component parts first and do: Exercises that strengthen the intrinsic muscles inside the foot. These are meant to support your foot’s arch as your walk. Exercises that strengthen the muscles that control pronation like the Tibialis Anterior and the Tibialis Posterior muscles. Putting it all together Once you’ve got the hang of the basic exercises you have to put it all together. I usually get my patients to first practise correcting their feet in sitting. Once they can do it easily in sitting I get them to do it in standing and finally in more challenging positions like standing on one leg and while doing more dynamic movements. Have a look at the video below for some ideas. Video demonstration of exercises to correct over-pronation In this video, I walk you through some of the most basic exercises that you can do to help strengthen your feet and correct over-pronation. 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. 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 or ReasearchGate .

It’s very easy to lose motivation and just sit on the couch and sulk when you’re struggling with an injury that is taking a long time to get better. You would think that anyone who loves sport will naturally work tirelessly at getting better. But the problem is that a lot of injuries can feel as if they will never get better and progress can be excruciatingly slow. Unfortunately sitting on the couch often just makes your mood darker and definitely does not help your body to recover. In this article, I share the 6 steps that I’ve identified over the years that help my patients stay focused and motivated while recovering. In this article: Step 1: Where do you want to get to? Step 2: Do NOT create a deadline Step 3: Where are you now? Step 4: Identify mini-steps Step 5: Keep a diary Step 6: Check in with someone on a regular basis Here's the video I did about this: Step 1: Where do you want to get to? Write down exactly what sport or activity you would like to get back to doing. Be very specific. For instance, if you would like to get back to running, how far and fast and how often do you want to be running? This is very important because you need to slowly strengthen your body over time to be able to achieve this goal and you won’t know what you have to do if you don’t know exactly what it is that you want to achieve. Step 2: Do NOT create a deadline This may sound strange. Is the point of having a goal not to set a date by which you would like to achieve it by? Not when it comes to injuries. When it comes to recovering from an injury, the worst thing you can do is book a race for in 6 months’ time thinking that it will keep your motivated. Having a deadline like that hanging over your head can often make you push when actually you should be taking an easy day or changing tack. Injuries never follow a linear line of improvement – you will always have small set-backs and you have to allow yourself the time to take a step back when needed. Step 3: Where are you now? Make a list of all the things that you can do at the moment. Again, be very specific e.g. I can walk 500 metres, stand for 20 minutes, do bodyweight squats only etc. This list has 2 functions. Firstly it is a nice baseline to identify the areas you have to work on and secondly it can be an extremely good motivational tool to look back to a few weeks later. Step 4: Identify mini-steps Take a look at all the activities that you can currently do and work out how you can slowly build on them in order to achieve your final goal. You may need the help of a physio or other exercise specialist with this bit. For example before you can jog you need strong legs and pain free walking. Work out a programme to strengthen your legs and slowly increase your walking. This may take several months. You should ideally break this down even further, e.g. I need to be able to do 3 x15 pistol squats, etc. Once you can walk without restriction and your legs have a base strength the next step would be to incorporate jumping and a run/walk programme. From there one would progress to continuous jog and then finally you would add in some speed work and harder sessions. I remember having an adductor tendinopathy a few years ago and my first run back was just 400 metres! I felt really silly but just persevered because I could feel that it was just enough for my tendon and knew that the strength gains from that short run was helping it to recover. By the end of that month I managed to do 5km. Step 5: Keep a diary Keep short notes on when you feel pain or discomfort as well as what training you’re doing. It can be extremely good motivation when you look back and realise that some of your aches and pains had disappeared but that it had happened so gradually that you’d not noticed. For example that you can now sleep in any position without pain or you can now do squats with extra weight or you can walk 40min when you could only do 15 a few weeks back. People often disregard these small improvements because they think that they have no obvious link to their overall goal, but they are all signs that you’re getting better! Remember, recovery is all about taking small steps forward and you have to acknowledge the small victories if you want to stay motivated. Step 6: Check in with someone on a regular basis Make sure that you discuss your progress with someone else on a regular basis. This does not have to be a physio but it has to be someone who is good at listening. Their job is to help you acknowledge your progress and put things in perspective. When you’re the one stuck in a specific situation it can be difficult to notice things that are quite obvious to other people who are looking in from outside. 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. 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 .

