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I’ve treated several children for a variety of sports injuries over the years, and a significant portion of these are due to growth spurts. In this article, I’m going to focus specifically on what happens to children/teenagers’ muscles, bones and nerves when they go through a growth spurt and how this can make them vulnerable to certain injuries. When I see them in clinic, kids who have sustained injuries during growth spurts often report feeling as if they can’t stride out when running or that they struggle to move freely and parents will say things like “He just doesn’t look comfortable when he runs”. My first question to these parents is usually “How much has he/she grown in the last few months?” When kids grow, their bones tend to grow and elongate faster than the muscles and nerves can change length. Here's the video of the livestream I did about this. These “longer” bones can cause trouble because when we move our muscles are meant to lengthen to allow us full range. If the bones have suddenly increased in length and the muscles have not, the muscles pull very tight when kids run or jump. This can predispose them to injuries like muscle strains and apophysitis ( Osgood Schlatter , Severs’ etc.). The relatively “shorter” nerves can also cause trouble. Our nervous systems are formed by our brains that are connected to our spinal cords which in turn are connected to the nerves that run into our toes and fingers. The nerves are meant to have some slack and be able to slide up and down as we move our arms and legs. If a kid/teenager’s bones have suddenly elongated, the slack in the nerves is reduced and they have to stretch instead of slide. Nerves don’t like to be stretched and this can also lead to muscle strains. The brain has to also suddenly control legs and arms that are of different lengths than what it’s used to – hence why kids or teenagers can look so off balance and clumsy. This temporary lack of balance and control can predispose young athletes to sprains and strains in nearly any part of the body, depending on the sport they do. How to prevent injuries caused by growth spurts 1. Make sure that they do regular full-body flexibility work. I’m not talking about some quick stretches before a match. I’m talking about a proper session of sustained stretches done 2 to 3 times a week. Each muscle group has to be stretched for 30seconds and the stretch repeated 3 times. Stretching should not be painful. I find that kids are often put off because they are trying too hard and it’s really uncomfortable. My young patients see much better results when they take stretches to the first point where they feel a mild stretch and keep it there for a long time. If you notice that they’re going through a growth spurt, get them to do the “high risk” muscles every day. What do I mean with “high risk” muscles? That will depend on the sport they play. If they do running sports it is usually the glutes, hamstrings, calves and quads. Check out the video in the previous section if you would like examples of what I do. Are you struggling to get them to do it? Doing it while watching TV can be a very nice way to distract them and get it done with as little moaning as possible! A word of caution: Don't get them to do strong stretches when they're injured, as it can make the injury worse. Rather see a physio to get a treatment plan. The advice above is for injury prevention, not treatment. 2. Get them to do balance work. This will teach the brain how to control its new body. Start with simple balance exercises but make sure you play with it and make it more complex. Let me know if you have any questions . Do you need help with an injury? You can consult me online via video call for a diagnosis 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 .

One of our followers on Facebook recently requested a video about “core exercises that protect your lower back”. Instead of just demonstrating lots of core exercises for your back, I’ve decided to take it right back to basics and show you how to effectively recruit your core so that you don’t just end up bracing with all your might. I would also like to point out that you don't have to do any specific "core" exercises to protect your lower back. Any exercises that strengthens the muscles around your trunk, in your legs and even in your arms will help to take the load off your back. The same goes for back pain - research has shown that you may get quicker results from doing core exercises but that, in the long term, any exercise will help your back pain - it just has to be the right type and intensity for you. In this article: Understanding the core Signs that you may be doing it wrong How to get that deep core working How to activate your pelvic floor muscles Here's the video I did about this: Understanding the core Your core muscles are the muscles that surround your trunk and can be split into a deep layer and superficial layer. The deep layer is made up of your diaphragm at the top, transverse abdominus at the front, pelvic floor muscles at the bottom and multifidus at the back. These muscles have been shown to fire at a very low level during all activities we do and plays a very important role in stabilizing your back. The superficial layer consist of the rectus abdominus (six pack), internal obliques, external obliques and erector spinae. They also play an important role in stability and protecting your back, but I often find that my patients overuse these and don’t really recruit their deep layer properly. Signs that you may be doing it "wrong" Signs that you may be recruiting your core muscles in a less than efficient way include: if you’re bracing your stomach with all your might; or you’re pulling your stomach in and up into your ribcage; or you’re holding your breath. I demonstrate this in the video. How to get that deep core working So how on earth can you get those deep muscles to work? Well, research has shown that when you contract your pelvic floor muscles, you also automatically activate your transverse abdominus and multifidus muscles. Pelvic floor exercises are often associated with woman and having babies, but guess what - men have them to! They are the muscles that stop our abdominal content dropping to the floor, they help us control our bladders and weak pelvic floor muscles in men can even contribute to erectile dysfunction . Strong pelvic floor muscles provide stability to your lower back in 2 ways: Contracting them increases the intra-abdominal pressure which provides stiffness and stability; Like I mentioned before, activating them also kicks the other deep core muscles into action so that you get a nice all-round stability effect. That's why my first step when teaching people core exercises is always to teach them how to effectively recruit their pelvic floor muscles. How to activate your pelvic floor muscles Your pelvic floor muscles can be split into 2 groups. The ones at the front helps with bladder control and stops you from wetting yourself. The ones at the back supports your rectum and helps you to control your bowel movements and farts (yip, lovely topic for discussion!). Some of my patients find it easier to activate the front ones and others the back ones, but I want you to be able to recruit both parts. Here’s a bit of a strange request: When you do the following exercises, can I get you to NOT try too hard. I find the harder my patients try the more they just end up recruiting the obliques and other superficial muscles. I have to be honest, I was going to write all of the exercises out and then I ran out of time. Please watch the video. In it I explain in detail how to activate the front and rear pelvic floor muscles, what not to do and then I also show you how to incorporate that into all your other core exercises. Let me know if you have any questions . Need more help with an injury? You can consult me online via video call for a diagnosis 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 . References Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment: A literature review. J Sex Med 2007;4:4–13. Wang, Xue-Qiang, et al. "A meta-analysis of core stability exercise versus general exercise for chronic low back pain." PloS one 7.12 (2012): e52082.

