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Someone recently asked me on Facebook for some exercises that can help with his hip flexibility. He has osteoarthritis in his hip and as a result is struggling to reach his feet to put his shoes and socks on. This is actually an extremely common complaint for my patients who have OA in their hips. In this article: Why osteoarthritis can make hips stiff How to get rid of the stiffness Time your exercises right Video: Exercises to improve hip flexibility in OA hips Why osteoarthritis can make hips stiff Osteoarthritis is a condition that affect joints in several ways. Most people will develop some of the changes that we see with OA as they get older but the severity of these changes can vary a lot from person to person. Several factors (including things like genetics, diet, activity and previous injury) can play a role. Some of the reasons why joints become stiff when you have OA are: OA can cause the capsule that surrounds the joint to thicken, It can reduce the free space inside the joint, It can cause little bony growths which can limit joint range if they impinge when you move the joint, Or it may just be that you’ve stopped moving your joint properly because it’s painful to do so. How to get rid of the stiffness Movement. The problem with osteoarthritis is that it can cause a vicious cycle: Your joint hurts so you stop moving it, but now because you've stopped moving it, it becomes stiff and hurts more when you do move it. Joints don’t have arteries that go into them. They rely fully on movement to get nutrients in and out and to stay healthy. When you have osteoarthritis, regular movement becomes even more important for your joint health, but it has to be at the right level so that it doesn’t aggravate your pain. You can also keep the joint capsule more flexible by doing regular movements and exercises. Time your exercises right Joints that have OA in them, can sometimes be very acutely painful and have inflammation in them. It is NOT the time to do strong stretches or heavy exercise when they are actively inflamed – you will make them feel a lot worse. Other times the joints can just feel stiff and a bit niggly – this is when you can do stretches and strength training. Strength training is extremely important for anyone who has OA, because the stronger your muscles are, the better they can protect and decrease the strain on your joints. If you’re finding that your exercises are making your joints feel worse or you don’t know if what you’re doing is enough, speak to a physiotherapist. They are really good at advising on exercise plans for people with osteoarthritis. Video: Exercises to improve flexibility in OA hips To get back to the group member’s question – what exercises can you do to improve hip flexibility when you have OA? I demonstrate some in this video. Jump in at 04:06 if you don’t want to watch the full thing. 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 .

This mysterious syndrome is also called Anterior Exertional Lower Leg Pain. I know, it's a mouthful, but it’s because we’re not entirely sure what the mechanism behind this injury is. There are many different things that can cause pain in the front of your shin, but the important clue that you may have compartment syndrome is that the pain is only present with exercise and eases within a minute or so afterwards. It is felt in the muscles in the front of the shin and is often described as a constricting pain or severe tightness. It tends to build slowly as you run and gets so intense that you have to stop and rest. It usually settles after a few minutes of rest and you may even be able to continue your run for a bit, but then it stops you again. In some cases people can also describe a tingling or that their foot drops. These symptoms can also indicate other nerve injuries, but the big difference is that the tingling and foot drop recovers after a few minutes of rest. This is not the case if you have a nerve injury like sciatica. Patients with this condition usually don’t have any pain at rest – only when they exercise. I've discussed this all in more detail in this video: What causes compartment syndrome? We used to think that it was caused by the fascia sheath that surrounds the muscles in the lower leg being to tight. When we exercise our muscles swell and expand. If the fascia sheath around the muscles don’t allow them to expand, it can cut off the blood and oxygen supply and compress the nerve which gives you the symptoms. When you rest, the muscles’ demand for oxygen decreases and the compression decreases and as a result the pain decreases. But in recent years researchers have started to question this traditional model of compartment syndrome. Some now argue that it is actually a chronic over-load of specifically the Tibialis Anterior muscle. What treatments work for compartment syndrome? Conservative treatments (stretching, myofascial release, dry needling etc.) have traditionally been aimed at trying to improve the flexibility of the fascia in the lower leg as it was argued that that would alleviate the compression. But these treatment have been proven to be very ineffective and the patients usually had to undergo surgery. Surgery, however, has also not proven to be massively successful in that a larger number of patients would still experience symptoms. Recently researchers have shifted their focus away from hands-on and surgical treatment and started to look at ways that they could reduce the work load on the muscles in the anterior shin (Tibialis Anterior specifically) when someone runs. We still need a bit more research on this, but the available studies suggest that running retraining may be an effective way of treating anterior compartment syndrome. Running retraining for anterior compartment syndrome Your Tibialis Anterior muscle is the main one that flexes your foot and ankle up (into dorsiflexion) when you run. What the research is showing is that we may be able to decrease the load on the Tib Ant by getting runners to land with their ankles in less dorsiflexion and that increasing a runners’ step rate can decrease the activity of the Tib Ant throughout the swing phase of running. These are some of the things you can do that may help your pain: Increase your step rate. I’ve written a whole blog post on how you can do this . Try not to over-stride or land on your heel with your foot making contact far in front of your body. Instead, try to lean forward slightly and make contact with the ground underneath your body (see the video for a demo of this). Shift to using a mid-foot or forefoot strike pattern. You have to introduce these changes very slowly and build it up as run/walk sessions. If you do it too aggressively, you can easily end up with other injuries e.g. Achilles tendinopathy. I explain this in detail in the video. Let me know if you have any questions . Need more help with your 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: Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526. Breen, David T., et al. "Gait re‐training to alleviate the symptoms of anterior exertional lower leg pain: a case series." International journal of sports physical therapy 10.1 (2015): 85.

