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Being injured really isn’t any fun.  I am often asked on social media “I’ve injured my *insert your injury*. What should I do to recover?” The problem is that by the time you ask a random question on Twitter, you’ve likely already done several things that will prolong your recovery. Four of the most common things that people do wrong can easily be remembered by the phrase: Do no HARM. (Heat/Alcohol/Running/Massage) We all know the old mantra of things you should do: Rest, Ice, Compression, Elevation (RICE). The aim of the RICE regime is to protect the first (primary) injury and limit the secondary injury by protecting tissue from further trauma and reducing bleeding and swelling. Excessive bleeding/swelling 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 (= secondary injury). The four components of HARM should all be avoided during the first few days of injury, because they will very likely increase the extent of your injury and prolong your recovery. Heat Do not apply heat to a fresh injury that you've sustained less than 7 days ago. When you sustain an injury, you also tear several blood vessels in that area. If you’re lucky, you only tear a few small ones. If the area swells up quickly, it is likely that you’ve torn a rather large one. Your aim should be to try and stop the bleeding as quickly as possible. Heat leads to an increase in blood circulation in that area and will obviously have the opposite effect – causing your injury to worsen as explained above. Ice should be your weapon of choice for an acute injury and you can read more about how to safely apply ice here. Damaged blood vessels can continue to be weak and leak for a few days after injury, so it is best to avoid heat for at least a week (this may vary according to the extent of your injury). It is also thought that heat can increase the inflammatory response. While inflammation is a very important part of the healing response, excessive inflammation can actually lead to more tissue damage. Alcohol Alcohol has a blood thinning effect which means that it decreases your blood’s ability to form clots. The longer it takes for your blood to clot, the more you will bleed into the injured area and the worse your injury will get. My advice would be to definitely stay away from alcohol for 24 hours after injuring yourself. Consider abstaining for 72 hours if your injury swelled up quickly (which may indicate damage to a slightly larger blood vessel). Running Running is bad for acute injuries (injuries that are less than 5 days old) for 2 reasons: The first is rather obvious. If you have injured any structure in your lower body, that structure is now weaker and you may tear more muscle fibres if you continue to use it. You may not realise this when you are healthy, but running is actually a full body activity. It uses a lot of shoulder and spine movement and you may even make injuries in those areas worse if you continue. One may be tempted to think “I’ve injured my arm, I should be OK to carry on running.” But, this may be a bad idea for a similar reason as the 2 cases above. Running will increase the blood circulation in the whole body. This will lead to increased bleeding and swelling at the site of injury and ultimately increase the extent of your injury regardless of where it is. Massage When you sustain an injury, that area is weak and the new cells that form can easily be torn or damaged. You can read a more detailed description of how healing takes place here. For this reason massage within the first 5 days of sustaining an injury is a taboo. After this period, it should be applied with great care and with very graded pressure. Very light strokes should be used during the first few weeks and DO NOT ALLOW ANYONE TO DIG INTO A MUSCLE within the first 3 to 4 weeks of tearing it. All pressure should be comfortably uncomfortable. 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.

I often use this taping technique for patients with pain over the front of their knees e.g. patellofemoral syndrome, osteoarthritis, or Osgood-Schlatters. What you need: Kinesiology tape Scissors DO NOT USE TAPE IF YOU ARE ALLERGIC TO PLASTERS! 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.