Doing stretches/flexibility exercises for the whole body is always a good idea, and you’ll do yourself a favour if you get into the habit while you’re young and things still move (relatively) easy. In this blog I’m going to focus on the three main areas that I find can become problematic if you don’t do exercises that counter the cycling posture. Tight chest and upper back The bent over position that’s so important for aerodynamics when cycling can cause your upper back to stiffen up in that position. This can cause problems both on and off the bike. On the bike, it can place more strain on your neck – especially at the junction between you neck and upper back, causing those joints to become painful and the muscles in your neck and shoulders to feel tight and sore. Off the bike, it can cause trouble when you’re doing other activities that require large ranges of movement. For example I’ve seen a few triathletes through the years struggling with neck pain and arm pain while swimming which was mainly caused by the stiffness in their upper backs and necks. An increased rounding in your upper back also forces your shoulders into a more rounded posture which, combined with the pectoral muscles in the chest becoming tight, may predispose you to injuries like shoulder impingement. You may not even realise that your cycling has contributed to your shoulder pain as it will often come on with repetitive activities like gardening or swimming. Top tip: Include flexibility exercises aimed at improving your thoracic spine (upper back) extension and rotation as well as pec stretches. I demonstrate some of my favourite stretches in the video above. Hip flexors Cycling can give you extremely strong hip flexor muscles – especially if you use cleats. But due to the cycling posture you always use them in their shortened position and they’re never moved through their full range. Overly tight hip flexors can contribute to a range of injuries including lower back and knee pain. If you’re a triathlete you should have extra incentive to keep them flexible as you’ll be able to stride better when running if your hips can easily move into extension. Top tip: I tend to stretch off the hip flexors first (iliopsoas) and then do a combined hip flexor quad stretch. Part of the quadricep muscle attaches to the front of the pelvis, so you have to incorporate knee flexion into the stretch to allow full hip extension range (see video). Glutes The gluteal muscles work pretty hard on the bike and I find that tight glutes can also affect your lower back. Check out the video for 2 of my favourite stretches for the glutes. Let me know if you have any questions . Remember, you can consult me online via video call for an assessment of any 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 .

Peroneal tendonitis (or tendinopathy) is an overuse injury that causes pain over the outside (lateral) of your ankle or foot. You have three peroneal muscles, but peroneus brevis tendonitis is the most common, followed by peroneus longus tendonitis. In this article: Anatomy of the peroneal muscles How do you know that you have a peroneal tendinopathy? Common causes of peroneal tendinopathy in runners Top tips for treating peroneal tendinopathy We've also made a video about peroneal tendonitis: 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. Anatomy of the peroneal muscles Both the Peroneus Brevis and Peroneus Longus muscles are located on the outside of your lower leg. The Peroneus Longus muscle starts from just below the head of the fibula. Its tendon runs behind the lateral malleolus of the ankle to the outside of your foot and wraps under your foot to attach the base of your big toe. The Peroneus Brevis muscle starts just above the middle of your fibula and runs down the side of your leg. Its tendon also wraps around the outside of your ankle and it attaches to the outside of your foot at the base of the 5th metatarsal bone (the knobbly bit you can feel on the outside border of your foot). Both these muscles help to point your foot down and to turn your foot out. They play a very important role in stabilising your ankle. How do you know you have a peroneal tendonitis? There are several different structures that can cause pain in the same area as the peroneal tendons so it’s always good to consult a physiotherapist to confirm the diagnosis. You may have a peroneal tendinopathy if: You have pain on the outside of the ankle or heel in the area where the peroneal tendons run. This pain is usually made worse by activities like running and walking and eases with rest. If it is tender or sore when you press on the peroneal tendons. Make sure you test the other side as well, because even healthy tendons can feel a bit tender when you press on them. It has to be more tender than your other foot to be significant. Turning your foot in fully (inversion) while it is pointing down (plantar flexion) may cause pain in the tendons. Remember, the pain you feel with this has to correlate with where the tendons are. This test can also cause pain in the ligaments or the tibial nerve (and its branches) if they are strained - where you feel the pain as well as the type of pain you feel is important when making the diagnosis. Trying to turn your foot out (eversion) against resistance may cause you pain in the tendons. I find in practice that this is not always easy to reproduce. Sometimes you have to contract the tendons in a lengthened position (inversion + plantar flexion) or do an eccentric contraction to elicit pain in them. Common causes of peroneal tendonitis in runners Lateral ankle sprains are one of the most common causes for this injury. When you sprain your ankle by turning it in, the tendons undergo a severe stretch injury. If you then neglect the injury and don’t rehabilitate it properly it can lead to peroneal tendonitis/tendinopathy. Chronic ankle instability. This usually develops as a result of an ankle sprain that’s not been treated properly which causes you to have poor control over your ankle. A sign that you may have an unstable ankle is when you find yourself spraining your ankle for no apparent reason – often when just walking. Not only do the peroneals strain every time you twist your ankle, but they tend to also get over-worked because the other muscles aren’t doing their part. This can easily be fixed through a good rehab programme that strengthens all the muscles around the ankle. Soft or very flexible shoes act as an “unstable” base when you walk or run. For some runners