Your piriformis muscle is located deep inside your buttock. It runs from the underside of your sacrum and attaches to the side of your hip (greater trochanter on the femur). Your sciatic nerve can run over, under, or through the piriformis muscle. This means that whenever the piriformis goes into spasm, it can also affect your sciatic nerve, which runs down the back of your leg. In this article: The piriformis muscle is very seldom the main cause 5 Tips for treating piriformis pain Here's the livestream video that I did about this in the Sports Injury Group The piriformis muscle is very seldom the main cause Not many things are as painful as a piriformis muscle that is in spasm and I think that this is why it is so often (wrongly) seen as the main cause for people’s buttock pain. True piriformis syndrome is quite rare. When you have piriformis syndrome, the piriformis muscle compresses the sciatic nerve and causes sciatica type pain down your leg. It can feel like a crampy achy pain in your buttock and also gives your pain down the back of your leg. You don’t have piriformis syndrome just because your piriformis muscle is tight and/or sore. It is much more common to find that the piriformis muscle is irritated by an injury nearby e.g. the lower back, sacroiliac joint, top of the hamstrings, bursitis or glute med tendinopathy. If you want to get rid of your buttock pain, you have to address the true cause of your pain, not just hammer the poor piriformis muscle. A physiotherapist can help you establish your cause by listening to how you describe your symptoms and getting you to do a few simple test movements. 5 Tips for treating piriformis pain 1. Diagnose First of all, make sure that you understand why your piriformis is angry with life – a physio can help you with this. You have to address the cause (back, SIJ, hamstring etc.) in order for it to calm down and to prevent it from coming back in the future. 2. Stretches GENTLE piriformis and glute stretches held for long periods can be useful to decrease the muscle tension and pain. The piriformis muscle is very easily irritated and you can make your pain worse by pulling too hard. I demonstrate one of my favourite ones in the video. 3. Massage Massage and self-massage with a lacrosse ball can be useful. But again, be careful not to irritate the muscle. Remember, you sciatic nerve runs through it and you can easily make things worse by pressing too hard. You should apply firm pressure that is comfortably uncomfortable. You should not feel any pain or tingling down your leg during or after the massage. I find that doing it standing up against a wall can work well if it is very sensitive – see the video for a demo of this. 4. Strength training General buttock strength training can also be useful. I find that exercises like the clam can often make it feel worse during the initial stages. The glute bridge seems to be a better option for my patients and I often get them to do a spine curl into the position to help mobilise their lower backs at the same time. The glute bridge is a great exercise that strengthens most of the muscles in the buttock including the piriformis, glute max and glute med. 5. Be careful with hamstring stretches Be careful of doing hamstring stretches, because your sciatic nerve may take strain if the piriformis is still in spasm and holding on to it. When you take your leg into the hamstring stretch position, your sciatic nerve is meant to slide. But if the piriformis is holding on to it, the nerve will stretch rather than slide and that can make your pain worse. I only get my patients to stretch their hamstrings once I'm happy that the sciatic nerve can slide. Let me know if you have any questions . You're also welcome to consult me online via video call for an assessment of your injury and a bespoke treatment plan. Best wishes Maryke 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 , Facebook , Twitter or Instagram . References Franklyn-Miller, A., et al. (2009). "The gluteal triangle: a clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes." British Journal of Sports Medicine 43(6): 460-466. McCrory, P. (2001). "The “piriformis syndrome”—myth or reality?" British Journal of Sports Medicine 35(4): 209-210.