I'm a firm believer that if you know how an injury is caused you can fix it and stop it from happening again. In this article I explain how shin splints develop and what treatment works for it. In this article: What causes shin splints? Make sure it’s shin splints How do you fix shin splints? How to prevent shin splints You can watch the recording of the livestream I did below. What causes shin splints? The medical name for shin splints is Medial Tibial Stress Syndrome. I know – It’s a mouth full! But the name actually explains exactly what it is. Shin splints is an overuse injury which develops when too much strain (stress) is put on the inside (medial part) of the shin bone (tibia). Shin splints can also be described as a stress reaction in the shin bone. When we exercise, our bones and muscles and tendons etc. all develop micro-damage. This micro-damage is normal and needed because it acts as the message to the brain that it has to rebuild your body stronger. If you give your body enough time between exercise bouts, the micro-damage gets repaired and the bones, muscles ligaments etc. are all stronger than before you exercised. If, however, you train too often and at too high intensities the body can’t repair all the damage and that’s when you can develop overuse injuries like shin splints. You can overstrain the shin bone or tibia by: increasing your training volume too suddenly e.g. having the summer off and then suddenly jumping into 3 times a week hockey training, doing too many intense training sessions in a week e.g. hill running, track sessions and or tempo runs, having a running style that places more strain on the shin bone e.g. low cadence, narrow gait or over-striding, poor hip control can potentially cause your legs to turn in more during running which can lead to strain lower down, excessive foot pronation (rolling in of the foot) can also cause the legs to turn in more, straining the tibia. Remember, bones can only grow and recover if they have all the building blocks that they require. So make sure that you’re getting enough Vitamin D and calories in your diet. Your body can only absorb calcium (a building block of bones) if it has enough Vitamin D. There is also strong evidence that suggests that athletes are at a higher risk of having poor bone health and developing stress fractures if they restrict their calorie intake while training hard. Make sure it’s shin splints When shin splints first start the pain is often only noticeable at the beginning of an activity but then goes away while you train or exercise. As the condition gets worse the pain may increase and stop you from training. It will then often also hurt during normal daily activities e.g. walking. It is important to distinguish shin splints from other conditions e.g. stress fractures and exertional compartment syndrome. You likely have shin splints if the pain is: on the inner border of the shin bone where the muscles attach, the pain stretches over an area of at least 5cm, the pain does not interfere with your sleep, you don’t have any of the symptoms listed below for stress fractures or compartment syndrome. You may have a stress fracture if: you have a very localised point on the bone that is painful (less than 5cm) to press, you have pain when lying down or resting, you have pain on the front of the shin bone (not the muscles but on the bone). If any of these symptoms fit you, don’t panic – consult a sports physio or doctor and let them check it for you. You may have exertional compartment syndrome (where there is too much pressure in the calf during exercise) if: the pain is only really present during exercise and usually settles within a short period e.g. within 15 minutes of stopping, the pain is associated with cramping, burning, tingling or pressure-like calf pain, or your foot feels cold or numb while exercising. How do you fix shin splints? Rest from aggravating activities Remember that shin splints is an over-use injury of the bone where the bone has not been given enough time to recover between exercise bouts. If you continue to do exercise or activities that cause pain, the injury will just drag on. You may also be at risk of developing a full blown stress fracture if you neglect it for too long. This does not mean that you can’t do any exercise! You must just cut the stuff out that hurts. This usually includes running and jumping activities. You should still be able to swim and cycle or cross train to keep your fitness up. Strengthen your legs Start working on your glute max, glute med, hamstring, quad and calf strength. Choose exercises that does not cause any pain and that also develops your stability. Make sure that you include exercises for foot and ankle stability. Flexibility Not all my patients benefit from flexibility exercises. Some of them develop shin splints because the muscles around their ankles are too weak and their joints are too flexible. These patients benefit more from strength training and orthotics. A number of patients do present with extremely tight calves and ankles. I find that these patients often benefit from adding calf stretches and general flexibility work into their rehab programmes. Orthotics or supportive insoles If you suspect that your feet roll in or your arches drop excessively when you run or walk, you may benefit from wearing some orthotics in your trainers. These insoles act as a little support for your foot arch and can in theory reduce the strain on the shin bone by not allowing the foot to roll in excessively. Slowly return to sport It is always very tempting to jump right back into training once the pain has settled. Please don’t do this. The bone needs to slowly get used to exercise again and you risk flaring it all back up again if you go back to your normal training regime. This is where it can really help to work with a physio or other sports clinician who can work out a programme that is specific to your sport and takes your goals into consideration. If you’re a runner