this can cause the peroneal tendons to overwork and strain as they will have to work a lot harder to try and stabilise your ankle than if you were wearing a less flexible shoe. Doing a lot of running on a cambered surface that forces your foot to turn in excessively (inversion) can also cause an overuse injury / tendinopathy in the peroneal tendons. Top 5 tips for treating peroneal tendonitis/tendinopathy Make sure that you wear supportive shoes. Strengthen all the muscles in the lower leg that support the ankle – especially the Soleus. Be careful when strengthening the peroneal muscles themselves – if the exercises are too hard you can make it feel worse. Make sure you retrain your position sense/proprioception so that your brain knows exactly where you ankle is. That way it can control it better when you run and walk. If you’re getting sharp pains/electric shock sensations/pins and needles go and see a physio because you may also have irritated the nerve that runs in that area. 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 Brukner, Peter & Khan, Karim, (author.) (2016). Brukner & Khan's clinical sports medicine : injuries (5th edition). McGraw-Hill Education (Australia), North Ryde, N.S.W Hallinan JTPD, Wang W, Pathria MN, et al. The peroneus longus muscle and tendon: a review of its anatomy and pathology. Skeletal radiology 2019:1-16.

Whilst strength training forms an integral part of injury prevention in running, this is not actually the case for cycling . Cycling injuries are mainly caused by training errors and/or faulty bike set-up. However, strength training for cyclists can improve performance and economy. So if you’re interested in improving your performance, keep on reading. If you’re just cycling for the fun of it, rather go for a bike ride or check out this post on stretching for cyclists ! In this article: You have to plan your year Best type of strength training for cyclists Example strength training programme to improve cycling performance Here's the video of the livestream I did on the topic: You have to plan your year If you’re serious about your training, you’ll have heard about periodization. Periodization in sport means that you divide your year into different training phases. These tend to include a general preparatory phase, competitive phase, peak phase and active rest phase. Why is this needed? Because our bodies need time to recover and repair. If you try and push yourself all year round to perform and train at max intensities, your performance will eventually drop and you’ll likely end up with an injury. It is generally suggested that you use high volumes of heavy strength training during your preparatory phase to work on gaining muscle bulk as your cycling training is usually not so intense during this period. As you enter the competition phase and your cycling training becomes more intense and tiring, you have to decrease the volume of your strength training to a maintenance dose. Otherwise you can end up over-training your body and decreasing your performance. A common concern for cyclists is that they don’t want to put on more weight (even through muscle) because that could in theory cause a drop in their performance. But what the research has shown is cyclists don’t have to worry about this when it comes to weight training – their performance increases despite gaining an extra few pounds because their power to weight ratio also changes – the new muscle may be a bit heavier but it allows you to create a lot more force and power! Best type of strength training for cyclists The research seems to suggest that cyclists who are new to strength training will gain the most from following a high load, slow velocity programme. This programme also has to be done for at least 12 weeks before you’ll notice big improvements in cycling performance. It should include exercises that target the main muscles that you use in cycling (quads, hip flexors, hamstrings, glutes and calves) and work them in similar ways to cycling. Highly trained athletes don’t seem to be able to gain as much from this type of strength training. They seem to require more explosive load training to see extra gains in performance. Example strength training programme to improve cycling performance This is the programme that Vilkmoen et al. found improved the cycling performance of a group of female cyclists. Duration of programme: 11 weeks Number of sessions: 2 per week Warm-up: The cyclists performed a 5 to 10-min warm-up at self-selected intensity on a stationary bike, followed by 2 to 3 warm-up sets of half squats with gradually increasing load. Exercises used: half squat in a smith machine, one-legged leg press, standing one-legged hip flexion and ankle plantar flexion. They worked the knee from 90 degrees flexion to full extension as this is the range that cyclists use on the bike. They also included exercises that trained one leg at a time to mimic the cycling action. Speed of contraction: Participants were told to do it as fast as they could during the concentric contraction phase (cycling specific contraction) and more slowly during the eccentric phase (2 – 3 seconds). Weights: RM stands for Repetitions Max or in other words how many repetitions you can complete before your muscle is completely tired. Weeks 1-3 Session 1: 10RM (a weight that allows you to complete only 10 reps) Session 2: 6RM (a weight that allows you to complete only 6 reps before you’re tired) Weeks 4-6 Session 1: 8RM Session 2: 5RM Weeks 7-11 Session 1: 6RM Session 2: 4RM Important! If you’re new to strength training you may have to take it a lot easier and use much lighter weights. You have to also make sure that you have good technique so I would recommend that you work with someone who can check that you’re doing it right. 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 Bazyler CD, Abbott HA, Bellon CR, et al. Strength training for endurance athletes: theory to practice. Strength & Conditioning Journal 2015;37(2):1-12. Luckin KM, Badenhorst CE, Cripps AJ, et al. Strength Training in Long-Distance Triathletes: Barriers and Characteristics. Journal of strength and conditioning research 2018 Schwellnus MP, Derman E. Common injuries in cycling: Prevention, diagnosis and management. South African Family Practice 2005;47(7):14-19. Vikmoen O, Ellefsen S, Trøen Ø, et al. Strength training improves cycling performance, fractional utilization of VO2max and cycling economy in female cyclists. Scandinavian journal of medicine & science in sports 2016;26(4):384-96.