As with most injuries, there is no one-size-fits-all approach that applies to everyone when it comes to running with IT band syndrome. In this article, we'll share some tips on how you can decide whether it is OK for you to continue running and when it might be better to stop and concentrate on rehab first. We also discuss some common running style factors that may predispose you to developing IT band pain and how you can fix it. 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: Can you continue running with IT band syndrome? Don’t lie to yourself Running style factors that may cause IT band syndrome How can you improve your running style? If you’ve had time off running, implement a run-walk programme How we can help We've also made a video about this: Can you continue running with IT band syndrome? Yes, some people can continue to run while they have IT band syndrome, but others can’t or shouldn’t. Let me explain how you can tell what is right for you. When deciding if you can continue to run with IT band syndrome or not, there are two questions to consider: What happens to your pain while you’re running (immediate pain response)? What happens to your pain in the 24 hours after the run (24 hour pain response)? When might it be OK to continue running If your pain starts only after a few kilometres into your run, AND the discomfort never increases above a slight discomfort while you’re running, AND the discomfort settles back down within an hour or two after you’ve completed the run, then it may be OK to continue running while you undergo treatment for your IT band syndrome. I would still suggest that you try and limit/reduce your running distance to whatever you can do pain free. When might it be better not to run? If your pain starts quite early on into the run, OR You notice that it is starting a bit earlier into each run, OR it increases dramatically during the run, OR regardless of how much it hurts during the run (even if it is pain free), it causes your knee to hurt significantly more for the next 24 hours after your run, then it may be best to stop running and first focus on your rehab. Don’t lie to yourself I know, it’s really hard to stop running. But I want to urge you not to lie to yourself when answering the above questions. If you get any indication that your knee is more sensitive this week compared to last week, or you’re just not making progress with your rehab, rather stop running. IT band syndrome responds really well to an exercise-based treatment plan and most patients will be able to ease back into running within 6 weeks. Running style factors that may cause IT band syndrome There are some characteristics in your running style that may predispose you to developing IT band syndrome. These include if you run with: Excessive pelvic drop; Excessive internal (inward) rotation of the leg; Excessive adduction of the leg (where the leg crosses over to the mid-line). All of these are part of the normal running gait cycle. It is only when it is excessive that it may cause your IT band to pull too tight and get injured. This is why it’s good to have it assessed, otherwise you may waste your time trying to fix something that doesn’t need fixing. How can you improve your running style? Increase your cadence Increasing your cadence (how many steps you take in a minute) by as little as 5% can significantly reduce the impact forces on your body when you run. This in turn has been shown to reduce the amount of pelvic drop and internal rotation of your leg. Cadence drill Get your cadence. Most running watches these days tell you your cadence, but you could also just count how many steps you take in 1 minute when you’re running at your preferred speed. Download a metronome app to your phone and set it to 5% quicker than your current cadence. For example: If your current step rate or cadence is 160 steps per minute, set the metronome to 168 (5% of 160 = 8) beats per minute. Go out for your normal training runs and try to do 1 or 2 minute sessions at this new cadence. You won’t be able to do a full run at this new rhythm immediately, as it will feel like quite a hard effort, but keep practicing. Widen your stride If you find that you run with a cross over pattern (like you’re running on a tight rope), widen your stride a bit. How do you know if this is what you do? Signs that your legs are crossing over too far to the mid-line are: If you kick your ankles, or When filmed from behind, you can’t see a gap between your thighs. If you’ve had time off running, implement a run-walk programme A run-walk programme is where you alternate between short periods of running and walking. By adding in walks, you ensure that your IT band is never pushed to its limit. It has two benefits: It ensures that your body gets used to running again without reinjuring, and It is perfect for teaching yourself an improved running technique (if needed). Your physiotherapist will be able to advise you on what the best run-walk programme is for you. You can read more about the treatments for IT band syndrome in this article . How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. 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 Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskeletal Disorders 2015;16(1):356. Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait re‐training emphasizing step rate manipulation. International Journal of Sports Physical Therapy 2014;9(2):222. Balachandar, V., et al. (2019). "Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment." Muscles, Ligaments & Tendons Journal (MLTJ) 9(2). Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526. Dodelin D, Tourny C, Menez C, et al. Reduction of Foot Overpronation to Improve Iliotibial Band Syndrome in Runners: A Case Series. Clin Res Foot Ankle 2018;6(272):2. Friede, M. C., et al. (2021). "Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?" Physical Therapy in Sport. McKay, J., et al. (2020). "Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study." Journal of Orthopaedic Surgery and Research 15(1): 188. Louw, Maryke, and Clare Deary. "The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–A systematic review of the literature." Physical Therapy in Sport 15.1 (2014): 64-75. Phinyomark A, Osis S, Hettinga B, et al. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scandinavian Journal of Medicine & Science in Sports 2015;25(6):744-53. Van der Worp MP, van der Horst N, de Wijer A, et al. Iliotibial band syndrome in runners. Sports Med 2012;42(11):969-92.

Gluteal tendinopathy is one of the conditions that can cause deep glute pain and/or pain over the side of the hip. As with most injuries, it can have many causes, and one of these that you should address in your treatment plan is your running style. I’ve shared some more tips on treating gluteal tendinopathy here . Factors in your running style that can contribute to overloading the gluteal tendons include: if you run with a narrow gait, causing the legs to adduct; if your leg turns in excessively; allowing your pelvis to drop excessively as you run; if you over-stride as this causes higher impact forces for the glutes to absorb. I've also explained all of it in this video: How can you address this? Firstly, make sure that you have adequate strength in your glutes and other leg muscles before you go back to running. Once you’re ready to start running again, get some help with analysing your running style. It doesn’t have to be a super expensive test. I just get my online patients to film themselves while running at a comfortable pace. This is usually good enough to identify what we have to work on. Remember, it’s best to practise the cues I list below through a run/walk programme. This will allow your body to get used to the new movement pattern without causing other areas to strain. Narrow gait: If you cross your legs over into the midline (running on a tight rope), try to widen your steps a little bit. Over-stride and pelvic drop: Over-stride is when you land with your foot (usually on the heel) far in front of your body. Try to teach yourself to land more underneath your body. Increasing your step rate slightly is also a great way to reduce both over-stride and pelvic drop as it reduces the impact forces through the hips. Thinking about giving soft steps can also help to reduce impact forces. Knee turning in: If you find that your knees turn in excessively when you run, simply try to think about pointing your knee caps forward or just reducing how much they turn in by a little bit. Be careful not to go the other way – you shouldn’t run with your knees pointing out either. 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 . Reference Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526.