or you do running sports, I suggest that you follow a run/walk programme to get the shin bone used to the impact of running. You can find an example of a run/walk programme in this blog post. How to prevent shin splints Like so many other sports injuries the research seems to suggest that if you’ve had shin splints in the past, you may be at risk of getting it again in the future. These are the steps I suggest you take to prevent this from happening: Make sure your legs are strong. Do at least 2 strength training sessions per week. Plan and log your training! Make sure that you ease into training and that you allow enough recovery time between sessions. Do you have flat feet or over-pronate? You may benefit from using orthotics and having more stable running shoes. Have your running style checked. There’s no perfect running style but the research does seem to suggest that certain things e.g. a narrow gait or turning in of the legs etc. can contribute to shin splints. I get my patients to email me a video of themselves running on a treadmill and then look at it in slow motion. There are some very simple but effective cues that you can use to correct your running style depending on what is needed. Eat enough and make sure your Vitamin D levels are topped up. Sleep is extremely important for recovery so make sure you get enough! 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 Agresta C, Brown A. Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review. Journal of orthopaedic & sports physical therapy 2015;45(8):576-84. Bliekendaal S, Moen M, Fokker Y, et al. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport & Exercise Medicine 2018;4(1) doi: 10.1136/bmjsem-2018-000421 Garnock C, Witchalls J, Newman P. Predicting individual risk for medial tibial stress syndrome in navy recruits. Journal of science and medicine in sport 2018;21(6):586-90. Sharma J, Weston M, Batterham A, et al. Gait retraining and incidence of medial tibial stress syndrome in army recruits. Medicine and science in sports and exercise 2014;46(9):1684. Verrelst R, Willems TM, Clercq DD, et al. The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study. British Journal of Sports Medicine 2014;48(21):1564-69. doi: 10.1136/bjsports-2012-091710 Verrelst R, De Clercq D, Vanrenterghem J, et al. The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study. Br J Sports Med 2013:bjsports-2012-092126. Winters M, Bakker EWP, Moen MH, et al. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine 2018;52(19):1267-72. doi: 10.1136/bjsports-2016-097037 Zimmermann WO, Helmhout P, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. Journal of the Royal Army Medical Corps 2017;163(2):94-103.

When people think of exercise, a lot of times running is their first thought. It’s the most simple, in that it can be done anywhere, you don’t need equipment, it can contribute to fat loss, and it makes most people feel good after. Often times, if someone doesn’t have proper strength training to go along with running, they can end up getting burnt out, or worse, with an injury that takes them “out of the race”. Running takes a huge toll on our bodies, so it is very important that we strengthen that foundation so we can run further, faster, and longer, all while staying injury free! Walking into a gym can be scary. There are so many different types of equipment that look weird and you see all these people that you automatically decide are more fit than you, so you spot that treadmill in the corner and make a mad dash so no one steals it before you get there, right? The main thing to remember the first few times you walk through those doors is that every single one of those people were beginners at some point as well. They had to learn how everything works, just like you do. Gym workout for runners I want to make that process easier for you, if you are a beginner to the gym. If you’re a gym pro already, I still want to make it easier for you to walk in there locked and loaded with some total body workouts that will help you take your strength to new levels, while boosting your cardio endurance at the same time! How to use the programme The following four workouts can be cycled throughout the week. If you plan to go to the gym 4 times a week, you’ll do each one once. If you go three times, you can do the first 3 the first week, then start with the 4th and do the first 2 again the second week, etc. If you go 5+ times, feel free to begin cycling back through them, or trying new things to see what you like, however, I do STRONGLY recommend at least 1-2 days of rest per week! Three of the workouts are “circuit style” with two or three exercises per circuit. For those, go through each circuit three times with the prescribed reps for each exercise, with as little rest as possible. Take two minutes rest after all three sets are complete, before moving on to your next circuit. The fourth one is all cardio with the instructions in the actual exercise program. Select weights that are challenging for you, record them, and try to increase them over the next several weeks. By the time you have 2-3 reps left in the set, you should be struggling to complete it. If you can easily bang out all the reps, time to pick up a heavier weight! If you are unsure about an exercise, please take a look at the linked demonstration video. In this video Ali discussed the gym programme and how runners should use it in more detail. Download Programme If you need any further assistance, please feel free to email me at ali@finalstrawfitness.com! Happy Lifting! Ali Greenman Final Straw Fitness Ali Greenman Ali is a Certified Personal Trainer who works with women all over the world on building strength, confidence, and excitement within themselves through online health and fitness training. Throughout her own weight loss journey to lose 70 pounds, Ali had plenty of ups and downs, but finally came out the other side and loves helping others streamline the process of losing weight, and gaining strength!