Some of the most common causes of shoulder injuries from weight lifting cited in the research include training at too high intensities, wrong technique, and lack of concentration. In this article, I’m going to focus on how to adapt your technique in the bench press, overhead press, and lat pull-down to reduce your risk of shoulder injuries. Here's a video of the livestream I did about this in the Sports Injury Group : 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. Bench press The bench press is a very popular upper body strength exercise, but can place very high loads on the shoulder stabilisers – mostly the rotator cuff and long head of biceps. It is commonly advised in the research that you avoid doing 1 repetition max lifts or if it’s needed for your sport limit the practice of these very heavy lifts to only a few times a year. Hand spacing: A narrower hand spacing (no wider than 1.5 times the biacromial width) minimises the peak torque in your shoulder and places less stress on the ligaments and capsule at the front of the shoulder as well as the rotator cuff and long head of biceps. This narrow hand grip is better for athletes who are prone to shoulder impingement, rotator cuff injuries and anterior instability. Grip Selection: The overhand grip (with forearm in pronation) brings the shoulder into internal rotation. In this position the biceps tendon is moved out from under the acromion while the supraspinatus tendon is moved underneath the acromion. If you’re prone to bicep tendon injuries, you may benefit from using this grip. The opposite happens when you use the underhand grip – it places the long head of biceps tendon under the acromion during the pressing motion while the supraspinatus tendon is moved away from the acromion. If you’re prone to rotator cuff injuries, you may benefit from this grip. This can be a bit of an awkward grip to get used to and it’s best to use a spotter to help you. You could benefit from using a mix of these grips to prevent over-straining the same muscles all the time. Flat vs. Incline vs. Decline: The flat and decline bench press positions are advised for anyone who has or is at risk of developing anterior shoulder instability, because it limits the amount of external rotation that the shoulder goes into. In fact, it is advised that athletes who have undergone anterior shoulder stabilisation surgery avoid the incline bench press positions because it places a lot of strain on the structures over the front of the shoulder. Shoulder press It is advised that you avoid the behind neck position when doing the shoulder press, because it places significant strain on the anteroinferior glenohumeral ligaments and neck. It also places the shoulder in a position where it is quite easy to cause impingement injuries. Doing the shoulder press from your chest may be a better option. Lat pull-down The main aim of doing a lat pull-down is to strengthen the latissimus dorsi muscle. When you observe people using the lat machine in the gym most of them pull the bar down behind their heads. Interestingly, research has shown that this is actually not the best way to do it. In a study where they tested the activity of different muscles in several different latissimus dorsi pull-down positions they found that the optimum position for latissimus dorsi and scapular retractor muscle involvement was to do the exercise with the trunk reclined 30° and pulling the bar onto the chest, near the bottom of the sternum. They found that the popular behind neck position actually worked the biceps more than the lats. I would also recommend using the chest pull-down position from an injury prevention point of view because the behind neck position places the shoulder in a position where it can more easily cause impingement injuries and potentially also strain the neck. 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 Brukner, P, et. al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon) Fees M, Decker T, Snyder-Mackler L, et al. Upper extremity weight-training modifications for the injured athlete. The American journal of sports medicine 1998;26(5):732-42. Reichel T, Mitnacht M, Fenwick A, et al. Incidence and characteristics of acute and overuse injuries in elite powerlifters. Cogent Medicine 2019;6(1):1588192.

THE ANKLE SPRAIN SELF-TREATMENT SERIES: How to diagnose your Ankle Sprain How to know whether you've broken your ankle (this article) How to treat your Ankle Sprain OK, so you've sprained your ankle and you don’t fancy waiting at the emergency room for no good reason. You can use the Ottawa Ankle Rules to decide whether you have a broken ankle. While broken bones sounds like the worst injury you can have, I would also go to A&E if the ankle swells significantly within 15 to 30 minutes (a possible sign that you've injured something inside the joint) or you suspect that you may have torn a tendon. It is best to have these injuries evaluated properly as they can have a prolonged healing time compared to ligament or muscle tears. The Ottawa Rules have been shown to have a very high sensitivity and a modest specificity to pick up ankle and foot fractures across various populations. This means that it is very unlikely that you've a broken your foot or ankle if the rules have a negative finding. How to know whether you have a broken ankle The Ottawa Rules state that an X-ray of the ankle and/or foot is indicated if: Pain is present in the Malleolar Areas (Zones A and B) or Midfoot (Zone C) combined with pain when you press on one or more of the following: The bone in area 1 The bone in area 2 The navicular bone – area 3 The base of your 5th meta-tarsal bone – area 4 Or if you are unable to walk for at least 4 steps (even with a limp) I am pretty sure I don't have to go to A&E, so what now? You should not underestimate the debilitating effect a torn ligament or muscle can have on your sport. It is important to establish whether you have injured any ligaments or muscles and then rehabilitate or strengthen them to prevent recurrent ankle sprains . It's pretty easy to diagnose diagnose exactly what you've injured if you understand the body well. A consultation with an experienced physiotherapist will be money well spent, as they can provide you with a diagnosis and tailored treatment plan that will speed up your recovery. This is something that our team of sports physios can easily help you with during an online physio consultation . Need more help? Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate . References Kerkhoffs, G. M., van den Bekerom, M. et al. (2012). "Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline." British Journal of Sports Medicine 46 (12): 854-860. Tayeb, R. (2013). "DIAGNOSTIC VALUE OF OTTAWA ANKLE RULES: SIMPLE GUIDELINES WITH HIGH SENSITIVITY." British Journal of Sports Medicine 47 (10): e3. Wang, X., Chang, S. et al. (2013). "Clinical Value of the Ottawa Ankle Rules for Diagnosis of Fractures in Acute " PLoS One http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0063228.