It is sooo annoying when an injury that is totally unrelated to running prevents you from hitting the road. In this article, I explain what 4 steps you should take to safely return to running when you have had back pain. I've also discussed this in more detail in this video: Step 1: Understand the cause This is really key to getting your recovery on track. If you can understand why you have your back pain and what structures are involved, then you know what exercises you should be doing as well as roughly how long your recovery period will take. You don’t need any scans for this. A skilled physiotherapist will be able to assess you and provide you with a diagnosis and treatment plan. Step 2: Treatment = Mobility + Strength + Moving There are plenty of different structures (muscles, ligaments, joints, discs, nerves) that you can injure in your back as well as different types of injuries (overuse, acute strains, compression etc.) that the same structure can sustain. And all of these will require a slightly different mix of mobility and strength exercises as well as just general movement. I explain this in a bit more detail in the video but if I had to summarise these: Mobility: Some back injuries do really well with strong stretches and movements into full range while others (like acute strains or disc injuries) only want very gentle range of motion movements that are initially kept in the pain free ranges. Strength exercises: Most back injuries can benefit from strength training as it helps to improve the circulation and the stronger your muscles, the better they can support your spine. However, these have to be set at the correct level for your injury and not cause any pain during or after you’ve done them. There’s an endless list of exercises that you can do, so just because one set hasn’t worked for you does not mean that you can’t strength train – you just have to find the ones that are right for your back. Moving: Probably the best thing that you can do for a back that is sore, is to move. For someone with an acutely painful back, this may mean a short walk. but for others this may mean a long walk, swimming or cycling. Any activity that can increase the blood flow in that area and get the joints moving will help as long as you can do it with only mild discomfort. Step 3: Time The body takes time to heal because it has to produce new healthy cells to replace the damaged ones. Changes in flexibility and strength also takes several weeks. As a rough guide you can expect the following healing times: A mild sprain – 4 to 6 weeks A more significant sprain – 8 week or several months A mild disc injury – 8 to 12 weeks A more severe disc injury – This can vary a lot but anything from 6 months to 2 years to get back to full function. An injury affecting one of your nerves in your leg – this can vary a lot depending on the type of injury but can take anything from 3 months to 2 years. Important: The level of pain you have is NOT an indication of the severity of your injury. I often find that severe pain can actually settle down to very mild levels once a person start doing the right things. I can usually predict much more effectively how long an injury will take to recover by observing how a person's pain changes within the first 2 weeks of following my treatment advice. Step 4: Walk-run programme This is a very important step. By following a walk/run programme, it allows your back to slowly get used to the impact forces from running. It also allows you to really focus on your form during the short run intervals. I discuss this in more detail in the video above. Because the first sessions are usually also quite short, if your back does decide to flare up it is usually only a mild discomfort that settles quickly. Whereas if you go for a long continuous run, it can often cause a quite intense flare-up that may take several days to settle down. Let me know if you have any questions . Need more help with your injury? You’re welcome to consult me or one of my colleagues 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 .

People seem to view vaping as a safe alternative to smoking, but when it comes to injury recovery that may not be the case. In this article, Maryke looks at why it is that smoking and vaping can stop your injuries from healing properly. Yes, vaping is relatively clean compared to regular cigarette smoke, which can contain more than 4,000 toxic compounds, but if your vaping solution contains nicotine, it is still very bad for injury healing. I have also discussed this in this video: How nicotine slows healing Getting a good supply of fresh blood to the injury site is extremely important as your cells require a constant supply of oxygen and nutrients to multiply and be healthy. Nicotine reduces the blood flow to your tissue in two ways: It causes your blood vessels to contract and narrow (vasoconstriction) so that less blood can flow through it and it also makes your platelets in your blood stick together more, causing your blood to thicken and this makes it more difficult for the blood to move through the smaller blood vessels in your body. So, if you smoke or vape regularly, your injured body part may be struggling to get enough oxygen and nutrients for large parts of the day, which will interfere with its ability to heal. Carbon monoxide & hydrogen cyanide Tobacco smoke also contains carbon monoxide and hydrogen cyanide. These two components have been shown to further reduce the oxygen that is available to cells. Carbon Monoxide binds much more easily to red blood cells than oxygen does which means that, instead of carrying oxygen to your injury the blood will carry carbon monoxide. Carbon monoxide and hydrogen cyanide also reduces the number of white blood cells in your blood and these play an extremely important role during the first 3 to 5 days after you’ve sustained an injury. If you don’t have enough white blood cells, your body will struggle to get rid of the damaged tissue and, in the case of open wounds, it will also struggle to defend you against infections. How tobacco smoke affects collagen turnover Collagen is one of the key building blocks of all the structures in the body. For instance, in bones the collagen provides the framework for the minerals to attach to while tendons are nearly totally (80%) made up of collagen. Every single structure of your body uses collagen in some way or form. The researchers are not entirely sure which of the toxins in cigarette smoke are to blame, but smoking has a very detrimental effect on collagen production. This means, that if you choose to smoke while injured, you’re effectively dialling down your body’s ability to produce the key building block that it needs to heal. Smoking can cause degenerative disc disease Compelling evidence exists that tobacco smoking can lead to the degeneration of the intervertebral discs in your spine. This is thought to be due to the combined effect of reducing the blood flow (and therefore nutrients and oxygen) to the discs and also reducing the production of new cells that are needed to keep the discs healthy. Would it help if I reduced my smoking or stopped for a short period? Very likely. It can take up to three days for all the carbon monoxide to leave your body, but the research is not clear on how long the other toxins may be hanging around for. Even a small reduction in the level may already help to increase the blood flow to your injury and allow your body to function better. I know that nicotine addiction is extremely hard to kick, but making the switch from cigarette smoke to nicotine only options (like vaping or gum) may already provide you with some benefit. There are so many different services and products out there these days that could be of help and speaking to your GP about it is usually a good first step. Injured? How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. 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 Elmasry, S., Asfour, S., de Rivero Vaccari, J. P., & Travascio, F. (2015). Effects of tobacco smoking on the degeneration of the intervertebral disc: a finite element study. PLoS One, 10(8), e0136137. McDaniel, Jodi C.; Browning, Kristine K. Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice. Journal of Wound, Ostomy and Continence Nursing: September/October 2014 - Volume 41 - Issue 5 - p 415-423 .