The severity of ankle fractures can vary dramatically, and the treatment has to be adjusted accordingly. In this article, we’ll cover what exercises and rehab you should do to get your broken ankle back to full function. This includes what you can do already while your ankle is still in a boot or cast and what you should do after the boot or cast has been removed. We’ll also discuss recovery times and things you should keep in mind before returning to your sport. Please check with your doctor or physiotherapist before you start any of the suggested exercises, as they may not be right for you. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What happens to your ankle when it is stuck in a boot or cast? How long will your broken ankle take to recover? Exercises while your broken ankle is still in a cast/boot Ankle fracture rehab - when your cast/boot is finally removed How we can help We've also made a video about this: What happens to your ankle when it is stuck in a boot or cast? To appreciate what we need to do to get a broken ankle better, it helps to understand what happens to a body part that is stuck in a boot or cast. It heals This is the obvious and desired effect. Your bones need this period of immobilisation to knit together. If you remove the cast or boot too early, the bones may not knit together properly, and you may end up needing surgery. You lose muscle mass This is not great, but unfortunately it’s unavoidable. Our bodies are designed to save energy, as it is constantly expecting us to run out of food and starve. If you don’t use a muscle for a while, your brain’s control centre thinks that you don’t require that area of the body to be strong, so it reduces its muscle mass and rather sends resources to the parts that you are using. Your nerves and a part of your brain go to sleep The nerves in our bodies are constantly sending signals to our brains. The brain also has a specific area that is dedicated to managing that specific part of your body. When an area of our body is not being used and is shielded from experiencing normal sensations (like a cast stopping you from touching your leg), the nerves in that area eventually become less active, as the brain feels it’s a waste of energy to keep them active in an area that is not being used. The control centre in the brain also reduces its activity. Our brain and nerves control everything in the body, including circulation, muscle contractions, and sensation. This is why it may feel extremely strange to touch your ankle right after your cast has been removed and why it can be so difficult to get your muscles to contract during those first few days. Interesting fact: You lose most of your muscle strength in the first week or two of being stuck in a cast. This is before you start to lose muscle mass. The reason for this loss of strength is thought to be down to the control centre in the brain in charge of contracting your muscles in that area going to sleep. There are simple ways to reduce this loss, which we discuss lower down. Your cartilage gets a bit thinner Joints don’t have arteries or veins that provide them with nutrients and oxygen. They rely on the changes in pressure created when you move to push fresh nutrients and oxygen into them. This is why a joint loses some of the cartilage that lines its surfaces when it is immobilised. But don’t worry, the cartilage will repair once you start moving. It just explains why your joints can feel so uncomfortable when they first come out of a cast. Your ligaments and joint capsules become tight Being stuck in one position for some time stiffens all the soft tissue in that area, but this is reversible. How long will your broken ankle take to recover? You’re looking at a minimum of 24 weeks for your ankle to be ready for full-on sport again. Ironically, your broken bones take only 12 weeks to fully mend. The subsequent 12 weeks are needed to undo all those negative effects your joints, muscles, and nerves suffered due to being stuck in a boot or cast for so long (see previous section). The recovery can be divided into three stages: The bones knit together: This takes about six weeks. At the end of this period, the fractured ankle bones would have knitted but the area will still be quite weak. You will be wearing a cast or boot for the duration of this period. The fracture area strengthens to pre-fracture strength and beyond: This takes another six weeks. The severity of your fracture and healing response will determine when your cast or boot can be removed (usually around 10 to 12 weeks after it was applied). By the end of this stage, your mended bones will be very strong. Rehab phase - restoring full range and strength: When your ankle is taken out of the boot or cast, it will likely be very stiff and weak. Twelve weeks is the minimum time your body will need to restore your cartilage, ligaments, joint capsules, muscles, and nerves to their full function. Exercises while your broken ankle is still in a cast/boot There are certain things you can do during this period that can help reduce the negative effect immobilisation has on your body. Please check with your doctor or physiotherapist before you start any of these exercises, as it can cause harm if you do them too soon. Moving your toes Don’t be too vigorous with this at the start. All broken ankles require a few days to settle. Start with gentle movements. It can improve circulation and help to