Understanding the three phases of hamstring healing will help you to know what to do – and what not to do – during each phase to speed up your recovery. In this article: Phase 1: Clot forms and cleaning starts Phase 2: New cells form Phase 3: New cells grow stronger and get organised How we can help We've also made a video about this: Hamstring Healing Phase 1: Clot forms and cleaning starts What happens when you strain your hamstring is that you tear some of the fibres in that muscle. This can range from a mild strain, where only a few fibres are torn, to a severe one involving a large portion of the whole muscle. Think of the muscle as a building that’s been damaged in an earthquake. The debris has to be removed before we can start repairing the building. In the case of your hamstring, the damaged muscle fibres and cells have to be taken away so that new ones can replace them. Two things happen to your muscle during this phase, which lasts for about the first three to five days: A blood clot forms and inflammation sets in. The blood clot, which is like an internal scab, is the ‘scaffolding’ to which the new cells that replace the damaged ones will attach themselves to. The job of the inflammatory cells is to absorb the damaged cells – clearing away the debris. This is why it is not a good idea to take anti-inflammatories in the first three to five days after a hamstring injury. Inflammation is a really important part of the healing process. Research has found that if you heavily suppress the inflammatory phase with anti-inflammatories during that first period, you can actually slow down your healing process. If your injury is really painful, ask your doctor if it’s OK to take something like paracetamol instead. On that note, some people wonder about the use of ice during this phase, because ice also decreases inflammation. However, the effect of ice lasts only for a very short time, whereas anti-inflammatories are in your blood for six to eight hours per dose. So, as long as you use it correctly , ice is less likely to negatively impact your healing. You should avoid stretching or any rigorous movements during this time, as this will damage the new ‘scaffolding’ and therefore also slow down the process of adding new cells. You may also further damage other muscle fibres because the whole muscle is a bit weaker. Phase 2: New cells form After about three to five days, depending on the severity of the injury, your hamstring healing process enters the regeneration phase. Your body starts forming new cells and these cells attach to that scaffolding – the blood clot. This goes on for about three weeks and overlaps with the next phase, which is the remodelling phase. These new cells are not strong yet, and they are not oriented in the correct way. Healthy muscle cells and fibres are aligned in the direction of the force that they need to exert, all parallel to each other. The new muscle cells are more like a plate of cooked spaghetti – all jumbled up, which is typical of scar tissue. Phase 3: New cells grow stronger and get organised To get this scar tissue / new cells to line up correctly and get stronger, you need to ‘remodel’ it and signal to your body what you want it to do by means of tensing the scar tissue. You do this through following a progressive strength training programme. Such a programme has to start with low load exercises that are appropriate for the current strength of your injured muscle. However, as your hamstring injury heals, the exercises should increase in intensity and complexity until your muscle is as strong as before you injured it. It can take anything from a few weeks to several months, depending on how bad your injury was and the type and intensity of activity that you would like to be able to do. How does exercise remodel tissue? Every time you do an exercise that's a tiny bit harder than what your new muscle cells and fibres are used to, but not too hard, the body goes ‘Oh, you actually want them to be stronger!’ In response, it rebuilds the muscle fibres fatter and stronger, and they can cope better with what is expected of them. It also senses in what direction these muscle fibres have to work and aligns them accordingly. As soon as you're used to a certain level of rehab, you should increase the intensity of the rehab a tiny bit more, until you've reached your full strength. Just resting an injury doesn't work. It may make the pain go away, but you're very likely to reinjure it if you go back to sport without doing rehab first. Just like you can't build strong muscles by just lying on the couch, you need exercise to strengthen those new cells slowly and progressively during the regeneration and the remodelling phases. 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 Bisciotti, G. N., et al. (2019). "Italian consensus statement (2020) on return to play after lower limb muscle injury in football (soccer)." BMJ open sport & exercise medicine 5(1): e000505. Hickey, J. T., et al. (2017). "Criteria for progressing rehabilitation and determining return-to-play clearance following hamstring strain injury: a systematic review." Sports medicine 47(7): 1375-1387. Ramos, G. A., et al. (2017). "Rehabilitation of hamstring muscle injuries: a literature review." Revista brasileira de ortopedia 52(1): 11-16.