I recently received an email from a veteran runner asking me whether age plays a role in how often you should do your strength training, how many sets and reps you do, or when deciding what weight to use. The short answer is that age isn't the main factor that should determine when or how you strength train, but it can have an effect. I've also discussed it in this video: Training status (not age) is most important in strength training for older runners Both long-term (for how many years you've been strength training continuously) and short-term (what have you done in the last few weeks) training status play a role in determining your strength training schedule and intensity. Long-term training status Someone who has been doing progressive strength training for several years would have strengthened their tissue (muscles, bones, tendons, ligaments) to a level where they can handle weights that are quite heavy and also larger volumes or more frequent strength training sessions. Someone who has only recently started strength training will have only a fraction of that strength and will require longer recovery periods between sessions. Short-term training status Whenever you have a break in training, you lose some of your strength. So regardless of whether you have strength trained for years or started only quite recently, you will have to slowly ease back into training if you have had a break of more than two weeks. The longer the break, the lower the intensities you should start with and the slower you should ramp it up. Strength training recommendations according to training status: 1. If you're relatively new to strength training: do only two sessions per muscle group per week; start with bodyweight exercises; once you're ready to move on to weights, use lighter weights that fatigue you within about 15 repetitions. 2. If you're an experienced or regular strength trainer: you may be able to do three strength training sessions per muscle group per week, but this will depend on what other training you do; you'll benefit more from using slightly heavier weights that fatigue you within about 8 to 10 repetitions. 3. Regardless of your training status, if you've had a break from training, reduce your intensity and gradually ease back into it. How age affects strength training in runners Around the age of 50, both men and women experience a drop in hormone levels. This is important to understand because it affects your ability to build/maintain muscle and also how quickly you can recover from training. I think even children know about women going through "the change", but the fact that men experience a similar decline in hormone levels has not been that well advertised. Maybe it's because females experience very visible changes in that our menstruation stops? Regardless of the reason, it's important to understand that all runners over the age of 50 will have to put a bit of extra effort into getting the most out of their strength training and they will likely have to rejig their training schedules. Tips to optimise recovery as you get older Due to lower hormone levels, our ability to repair the damage we accumulate during a training session reduces - what used to take 24 hours to repair may now require 48 to 72 hours. This often catches older runners off guard and can lead to injuries because there's no flashing light that goes off and tells you that your normal training habits (that's worked well for the last 20 years!) are now suddenly not right any more. Achilles tendinopathy , gluteal tendinopathy , and recurring calf strains are some of the running injuries that are linked to this and that we commonly see in this age group. How can you tell whether you're allowing enough recovery time? Listen to your body. You likely need more recovery time if you: still have tired or sore muscles from your previous strength training session; feel that your legs never feel rested and are always a bit fatigued; feel that your muscles are tight and stiff most of the time regardless of how much strength training and foam rolling you do. Tips to optimise strength gains as you get older Lifestyle can impact our ability to build muscle and the effects of this become more prominent as we grow older. Protein When you're in your 20s, you only need about 20g of protein per meal to stimulate muscle growth. As we grow older, the body's response to the protein we eat reduces, so we need to eat a bit more of it. When we eat it in relation to our training sessions plus what other nutrients we include in our meals can also play a role. You can read an in-depth discussion here . Chronic inflammation Several factors in our diet and lifestyle can combine to cause low-grade chronic inflammation, which has been shown to increase muscle loss in old age. Some of the most common things to blame are high-sugar diets, processed food, alcohol, smoking, stress, and poor sleep. Taking antioxidant supplements may help, but it's always best to address the causes and make lifestyle changes rather than just take tablets. Vitamin D Vitamin D has several important functions. One is helping to build and maintain strong muscles. Sunshine is by far the most important source of Vitamin D, and it may be worth taking supplements if you don't get exposure to strong sunlight all year round. Your doctor should be able to test your levels and advise you on this. Injured? 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. 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 Dickinson, J. M., Volpi, E., & Rasmussen, B. B. (2013). Exercise and Nutrition to Target Protein Synthesis Impairments in Aging Skeletal Muscle. Exercise and Sport Sciences Reviews, 41(4), 216-223. Zhai Y, Xiao Q. The Common Mechanisms of Sarcopenia and NAFLD. Biomed Res Int 2017;2017

Our bodies are really good at healing themselves IF we give them the chance to do so. In this article, I explain how to recover from sports injury by understanding and working with the three phases of the healing process, and what you should do in each one to get the best results. In this article: How injuries heal Understanding the phases of healing to recover from sports injury Inflammatory phase Proliferation phase Remodelling phase How we can help How injuries heal This may sound like a strange thing for a physio to say, but you really don’t need anyone to rub, poke or zap your injury better. Our bodies have evolved over millions of years and are very capable of healing themselves. In fact, getting a strong massage during the wrong phase of healing can actually make your injury worse! Treatments like massage, acupuncture, electrotherapy etc. can help to alleviate the symptoms e.g. pain and stiffness that you experience, but they don’t actually affect the healing processes that happens inside your cells. What your body needs to recover is the right mixture of rest and exercise. It will all make sense when you read the sections below. There are three phases in the healing process