keep your nerves awake and active. Strengthening your uninjured leg You will always lose some muscle mass and strength when you have to wear a cast or boot. Now, I know this sounds bonkers, but researchers have found that if you strengthen the muscles on the limb that is not injured, it can help to preserve your muscle strength and mass in the injured limb that is stuck in the cast. This is called cross-education. Researchers think that it has to do with neural activity and that our nervous system works a bit like a mirror. If you strength train the muscles around your uninjured ankle, it activates the control centre in your brain for the area you’re training as well as for the same area on your opposite limb. Like mentioned before, most of the strength losses we seem to experience due to immobilisation seem to be linked to the nervous system becoming less active. Cross-education strength training can help to keep the nervous system active and reduce these losses. However, if you’re hobbling around on crutches and already placing a lot of weight on your uninjured leg to compensate for loss of use of the injured one, it may be best not to train it too hard, as it will already be doing a lot more work than usual. Strengthening the rest of your body This is the ideal time to ensure that the rest of your body is nice and strong. Our bodies work as kinetic chains, which means that weakness in one area can also affect the other areas. By ensuring that your whole body is strong, you will support and protect your injured ankle. It will be especially useful to focus on strengthening your core and the muscles in your thigh and gluteal area on your injured side. Choose exercises that don’t place strain on your boot or cast. A physiotherapist can provide you with a programme for this. Examples of core exercises that may be useful: Sit-ups Russian twists Planks on your knees Examples of hip exercises: Side leg lifts Clams Hip extension in four-point kneel Quad exercise (injured leg): Seated knee extension: Your boot or cast will provide plenty of resistance. Sit on a chair and extend your injured leg out in front of you, lifting your foot off the floor. Hold the position for several seconds, then lower it down and rest. Hamstring exercise (injured leg): Standing hamstring curls: Stand on your uninjured leg, holding on to a sturdy object. Slowly lift your injured foot towards your bottom, pause for a moment at the top, then lower it back down. The weight of your cast will help to strengthen your hamstrings. Ankle fracture rehab - when your cast/boot is finally removed Restoring your broken ankle to its full strength and function is about more than just exercises. I’ll discuss the most important aspects here, but I would suggest that you seek guidance from a physiotherapist, as everyone’s situation tends to be unique, and you will get better results from a bespoke plan. Load management I've put this at the top, because it is a very important part of the rehab process that is often neglected or not very well explained. When you stand or walk, your feet carry all of your weight. Being stuck in a boot for so many weeks would have weakened the muscles and ligaments that are meant to support your foot arch. So, your foot won’t be able to cope with carrying your weight when you first take it out of the boot. If you increase the amounts of standing and walking too suddenly, you can end up straining your ligaments or plantar fascia and may develop plantar fasciitis. My advice is: Always wear supportive shoes, with added arch support if needed, when you’re on your feet. This is especially important for when you’re standing still for long periods, e.g. while cooking. Once your foot and ankle have regained their strength, you can slowly transition back to wearing less supportive shoes and walking barefoot. Slowly increase the time you spend on your feet. Remember, it’s the total amount of standing and walking in a day that is important as well as for how long you do it in one go. Start with short periods of standing and walking interspersed with rest periods, and slowly build it over time. Exercises that train your nervous system As mentioned earlier, being stuck in a cast or boot causes your nerves and the central control centre in the brain to be less active and alert. This affects your body in several ways, but the main one I want to highlight here is loss of control. When you move, the central control system in your brain uses feedback from the nerves in your muscles, joints, ligaments, and tendons to understand where your limbs are in space and time and to calculate the optimal movement pattern. This is how you know where your hands and feet are even when you close your eyes and why you can walk down a flight of stairs without having to look at your feet. We call this position sense or proprioception. An injury affects these messages from the nerves, and immobilising an injured limb for some time amplifies this loss. A reduced position sense means that you could injure yourself again once you get moving, because you will be somewhat clumsy to start with. It is extremely important (and quite easy) to retrain the control and position sense in your body. You can regain your position sense with a combination of techniques: Doing your strength training exercises very slowly and looking at your limb while you’re moving it. Focus on doing smooth movements and not using momentum. Exercises