Patello-femoral pain (or pain in the kneecap) is often also referred to as runner’s knee, as it’s a common injury in runners. The pain is usually felt over the front of the knee. It is thought that two of the main causes of this injury are poor running mechanics and decreased muscle strength. Your kneecap runs in a shallow groove over the front of the main knee joint. If your knee turns in excessively or your leg adducts excessively when you run, it can cause the kneecap to take more strain in certain areas, resulting in patello-femoral pain. Like with most injuries, the treatment for this condition usually consists of a mixture of different things but the main components are load management (reducing your training load to a pain free level), strength training exercises and running gait retraining. Watch this video if you want a demonstration of the movements I discuss lower down in this article. Strength training alone may not be enough In the early days, we used to think that if you strengthened the muscles that control how much your hip and knee turns in when you run (glutes, quads etc.), you would automatically see an improvement in running style. But this is not the case. What the research is showing is that a strength training programme only produces an improvement in muscle strength. It doesn’t change anything in a runner's running style. The reason for this is likely that we all have certain movements patterns that we’ve adopted and gotten used to throughout the years and you’re not necessarily going to change it just because you’ve now got stronger muscles. It is clear from the research that the only way to improve or change a certain running style, is by retraining the runner to use a different pattern. These gait retraining programmes usually have three phases: Phase 1: This phase takes a lot of thinking and concentrating as you learn the new pattern. You usually have to use feedback from devices or video to help keep you on track and make adjustments. Phase 2: During this phase you consolidate and practice your new pattern and you usually become progressively less reliant on feedback from devices etc. Phase 3: This is when the new running gait pattern has been practised so much that you can maintain it without having to think about it. What elements in your running style may contribute to runner's knee? The following biomechanical variables are currently thought to contribute to patello-femoral pain: Excessive hip adduction Excessive internal rotation of the thigh and knee Pelvic drop Over-striding Hard heel landings. How can you correct it? Increased your cadence or step rate by 5 to 10% – this has been shown to help reduce impact forces, internal rotation, hip adduction angles and pelvic drop. Most of the running watches can show you your step rate these days, but you could also use a metronome app to help you keep pace. I’ve discussed this in more detail here . Think about pointing your kneecaps forward when you run – this can help to reduce excessive internal rotation Lean slightly forward with your trunk – this can help to reduce impact forces. See the video above for a demonstration of this. Make contact with the ground nearer to your centre of gravity – I find that this goes hand in hand with leaning a bit further forward with your trunk. Both these strategies can help to reduce over-stride and impact forces. Be careful that you don’t end up compensating in other part, by for instance turning your feet out excessively. I usually take my patients through some standing drills first so that they get a good idea of how to correct it using the right muscle groups etc. I would strongly suggest that you watch the video above as I’ve explained all of this in a bit more detail in there. Let me know if you have any questions . Need more help with your injury? You’re welcome to consult one of us 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 Agresta, C. and A. Brown (2015). "Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review." Journal of Orthopaedic & Sports Physical Therapy 45(8): 576-584. 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. dos Santos, A. F., et al. (2019). "Effects of three gait retraining techniques in runners with patellofemoral pain." Physical Therapy in Sport 36: 92-100. Noehren, B., et al. (2011). "The effect of real-time gait retraining on hip kinematics, pain and function in subjects with patellofemoral pain syndrome." British Journal of Sports Medicine 45(9): 691-696. Willy, R., et al. (2016). "In‐field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture." Scandinavian Journal of Medicine & Science in Sports 26(2): 197-205. Willy, R. W., et al. (2012). "Mirror gait retraining for the treatment of patellofemoral pain in female runners." Clinical Biomechanics 27(10): 1045-1051.

The tips in this article is specifically for people who struggle with wrist tendinitis due to overuse injuries from computer work. I've also discussed it in this video: Tip 1: Start with relative rest! Wrist tendinitis is an overuse injury. It happens because you’ve used a muscle and tendon too much in the same position. If you’ve been reading my blog for a while you’ll know that I’m a massive fan of relative rest which means that you don’t necessarily rest the injury fully. You just cut out the really aggravating activities or you adapt them so that they no longer irritate the tendons. When we think of computer related overuse injuries, adapting and changing your work space is one of the most important ways that you can off-load or rest a tendon. For instance, if you switch from using a regular mouse to an upright mouse, it totally changes what muscles you use and can be very a useful way to rest the tendons that extend our wrist. Or if you use a higher chair, your wrists will be in a less extended posture when you type (see video for demo) which also offloads the wrist extensors. Tip number 3, taking regular breaks, should actually also fall under here, but it is so important that I decided to make it one on it’s own. Tip 2: Do strength training exercises When you have irritated tendons around your wrists, it can feel very nice to stretch them, but have you noticed that the pain and discomfort come back quite quickly? Stretching feels good and can play a role in your treatment, but strength training is much more important. When you do strengthening exercises you get the blood flowing through the muscles and tendons and increases the oxygen supply. This helps with the healing process and you’ll find that if you do it right, it also decreases the pain for much longer than stretching does. Just be careful – you’ll make things worse if you jump in with very heavy strength exercises during the acute stages of a tendinitis. It has to be introduced at the right level for you. Check out the video for some ideas. Tip 3: Take regular breaks from your desk Once you’ve got an overuse injury from spending too many hours working at your desk, it can be very hard to get rid of it unless you change your habits dramatically. It’s great to do your exercises first thing in the morning, but 3 hours into the day, that tendon is gagging for some blood and oxygen! You have to take regular breaks throughout the day AND do some exercises in them. It doesn’t have to take long. Stopping for 5 min to do one band exercise can be all that’s needed. Check out the video for some ideas on exercises that you can do. 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 20 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate , Facebook , Twitter , and Instagram .

I’ve never understood why people describe frozen shoulder or adhesive capsulitis as a self-limiting condition that fully resolves over time. It doesn’t resolve by itself . You have to work VERY hard to get your full shoulder function back to normal and then it still doesn’t always get back to where it was before. And this is not just my opinion - the research also shows that several patients will still have limited range of motion or pain 5 years after developing a frozen shoulder. Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We earn a small commission on the sale of these products at no extra cost to you. In this article: What causes a frozen shoulder? Treatments for frozen shoulder Here's the video of the live stream I did about frozen shoulder. You'll find a detailed demonstration of some of the exercises that I prescribe my patients. What causes a frozen shoulder? Researchers are not quite clear yet on why some people develop frozen shoulders. What they do know is that it seems to be caused by an over-reaction of the immune system. Your own immune system causes a massive inflammatory reaction (inflammation) in the shoulder which causes adhesions, fibrosis and thickening of the capsule and ligaments that surround the shoulder joint. This in turn causes the space inside the joint to narrow. Primary frozen shoulders develop without any clear cause while secondary ones can be triggered by a trauma or injury to the shoulder. Women between the ages of 40 and 60 tend to get this more often than men. I couldn’t find any research that linked this to the menopause but one has to wonder if it plays a role when you look at that age bracket. Other conditions that have been found to be risk factors include having auto-immune conditions e.g. rheumatoid arthritis, diabetes, very high cholesterol, thyroid disease and after having a stroke. Treatments for frozen shoulder For most patients their frozen shoulders usually start with a niggle which very quickly (over days or weeks) turns into a very painful shoulder that interrupts their sleep. During this phase my patients are often very frightened of moving the arm since even small movements or bumps can cause intense pain. This pain is thought to be mostly due to the active inflammatory reaction that is taking place inside the shoulder’s capsule. Most of my patients find very little relief from regular pain medication and anti-inflammatory drugs during this stage. I also find hands-on therapies like massage and dry needling often have extremely short lived effects when the shoulder is in this very painful phase and they’re pretty much a waste of time because they don’t alter the inflammatory response, hence the pain just returns. The most useful intervention for this stage is a corticosteroid injection and I tend to work very closely with our sports doctors when it comes to frozen shoulders. We’ve found that early intervention with corticosteroid injections can shorten the painful phase (and the research agrees ) because it shuts the inflammation down and this in turn prevents our patients from losing so much of their movement. The research has also shown that injections into the shoulder joint are more effective than ones into the sub-acromial space. Once the inflammation has calmed down and patients report that they can sleep better at night, both massage and dry needling can help to reduce muscle spasm and pain that is caused through the irritated muscles in the neck and shoulder girdle. Exercise is an extremely important part of the treatment for frozen shoulder. BUT please don’t do forceful stretches when your poor shoulder is in the very painful phase. You’ll just make the pain feel worse. Gentle pendulum movements are more appropriate during this phase (see the video for a full demonstration). Throughout this painful stage the shoulder starts to progressively stiffen up due to the adhesions and thickening of the capsule and ligaments. People with frozen shoulders usually have severely limited range of motion. In practice I find that external rotation and trying to take the arm behind their backs are by far the 2 most limited movements. As your shoulder pain settles down, doing strong stretches are very important. I don’t believe in doing strong painful stretches or passive mobilisation for my patients in the clinic. I get very good results from just getting them to do their own stretches 3 to 5 times a day. Doing little bits often seem to produce very good results, BUT the stretches has to be held for 30sec or longer in a strongly uncomfortable range and repeated at least 4 times (see the video for a detailed explanation). They should not cause their shoulders to hurt for more than 30minutes after doing the exercises and it should definitely not stir up their night pain. If we reach a plateau and the shoulder seems unwilling to budge despite them doing their exercises regularly, I will usually refer them back to the sports doc for an Ultrasound–Guided Hydrodistention injection . During this injection the doctor injects a large volume of sterile water into the joint capsule, causing it to stretch. This works really well. In the old days the only option for these patients would have been to have the shoulder manipulated under anaesthetic, but these injections work just as well and they are much less traumatic. Manipulations under anaesthetic can cause labral tear, rotator cuff tears and even fractures. I usually also introduce strengthening exercises long before my patients have regained full range. I find that this can help them regain their range of motion more quickly than if they were only doing flexibility exercises (see video). In practice I find that with this combination of treatment (injections + exercise) my patients take between 4 to 6 months to get 90% of their shoulder function back. They then have to work very hard for at least another 6 months to get that last 10%. In the sports medicine practice that I’ve worked in for the last 9 years we’ve never had to send a patients for surgery. I think this is down to the combination of the injections and exercise and making sure that patients understand that they have to be VERY diligent with their exercises. 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 Brukner, P, et. al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. Akbar M, McLean M, Garcia-Melchor E, et al. Fibroblast activation and inflammation in frozen shoulder. PloS One 2019;14(4):e0215301. Butt MI, Iqbal T, Anjum S. Comparison Between Manipulation Under Anaesthesia and Intra-Articular Steroid Injections for Frozen Shoulder. Journal of Rawalpindi Medical College 2018:342-45. Chen R, Jiang C, Huang G. Comparison of intra-articular and subacromial corticosteroid injection in frozen shoulder: A meta-analysis of randomized controlled trials. International Journal of Surgery 2019 Cui J, Lu W, He Y, et al. Molecular biology of frozen shoulder-induced limitation of shoulder joint movements. Journal of Research in Medical Sciences 2017;22 Kitridis D, Tsikopoulos K, Bisbinas I, et al. Efficacy of Pharmacological Therapies for Adhesive Capsulitis of the Shoulder: A Systematic Review and Network Meta-analysis. The American Journal of Sports Medicine 2019:0363546518823337. Rossi LA, Ranalletta M. Current Concepts in the Treatment of adhesive capsulitis of the Shoulder. International Journal of Medical Science and Clinical Invention 2019;6(03):4354-57. Wong C, Levine W, Deo K, et al. Natural history of frozen shoulder: fact or fiction? A systematic review. Physiotherapy 2017;103(1):40-47. Wu W-T, Chang K-V, Han D-S, et al. Effectiveness of glenohumeral joint dilatation for treatment of frozen shoulder: a systematic review and meta-analysis of randomized controlled trials. Scientific Reports 2017;7(1):10507.

The current research shows that, while stretches should be an important part of the treatment plan for iliotibial band syndrome (IT band syndrome), it’s not actually the IT band itself that you should aim to stretch. In this article, we’ll explain why you can’t stretch the IT band, what muscles you should rather stretch, and provide you with examples of useful stretches for IT band syndrome. 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 stretch the IT band? What should you be stretching if you have IT band syndrome? How often should you stretch for IT band syndrome? Stretching may not be enough How we can help We also made a video about this: Can you stretch the IT band? No. The IT band is a thick, fibrous band of fascia. Fascia is the white, sinewy stuff you find in meat. It is extremely tough and specifically designed not to easily stretch under load. It also can’t contract, like muscles do, but it has a very important stability function. There are several muscles that attach into the IT band (glute max, tensor fascia latae, outer quad). When you walk, run, or jump, these muscles contract and pull the IT band tight, which in turn helps to stabilise your pelvis (stops it from dropping to one side). What should you be stretching if you have IT band syndrome? You should stretch the muscles that attach onto the IT band, which are the glute max, tensor fascia latae (TFL), and outer quads (front thigh muscle). Whilst the IT band itself has no control over how tight it feels, the muscles that attach onto it can become in tone or tight. When this happens, they may pull the IT band too tight, causing increased compression, and eventually IT band syndrome, where it passes over the outer knee joint. Glute stretch If your IT band is very sensitive, you may have to wait with this stretch until it is happy for you to bend your knee into the required position. Instructions (for IT band syndrome on the right): Lie on your back with both knees bent up. Place the outside of your right ankle just above your left knee. Take hold of your left thigh with both hands and pull it towards your chest. Put a pillow under your head if you struggle to keep your neck in a comfortable position. You will feel the stretch in the right buttock/thigh/back depending on which part is the tightest. Hold the stretch for 30 to 40 seconds. Do 2 to 3 repetitions on each side. Quad stretch If your quads are very tight, you may have to start by doing this stretch without catching your foot. And then later on add in the foot catch. Instructions: Place a cushion under your knee to protect it from the hard floor. Half kneel with your one knee on the pillow and your other leg out in front of you. Hold on to something for balance. Push your hips forward, but at the same time tilt your pelvis backwards so that you feel a stretch over the front of your thigh and hip. This is important - if you allow your pelvis to tilt forward, the stretch will not be as effective. Maintain that position and grab hold of your foot. Hold the stretch for 30 to 40 seconds. Do 2 to 3 repetitions on each side. Trunk side bend IT band stretch Yes, I know, I said you can’t stretch the IT band. But this is the name most often used for this stretch. In reality it actually stretches your TFL, glute med, and side trunk muscles, which are all connected to each other via layers of fascia. So this is a great stretch to reduce the muscle tone along the side of the body. Instructions: Stand upright. Cross the leg on the side you're aiming to stretch behind your other leg. Then lift that same side's arm up and reach over your head to the other side until you bend at the trunk and feel a stretch over your side hip and trunk. Hold the stretch for 30 to 40 seconds. Do 2 to 3 repetitions on each side. How often should you stretch for IT band syndrome? Research has shown that stretching three times per week is enough. A good time for doing stretches is after your strength training. That way, you ensure that you relax the muscles properly after you’ve worked them. Remember, too much of a good thing is usually not a good idea, and you can injure yourself if you stretch too aggressively and too often. Stretching may not be enough Stretching only addresses one of the possible causes of IT band syndrome . You should also check if you should be including strengthening exercises or exercises that train your movement patterns in your IT band rehab . Running retraining has also been beneficial for some patients. Other treatments, like anti-inflammatory medication, may also benefit you during the early stage - we’ve listed the most beneficial conservative treatment options for IT band syndrome in this article . 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: 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.