of injuries. The Inflammatory Phase The Proliferation Phase The Remodelling Phase. How long these phases last depends on how badly you’ve injured yourself. And there’s an overlap between when one phase stops and the next one starts. Understanding the phases of healing to recover from sports injury Your body’s most important mission in this world is survival. It is always worried about the possibility of starvation and as a result won’t waste energy on things it thinks that you don’t need. For example, you may want big muscles but just “wanting” them is not enough to actually develop them. You have to tell your brain that you need them to be stronger and you do this through giving it a stimulus. In the case of bigger muscles, the stimulus is when you pick up heavy weights. The brain registers that your muscles are currently struggling with the job at hand and that acts as the stimulus to produce stronger and bigger muscles. Most injuries (sprains, tears, breaks etc.) are associated with cell damage. These damaged cells have to first be removed (inflammatory phase), new cells have to then form (proliferation phase) and these new cells then have to grow stronger to match the original ones (remodelling phase). This is the reason why you need to use a carefully graded treatment programme consisting of the right amounts of rest and exercise to allow your injury to heal back to full strength. If you exercise it too vigorously too soon, you’ll just break the weak new cells down. If you just rest the injury and don’t do any exercise, the cells will likely not regain their full strength because you’ve not indicated to the brain (through graded exercise) that it needs to rebuild it back stronger please. This will make more sense when you read my explanations under each of the phases. Inflammatory phase The inflammatory phase starts as soon as you injure yourself and usually lasts between 4 to 6 days. Simply put: when you injure yourself cells, fibres and blood vessels are torn or disrupted and you get some bleeding. This signals the start of the inflammatory phase. First a clot forms in the wound to stop the bleeding. The clot also provides scaffolding for other cells to attach to during the healing process. This is in a way similar to the scab that forms on your skin when you cut yourself. The injured cells then send out a distress signal which calls all the ‘cleaner’ cells needed for the process of inflammation to take place. Inflammation has been given a bad name over the years and patients are often keen to take anti-inflammatory drugs as quickly as possible after an injury to “stop the inflammation”. Thing is,  inflammation is extremely important for wound healing  and research suggests that you can delay or hinder your recovery from muscle and bone injuries by taking anti-inflammatory drugs, e.g. ibuprofen or naproxen, within the first few days of sustaining an injury. SMOKING and CORTICOSTEROIDS (cortisone) also interfere with wound healing and can either cause non-healing or poor healing. Corticosteroids may have a role to play in chronic injuries, but should be avoided during the acute stages of any sports injury. You should see inflammation as the body’s way of cleaning the wound and preparing it to rebuild strong tissue. During this time certain cells migrate into the wound and destroy bacteria and cell debris. They are preparing the cell for the next phase, the proliferation phase. The inflammatory phase is characterised by: Swelling Redness Warm to touch What to do during the inflammatory phase Treatment during the inflammatory phase should be aimed at protecting the injured area to prevent further injury of the weakened tissue and also to limit how much it bleeds. Stop what you’re doing. Continuing to train or play your sport when you’ve injured yourself, will worsen the injury and bleeding and your recovery will take much longer. Limit the bleeding. Apply ice  and gentle compression for 10 minutes after sustaining the injury. It may also help to elevate the body part if possible. This helps to limit the internal bleeding without decreasing the inflammatory response. Excessive bleeding can cause lots of pressure in the muscle or joint. This increased pressure can cut off the blood circulation and oxygen supply to adjacent cells and you can end up with more damage than what the original injury actually caused. WORD OF CAUTION: applying the ice for longer than 10 minutes or applying very strong compression, may have the opposite effect. Limit swelling by applying ice and elevating the body part. Excessive swelling can also cause increased pressure in the surrounding tissue which, as explained above, can lead to a more severe injury.  You can  apply ice every two hours  during the first 3 to 5 days of recovery. Protect the body part. You may find that using a crutch or sling for a day or two after injury can help speed up your recovery in severe cases. The cells and fibres are very weak immediately after an injury and you will help their recovery if you can decrease the load on them for a few days. Crutches, splints and slings should never be used for more than 2 days without consulting a physiotherapist of medical professional, since prolonged use can also hinder your recovery. NOTE OF CAUTION: Being over-protective of an injury can lead to poor recovery outcomes. Gentle movement. Moving the body part within its pain free range can help to decrease your pain and help recovery. I usually tell people to start doing this on the second day after injury depending on how bad it is. So, if you injure it today, start moving it from tomorrow. Proliferation phase The body has used the inflammatory phase to clean the injury site and it now uses the proliferation phase to rebuild the tissue. During this phase new blood vessels and cells are formed and collagen fibres are laid down. This phase usually starts around day 4 post injury and can last up to 14 days depending on the severity of the injury. During this phase the injury is busy healing but the ligament, muscle etc. (whatever you’ve injured) is still very weak. The new cells and collagen fibres do not yet look like they will in healthy, uninjured tissue. They are randomly laid down and not organised to form a strong, functional scar. For a scar to be strong all fibres has to be aligned in the direction that it has to withstand force in. The scar is thus getting stronger during this period of time but is still very vulnerable. If you load it too quickly, e.g. strong exercise or returning to sport too quickly, you can easily tear it again. Think of the cells as being a mess of spaghetti in your plate during this phase. For the scar to be strong, all of the spaghetti strands have to align next to each other. This will happen in the remodelling phase. What to do during the proliferation phase Movement but within the limits of pain. This means that movements should be done PAIN FREE. Movement is important since it tells the body to form new cells and also in what direction it should align the new cells and collagen fibres. You may still have to  protect the body part to some degree by limiting how much force you put through it. If for instance your ankle sprain is severe enough to require you to use crutches, you should usually progress from using 2 crutches, to using 1 crutch, to using no crutches within 2 weeks. Again, this is heavily dependent on the extent of your injury and is best discussed with your physiotherapist. I’m a big advocate of relative rest . Remember that rest alone is not good for injuries? Relative rest means that you continue training but you just cut the aggravating exercises out or you reduce the weight or intensity to a level that you don’t aggravate your injury. This way you can keep some of your fitness while ensuring your injury heals in the best way possible. Remodelling phase This phase can start at 8 days after injury and last up to 1 year depending on the severity of your injury. Lower back injuries can sometimes take up to 2 years to fully recover! Doing the correct rehabilitation exercises during the remodelling phase is extremely important – I’ll explain why. The first collagen fibres and cells that are laid down are very thin and not aligned in the same way as normal, healthy tissue. (Think of your spaghetti bowl again.) By moving the body part and doing stretches and exercises, you tug on the scar tissue. This tugging acts as mechanical stimulation to tell the body in what direction it should align the fibres. It also acts as a signal for it to form stronger cells and collagen fibres. This allows the scar to become stronger over time. Progressively loading the scar tissue is thus key to creating a strong functional scar. It is important to understand that it can take a very long time for an injured muscle, ligament etc. to get back to full strength.  Research has shown that “at 1 week, the wound has only 3% of its final strength; at 3 weeks, 30%; and at 3 months (and beyond), approximately 80%.” What to do during the remodelling phase From the above it should be clear why it is so important to go through a carefully graded strengthening programme before returning to your sport. There is unfortunately no one size fits all recipe for rehabilitation. It’s best to seek guidance from an experienced physiotherapist who is willing to liaise with your personal trainer or coach. I find that my patients recover much better when I can team up with their personal trainer by providing certain parameters for them to work within until the injury is fully recovered. This way my patients loses a minimal amount of their fitness! You may also be able to play sport before you have gained full strength if you use appropriate braces or taping techniques. Summary You can make sure that you do not delay your recovery from sports injuries through understanding the phases of healing and doing the correct exercises in each phase. 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. 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 ResearchGate . References Broughton, G., 2nd, Janis, J. E., & Attinger, C. E. (2006). Wound healing: an overview. Plast Reconstr Surg, 117(7 Suppl), 32e-S. Paoloni, J. A., Milne, C., Orchard, J., & Hamilton, B. (2009). Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. British Journal of Sports Medicine, 43(11), 863-865. Wheeler, P., & Batt, M. E. (2005). Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. British Journal of Sports Medicine, 39(2), 65-69.

Sports physio Maryke Louw gives some tips on exercise after flu or a cold. When is it safe, and when is it better to wait until you've recovered? Also: what you can do to speed up your recovery. In this article: What’s the difference between a cold and the flu? Why you should respect flu symptoms How to decide whether to exercise after flu or a cold How to speed up your recovery Injured? How we can help If you prefer to watch rather than read, here's the recording from the livestream that I did on this topic. What’s the difference between a cold and the flu? Flu and the common cold are both caused by viruses, but completely different ones. The flu’s symptoms are usually a lot more severe than those of a cold, and people often have to spend several days in bed. A cold tends to develop gradually over a period of a few days, but the flu usually has a very quick onset. Their symptoms are very similar but the intensity is much worse when you have the flu. Cold symptoms include sore throats, runny or blocked noses, sneezing and coughing. People with a common cold can have mild fevers and body aches. With the flu people usually develop a sudden fever, chills, severe tiredness, headaches and muscle aches, a dry cough and to a lesser extent runny or blocked noses and sore throats. Why you should respect flu symptoms The Flu viruses are much more likely to cause other complications and land you in hospital. This can include inflammation of the heart , brain, muscles and even sepsis which can lead to multi-organ failure. Studies performed on animals also suggest that you are more likely to become ill and that your symptoms may be more severe if you exercise when you’re infected with a virus. How to decide whether to exercise after flu or a cold Currently the medical advice is to AVOID all training if you’re experiencing any flu-like symptoms , e.g. muscle/joint pain, headache, fever, congested chest or cough, and generalised feeling of tiredness. You could do light training (heart rate < 120 beats per minute) if you’re experiencing mild symptoms of the common cold, e.g. sore throat and a runny or congested nose. I would suggest that you weigh up the benefits to the risks. Remember that some research has suggested that you could make a cold worse by exercising with it – so would you be better off if you skipped a day and gave your body time to recover? All the articles that I’ve read advised that you should not do any hard training sessions or competitions if you have any cold or flu-like symptoms. How to speed up your recovery As mentioned above, some studies have shown that you’re more likely to develop a full blown cold if you exercise while infected. So it may be worth your while to make sure that you get enough sleep and rest when you feel under the weather. Currently the research shows that you don’t have to take any extra vitamins if you’re eating a healthy diet full of fruit and vegetables. The one thing that has been shown to help people fight off the common cold more quickly is zink lozenges. But you have to start sucking the sweets within 24 hours of when you first start feeling your cold symptoms. Make sure you check with your GP or pharmacist that you are safe to use these. To show you an example of what I’m talking about, here’s an affiliate link to Zink Lozenges on Amazon. Injured? How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. 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 .

In this article, I discuss the main benefits of static stretching and dynamic stretching as well as how you can decide which type of stretch is the best to do. In this article: The good and bad of static stretching The good and bad of dynamic stretching When warming up, your choice of stretch should depend on… What type of stretching to do after sport When to avoid stretches Download example stretching programmes Here's the video of the livestream I did on this topic: The good and bad of static stretching Static stretches are better than dynamic stretches at improving range of motion (ref) . Holding a static stretch for longer than 45 seconds can switch a muscle off and reduce your performance BUT several studies ( ref , ref , ref ) have now shown that you can safely do static stretches without affecting your performance as long as you hold them for shorter than 45 seconds and follow it up by doing some dynamic stretches. Stretching before, during, or after exercise does not have any significant effect on muscle soreness after exercise ( ref). The good and bad of dynamic stretching Dynamic stretches do increase range of motion but not to the same extent as static stretches ( ref ). This type of stretching has been shown to improve muscle force and power, which leads to improvements in sprint performance and explosive strength, e.g. jump height. But it is worth pointing out that some studies have also shown that dynamic stretches can cause a decrease in performance ( ref ). It seems that this is a clear case of more is not always better. The researchers in these studies think that the reason for this drop in performance after doing dynamics stretches was due to the participants doing too many and actually tiring their muscles out before they ran or jumped. Doing dynamic stretches will unfortunately also not decrease the amount of muscle soreness after exercise ( ref ). When warming up, your choice of stretch should depend on … What sport you’re about to do and what your body is telling you it needs at that moment. Think about it. If you’re a gymnast, getting large ranges of motion in all your joints before you train or compete is extremely important, in which case static stretches may form an important part of your warm-up routine. Runners on the other hand may be able to get the full range they need from dynamic stretches alone. You may even find that what you need to do before a run changes depending on the day. Take your hips for instance. If you’ve spent the day sitting, you may find that your hip flexors feel super tight and that you struggle to get your full hip extension through dynamic stretches alone. On those days you may have to do some passive hip flexor stretches before you do your dynamic ones. On other days you may find that dynamic ones does the job just fine, so make sure that you listen to your body. If you're doing static stretches before a run, make sure you hold them for less than 45 seconds and do some dynamic ones to activate those muscles afterwards. I would always do dynamic stretches as part of a warm-up as they prime your body for exercise by waking up your muscles and nerves and lubricating your joints. What movements I do will all depend on the sport I’m about to do. If my sport involves running, I will definitely include movements like backwards lunges that activate the muscles that I’m about to use but also move my body through the range that I need for running. The research isn’t clear on how many repetitions of dynamic stretches we should be doing. What it has shown is that dynamic stretches that are performed “as quickly as possible” produces better gains in performance than moderate speed ones ( ref ). Just remember, that you need to be careful to not tire yourself out with your dynamic warm-up routine or else you may perform worse! What type of stretching to do after sport Static stretches are a good choice to help you restore your full range of motion after sport. There is some evidence that regular stretching can prevent acute muscle tears in sprinters, but it doesn’t seem to protect against overuse injuries e.g. Achilles tendinopathy ( ref ). I usually hold my stretches between 30 and 40 seconds and do 2 or 3 repetitions on each side. Try combining it with deep breathing – it helps to lower cortisol levels and will provide the added benefit of lowering your stress levels. Never force a stretch! A gentle comfortable stretch usually produces better results than painful forceful stretches. When to avoid stretches Not all injuries should be stretched. In fact, very few should be stretched using static stretches within the first few weeks. Dynamic movements performed just short of pain is often the best choice. When you injure a ligament, muscle, tendon or joint you often tear a few of the fibres and cells in those structures. Can you see that stretching those torn fibres may not be a good idea when the body is still trying to repair them? That said, there are definitely some injuries that react very well to static stretches but these are often patient specific and I would strongly advise that you consult a physiotherapist before you try any stretches for your injuries. This is something that our team of physios could help you with through an online physio consultation . Another good example of a condition that often does not react well to stretches is sciatica (or pretty much any other nerve pain). Doing hamstring or glute/piriformis stretches can often make sciatica worse. Please consult a physio if you suspect that you may have nerve pain. It is possible to over-stretch More is not always better. As mentioned above, doing too many dynamic stretches before you train can tire your muscles out and actually decrease your performance. Pushing static stretches into pain or too strongly can cause strains and tears. Also, there is really no evidence that being super stretchy will keep you injury free. You need enough range of motion to do your sports but having any more won't add any extra benefits. Download example stretching programmes I've prepared some example programmes for both static and dynamic stretches which you can download if you follow this link and subscribe to my email list. 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 . References Behm, David G., et al. “Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.” Applied physiology, nutrition, and metabolism 41.1 (2015): 1-11. Loughran, Martin, et al. “The effects of a combined static-dynamic stretching protocol on athletic performance in elite Gaelic footballers: A randomised controlled crossover trial.” Physical Therapy in Sport 25 (2017): 47-54. Opplert J, Babault N. Acute Effects of Dynamic Stretching on Muscle Flexibility and Performance: An Analysis of the Current Literature. Sports Med 2017:1-27. Reid JC, Greene R, Young JD, et al. The effects of different durations of static stretching within a comprehensive warm-up on voluntary and evoked contractile properties. Eur J Appl Physiol 2018:1-19. Samson, Michael, et al. “Effects of dynamic and static stretching within general and activity specific warm-up protocols.” Journal of sports science & medicine 11.2 (2012): 279.

Let’s face it, we’ve all tried training with a niggle injury or two. Sometimes it works, but other times it blows up in your face, and you end up with a full blown injury. In this article, I’ll share my method for deciding when to rest and when to train. I’ve spent quite a bit of time thinking about this article in the last week and I’ve come to the conclusion that I use a combination of four factors to decide when I can train vs. rest. Here's the video from the livestream I did: 1. Amount of pain/discomfort This is likely the most obvious factor that dictates my training. If what I feel falls more into the pain/ache category rather than “I can just feel something niggle”, I would usually opt for cross training. The activity that I choose to do instead of my normal training will be something that doesn’t put a lot of strain on the sore bit of my body. E.g. if my calf is hurting, I may opt for cycling or swimming instead of running. Both of those activities still uses the calf muscle but not nearly as much as running. Or if my shoulder is hurting I may opt for running rather than swimming. 2. Test it You have to be willing to adapt your training when you have a niggle. Test it out with an easy training session. How does it react within the first kilometre of an easy run? Is it getting worse? Consider turning that run into a walk and going cross training instead. Is it easing off? Great, but check how it feels in the 24 hours after the run. If it’s absolutely fine, then all is good and you should be able to continue light training until it has fully recovered. If, however, it’s more uncomfortable or keeps coming back, I would consider cross training instead and seeing a physio for injury advice. 3. Identify the cause Knowing what structure in the body you’ve annoyed and how you did it can help you mix up your training so that you can allow that bit to recover while maintaining your fitness. Here’s an example: My other half had a knee injury a few weeks back. Typical runner’s knee (patello-femoral pain) which was brought on by a lot of downhill running. Lucky for him his girlfriend decided to take pity on him (he was moaning my ears off) and give him some expert advice 😉. I suggested that he stuck to flat ground and keep his strides short (increasing step rate decreases the force through your legs) which meant that he was able to run pain free and allow his knee to recover at the same time. How can you mix up your terrain, speed/intensity or style to decrease the load on your niggly body part? 4. Learn from every niggle injury Every injury and niggle you get should become a learning opportunity. If you’re going to have to take time out from training, you may as well gain something positive from that experience! Think about the factors that may have combined to cause the niggle: Training volume, terrain, frequency, time of day, mental fatigue, warm-up etc. Think about previous times that you’ve felt similar niggles – how did you adapt your training then to get rid of it? Did it go badly wrong when you trained through this before? If you’ve never felt this niggle before, apply steps 1 to 3 above and make notes for the future. 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 .

We all have different reasons why we exercise. We all love different sports. We all gain different benefits from it. But the one similarity that I observe is that we all tend to enter a sort of grieving process when dealing with sports injuries mentally. I don’t know whether any research has been done on it, but I definitely find that my patients all go through very similar stages to the five stages of grief when we lose a loved one, as described by Elizabeth Kubler-Ross. The five stages are denial, anger, bargaining, depression (I think calling it low mood in this case is more appropriate), and acceptance. This grief can sometimes be so overwhelming for my patients that it stops them from doing the things that they need to do to help their injury recover. So it’s really important to understand that it’s normal to experience all of these emotions but that you need to find coping mechanisms, otherwise they can actually hinder your recovery. This “grieving” process isn’t linear either. It’s normal to experience a mix of emotions. It’s normal to fluctuate between them e.g. finding acceptance one day just to feel angry and have a low mood another day. In this article I’ll share with you the methods that I find help to get myself and my patients through this process. Here's the video I did on this topic. A little denial is natural … and sometimes useful I don’t think I’ve met many people who don’t “test” an injury or try to train with some pain before they seek medical advice. And to be honest, some pains and niggles do just go away by themselves. The key is to not enter into full denial mode and continue to train to the point where you’ve turned a small niggle into a full-blown injury. I’ve discussed my method of “safely” testing a niggle in last week’s blog post . If you consult me at the point where something is just a niggle, I can usually help you to adjust your training so that you can continue exercising while your injury recovers. My advice for the denial stage: Don’t hang around in the denial stage for too long. Be honest with yourself, and if it’s not showing signs of improving, get the right advice as quickly as possible. This will significantly speed up your recovery process. Be angry but don’t beat yourself up Yes, fine – you may not have been in this situation if you had just done x, y or z but we all make mistakes and this will not be your last. Or maybe it was a stupid dog that ran in front of you and you’re not even to blame for the situation you’re in. Anger is good and very normal but don’t allow it to get in the way of your recovery. As much as words like “learning experience” make my hair stand on end…this is exactly what you should use your injury for. My advice for the anger stage: Instead of just being angry, think about what you can learn from this to take with you and avoid injury in the future. I’m all for bargaining You should know by now that I’m a great supporter of relative rest. Relative rest is the ultimate positive “bargaining” tool as it allows you to be active while your injury recovers. Relative rest means that you only cut out or reduce the activities that really affect your injury. Some injuries may require that you do something different for a while, for example cycling instead of running. Often I can get my patients to rest their injury by just adjusting their training for a while, like limiting the distance or changing the terrain they run on or the speed they run at. Yes, I know it’s not the same as being able to do full training, but being active helps your injury recover, means that you keep your cardiovascular fitness (= quicker comeback) and usually helps my patients to cope better mentally. Identify the top 3 things that you like/enjoy about your favourite activity. Now see if you can find an alternative that can give you at least some of these benefits. When I was injured a few years back, I found that spinning was the only activity that gave me the same rush as running. But I had to supplement that with walking outside to get the stress relieving benefit of being in nature. My advice for the bargaining stage: Use relative rest – work with someone who can help you identify how to adjust your training programme to maintain as much of your fitness (and sanity!) as possible. Of course injury can make you feel VERY low Being injured can shake your faith. I’m not talking about spiritual faith. I’m talking about your faith in your body. I’ve been there myself and I experience this with my patients on a weekly basis. It can feel as if your body will never heal and that you’ll never be able to run or swim or walk again. But never is a very long time and in my experience most sports injuries do heal – some just take a VERY long time. Most people underestimate how long the body takes to heal. This is why it can be reassuring to chat with someone who can help you understand exactly what is normal for your specific injury and how long you can expect it to take to recover. Did you know that a simple muscle strain takes at least 4 weeks to heal? That’s a whole month. A severe muscle tear can take 12 weeks (3 months). This is because the body first has to absorb all the torn muscle fibres and then replace them with new strong ones…and this takes time. So if your injury is still painful or you can’t yet run after 3 weeks, it doesn’t mean that you have a bad injury that won’t ever heal. It may actually be healing exactly as expected. There are always certain milestones that I would expect my patients to achieve within a certain timeframe and these differ depending on the type and the severity of the injury. Knowing that you’re hitting the right targets can be very reassuring. Top tip – mark your projected injury recovery timeline out on a calendar. It will help you keep things in perspective. And make sure that you celebrate your small victories. Write down things that you can do this week/month that you couldn’t do last week/month so that you can look back at this when you find yourself thinking that things will never change. My advice to limit the low mood stage: Seek advice early on so that you know what is normal and what to expect. Keep a diary and celebrate every small step forward. Your body will heal – you just need to give it the chance to do so. Acceptance makes my life easy! Oh boy is it easy to treat someone when they’ve full-on embraced acceptance. They are usually receptive to anything I say and willing to try any other cross training activities that will keep them fit. Acceptance is not just about accepting that you’re injured – more importantly it’s about accepting/believing that you will get back to full health if you do the right things. Accepting that you will get back to running if, for a little while, you cycle or swim instead. Accepting that you will be able to run fast again if you keep your runs easy for a while. Accepting that you will be able to run the rest of this year’s races properly if you withdraw from this one. My advice for the accepting phase: Accept that your body will heal because you’re doing all the right things for it. 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 ResearchGate