that challenge your balance. Now, people tend to immediately think about standing on one leg or on balance boards when they hear mention of balancing exercises. But this will likely be too difficult for you at the start. Often, just standing on both feet and slowly transferring your weight to your injured side would be difficult enough. As with all exercises, these should be progressed in difficulty and complexity as your ankle regains strength and control. This can be followed by tandem standing (heel-to-toe on a line), balancing on one leg, balancing while closing your eyes, and finally on unstable surfaces. Strength training exercises for the ankle and foot These exercises will help to restore the strength you’ve lost in all those small, intrinsic foot muscles as well as the ones that control your ankle. The specific type and intensity of the exercises will depend on each case, so I won’t go into too much detail here. The muscles that you want to focus on include those with the following functions: Supporting your foot’s arch (intrinsic muscles) Turning your ankle out (the peroneals) Turning your ankle and foot in (tibialis posterior, tibialis anterior); they also help to support your foot’s arch Pointing your foot down and propelling you forward when you walk, run, and jump (gastrocnemius, soleus) When you strengthen these muscles, you should start in positions that place very little strain on your ankle and focus on regaining control before you start adding load. As you grow stronger, the exercises should increase in complexity as well as load until you do exercises that mimic the movements and forces required for your specific sport. Let’s take the plantar flexors (calf muscles) as an example. A good exercise to start with is seated heel raises. These can then be progressed to standing double leg heel raises, followed by adding weight or doing them on one leg, and finally plyometrics where you hop and jump. Your physio will help to guide you in when you’re ready to move on to the next type of exercise. Mobility exercises Don’t be too forceful with your stretches, as overstretching can cause your joint to be achy and painful. I find that doing active stretches and movements often and throughout the day seems to work better than doing long, sustained holds where you really try and force the movement. Repetitive movements have been shown to feed joints and help restore the cartilage. Patients seem to regain their ankle mobility at different rates, and from what I’ve observed the main factors that influence this are: How severe their fracture and intra-articular (inside the joint) injury was. How flexible or stiff their soft tissue is in general. If you are generally a flexible person (can manage most yoga poses with only a bit of effort), you will likely regain your full range of motion a bit more quickly than if you’re on the less flexible side (that guy who remains sitting bolt-upright in yoga class when he is actually trying to bend towards his toes). How diligent people are with doing their exercises. But diligence only goes so far. Even if you’re super diligent, it will still take at least 8 to 12 weeks to regain your full range of motion. This is just how long it takes the body to remodel and reverse the effects of the immobilisation. You should aim to regain your full movement in all directions. See what your uninjured leg can do and compare that with your injured side. How far can your foot point down (plantar flexion), pull up (dorsiflexion), turn in (inversion), and turn out (eversion)? Dorsiflexion is often the most difficult to restore. A good starter exercise is the knee-to-wall stretch. This can later be progressed to the typical runner's calf stretch or heel drops over the side of a step. Whatever you choose, do them as active stretches: Hold the position where you feel the restriction for 10 seconds, then move out of it for a second of two. Repeat this several times in one go – six is a good number – and do it two to three times a day. Exercises for the rest of the body Our bodies work as kinetic chains. Weakness or lack of control in one area will also affect the rest. This is why it’s important to include exercises for your core, glutes, quads, and hamstrings. These exercises should start easy and in low-load positions. However, it is really important to eventually progress them to resemble the movements used in your sport. For instance, a basketball player should include several hopping and jumping drills, whereas a walker’s rehab plan would focus more on building endurance. 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: Campbell, M., et al. (2019). "Effect of immobilisation on neuromuscular function in vivo in humans: a systematic review." Sports Medicine. 49(6): 931-950. Knapik, Derrick M., et al. (2013) "The basic science of continuous passive motion in promoting knee health: a systematic review of studies in a rabbit model." Arthroscopy. Oct; 29(10):1722-31. doi: 10.1016/j.arthro.2013.05.028 Haggert, M., et al. (2020). "Determining the effects of cross-education on muscle strength, thickness and cortical activation following limb immobilization: a systematic review and meta-analysis." The Journal of Science and Medicine. 2(4): 1-19. Andrushko, J. W., et al. (2018). "Unilateral strength training leads to muscle-specific sparing effects during opposite homologous limb immobilization." Journal of Applied Physiology. 124(4): 866-876.