Tib post tendinopathy can cause a lot of pain on the inside of your ankle and foot and be notoriously slow to react to treatment. In this article, I’ll share some tips that have made the biggest differences for my patients who had "difficult to fix" cases of this condition. I’ve previously done a livestream where I explained the full array of treatments for tib post tendinopathy and you may find that video useful as well. In this article: Be careful of exercises Shoes matter Time on feet What if it still doesn’t work? Here's the video recording of the livestream I did about this: Be careful of exercises We all know by now that research has shown that exercise is a very important part of treating tendinopathies. But not all tendons react in the same way. In my experience, I’ve often found that my patients do better if they stay away from strength training exercises and stretches that specifically target the Tib Post tendon and I think it’s because compression plays such a large part in how this injury is created. The same appears to be true for other tendons in the body that experiences a high level of compression. Take for instance insertional Achilles tendinopathy vs. mid-portion Achilles tendinopathy. For insertional Achilles tendinopathy you have to be really conservative with the strength training and often first off-load the tendon by lifting a patient’s heel in their shoes etc. to stop the tendon compressing against the bone. But patients with mid portion Achilles tendinopathy can usually immediately jump in to doing strength training because that part of the tendon doesn’t make contact with the bone. The tib post tendon gets compressed against the bones as it wraps around the inside of the ankle and foot. This is normal and its job is to help control how much your foot rolls in (pronates). Patients who develop tib post tendinopathy usually does so because their feet turn in excessively, causing the tendon to over-work but also to compress excessively against the bones of the foot. The typical stretches and strengthening exercises that patients are prescribed for Tib Post tendinopathy also causes the tendon to compress against the bones and I find that many of my patients can’t tolerate them for a very long time. What can you do? Start with exercises that strengthen the foot arch but does not cause tendon compression. Rather than stretching it, foam roll your calf if it’s feeling tight. I demonstrate examples of this in the video above. Shoes matter Shoes are important for two reasons: Supportive shoes that includes arch support will act as a “crutch” for your tendon and allow it to rest and recover. It is difficult to find shoes with enough support so I usually get my patients to also invest in some orthotics. Look for firm but slightly softer insoles because if they press on the tendon in the wrong way, they can cause extra compression and keep the pain going. It's not rocket science! If they feel comfortable, they're good - if they hurt you, they're not right for you. If you tie your shoes quite tight, even that low level of compression can sometimes be enough to irritate your tendon and cause it to ache. Some of my patients, myself included, have found it useful to really loosen their laces during the first period of recovery. Time on feet Standing for extended periods of time can often be even more aggravating to your Tip Post tendon than walking. Yes, the tendon helps to control pronation when you walk, but it also carries load when you’re just standing as it still helps to support your arch. You have to decrease this load to a level that doesn't irritate your tendon. I’ve had first-hand experience of this when I developed this condition in both my feet! As a physio I sometimes spend up to 12 hours on my feet while treating patients and I found that all the progress that I made in the days where I was spending less time on my feet, were wiped out by the days when I was forced to walk and stand a lot. I eventually realised that I had to make a change if I wanted to get rid of my problem, but cutting my work hours was not an option. Instead I made sure that I sat down at every opportunity I got. It’s amazing how much hands-on physio you can actually do while sitting down! Also, we tend to stand when we chat to colleagues or when we’re waiting for the bus etc. – all of this I adapted and if I couldn’t sit down I would try and perch against something or take some of my weight on my arms. This may sound extreme, but it was the thing that made the biggest difference to my recovery. Well, that and finally figuring out that I had to loosen my laces! Please don’t think that this means that you’ve got to be totally inactive. During this time I still cycled and swam as much as I wanted. It was just time on feet that I had to restrict. What if it still doesn’t work? See if you can get a referral to see a sports physician. They can do an ultrasound scan of your tendon and determine exactly what is going on – sometimes a tear of the Tib Post tendon can feel very similar to a tendinopathy but they may require slightly different treatments. Sport physicians also have lots of other treatment options available. Some patients may benefit from injections while for others shockwave may be the better choice. You may also find it useful to watch the video I did previously where I explained the normal treatment for Tib Post tendinopathy. 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. Best wishes Maryke 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 , Facebook , Twitter or Instagram . 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. Scott, A., et al. (2013). "Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012." British Journal of Sports Medicine 47(9): 536-544.

Have you been told that you have osteoarthritis in your hips but would like to continue running? You’re not alone – there are loads of runners in the same situation. In this article, I share some tips for runners with hip osteoarthritis that have helped my patients. In this article: Anatomy of the hip joint What is hip osteoarthritis? 3 Tips for runners with hip osteoarthritis I also explain this in a bit more detail in this video: Anatomy of the hip joint Our hip joints are synovial joints. The top end of the femur (the ball) fits snugly into its socket (the acetabulum) on the pelvis. The joint surfaces are covered in very smooth cartilage. The hip joint is surrounded by a thick capsule that’s lined with a membrane that produces synovial fluid. This fluid lubricates the joint surfaces and makes them even more slippery. The joint surfaces get all their nutrients from the synovial fluid. Joints don’t have arteries and veins going into them – they rely on movement to push fluid and nutrients in and out of the joint. This is why joints feel stiff when you don’t move them enough. I discuss this in more detail in the above video. What is hip osteoarthritis? Osteoarthritis is often described as “normal wear and tear” of joints. We all show some signs of osteoarthritis as we age, but how much our joints are affected varies dramatically from person to person. Some people seem to have a genetic predisposition to it. Injuries that you sustain when you’re younger can also cause a specific joint to develop arthritis while your other joints may still be in good nick. Osteoarthritis is graded from minor to severe. Changes affect all parts of the joint: Cartilage damage: In minor cases the cartilage will just have some tiny cracks. In severe cases, the joint cartilage may be totally worn away. Bones: The bones can form bony spikes or osteophytes. Synovial membrane: The membrane becomes thickened and produces lots of fluid. Joint Capsule: The joint capsule can become thickened and tight. Inflammation: The joint can experience periods of active inflammation where it feels extra painful and stiff. 3 Tips for runners with hip osteoarthritis Tip 1: Maintain flexibility One of the things that tend to happen to a hip joint with osteoarthritis is that it gradually becomes stiff and loses its range of motion. This causes your body to compensate when you run and place more strain on other structures in your legs. If you have osteoarthritis in your hips, it will stand you in good stead if you can get into the habit of doing regular flexibility exercises for them. I demonstrate 4 basic stretches in the video. BE GENTLE when you stretch. Depending on what part of your joint is affected, you may not be able to move your hip very far into certain directions. You should only feel a sensation of a muscle stretching – no pain during or after stretching! Tip 2: Strengthen all the muscles in your legs The muscles that surround your hip joint is supposed to absorb up to 60% of the forces that you generate when you run. The stronger the muscles, the less strain on your joint. But you should really strengthen ALL the muscles in your legs because they should all help to absorb the load. Here are some strength training ideas . Tip 3: Add some cross training Some of my patients with hip osteoarthritis find that their hips tolerate running better if they add in some cross training sessions like cycling and/or swimming. This is likely because the cross training sessions help their joints to recover better from your running sessions. Remember that joints don’t have arteries going into them and that they rely on movement to get the fluid and nutrients in and out of them? When you swim and cycle you move your joints a lot, but without impact. This means that you’re “feeding” your joints without putting them under much strain which helps their recovery. 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. Best wishes Maryke 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 , Facebook , Twitter , and Instagram .

There’s plenty of evidence in the research that yoga can help to reduce pain , build muscle strength and improve flexibility. It’s also an effective tool to reduce stress and anxiety and can help with general mental well-being . But it’s still physical exercise, and whenever you do exercise there is a risk of injury. In this article, I’ll explain what you can do to avoid yoga injuries while reaping all its benefits. In this article: Traditional poses aren't for everyone Adapt poses if you have other medical conditions More is not better Here’s the video that I did about this for the Sports Injury Group : Traditional poses aren't for everyone Traditional yoga poses are seen as the ideal to work towards, but the problem is that our bodies are all different. Several studies have reported meniscus tears and hip labrum tears as some of the injuries that people sustained from practicing yoga. In yoga, these injuries typically happen when you force your knees and hips into positions where the joints are strained. Yoga originated in India. People from that part of the world are naturally more bendy and flexible. Traditional yoga poses are great if your body can move in that way, but if for instance you’re feeling a pinching or uncomfortable blocking sensation in your groin when doing a pose, it is an indication that your joint surfaces can’t move further past one another. If you continue to force that movement, you may end up injuring the cartilage inside your joint. Top Tip: Don’t force movements. You have to ease off and ask your teacher to adjust the pose for you if the sensation is strongly uncomfortable or painful. Adapt poses if you have other medical conditions There are certain yoga poses that you may be better off avoiding if you have certain medical conditions or pre-existing injurie Glaucoma: Positions like the headstand and shoulder stand have been reported to worsen conditions like glaucoma. This does make sense because the blood rushing into your head will also increase the already high pressure inside your eyes. Low bone density: People who have low bone density or osteoporosis can easily break their bones. The research seems to suggests that, for people who have osteoporosis, positions where they take their backs into full extreme flexion or extension can cause compression fractures or the vertebrae in their backs. Arthritis: Forcing yoga poses into end ranges can irritate your joints more easily when you have arthritis. This is because when you have arthritis it changes the shape of your joint surfaces and your joints may be very sensitive to being compressed. Top Tip: Have a chat with your physiotherapist. Just because you have a pre-existing condition like arthritis or an old injury, doesn’t mean that you can’t do yoga. In fact, yoga may have many benefits for you – it just has to be adapted a bit. Physiotherapists have an in-depth understanding of medical conditions as well as exercise and are best placed to advise on how you can adapt poses or positions to allow you to reap the benefits but avoid injury. More is not better Yoga is exercise. Just like with other forms of exercise, you can overdo it and cause yourself overuse injuries if you do too much too often. One example of an yoga related overuse injury that I see in clinic is when people do too many deep hamstring stretches and cause themselves high hamstring tendinopathy – a condition that can make sitting extremely uncomfortable. In a recent article on the BBC news site, a leading physiotherapist also warned yoga teachers that he was seeing more and more teachers with injuries to their hips which were caused by doing too many forceful hip stretches too often. Top Tip: Listen to your body and your yoga sessions. If you like to do yoga every day, vary the intensity of the sessions so that you don’t work the same parts of the body at the same intensity during every session. Let me know if you have any questions . Need more help with an injury? You’re welcome to consult me online via video call for an assessment of your injury and a tailored treatment plan. Best wishes Maryke 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 , Facebook , Twitter or Instagram . References Büssing, Arndt, et al. "Effects of yoga on mental and physical health: a short summary of reviews." Evidence-Based Complementary and Alternative Medicine 2012 (2012). Cramer, H., et al. (2013). "Adverse events associated with yoga: a systematic review of published case reports and case series." PLoS One 8(10): e75515. Le Corroller, T., et al. (2012). "Musculoskeletal injuries related to yoga: imaging observations." American Journal of Roentgenology 199(2): 413-418. Lee, M., et al. (2019). Soft tissue and bony injuries attributed to the practice of yoga: a biomechanical analysis and implications for management. Swain, T. A. and G. McGwin (2016). "Yoga-related injuries in the United States from 2001 to 2014." Orthopaedic journal of sports medicine 4(11): 2325967116671703.

I was recently asked by one of the members of the Sports Injury Group: “What exercises can I do to correct upper crossed syndrome and is it OK to continue weight training my whole body while I correct it?” In this article, I’ll discuss what upper crossed syndrome is and why it can cause problems. Check out the video below for examples of exercises that you can do to correct it and advice on how to adapt your weight training if you have this posture. In this article: What is upper crossed syndrome? What problems can it cause? Video demo of exercises to correct upper crossed syndrome What is upper crossed syndrome? I tend to call it forward head posture because it’s more descriptive and doesn’t sound quite so alien. It is basically a posture where your head sits slightly forward compared your torso, your shoulders are rounded and you have an increased curve (kyphosis) in your upper back. It develops mostly due to activities such as the following: Sitting with poor posture while working on a computer Slouching while playing video games Over-training the chest muscles in the gym compared to the back muscles Doing strength training while in a poor posture As a result of this posture you end up with weak muscles in the front of the neck and in the mid back between the shoulder blades (rhomboids, mid and lower traps) – this forms the one arm of the cross. The other arm of the cross indicates the muscles or areas that become tight which include the muscles in the back of the neck, upper traps, levator scap and the pecs in the front of the chest. What problems can it cause? This posture doesn’t cause trouble for everyone, but for some people it can cause headaches and pain in their necks and upper backs. It can also predispose you to neck and shoulder injuries when you do sport, because it decreases the space in the neck and shoulder joints – I explain this in detail in the video below. I also find that my older patients tend to have much stiffer necks if they have a severely forward head posture and this can make it difficult for them to drive their cars safely. Lastly, it also just doesn’t look nice. In severe cases it can look as if you have a lump at the base of your neck. Video demo of exercises to correct upper crossed syndrome In this video I explain all of the above in more detail. If you’re just interested in exercises and how to strength train if you have upper crossed syndrome, start watching from 09:00. Let me know if you have any questions . Need more help with an injury? You’re welcome to consult me online via video call for an assessment of your injury and a tailored treatment plan. Best wishes Maryke 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 , Facebook , Twitter or Instagram . References Daneshmandi, H., et al. (2017). "Bodybuilding links to Upper Crossed Syndrome." Physical Activity Review 5: 124-131. Griegel-Morris, P., et al. (1992). "Incidence of Common Postural Abnormalities in the Cervical, Shoulder, and Thoracic Regions and Their Association with Pain in Two Age Groups of Healthy Subjects." Physical Therapy 72(6): 425-431 .