Non-steroidal anti-inflammatory drugs (NSAIDs) like Naproxen and Ibuprofen are very effective for relieving muscle pain in various scenarios. However, this article highlights the drawbacks of using anti-inflammatories for muscle pain, whether it’s shortly after an injury or to deal with muscle soreness during or after sport. 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: Anti-inflammatories to relieve muscle pain (injuries and DOMS) Anti-inflammatories to enhance performance How we can help We've also made a video about this: We also have an article about the use of anti-inflammatories for tendon pain, if you’re interested in that. Anti-inflammatories to relieve muscle pain (injuries and DOMS) People use NSAIDs to relieve muscle pain in two scenarios: First, pain caused by an acute muscle injury, and also for that general muscle pain you get a day or two after a hard match, race, or training session. In both cases, this is not a good idea. Anti-inflammatories for acute muscle injuries (strains and tears) Inflammation plays a crucial role in how your body heals a muscle injuries. When you strain or tear a muscle, the cells that make up your muscle fibres get damaged. Two things then happen during the first three to seven days after the injury: inflammation sets in, and a blood clot forms in the muscle – very much like an internal scab. Think of the injured part of the muscle like a building that’s been demolished to make way for a new one. The role of the inflammatory cells is to absorb the damaged cells and get rid of them – to clear away the debris, in our analogy. The role of the internal scab is to act like scaffolding for the new cells that replace the damaged ones to attach themselves to – i.e. to erect the new building. This cleaning-away-and-rebuilding process can take up to three weeks after the injury. By taking anti-inflammatories for an injured muscle, you inhibit the inflammation and therefore the process of getting rid of the damaged cells. This has a knock-on effect on the formation of new cells to rebuild the injured part of the muscle, and so the whole healing process is compromised. Yes, anti-inflammatories do reduce the pain caused by such an injury but it may have a negative effect on your recovery. However, if you can’t stand the pain, it is better to speak to your doctor about taking something like paracetamol instead. Anti-inflammatories for muscle soreness after sport or exercise When we exert ourselves physically, our muscle cells get micro-damage. This is normal and not as bad as it sounds. Our bodies then repair our muscle fibres to be a bit better than before, and this is how we gradually get fitter and stronger through exercise. When we overdo the exertion, it can cause some muscle pain in the day or two afterwards, and this is known as DOMS (delayed-onset muscle soreness). Here also, inflammation plays an important role in the process that allows us to grow stronger in response to a workout. The research suggests that if you regularly take NSAIDs for DOMS, you may deprive yourself of the training benefits and not gain as much muscle strength as you would otherwise. Anti-inflammatories to enhance performance Some people also take anti-inflammatories to alleviate or avoid muscle pain during sport, especially endurance races, in the hope that it will enhance their performance. A recent review of the available research found no evidence that this ploy works. It analysed 23 studies involving a total of 514 athletes and found that there were “neither significant difference in the maximum performance between NSAIDs and control groups nor in the time until exhaustion nor in self-perceived pain”. Therefore, we don’t recommend that athletes take NSAIDs to enhance their performance because they are known to be bad for your kidneys and stomach lining, especially if you were to dehydrate during an endurance event. 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: Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005 May;33(5):745-64. doi: 10.1177/0363546505274714. PMID: 15851777 Baldwin Lanier, A. (2004). Treating DOMS in sport with NSAIDs. International SportMed Journal, 5(2), 129-140 Cornu, C., Grange, C., Regalin, A. et al. Effect of Non-Steroidal Anti-Inflammatory Drugs on Sport Performance Indices in Healthy People: a Meta-Analysis of Randomized Controlled Trials. Sports Med - Open 6, 20 (2020). https://doi.org/10.1186/s40798-020-00247-w Schoenfeld, B.J. The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage. Sports Med 42, 1017–1028 (2012). https://doi.org/10.1007/BF03262309 Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab. 2002;282(3):E551-6

One of the most common types of shoulder pain that I treat in clinic is sub-acromial impingement. I know, it’s a mouthful! But the name will make a lot of sense once I’ve explained how the shoulder joint works and what the cause of this type of shoulder pain is. I’ve also included some exercises that I use for shoulder impingement. 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: A quick lesson in shoulder anatomy How do you know if you have shoulder impingement? The most common causes of shoulder impingement How to treat shoulder impingement Exercises for shoulder impingement A quick lesson in shoulder anatomy Your shoulder joint is formed by three bones. The collarbone and the tip of the shoulder blade (acromion) forms the roof of the shoulder joint – that’s the hard bone you can touch on top of your shoulder. The head of your arm bone (humerus) sits comfortably in the cavity they form. The space between the roof (collarbone + acromion) and the head of the humerus is called the sub-acromial space. This space is home to several tendons including the tendons of your rotator cuff and bicep muscles. It also has a bursa which is a little fluid filled sac that is meant to reduce the friction between the bones and the tendons. As you move your arm up, the shoulder blade has to tilt backwards to prevent the bones from hitting each other and squashing the tendons and bursa. If for some reason (I discuss these below) the shoulder blade does not get out of the way of the arm bone and you repeat this movement several times, this compression eventually causes inflammation in either the tendons or the bursa or both, resulting in shoulder impingement. How do you know if you have shoulder impingement? Shoulder impingement is usually caused by an activity that involves repetitive arm movements e.g. swimming, doing overhead weights, cutting hedges, painting a wall, cleaning etc. You often don’t feel any pain while you’re doing the activity but only develop the pain a few hours later or wake up with a painful shoulder the next morning. It’s important to distinguish between a muscle tear and impingement. You’ve likely torn a muscle if you’ve felt a sudden sharp pain while doing an exercise or while working.I t’s painful to reach above shoulder height or to put your arm behind you. It's normal for the pain to refer into your upper arm and down to your elbow. The most common causes of shoulder impingement There are several reasons why your shoulder blade may be slow to move out of the way of the humerus and cause shoulder impingement. The top causes I see in practice are: 1. Rounded shoulders Rounded shoulders are caused by the shoulder blades sitting in a protracted and forward tilted position. Remember that we need the shoulder blades to tilt backward to get out of the way of the humerus when the arm moves? Protracted shoulder blades cause the sub-acromial space to narrow and is one of the main causes for shoulder impingement. People end up with rounded shoulders for several reasons: They may have generally poor posture and slouch. Try this: Slouch your spine and stick your chin out. Notice what happens to your shoulders – they drop forward. Now sit up nice and straight – try and push the ceiling away with the top of your skull. Notice how your shoulders immediately fall into a better position. Over time your spine and shoulders will get stiff in this slouched position and your postural muscle will become weak (because you’re not using them!). You can turn this around by doing specific exercises, but the longer you wait the harder it will be. If you exercise the front of your chest (especially your pec muscles) a lot and don’t stretch it out to maintain your flexibility, your pecs will become tight and pull your shoulders forward. 2. When you do an activity that you’re not used to You may have fair posture, but if you do an activity that you’re not used to or do too much of the same activity your muscles around your shoulder blades may get tired and allow your shoulder blades to tilt forward. For example if you do too many hard swimming sessions without allowing enough recovery time or if you spend 3 hours cutting hedges in the garden. How to treat shoulder impingement Step 1: Get it diagnosed to make sure it’s not a muscles tear – the two conditions can feel very similar. Step 2: Correct your posture and retrain your shoulder blades to sit in a more retracted position. I show you how to do this in the video below. Step 3: Teach your shoulder blades to stay out of the way as you move your arms and strengthen the muscles that are meant to stabilise your shoulder blades. Exercises for shoulder impingement You should always work on improving your posture and teaching yourself how to move your shoulder blade before you do and strengthening exercises. In the video below, I show you how to correct your spinal posture and set your shoulder blades. I also demonstrate 2 of my favourite exercises for shoulder impingement. These may not be appropriate for you so please consult a medical professional before you try them. 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: Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon)