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Are tendon repair supplements a fad, or do they really help you to recover quicker from your tendon injury? We take a look at the research into eight tendonitis supplements and tendon tear recovery supplements. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Tendon injury overview Research on tendon repair supplements What supplements help tendon repair? Some words of caution Our tendon repair supplement recommendations How we can help We've also made a video about this: Tendon injury overview Tendon anatomy and function Our tendons connect our muscles to our bones and therefore play an active role in how we move – every time you contract a muscle, it pulls on its tendon, and something moves. They also act like springs – absorbing forces and then releasing them, for example the Achilles tendon when we walk, run, or jump.   Tendons are mostly made up of collagen fibres. Collagen is the most abundant form of protein in our bodies and is also found in various forms in our bones, cartilage, ligaments, and skin. Types of tendon injury There are two main types of tendon injury: a tendinopathy (sometimes called a tendonitis or a tendinosis ) and a tendon tear or rupture .   A tendinopathy  occurs when a part of the tendon is injured (most commonly through overuse), causing the collagen fibres to move away from each other and lose their strong, parallel arrangement. This results in the tendon losing strength in that area. Typical tendinopathies: Achilles tendinopathy Patellar tendinopathy  (in the front of your knee) Lateral epicondyle tendinopathy  (tennis elbow) High/proximal hamstring tendinopathy Lower/distal hamstring tendinopathy Gluteal tendinopathy Tibialis posterior tendinopathy Peroneal tendinopathy.   Tendon tear  is self-explanatory, but when the tendon is fully torn, it is usually referred to as a rupture .   Research-backed treatments The best research-backed treatment for a tendinopathy is a progressive rehab programme that consists of the right combination of rest and exercise to replace and strengthen the weakened collagen fibres.   Most partial tears will benefit from the same type of rehab programme. On the other hand, some complete ruptures need surgery and others don’t. In any event, a rehab programme as mentioned above will also be necessary post-surgery, after the torn tendon ends have grown back together. Research on tendon repair supplements   Because tendons heal through replacing and strengthening their collagen fibres, the people in the white lab coats are interested in studying the effects of supplements that are known or thought to help with: the formation of new collagen cells in our bodies or that might reduce inflammation in the injured tendon.   Some of the studies discussed below focused on people with tendinopathies, some on people who have had tendon surgery, and some on healthy people who exercise. The latter is useful, because it is generally accepted that a supplement is not a stand-alone silver bullet that will get your injured tendon back to normal – it is meant to enhance the effects of a recognised tendon rehab treatment such as an exercise programme.   Also, most of the studies below had two groups of subjects: a treatment group who was given the supplement plus a conventional tendon rehab treatment, as well as a placebo group who received a “fake” supplement (without knowing it) plus the same conventional treatment. This enabled the scientists to figure out whether a supplement had a real effect or whether any improvements were “all in the mind” and/or thanks to the conventional treatment. What supplements help tendon repair?   Most of the supplements that have been tested either consist of some form of collagen (the main building block of tendons), substances that are known to play a role in creating collagen in the body, or substances that may help to regulate inflammation. Hydrolysed collagen Vitamin C-enriched gelatine Tendoactive® Tendisulfur® Forte Tenosan® Essential fatty acids and antioxidants Omega-3 polyunsaturated fatty acids High-leucine whey protein hydrolysate   1. Hydrolysed collagen What is hydrolysed collagen? Hydrolysed collagen is collagen that is broken down into smaller particles/peptides, which makes it easier for the body to absorb. The study: Praet et al. (2019) Test subjects: Twenty people with midportion Achilles tendinopathy. Dosage:  2.5 g of hydrolysed collagen OR a placebo, taken 30 mins before rehab exercises (twice daily) for 6 months. Additional treatment: Eccentric heel raises  and running exercises for the treatment group and the placebo group. Results: The group receiving the hydrolysed collagen supplement gained more benefits from their rehab exercises than the placebo group. Limitations of the study:  Very small sample size – the results may not be accurate. The study was sponsored by GELITA AG, Germany, a company that sells collagen supplements, so the results may be biased towards showing a positive effect. The supplements below are similar the one used in the study: 2. Vitamin C-enriched gelatine What is Vitamin C-enriched gelatine? In addition to its well-known health benefits, Vitamin C is involved in the formation of collagen. Gelatine is a derivative of collagen that is used in food, and therefore easy to ingest. The study: Shaw et al. (2016) Test subjects: Eight men, not injured. Dosage:  5 g of gelatine with 48 mg of Vitamin C OR 15 g of gelatine with 48 mg of Vitamin C OR a placebo, taken one hour before skipping rope. Additional treatment:  Rope skipping for 6 minutes, three times a day, for three days for the treatment group and the placebo group. Results: The subjects that took 15 g of gelatine had a better increase in collagen formation (due to the rope skipping exercise) than the 5 g group and the placebo group. We cannot say from this study whether Vitamin C played a role. Limitations of the study:  Very small sample size – the results may not be accurate. This supplement is similar to the one used in the study: 3. Tendoactive® What is Tendoactive? Tendoactive is a food supplement that has been formulated to help with the formation of connective tissue such as tendons and ligaments. Its main ingredient is mucopolysaccharide, which is thought to play a role in tendon strengthening. It also contains collagen and Vitamin C (see above for an explanation of what these are). The study: Arquer et al. (2014) Test subjects: 98 tendinopathy patients (Achilles tendon, patellar tendon, tennis elbow). Dosage:  Three capsules of Tendoactive per day (totalling 435 mg mucopolysaccharide, 75 mg Vitamin C, and 75 mg collagen) for 90 days. (Please note that the manufacturer recommends only two capsules per day for at least 90 days.) Additional treatment: None. Results: Reduced pain at rest and during activity, improved tendon function, and reduced tendon swelling. Limitations of the study:  This study didn’t have a placebo group, nor did they ask the participants about other treatments they may have received during this period, so the improved symptoms might have been wholly or partly thanks to the passage of time or something else entirely. There is also no mention of who paid for the research, so we can’t tell whether the results may be biased.   4. Tendisulfur® Forte What is Tendisulfur Forte? According to the manufacturer, it is a food supplement containing methylsulfonylmethane (which has been shown to reduce pain and inflammation in arthritis), hydrolysed collagen, D-glucosamine, chondroitin sulphate, arginine, lysine, with vegetable extracts of Boswellia, turmeric, myrrh, and Vitamin C.   This was researched in two studies.   A) First study: Vitali et al. (2019) Test subjects: 90 people: 30 with Achilles tendinopathy, 30 with a shoulder tendinopathy, 30 with tennis elbow. Dosage:  For the treatment groups, two sachets of Tendisulfur Forte per day for a month, and then one sachet per day for a month ( see here for sachet contents and the manufacturer’s recommended dosage ); for the control groups, zero dosage. Additional treatment: Shockwave therapy  for the treatment and the control groups. Results: For all three types of injury, a combined treatment of shockwave therapy and the supplement led to a faster recovery than just shockwave therapy. Limitations:  The control group did not receive a placebo supplement, which may mean that the positive results are actually due to a placebo effect rather than a true clinical effect. A medical company sponsored the supplements. ______________ B) Second study: Merolla et al. (2015) Test subjects: 100 patients who had had surgery to repair torn rotator cuff tendons. Dosage:  Two sachets daily for 15 days OR a placebo, and then one sachet per day for 45 days OR a placebo. Additional treatment: Painkillers for the treatment group and the placebo group. Results: The group that received the Tendisulfur Forte had better pain relief in the short term (after 1 week) and somewhat better pain relief in the medium term (after 2 weeks) but no better pain relief than the placebo group after that. Limitations: No mention of who funded the research. 5. Tenosan® What is Tenosan? According to the manufacturer, it is a supplement that promotes the formation of collagen. It contains L-arginine alpha ketoglutarate, TruBeet®, ViNitrox®, hydrolysed collagen type I, Vitamin C, and Vitamin D3. The study: Notarnicola et al. (2012) Test subjects: 64 patients with insertional Achilles tendinopathy . Dosage:  Two sachets of Tenosan (500 mg arginine-L-alpha-ketoglutarate, 550 mg methylsulfonylmethane, 300 mg hydrolysed collagen type I, 125 mg Vinitrox, 50 mg bromelain, 60 mg Vitamin C) OR a placebo, every day for 60 days. ( See here for sachet contents and the manufacturer’s recommended dosage .) Additional treatment: Three sessions of shockwave therapy for the treatment group and the placebo group. Results: There was no significant difference in perceived Achilles pain between the two groups after two months, but after six months, the group that received the real McCoy had less pain. The treatment group had better Achilles tendon function two months after the treatment started and after six months. Limitations: We don’t know who funded the research.   6. Essential fatty acids and antioxidants What are essential fatty acids and antioxidants? Essential fatty acids are a type of fat essential to several functions in our bodies, but we have to ingest them because our bodies cannot manufacture them. Researchers are interested in fatty acids because they may play a role in controlling inflammation. Antioxidants prevent the formation of free radicals, which can damage our cells; examples of antioxidants are Vitamins A, C, and E. The main rationale for including them in this supplement was to protect against any negative effects that ingesting such large quantities of fatty acids may have. The study: Mavrogenis et al. (2004) Test subjects: 31 recreational athletes with chronic tendon disorders (tendinitis, tendinopathy, para-tenonitis with or without tendinopathy). Dosage: Daily for 32 days, a placebo OR the following supplement: Essential fatty acids: 376 mg eicosapentaenoic acid, 264 mg docosahexaenoic acid, and 672 mg gamma-linolenic acid. Antioxidants: 100 µg selenium, 15 mg zinc, 1 mg Vitamin A, 2.2 mg Vitamin B6, 90 mg Vitamin C, and 15 mg Vitamin E. Additional treatment: Ultrasound for the treatment group and the placebo group. Results: The group treated with essential fatty acids and antioxidants had a greater reduction in pain during activities, and their participation in sports activities increased by more than that of the placebo group. Limitations: It is a small study, and we don’t know who funded it.   7. Omega-3 polyunsaturated fatty acids What are omega-3 polyunsaturated fatty acids? These are a type of fatty acid, typically found in fish oil and certain plant oils, which plays various roles in human physiology. The rationale underpinning fish oil supplementation lies in the anti-inflammatory effects it may have. The study: Sandford et al. (2018) Test subjects: 73 patients with rotator cuff injuries. Dosage:  Nine capsules per day, each containing 170 mg eicosapentaenoic acid (EPA), 115 mg docosahexaenoic acid (DHA), and 2 units/g tocopherols acetate (vitamin E) OR a placebo, for two months. Additional treatment: Weekly rotator cuff injury exercises for eight weeks for the treatment group and the placebo group. Results: The treatment group had a slight improvement over the placebo group after three months, but the injuries of both groups showed similar improvements after 12 months. Limitations: Seven Seas Ltd. provided the active and placebo capsules but did not commission or fund the full study. These supplements might not have the same concentrations of Omega-3 as that used in the research. Please follow the manufacturer's dosage instructions.   8. High-leucine whey protein hydrolysate What is high-leucine whey protein hydrolysate? Leucine is an essential amino acid (i.e. the body can’t manufacture it; it has to be ingested), and whey (a by-product of cheese production) is one way to ingest it. Hydrolysate is a type of whey that is easily digested. Amino acids have been shown to play a role in collagen production and may hence help tendon repair. The study: Farup et al. (2014) Test subjects: 22 healthy young recreationally active men. Dosage: 19.5 g high-leucine whey protein hydrolysate OR a placebo, on each of 33 exercise days over 12 weeks. Additional treatment: Patellar tendon exercises (leg extensions) for the treatment group and the placebo group. Results: The patellar tendons of the group taking the supplement grew thicker (due to the exercises) than those of the placebo group. The strength of both groups increased about equally (due to the exercises). Limitations: Again, this was a small study. Arla Foods Ingredients Group P/S DK funded the study, but it is not clear whether they just provided the supplements or actually commissioned the study. This whey protein supplement may not have the same concentrations as the one used in the study. Please follow the manufacturer's dosage instructions. Some words of caution   Anti-inflammatory effects of some tendon repair supplements Some of the pain reduction caused by some tendon repair supplements could be due to a reduction in inflammation.   However, it should be noted that inflammation plays a vital role in the healing process of a tendon injury (tendon tears specifically), especially in the first few days. So, reducing the inflammation could suppress the healing process .   Also, in many cases of tendinopathy, especially chronic / long-term tendinopathy, there is little or no inflammation, even though the tendon might be painful. In such cases, taking a supplement with the sole purpose of reducing inflammation will be useless, and there is some evidence that it may limit your strength gains after workouts , including rehab workouts.   Overdosing and interaction with other supplements / medication It is easy to overdose on certain minerals and vitamins if you take several supplements that contain the same thing – check the contents of any supplements you take carefully.   There are also several medications that can be affected by some of the substances included in these supplements (stopping them from working as effectively), so if you are taking any medication, check with your doctor before you start taking supplements.   Sports doping Supplements are not regulated by the USA’s FDA and similar bodies elsewhere, and therefore not all the ingredients have to be listed. This could cause you to test positive for prohibited drugs.   Our tendon repair supplement recommendations As I pointed out above in my discussion of the various research studies, they have some limitations: Some had small sample sizes. Some were sponsored by medical companies with skin in the game, and others didn’t disclose who funded the study. Some lacked a placebo group or a control group.   So, at this stage, we can’t tell for sure whether these supplements work or not. However, none of the studies reported any negative effects. So, this is something that you might add to your treatment, but I would not spend crazy money on it, and I wouldn’t depend on it as a standalone to get my tendon injury to heal properly. Please follow the dosage instructions on these supplements if you do get them. How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. For help with an Achilles injury, you can head over to our specialists at Treat My Achilles . We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Praet S, Purdam C, Welvaert M, et al. (2019) “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients” Nutrients 11(1):76. Shaw G, Lee-Barthel A, Ross ML, et al. (2016) “Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis” The American Journal of Clinical Nutrition 105(1):136-43. Arquer A, García M, Laucirica JA, et al. (2014) “Efficacy and safety of an oral treatment based on mucopolysaccharides, collagen type i and vitamin C in patients with tendinopathies” Apunts Medicina de l’Esport 48(182):31–36. Vitali, M., Naim Rodriguez, N., Pironti, P., Drossinos, A., Di Carlo, G., Chawla, A., & Gianfranco, F. (2019) “ESWT and nutraceutical supplementation (Tendisulfur Forte) vs ESWT-only in the treatment of lateral epicondylitis, Achilles tendinopathy, and rotator cuff tendinopathy: a comparative study” Journal of Drug Assessment 8(1):77–86. Merolla, G., Dellabiancia, F., Ingardia, A. et al. (2015) “Co-analgesic therapy for arthroscopic supraspinatus tendon repair pain using a dietary supplement containing Boswellia serrata and Curcuma longa: a prospective randomized placebo-controlled study” Musculoskelet Surg 99 (Suppl 1):43–52. Notarnicola A, Pesce V, Vicenti G, et al. (2012) “SWAAT study: extracorporeal shock wave therapy and arginine supplementation and other nutraceuticals for insertional achilles tendinopathy” Adv Ther 29(11):992. Søren Mavrogenis, Egil Johannessen, Pål Jensen, Christian Sindberg (2004) “The effect of essential fatty acids and antioxidants combined with physiotherapy treatment in recreational athletes with chronic tendon disorders: A randomised, double-blind, placebo-controlled study” Physical Therapy in Sport 5(4):194–199. Farup, J., Rahbek, S.K., Vendelbo, M.H., Matzon, A., Hindhede, J., Bejder, A., Ringgard, S. and Vissing, K. (2014) “Whey protein and tissue hypertrophy” Scand J Med Sci Sports 24:788–798. Balius R, Álvarez G, Baró F, et al. (2016) “A 3-arm randomized trial for achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides” Curr Ther Res Clin Exp 78:1–7. Hijlkema, A., Roozenboom, C., Mensink, M., & Zwerver, J. (2022). “The impact of nutrition on tendon health and tendinopathy: a systematic review” Journal of the International Society of Sports Nutrition, 19(1):474–504 . Qiu, F.; Li, J.; Legerlotz, K. (2022) “Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome in Tendinopathy? A Systematic Review and Meta-Analysis” J Clin Med 11(6):1666 .

THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis (this article) Self-treatment – overview of all the treatment options Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis That pain in your heel may well be plantar fasciitis. It’s one of the most common foot injuries, after all. The good news is that you can fix it yourself with some simple equipment in most cases, if you can pinpoint the cause. In this article, we describe the most common symptoms of plantar fasciitis, how the plantar fascia functions, and what causes it to become injured. In this article: Typical plantar fasciitis symptoms What your plantar fascia actually does What causes plantar fasciitis? We've also made a video about this. Typical plantar fasciitis symptoms The typical symptoms of plantar fasciitis include:  Pain and stiffness in the heel and/or inside arch of the foot (see picture below). Pain when you put your foot down and walk first thing in the morning. Your pain decreases with movement, but then increases if you spend too much time on your feet. Increased pain when you walk after sitting still for a while. When you press under your foot with your finger, you find a painful spot to the inside of the heel bone where the back end of the plantar fascia attaches. This painful area may extend into the arch of the foot (see picture below). One of the main symptoms of plantar fasciitis is pain in the area where the plantar fascia attaches to your heel bone. What the plantar fascia does The first step to understanding the causes of plantar fasciitis is to get a basic idea of how the foot works. The plantar fascia is a thick band of sinewy white tissue under the arch of your foot that runs from your heelbone to the ball of your foot. The plantar fascia supports the foot's arch and stops it from collapsing. It is part of a system in the foot and lower leg that keeps your body stable as you stand, walk or run. The system consists of muscles, tendons, bones, ligaments, and the plantar fascia. The role of the plantar fascia is to keep your foot from collapsing while there’s weight on the foot. Picture it as a cable that runs between the heel and the toes and tightens when you place weight on your foot. It also plays an important part in transferring load from the heel to the ball of the foot while you walk or run. What causes plantar fasciitis? Plantar fasciitis is caused when the load that the plantar fascia has to work against is too high, causing it to develop micro-tears and inflammation. The amount of force the plantar fascia has to deal with can be influenced by activity (e.g. running vs. walking), your weight, surfaces (e.g. lawn vs. pavement), foot arch height (high vs. flat arches), muscle tension (tight calves), as well as weak muscles. The injury can happen suddenly or over time through repetitive strain. Common causes of plantar fasciitis include: The most common cause of plantar fasciitis I see in my clinic is when your shoes do not support your foot arch enough and you’re on your feet for a long time. Examples are a long shopping trip, going sightseeing in flip-flops while on holiday, or running an endurance race. Flat shoes that don't offer support can cause plantar fasciitis. If you gain a lot of weight, it will increase the force through your feet and the plantar fascia will have to work harder to keep the foot arch from collapsing. Your calves or other muscles in your legs are too tight. If you suddenly take up running and overdo it, or if you do something like sprint to catch a bus while wearing the wrong shoes. If you walk or run on very hard surfaces. Softs surfaces help to absorb some of the shock created when you run or walk, but if you do it on hard surfaces the plantar fascia has to deal with all of it. Running or walking in thin-soled shoes on hard surfaces can cause plantar fasciitis. If other muscles in your lower body, all the way up to your glutes, aren’t strong enough and do not control the leg or absorb their share of the shock during running. Now that you know what could cause your plantar fasciitis, let’s take a look at how to go about treating it yourself . Or, if you're looking for a rehab plan, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped to design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. 🎉 Discount Code: MARYKE 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 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290. Rathleff, M. S., & Thorborg, K. (2015). ‘Load me up, Scotty’: mechanotherapy for plantar fasciopathy (formerly known as plantar fasciitis). British Journal of Sports Medicine, 49(10), 638-639. Robroy L.M. et al., (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

Exercises for plantar fasciitis can be divided into stretches and strength training exercises. I’ve already done a detailed article on stretches for plantar fasciitis , so in this article I’m going to focus on strength and control exercises, explain how they help, and demonstrate the ones I find work best during each phase of plantar fasciitis rehab. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: How do these exercises help plantar fasciitis? Important exercise guidelines - Please read Plantar fasciitis exercises - Early rehab Plantar fasciitis exercises – Mid-stage rehab Plantar fasciitis exercises - Later stage rehab How we can help I've also made a video about this: How do these exercises help plantar fasciitis? Doing the correct exercises at the correct time in your recovery can help your plantar fasciitis to recover as well as prevent it from coming back. How exercises help recovery The plantar fascia is the main structure that helps support your foot arches when you stand, walk, run, and jump. Once injured, your plantar fascia loses some of its strength and endurance, which means that it can no longer cope with the forces placed on it when you do your normal daily activities and sport. The only way to restore its strength and endurance is by following a progressive rehab plan that starts with easy, low-load exercises, but increase in intensity as your plantar fascia regains its strength. All other treatments , including rest and stretching exercises, may help to reduce your pain, but they can’t restore the strength and endurance of your foot. How exercises can prevent plantar fasciitis from recurring Our bodies work like kinetic chains, with each muscle and joint having to do some of the work when we move. If one part is weak, it often increases the strain on other parts. Also, having poor control around your hips and ankles may cause your legs to turn in excessively when you walk, run, or jump. This can also increase the strain on the plantar fascia. These issues can easily be addressed by adding some general leg strength and control exercises to your rehab plan. Important exercise guidelines - please read Remember, the exercises in this article may not be right for your specific case, so please check with your physiotherapist before starting any of them. Stage of recovery The exercises have to match your foot’s current stage of recovery. If they are too difficult or the load is too high, they can worsen your plantar fasciitis. To help you understand what type of exercises may be appropriate for you, I’ve grouped the exercises in this article into three stages: Early rehab, mid-rehab, late rehab. I’ve also provided progression criteria to help you decide when you may be ready to move to the next stage. The exercises should match your goals Every rehab plan should be tailored to the individual. For instance, a person who just walks for exercise will require a different level of strength and control than someone who runs or play football. Your rehab exercises should match your sporting and activity goals. If you do any sports that include running or jumping activities, you should definitely work up to doing plyometric exercises (hopping and jumping). However, if you don’t do these types of activity and only want to walk, you can usually leave out hopping and jumping exercises, and you don’t have to progress to such very heavy weights with your strength training. I have made notes in the exercise instructions to help you understand what exercises may be needed to safely get back to various types of sport or activity. How often should you exercise? After every exercise session, your body requires a period of time to recover and strengthen your tissue in reaction to the exercise. If you don’t allow it this recovery time, it can actually cause your foot pain to worsen. Low-load exercises, that don’t work your body hard, usually only require 24 hours recovery time, so they can be done daily. Exercises that produce fatigue and work you harder should be followed by at least 48 hours of recovery time before the next hard session. What is classed as high load and low load is also relative to your current level of strength and fitness. So, I’ve provided guidance on how much recovery time fit vs. less fit people should leave between exercise sessions in each rehab stage. Monitor your pain It is usually OK to start gentle exercise when you have mild to moderate pain that you would rate as around 3 out of 10 on a pain scale (where 0 = no pain and 10 = severe pain). When you do an exercise, it is usually OK to feel a slight increase in your normal level of discomfort, as long as this settles back down to the previous level within a few hours. If your foot feels significantly more sore later in the day or the next day, it is usually a sign that your exercise session was a bit too much. Allow your pain to calm down, and then test a lighter session, e.g. do fewer repetitions, reduce the weights, or leave some of the exercises out. If you would like help with figuring out your rehab plan and what exercises may be best for you, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped to design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. It uses your feedback after each workout to help you adjust your exercise intensity to the right level. 🎉 Discount Code: MARYKE Plantar fasciitis exercises - Early rehab When to start these exercises These are usually good exercises to start with during the early stages of your recovery, when your foot is still quite sensitive and easy to irritate. 1. Toe grabs What it does It strengthens the foot muscles that are meant to support your plantar fascia. It can reduce your pain for several hours by increasing the circulation in the injured area. Equipment A towel. A chair. A slippery floor, or place a book or magazine under the towel to allow it to slide easily. Instructions Sit on a chair, resting your foot on the towel. Try to gather the towel up by grabbing it with your toes. Do 10 toe grabs. Rest 30 seconds or train the other foot. Do 3 to 6 sets on each foot. Who can do it and how often People of all levels of fitness can do this exercise once a day. 2. Calf raises - Double leg What it does It strengthens your calf muscles and plantar fascia. Improves the control around your ankle. It can also reduce your pain by increasing the circulation in your foot. Equipment Supportive shoes (like running shoes) if your foot is very sensitive. Soft carpet or mat if you want to do it without shoes. A stable surface to hold on to (e.g. kitchen counter). Instructions Steady yourself by holding on to a sturdy object like a kitchen counter. Slowly raise up on your toes and then slowly lower back down. Only raise as high as is comfortable. Start by doing 10 repetitions. If that is OK (remember to check what your foot feels like the next morning), gradually build the reps until you can do 20 in one go. Rest for 60 seconds. Do 3 sets in total. Who can do it and how often If you’re not very fit or your foot is very sensitive, it may be better to do this exercise every other day. If you’re pretty fit and strong, you may be able to do it daily. 3. Balance - Supported What it does It helps to restore your plantar fascia’s ability to support your full weight on one leg. It improves your control around your hip, knee, and ankle. Start by having one hand on the wall but aim to progress to balance without support. Equipment Supportive shoes (like running shoes) if your foot is very sensitive. Soft carpet or mat if you want to do it without shoes. A stable surface to hold on to (e.g. kitchen counter). Instructions Place one hand against a stable surface – this is to help reduce the work your foot and ankle have to do. As you get better at balancing, try to reduce the support until you can balance without holding on. Shift your weight over to one foot and lift the other off the floor. Try to keep your ankle as still as possible – your foot should not roll in. Start by holding the position for 10 seconds and check how your foot responds. If it is OK, slowly increase the time you hold the position for until you can balance for 30 seconds without support. Rest for 30 seconds or balance on the other leg while you wait. Do 3 times on each leg. Who can do it and how often It is usually best to do this exercise every other day, regardless of your fitness. 4. Box squat - Double leg What it does Strengthens the muscles in your glutes, hamstrings, and calves. Helps train good movement patterns. Place a cushion on the chair if you find it hard to squat to the level of the seat. Equipment Supportive shoes (like running shoes) if your foot is very sensitive. Soft carpet or mat if you want to do it without shoes. A dining room chair (or a box) that lets you squat to a 90-degrees knee bend. Instructions Place the chair against a wall so that it can’t slide away from you. Stand in front of it so that the backs of your legs are nearly touching it. Your feet should be hip distance apart. They can point slightly out to the side if it feels awkward when they face straight forward. Hold your hands in front of your chest or have your arms out straight in front to help you balance. Push your bottom out to the back, bend your knees, and slowly lower yourself onto the chair, but don’t sit down fully. Simply touch your bottom onto the chair and then come back up. Check that your knees move in line with the middle of your feet. Your feet should not roll in or out. Do 10 repetitions. Rest 60 seconds. Do 3 sets. Who can do it and how often It is best to do this exercise every other day, regardless of your level of fitness. Plantar fasciitis exercises – Mid-stage rehab 1. Calf raises - Single leg When to start these You can start this exercise once you can easily do 3 sets of 20 repetitions of the Double Leg Calf raise (see above) without it causing you pain during or after the exercise. What it does It strengthens your calf muscles and plantar fascia. Improves the control around your ankle. It can also reduce your pain by increasing the circulation in your foot Equipment Supportive shoes (like running shoes). A stable surface to hold on to (e.g. kitchen counter). Instructions It’s usually best to wear shoes for this exercise. Hold onto a stable surface. Shift your weight over to your one leg and lift the other off the floor. Slowly lift up and down on one leg. Gradually build up over several sessions to doing 15 repetitions in one go. Rest 60 seconds between sets. Do 3 sets on each leg. Who can do it and how often This exercise should only be done 2 to 3 times a week regardless of your general fitness. Leave at least 1 full rest day between sessions. If your foot doesn’t feel fully recovered by then, add an extra rest day and only do 2 sessions per week. 2. Balance - Moving head When to start these Once you are able to balance on one leg without placing a hand on the wall or table. What it does It further develops the control in your foot, ankle, knee, and hip. Equipment Soft mat. A stable surface in case you lose your balance. Instructions It is best to do this exercise in bare feet on a soft mat, as it makes it more challenging. However, if this hurts your foot, wear shoes. Stand close to a sturdy object that you can grab on to in case you lose your balance. Shift your weight over to one leg and lift the other off the floor. Pause for a moment and make sure that you have good balance while looking straight ahead. Then slowly turn your head, first to the right and then to the left. If you feel that you’re losing your balance, focus on a single point until you’ve regained it and then continue the turn. You don’t have to turn your head very far to start with. Do this for 30 seconds. Then rest for a moment to ensure you’re not dizzy. Switch legs. Repeat up to 3 times on each leg. Who can do it and how often Everyone can usually do this exercise 3 times a week with at least 1 rest day between sessions. 3. Lunge dip When to start these Once you can easily do 3 sets of 10 Double Leg Box Squats (see above) you can usually move on to Lunge Dips. What it does It strengthens your quads, glutes, and hamstrings. It further develops your control and movement pattern, as this is a more challenging position. Equipment Shoes (like running shoes). Instructions Stand with your feet hip distance apart. Take a step forward, not too large. Your front foot should be flat on the floor and your back foot supported on your toes. If you struggle to maintain your balance, shorten the stride. Bend your front knee to 90 degrees and drop your back knee down to the floor, but stop before you touch it. Only go down as low as is comfortable for your knees. Then slowly lift back up, but stay in the stride-stand position. Repeat 10 times on one leg, then switch sides and repeat. This counts as one set. Rest for 60 seconds. Do 3 sets. Who can do it and how often If you’re pretty fit, you can do this exercise 3 times a week with at least 1 rest day between sessions. If you’re not that fit, then it may be best to do this only 2 times per week with at least 2 rest days between sessions. Plantar fasciitis exercises - Later stage rehab 1. Calf raises - With weight When to start these Once you can easily do 3 sets of 15 Single Leg Calf Raises (see above) without aggravating your plantar fasciitis pain, you should start doing them with extra weight. What it does It strengthens your calf muscles and plantar fascia. Improves the control around your ankle. It can also reduce your pain by increasing the circulation in your foot. Place the weights in a backpack to have your hands free for support. Equipment Supportive shoes (like running shoes). A stable surface to hold on to (e.g. kitchen counter). Weights that you can hold in your hand or place in a backpack on your back. How much weight to use It is usually best to start with a very light weight and test how your foot reacts: 1 kg if you’re a smaller person and 2 kg if you have a larger body. The target weight you should aim to build up to will depend on your sport: Walkers: Aim to eventually use a weight equal to 10% of your bodyweight, e.g. if you weigh 70 kg, your target is 3 sets of 15 repetitions with 7 kg. Running and jumping sports: Aim to eventually use a weight equal to 20% of your bodyweight, e.g. if you weigh 70 kg, your target is 3 sets of 15 repetitions with 14 kg. Instructions Place the weight in a backpack on your back or hold it in one hand (same side as the leg you’re exercising). Stand on one leg and lift the other off the floor. Hold on to a sturdy object for added stability. Slowly lift up and down on one leg. Start with a light weight (see suggestion above) and test how your foot reacts to this by doing fewer repetitions in your first session. If it is OK, then gradually increase the repetitions over the next few sessions until you can easily do 15 in one go with good form. Rest 1 to 2 minutes between sets. Do 3 sets on each leg. Only increase the weight in the next session by 1 or 2 kg if you can easily complete 3 times 15 repetitions with your current weight. It is often better to be patient and progress more slowly, as you can flare your plantar fasciitis up if you rush it. Who can do it and how often It is usually best to do this exercise only twice a week with at least 2 rest days between sessions. If you’re very fit, you may be able to do it 3 times a week with one rest day between sessions. Get some hand weights on Amazon: 2. Single-leg box squat When to start these Once you can easily do 3 sets of 10 of the Lunge Dips (see above), you can usually move on to doing this exercise. What it does It strengthens your glutes, quads, and hamstrings. It challenges your balance and develops good control around your ankle, knee, and hip. Equipment Shoes (like running shoes). A dining room chair (or box) that lets you squat to a 90-degrees knee bend. Cushions, in case the exercise is too hard. Instructions Place the chair against a wall so that it can’t slide away from you. The surface should be at a height that feels challenging to get up from using one leg, but without having to strain. Place a few cushions on the chair to make the surface higher if you find it too hard. Stand in front of the chair so that the backs of your legs are nearly touching it. Shift your weight over to one leg and lift the other out in front of you. Initially, you can place one hand against a wall or table to help you balance. Push your bottom out to the back and bend your knee to slowly lower yourself onto the chair, but don’t sit down fully. Simply touch your bottom onto the chair and then come back up. Don’t plonk down; it should be a slow and controlled movement. Check that your knee moves in line with the middle of your foot. Your foot should not roll in or out. Build up to doing 10 repetitions on each leg. Rest 60 seconds. Do 3 sets. Who can do it and how often It is usually best to do this exercise only twice a week regardless of your level of fitness. If you struggle, make the surface higher by placing pillows on it. 3. Double-leg hops Please note - this is only one type of plyometric exercise. If your sport involves jumping or quick accelerations and changes or direction, you will likely benefit from adding in a variety of jumps. When to start these It is usually safe to start these exercises once you can do your Single Leg Calf Raises using weights that are equal to 10% of your bodyweight (see above). What it does It develops your plantar fascia’s ability to tolerate forceful and explosive movements. It further develops your control needed for fast movements. You should start with gentle, low hops - not as high as this one. Equipment Shoes (like running shoes). Instructions Hop gently up and down on both feet. You’re not looking to hop very high. Aim to land as softly as you can and don’t slam your heels into the floor. We usually start our patients with 3 to 5 sets of 20 hops and then increase it over time depending on their sport and personal goals. It is usually best to rest about 2 minutes between sets. Who can do it and how often Hopping and jumping exercises are only necessary if you do sports that involve running or jumping. Walkers, swimmers, and cyclists do not have to do them. You should usually leave at least 2 days for recovery between sessions and limit it to 2 sessions per week. THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis Self-treatment – overview of the treatment options Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis (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 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292-300. doi: 10.1111/sms.12313. Epub 2014 Aug 21. PMID: 25145882. Caratun R, Rutkowski NA, Finestone HM. Stubborn heel pain: Treatment of plantar fasciitis using high-load strength training. Can Fam Physician. 2018 Jan;64(1):44-46. PMID: 29358253; PMCID: PMC5962984. Cheung RT, Sze LK, Mok NW, Ng GY. Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis. J Sci Med Sport. 2016 Sep;19(9):713-5. doi: 10.1016/j.jsams.2015.11.004. Epub 2015 Nov 22. PMID: 26655866 McKeon PO, Hertel J, Bramble D, Davis I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290. Cotchett, M., Rathleff, M.S., Dilnot, M. et al. Lived experience and attitudes of people with plantar heel pain: a qualitative exploration. J Foot Ankle Res 13, 12 (2020). Harutaichun P, Boonyong S, Pensri P. Differences in lower-extremity kinematics between the male military personnel with and without plantar fasciitis. Phys Ther Sport. 2021;50:130-137.

There is indeed some evidence that beetroot juice benefits running performance, but you have to weigh this up against beetroot juice’s side effects, especially given the fact that it is easy to take too much if you use some of the supplements that are commercially available. In this article, we take a look at the research into the benefits of beetroot juice for athletic performance. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: The claims about beetroot juice benefits for runners What does the research say about beetroot juice and running? Beetroot juice side effects Should you use beetroot juice to enhance your running performance? If you take it, how much and when? Injured? We can help We've also made a video about this: The claims about beetroot juice benefits for runners   Beetroot is rich in nitrate (NO3-) compared to most other vegetables. Ingesting nitrate (in this case, beetroot juice or a supplement) increases the amount of nitric oxide (NO) in one’s blood. The amount of nitric oxide in one’s blood peaks typically two to three hours after the nitrate has been taken .   Nitric oxide, in turn, makes one’s nerves fire better , speeds up the conversion of glucose to energy , and improves the supply of oxygen and nutrients to the muscles  because it widens the arteries and veins.   In practical terms, these effects would increase a runner’s speed, endurance, and recovery. What does the research say about beetroot juice and running?   It’s a bit of a mixed bag, really.   Several systematic reviews (a summary of the findings of other studies on the subject) and meta-analyses (a statistical analysis of the combined results of several similar studies) have been done to attempt to answer the question whether beetroot juice increases running (or general endurance sports) performance.   A team of researchers in Brazil analysed the results of 12 studies  that conducted various randomised controlled trials (suggesting high-quality research) involving 185 people (some recreational athletes, some elite).   They found that: Four of the six studies involving short-term dosage  with beetroot juice reported improved performance in running and cycling. Six of the eight studies that involved chronic dosage  reported an improvement in performance. Of the six studies involving elite athletes , five reported an increase in VO2 max (how well your body uses oxygen to turn glycogen into energy).   They pointed out that only 15% of the research subjects were women  and that more research that targets women specifically is needed.   A systematic review by a team or researchers from Maastricht university reported similar results. They found that: Single dose supplementation as well as multiday strategies (2 doses per day for several days running) produced positive results for training, performance, and recovery. BUT it didn’t work for everyone, and the results varied a lot depending on the type of sport, the training level, of the athlete, etc. What makes it so difficult to answer the question is the many variables that might influence the results  and that no single study seems to have covered all the bases. These variables include: Dosage Single dose vs. acute/short-term dosage (2 days or fewer) vs. chronic dosage (3 days or more) Recreational athletes vs. elite athletes Women vs. men (with female subjects being severely underrepresented in studies) The type of sport Sprints and high-intensity intervals vs. longer distances. One side effect of drinking too much beetroot juice is an upset stomach. Beetroot juice side effects   The Maastricht researchers found in their review that “[c]ompared to studies on the beneficial effects, the amount of data and literature on the negative effects of BRJ [beetroot juice] is rather limited, and should be increased in order to perform a balanced risk assessment.”   However, they do point out that “[d]rinking BRJ may easily increase nitrate intake above the acceptable daily intake , which is known to stimulate the endogenous formation of N-nitroso compounds (NOC’s), a class of compounds that is known to be carcinogenic [potentially causing cancer] and that may also induce several other adverse effects.”   The Maastricht study cautions that, until we have more data on long term side effects, it is better to be cautious with chronic use of BRJ to enhance sports performances.   The Australian Institute of Sports  warns that large or concentrated doses of beetroot juice could upset your stomach . A harmless side effect that they point out is that it may temporarily colour your urine and stools pink .   If you have any chronic medical conditions or use medication , large doses of nitrate may impact those. It’s best to speak to your doctor if this applies to you.   👉 Main takeaways: More is not better – taking too much nitrate can have bad side effects. Don’t use it for longer than a few days at a time. Should you use beetroot juice to enhance your running performance?   So, it seems that there is some evidence across a large body of research that beetroot juice could enhance your running performance. But taking too much may be bad for you.   Also, keep in mind that the results of those studies are based on averages, and nobody is perfectly average . Factors like how fit you are, the type of running you’re into, your metabolism, your sex, your weight, and especially the dosage could play a role in whether and to what extent beetroot juice would make you run faster and/or further.   Based on the research, my sense is that you could take it or leave it. If you do take it, be careful not to take too much (see below), and don’t do it for long periods of time. If you take it, how much and when?   How much beetroot juice (nitrate) to take? The nitrate dosages (per shot) used in most of the research varied from 350 mg to 500 mg , and this is the range that the Australian Institute of Sport recommends. It might make sense to use a dosage towards the lower end of the range if your body weight is on the low side, and towards the higher end if you are heavy.  The amount of nitrate in fresh beet varies a lot. The presence of nitrate in fresh beet varies wildly (anything from 214 mg to 3,556 mg per kilogram), so I wouldn’t recommend making your own beetroot juice for running performance – you’d be likely to under- or overshoot the target dosage. Most of the research studies used Beet-It Shots (concentrated beetroot juice), which contains 400 mg of nitrate per shot. This falls within the recommended range of 350 mg to 500 mg. This is also the only product I could find on Amazon that provides a useful dosage; many beetroot products don’t list the nitrate content, or they contain way too much – up to 6,000 mg per serving! And keep in mind that supplements are not regulated in most countries, so the listed amount may not be accurate.   ⚠️ Whatever you buy, take care NOT to get a supplement containing nitr i te , which is different than nitr a te. You want the latter.   When to take your beetroot juice Whether you decide to take a single dose several days running or multiple doses on a single day, make sure to take the last dose two to three hours before the starting gun. This will allow your body enough time to absorb it properly. Thinking about the possible upset stomach side effect, it would be better to first try this out in training rather than straight away for a race. It seems that either of the following dosage strategies might work: Taking a single dose of beetroot juice (400 mg nitrate) as a once off on the day of competition. Taking two doses per day for several days running (400 mg x 2, several hours apart).   💡 A final tip:  The conversion process of beetroot juice nitrate into nitric oxide starts already in your saliva, so if you use antibacterial mouthwash shortly after taking your dose, this may limit any positive effects. Injured? We can help Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine and/or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Leal, L. D. dos S., Guimarães, M. P., Campos, Y. de A. C., Abreu, W. C., & Fernandes da Silva, S. (2022) "Effect of acute and chronic nitrate supplementation on the performance of endurance athletes: a systematic review" Multidisciplinary Reviews , 5 (2), 2022009 H. Zamani, M. E. J. R. de Joode, I. J. Hossein, N. F. T. Henckens, M. A. Guggeis, J. E. Berends, T. M. C. M. de Kok & S. G. J. van Breda (2021) "The benefits and risks of beetroot juice consumption: a systematic review" Critical Reviews in Food Science and Nutrition, 61:5, 788-804 Rothschild, J.A., Bishop, D.J. (2020) "Effects of Dietary Supplements on Adaptations to Endurance Training" Sports Med 50, 25–53 Wong, Tak Hiong, Alexiaa Sim, and Stephen F. Burns. (2021 "The Effect of Beetroot Ingestion on High-Intensity Interval Training: A Systematic Review and Meta-Analysis" Nutrients 13, no. 11: 3674 Daniel Rojas-Valverde, Jaqueline Montoya-Rodríguez, Christian Azofeifa-Mora & Braulio Sanchez-Urena (2021) "Effectiveness of beetroot juice derived nitrates supplementation on fatigue resistance during repeated-sprints: a systematic review" Critical Reviews in Food Science and Nutrition, 61:20, 3395-3406 Australian Institute of Sport (2021) " AIS SPORTS SUPPLEMENT FRAMEWORK: DIETARY NITRATE / BEETROOT JUICE" Lee J. Wylie, James Kelly, Stephen J. Bailey, Jamie R. Blackwell, Philip F. Skiba, Paul G. Winyard, Asker E. Jeukendrup, Anni Vanhatalo, and Andrew M. Jones (2013) " Beetroot juice and exercise: pharmacodynamic and dose-response relationships" Journal of Applied Physiology 2013 115:3, 325-336

THE ANKLE SPRAIN SELF-TREATMENT SERIES: How to diagnose your ankle sprain How to know whether you've broken your ankle How to treat your ankle sprain (this article) How long it will take you to recover from a sprained ankle heavily depends on how badly you've sprained it and what structures you've injured - something that our team of sports physios can easily help you diagnose via an online physio consultation. In this article, I'll walk you through the different treatments that you should apply if you want your ankle to make a quick and strong recovery. Some of the links in this article are to pages where you can buy products discussed or mentioned here. We might earn a small commission on sales at no extra cost to you. You can sustain any combination of the following injuries when you twist your ankle: Ligament damage Muscle strain or tears Cartilage damage Bone bruising Fractures or broken bones You can find out how to determine the extent of your injury in this article about how to diagnose ankle sprains . I've also written a piece on how to know if you've broken your foot or ankle that you may find useful. I've also discussed this topic in detail in this video: As a rule of thumb, I usually find that ankles that swell up a lot within a short period of time (30 minutes) takes longer to recover (8 to 12 weeks). Mild swelling or swelling that appears over the course of a day, usually indicates a quicker recovery time (4 to 6 weeks). It's very important to regain full flexibility and strength before you try and play your sport. My patients are always keen to strengthen up other injured body parts, e.g. knees, but they often neglect ankle injuries. They seem to think that they will just get stronger by themselves. You can end up with a chronically unstable ankle if you don’t rehabilitate it properly. You may have an unstable ankle if you find that you twist it often and without much effort. I have had patients who continuously sprain their ankles by just walking in the street. The good news is that this instability is often what we call a ‘functional’ instability (poor muscle control) rather than a ‘structural’ instability (ligaments have fully ruptured) and it can usually be rectified by following a specific exercise programme. The treatment of ankle sprains can be roughly divided into 2 stages: Acute management Rehabilitation / exercise therapy Your treatment plan should also take the stages of healing into account. If you do too much too quickly, you may reinjure yourself. Do too little and you'll see no improvement. Sprained Ankle Treatment: Acute Management Research update: The information in this article is still valid, but Steph has recently done an updated version of this article where she incorporated the latest research findings and recommendations for treating sprains which you may find useful. The acute phase for an ankle sprain can last anything between 4 to 6 days depending on the severity of your injury. Manage acute sprains as follows: Stop what you're doing.  Continuing to run etc. when you've injured your ankle causes further injury and internal bleeding and will make your recovery take much longer. Apply ice and gentle compression for 10 minutes immediately after twisting your ankle. It may also help to elevate your foot above the level of your heart, if possible. This helps to limit the internal bleeding and swelling. Excessive internal bleeding and swelling can cause increased pressure on the surrounding, healthy tissue. This pressure can cut off the blood circulation and oxygen supply to adjacent cells and you can end up with more damage than what the original injury actually caused. WORD OF CAUTION: applying the ice for longer than 10 minutes or applying very strong compression, may have the opposite effect. Do not use nonsteroidal anti-inflammatory drugs (NSAIDS) or corticosteroids during the first 3 days post injury. Inflammation is an important part of the initial phase of wound healing and you can delay your recovery by limiting this process. It is safer to use ice to decrease swelling and pain since it does not cause a decrease in the inflammatory response to the same extent that NSAIDS does. You can apply ice every 2 hours over the first 3 days. You may find that using a crutch for a day or two after injury can help speed up your recovery in severe cases. Crutches should never be used for more than 2 days without consulting a physiotherapist or medical professional, since prolonged use can also hinder your recovery. WORD OF CAUTION: Being over-protective of an injury can lead to poor recovery outcomes. You may have to wear a rigid ankle brace , boot or cast for up to 10 days if you have severe pain and swelling. Do not keep the ankle immobilised for too long – research has shown that doing early functional exercises leads to a quicker recovery than prolonged immobilisation. Examples of good ankle braces: Moving your ankle within its pain free range can help to decrease your pain and help speed up recovery. I usually tell people to start doing this on the second day after injury depending on how bad it is. So, if you injure it today, start moving it from tomorrow. The type of ankle sprain you sustained will determine what movements you start with. I usually get people to do very gentle dorsiflexion/plantar flexion movements (pull toes up and point toes down) for the typical inversion ankle sprain (where you pull the ligaments on the outside of your ankle). The movement should be done pain free and repeated 10 times in one go. You can do it often during the day. Ankle dorsiflexion Ankle plantar flexion Sprained Ankle Exercises A recent review of the literature has found that rehabilitation exercises are effective in preventing recurring ankle sprains . You can usually start doing some rehabilitation exercises on the 4th day post injury, but this time will vary depending on the extent of your injury. Remember to think about the stages of healing and not be too quick to progress your exercises. None of the exercises should cause you more than just a mild discomfort. It may be worth consulting a physiotherapist for guidance. Exercises should always be progressed from doing them on a stable base (two legs) to an unstable base (one leg), from stationary (standing still) to dynamic (stepping, jumping, running), from slow to fast and from simple (one movement) to complex (combined activities). A successful rehabilitation programme should include the following components: Flexibility Proprioception and coordination training Foot/ankle control and strength training Hip control and strength training Sport specific drills 1. Ankle Flexibility You should aim to regain full range of motion in the ankle within 4 to 6 weeks for a mild ankle sprain. More severe sprains can take 12 weeks or longer to regain full range. What does full range of motion mean? It just means that your injured ankle and foot should be able to bend up and down and turn in and out as far as your good ankle and foot can. Do not be aggressive with any stretches during the first 2 weeks after spraining your ankle. I usually get people to avoid the injuring movement for at least 1 week. For instance, if you went over on your ankle and pulled the ligaments on the outside of your ankle, you should avoid turning your foot in for a week. Start with free active dorsiflexion and plantar flexion (picture 2) as well as inversion and eversion (picture 3). This can be progressed to weight bearing dorsiflexion stretches and manually assisted inversion or eversion stretches. Ankle inversion (turning your ankle in) Ankle eversion (turning your ankle out) 2. Ankle proprioception and coordination Simply put, proprioception is the ability to know where your foot, ankle, finger, bottom etc. is without having to look at it.  Without proprioception we would have to continuously look at our feet while walking since we would have no idea where we are placing them (it’s actually pretty cool). This ability to know where your body part is without looking at it, is accomplished mainly through mechanoreceptors in joints, ligaments and muscles that continuously send messages to your brain while you move. When you injure any of these structures in the ankle, these messages aren't as clear and the brain’s ability to detect where you put your foot is reduced. This is one of the reasons why it is so easy to go over on your ankle, even while just walking in the street, once you've sprained it a first time. Decreased proprioception leads to what we call a functionally unstable ankle. This just means that the ligaments are strong and the joints stable, but you keep spraining it because your control over the ankle is poor. The good news is that proprioception is extremely easy to retrain! Here are some of the basic exercises that you should master before you can do more complex things. First aim to balance on one leg for 30 seconds without moving around. Once you can manage that, try to maintain your balance while moving your head from side to side. Proprioception exercises should be progressed to be sport specific and test you in the body positions and activities that you use during your sport. While standing on one leg is a good starting point for a footballer, it will in no way prepare him for what he has to deal with during a match. 3. Foot and ankle control and strengthening exercises Many of the exercises used to retrain proprioception will also double as strengthening exercises for the muscles of the foot and ankle as long as you make sure that you control your foot’s arch properly while doing them. The video below shows you how to correct your foot's position. You should maintain good ankle and foot posture during all your exercises. You should also target specific muscle groups that may have sustained injuries when you sprained your ankle. A common group of muscles involved in lateral ankle sprains are the peroneal muscles. You can strengthen them in the early days post injury using an elastic band or wobble board. I usually start these exercises about 2 or 3 weeks post injury depending on the severity of the ankle sprain. Peroneal exercise: Start with the foot turned in. Peroneal exercise: Turn your foot out against the band You should retrain these muscles in isolation first and then integrate it into more functional movements. 4. Hip control and strength training I always look at my athlete’s hip control when treating them for ankle sprains. If the muscles that control the hip (glute med and glute max) are weak, your hip will turn in when you walk and run. This in turn makes your knee turn in and can cause your foot to roll in or pronate excessively. The net effect is that you have extra strain through the ankle joint. You can find a quick test for hip control as well as examples of some strengthening exercises here . It will help you decide if your hip muscles are weak or not. 5. Sport specific drills You must include sport specific drills towards the end of your rehabilitation. Examples of this are for instance sprinting and cutting moves or sprinting and turning for football. In netball it will include jumping, catching a ball and landing. Steph demonstrates this well towards the end of this video You should do them at a slow pace at first. Once you feel confident you should start increasing the speed and difficulty. 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., Elders, L. A. M., van Beek, P. A., Hullegie, W. A. M., Bloemers, G. M. F. 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. Lephart, S. M., Pincivero, D. M., & Rozzi, S. L. (1998). Proprioception of the ankle and knee. Sports Medicine, 25(3), 149-155.

Ankle braces can help you to recover better from ankle sprains and prevent further sprains, but not everyone will need one. In this article, we discuss who needs to wear an ankle brace, what type of brace is best, and when and for how long to wear it. This article is specifically about lateral (outer) and medial (inner) ankle sprains; high ankle sprains may require different braces. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Do I need a brace for my ankle sprain? What does an ankle brace do? What type of brace is best for ankle sprains? When should you wear your ankle brace? How long to wear an ankle brace for How we can help We've also made a video about this: Do I need a brace for my ankle sprain? Not all ankle sprains require braces, but a brace can help you to recover better and return to work and sport sooner. Minor ankle ligament tears (Grade 1) usually don’t require a brace unless you have to walk over very uneven terrain or want to continue playing sport throughout your recovery. You’re very likely to benefit from wearing an ankle brace if you have a significant ankle ligament tear (Grade 2 or 3). (Read more about the grading of ankle ligament tears .) Minor ankle sprains usually don't require a brace, but Grade 2 and 3 sprains can benefit from one. What does an ankle brace do? Research shows that wearing the correct type of brace at the correct time can: Improve healing Reduce swelling Allow early return to work and sport Prevent further ankle sprains. To understand why an ankle brace may help treat and prevent ankle sprains, it’s useful to take a look at what happens when you sprain your ankle. What happens when you sprain your ankle When you sprain your ankle, you usually strain or tear the ligaments, but you may also injure the ankle joint itself and/or the muscles around your ankle, causing it to swell, hurt, bruise, and feel unstable. Given enough time, protection, and the correct rehab exercises, even severe ankle sprains can recover without the need for surgery. How ankle braces improve healing Traditionally, moderate to severe ankle sprains were immobilised (kept totally still) in an orthopaedic boot or a cast. But the most recent research shows that this is not the best approach. Even severe ankle sprains recover better when they are exposed to “protected movement”. Unlike muscles, joints don’t have a blood supply that feeds them with oxygen and nutrients and carries away bad stuff. The synovial fluid in joints does this work instead, but it needs movement to circulate through the joint. So, movement means improved circulation, oxygen, and nutrients for the injured ankle. It also means that you can safely strengthen your muscles and regain lost agility, which allows you to get back to sport or work sooner. Protected movement is achieved by wearing an ankle brace that allows your ankle and foot to move in all directions except for the direction that strains the injured ligaments, muscles, and joint surfaces. This is usually the same movement direction that caused the sprain. For instance, lateral (outer) ankle sprains usually benefit from braces that prevent your foot and ankle rolling in (where the sole of your foot points towards your other foot). Medial (inner) ankle sprains benefit from a brace that stops your foot turning out (the sole of your foot pointing away from the other foot). How braces reduce swelling Ankle sprains usually cause some swelling in and around the ankle joint. Protected movement also helps to reduce swelling by improving circulation. Ankle supports that incorporate a compression sock or sleeve may further reduce swelling by improving lymph drainage. If a brace causes pain or you notice that the area above or below the brace or compression sleeve is very swollen, it is very likely too tight or just not right for you. Remove it immediately. Early return to sport and work The protection an ankle brace offers you means that you can safely return to sport and work before your ankle sprain has fully healed. Without a brace, you would have to wait until your ankle ligaments, joint, and muscles have regained their full strength. Your physio will usually give you specific movement tests (similar to what happens in your sport or work) and monitor how your ankle reacts to performing these while wearing the brace. If it copes well, it may mean that you can safely ease back into normal activities while wearing the brace. You should obviously continue with your rehab until your ankle has fully recovered. An ankle brace can help you get back to sports (like basketball) sooner. How ankle braces prevent sprains You’re more likely to sprain your ankle when you’re walking on uneven terrain or do a sport that is characterised by running, cutting movements, and jumping, such as basketball, football, tennis, and volleyball. The research also shows that your risk of injuring your ankle once more is much higher when you’ve had a previous ankle sprain. Using an ankle brace can significantly reduce your risk of both first-time and recurring ankle sprains , especially when doing sports. It does this by preventing extreme ankle movements. Or, in other words, it stops the ankle from moving far enough to cause the ligaments, muscles, or joint to strain. What type of brace is best for ankle sprains? Stay away from braces that don’t allow your ankle to move at all; the same goes for plaster casts (unless you have a fracture). As mentioned before, in most cases total immobilisation leads to poorer healing. A semi-rigid ankle brace is best. Examples in the next section. The best type of brace for lateral and medial ankle sprains is a semi-rigid brace (see examples in next section) with metal, carbon fibre, or hard plastic rods on the sides. These braces: Stop your ankle from rolling in and out, which protects the injured ligaments, joint, and muscles Allow the ankle to move into dorsiflexion (toes moving towards shin) and plantar flexion (toes pointing away from you), which enables you to walk and move as normal. Soft ankle braces or sleeves are not useful, as they don’t provide enough support. Soft ankle braces do not offer enough protection. Not all semi-rigid ankle braces are the same High-stability ankle braces The most stable ankle braces are the ones that come slightly higher up above the ankle and, in addition to having supportive rods, lace up or tightly wrap around your ankle. They are the best type of brace to wear if you are prone to ankle sprains and play sports like basketball or soccer. If you order any of the ankle braces below, remember to select the correct foot. Examples: Medium-stability ankle braces – with support rods These braces have support rods on the sides, but they don’t wrap as securely around the ankle. They may not offer enough support for sports that involve quick changes of direction, but are perfect for walking, jogging on relatively even ground, or if you just want to wear a brace during the early stages of recovery. Examples: Medium-stability ankle braces – without support rods These braces don’t have support rods but still provide a fair level of support thanks to the type of material used and by wrapping tightly around the ankle. They may be appropriate for someone who has fully regained their ankle control and just wants a bit of extra support during sport or while walking. They may not offer enough support for sports that require quick, forceful changes of direction. Examples: When should you wear your ankle brace? Your need for a brace usually diminishes as your injury recovers. Initially you may have to wear it for most daily tasks, whilst towards the end of your rehab you will only need it for sport. At home If you have a severe ankle sprain, you may benefit from wearing your brace inside the house. Most mild and moderate sprains don’t require a brace inside the house unless you have animals or children who might bump into you, causing you to lose your balance, or you’re at risk of stepping on toys. In bed You can usually remove your ankle brace when you go to bed. The only exceptions are if you have a complete tear of the ligaments, a fracture, or if you find that the position you sleep in strains your ankle. You usually don't have to wear an ankle brace to bed. Out and about Until you’ve completed your rehab, it is usually beneficial to wear a brace whenever you walk on uneven terrain or in crowds where someone might bump into you. Here's our article with more advice on walking on a sprained ankle . When doing rehab exercises Whether you need an ankle brace will depend on what exercises your physio gives you and the severity of your sprain. In most cases, the exercises will be pitched at a level that you can safely complete without the need of a brace. Ask your physio if you're unsure. The type of rehab exercise and your ankle's stage of recovery will determine whether you need a brace. During sport If you do a sport that carries a higher risk for ankle sprains (like volleyball, basketball, tennis, football, and trail running), a brace can help you return to sport more quickly and reduce your risk of spraining an ankle. Should I wear the brace all day? If you have a severe ankle sprain, your doctor or physio may advise that you wear your brace all day during the first few weeks. In all other cases, ankle braces only have to be worn when you do an activity that is likely to twist or roll the ankle. The need for a brace will reduce as your rehab progresses and your ankle heals. How long to wear an ankle brace for How long you should wear the brace for depends on the severity of your injury and what type of sport or activities you do. Daily activities Lateral ankle sprains Severe lateral ankle sprain: at least 6 weeks and sometimes longer Moderate sprains: 4 to 6 weeks Minor sprains usually don’t require a brace unless the terrain or activity is very challenging. Medial ankle sprains Medial ankle sprains are usually much more severe and take a lot longer to recover. You may have to wear a brace for 6 to 12 weeks. Sport Some athletes find that they are prone to ankle sprains, and no amount of rehab is enough to prevent them effectively. The basketball player Stephen Curry is an example. In such a case, wearing a brace routinely during sport may be a good idea. If your rehab goes well and your sport doesn’t involve a lot of quick changes of direction, you may be able to discard your brace as soon as you’re able to perform all movements and train at full intensity without problems. 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 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References: Vuurberg, G., Hoorntje, A., Wink, L. M., Van Der Doelen, B. F., Van Den Bekerom, M. P., Dekker, R., ... & Kerkhoffs, G. M. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine , 52 (15), 956-956. Fuerst, P., Gollhofer, A., Wenning, M., & Gehring, D. (2021). People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements. Journal of Foot and Ankle Research , 14 (1), 1-11. Drakos, M. C., Domb, B., Starkey, C., Callahan, L., & Allen, A. A. (2010). Injury in the National Basketball Association: a 17-year overview. Sports Health , 2 (4), 284-290. Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training , 54 (6), 603-610. Castro, A., Marques, N. R., Hallal, C. Z., & Gonçalves, M. (2017). Ankle brace does not influence strength and functional balance of ankle muscles over an exercise at the intensity of basketball game. Revista Brasileira de Educação Física e Esporte , 31 (1), 71-81. Moore, M. L., Haglin, J. M., Hassebrock, J. D., Anastasi, M. B., & Chhabra, A. (2021). Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthopedic Reviews , 13 (1).

This must be one of the most common questions that I’ve been asked in my years of practising as a physiotherapist. Whether you use ice or heat for your injury will depend on what phase of healing your injury is in. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Immediately after injuring yourself During the first 3 to 5 days after injury After Day 5 How we can help I explain this in detail in this video: Immediately after injuring yourself Phase of healing: Inflammatory phase What to use: Ice Why: Your main aim immediately after injuring yourself is to stop any internal bleeding and prevent excessive swelling. Excessive bleeding and swelling inside the tissue causes an increase in pressure which can cut the blood circulation off to the adjacent, uninjured cells. Without an adequate blood and oxygen supply these cells may also be damaged, causing your injury to be worse than what it should be. Important: Do not apply the ice for more than 10 minutes at a time. I explain this in detail in the video but in short, if you apply it for more than 10 minutes the blood vessels may open up because the brain thinks that you are at risk of getting frost bite. This can then actually cause more bleeding. Check out this Ice User Manual for exact instruction on how to safely apply ice to an injury. Here's a selection of ice packs on Amazon. All of them are reusable and can be used for icing and heat (read on to see when using heat is appropriate). During the first 3 to 5 days after injury Phase of healing: Inflammatory phase What to use: Ice Why: Some injuries can continue to ooze inside and we still don’t want the blood vessels to expand like they would if you put heat on the injury. During this phase ice is mainly used to control pain and swelling. Ice can also calm down the inflammatory process and prevent excessive inflammation. Inflammation is an extremely important part of the healing process as it is needed to absorb the debris from the injury site. Excessive inflammation can however cause trouble. Please don’t take this to mean that you should be taking anti-inflammatory drugs like ibuprofen. These drugs may suppress the inflammatory response too much and actually interfere with your healing. You can read more about this and how to apply ice during this period in the Ice user Manual . Important: Never apply ice directly to your skin as it can cause ice burns and blisters. Always place a wet cloth or towel between your skin and your ice pack. After Day 5 Phase of healing: Regeneration and remodelling phases What to use: Ice or heat or contrast therapy Why: For most injuries, the blood vessels will usually be fully repaired after Day 5 (of course this may vary depending on your injury, so check with your doctor or physio), so you no longer have to worry about internal bleeding. The main reason for using these modalities are: Pain relief : Both ice or heat can work well for this. I usually let the patient decide what works best. Reducing swelling : Ice and/or contrast therapy (where you alternate hot and cold) are usually used for this. Improving circulation : Contrast therapy or heat may be best for this. The idea is that the increase in circulation helps to deliver more nutrients and oxygen to your injured tissue, helping it to heal more quickly. I’m not aware of any research to support or contradict this and some of my patients swear by it. Important: You can injure yourself by applying heat or ice for too long. Never apply it to areas where your sensation is dull or numb. Using ice shortly before doing exercise can also predispose you to injuries because it numbs your nerve endings – check out the Ice User Manual for more detail on this. Never apply heat or contrast therapy over an area with signs of inflammation (red, hot, swollen) as it can make the inflammation worse. 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 Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate .

Using ice on injuries elicit a wide range of responses from people – from “icing injuries is bad” to “ice will help your injury to heal”. The real situation is somewhat more nuanced. This article explains what ice can and cannot do for an injury, as well as when and how to use it correctly. Remember, if you need more help with an injury, you're welcome to consult our team of sports physios via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Is icing an injury bad? Does ice help to heal your injury? When to ice an injury How to apply ice to an injury Common mistakes when applying ice to an injury How we can help We've also made a video about this: Is icing an injury bad? The use of ice has been a hotly discussed topic, with some people arguing that it can negatively affect your healing process and that it should therefore never be used. This view is too simplistic, as there are cases where the benefits outweigh the potential negative effects. We know that inflammation is very important during the first few days of the healing process. Several studies have found that taking anti-inflammatory drugs (NSAIDs and corticosteroids) can interfere with this healing process because they reduce inflammation. The most commonly cited reason why icing injuries may be bad is that ice has likewise been shown to decrease inflammation, and you can thus argue that ice can hamper the healing process. Icing an injury is not bad if you do it correctly. However, the drugs stay in your system for six hours or longer, whereas the cooling effect of ice, if applied in a sensible way, only lasts for about an hour. Also, excessive inflammation, swelling, and internal bleeding in a new injury can cause increased pressure on the adjacent uninjured tissue, which, in turn, can reduce the blood and oxygen supply to that area, causing these cells to become damaged (this is called secondary injury). Icing an injury is a good way of reducing this. So, if used correctly (see below), ice is a relatively safe way of limiting secondary injury after an acute injury while not impeding the healing process. Does ice help to heal your injury? No. It can limit the extent of your injury by preventing excessive inflammation, swelling, and internal bleeding. However, routine icing will not speed up your healing and, if used excessively, it may delay healing. When to ice an injury Only use ice for an injury if you really need it. Icing an injury may be beneficial in the following circumstances: Immediately after an injury, to limit the amount of internal bleeding, swelling, and pain. If the injured area is still very swollen later on, ice can help to reduce swelling. If you have an excessive inflammatory response, ice may help to reduce it. If your injury is very painful, ice can provide temporary pain relief and may be a better option than pain medication. You can use ice during your rehabilitation to decrease swelling and pain when you experience a flare-up. How to apply ice to an injury Important: People with poor circulation or who suffer from conditions that compromise their circulation should not use ice on an injury without consulting their doctor. A pack of frozen peas is my weapon of choice, but you can use regular ice or frozen gel packs . I find that chemical cold packs (ones that you crack to make them cold) don’t stay cold for long enough. Have a damp towel or cloth between your skin and the ice to prevent it from burning your skin. Apply the ice for 5 to 10 minutes with gentle compression over the injured area. I used to use clingfilm to wrap the ice around the injured body part, but as part of my mission to reduce my plastic use I now just wrap a towel around it. It keeps the ice in place and also provides compression to help stop internal bleeding in a new injury. Five minutes are more appropriate for bony areas (little padding), while 10 minutes are advised for areas with lots of muscle. Do not leave the ice on for more than 10 minutes or use strong compression, as this can have a negative effect. Then, remove the ice for 10 minutes and then reapply it for another 5 to 10 minutes (so, 5-10min on, 10min off, 5-10min on). Removing the ice for 10 minutes will help to protect your skin from injury due to excessive cooling. In severe cases, this process can be repeated at 2-hour intervals, but not more than three times per day. If it is a new injury, having the injured body part higher than your heart will also help to stop the bleeding and reduce swelling. Here's a selection of ice packs on Amazon. All of them are reusable and can be used for icing and heat. (See our article on " When to use ice or heat for a sports injury ".) Common mistakes when applying ice to an injury Leaving it on for too long. This can cause excessive tissue cooling and may interfere with healing. Routinely icing after doing your rehab exercises. This may reduce the strength benefits you gain from the exercise session. Cooling a joint or large area of your body before you exercise. This can slow down the messages that your nerves send to your brain, which can reduce your motor control and position sense and may predispose you to getting injured. Summary Ice can be an effective way of limiting the extent of your injury as well decreasing pain and swelling. However, it doesn’t speed up healing and, if used excessively, may delay your healing. Be careful when using ice shortly before exercise, as it may decrease your balance, position sense, and muscle strength. 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 Masters Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Bleakley, C. M., McDonough, S. M., & MacAuley, D. C. (2006). Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. British Journal of Sports Medicine 40(8), 700-705. Kernozek, T. W., Greany, J. F., Anderson, D. R., Van Heel, D., Youngdahl, R. L., Benesh, B. G., et al. (2008). The effect of immersion cryotherapy on medial-lateral postural sway variability in individuals with a lateral ankle sprain. Physiotherapy Research International 13(2), 107-118. Kinzey, S. J., Cordova, M. L., Gallen, K. J., Smith, J. C., & Moore, J. B. (2000). The effects of cryotherapy on ground-reaction forces produced during a functional task. Journal of Sport Rehabilitation 9(1), 3-14. Schaser, K. D., Disch, A. C., Stover, J. F., Lauffer, A., Bail, H. J., & Mittlmeier, T. (2007). Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. The American Journal of Sports Medicine 35(1), 93-102. Surenkok, O., Aytar, A., Tuzun, E. H., & Akman, M. N. (2008). Cryotherapy impairs knee joint position sense and balance. Isokinetics and Exercise Science 16(1), 69-73. Thorsson O, Lilja B, Ahlgren L, Hemdal B, Westlin N. The effect of local cold application on intramuscular blood flow at rest and after running. Medicine and Science in Sports and Exercise 1985 Dec;17(6):710-713. Wassinger, Myers, J. B., Gatti, J. M., Conley, K. M., & Lephart, S. M. (2007). Proprioception and throwing accuracy in the dominant shoulder after cryotherapy. Journal of Athletic Training 42(1), 84-8 .

Beta-alanine supplementation has been scientifically proven to improve performance in certain types of sport … if you use it right. In this article, we delve into the science, benefits, safety, dosage recommendations, and whether beta-alanine is the right supplement for you. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Why is beta-alanine thought to enhance performance? Does beta-alanine actually work? Beta-alanine – is it safe and legal? My recommendation How to take beta-alanine and how much? Adding sodium bicarbonate into the mix Injured? We can help We've also made a video about this: Why is beta-alanine thought to enhance performance? When we exercise at high intensity (anaerobic exercise), hydrogen ions accumulate in our muscles. This increases the acidity of our muscles (not to be confused with lactic acid build-up), which has a detrimental effect on muscle power and how soon the muscles become exhausted. Beta-alanine (aka β-alanine) is one of the amino acids in our bodies from which a substance called carnosine is formed. Carnosine slows down the accumulation of hydrogen ions in our muscles. The people in the white lab coats say that carnosine acts as a “buffer” against hydrogen ion accumulation. The amount of beta-alanine in our bodies determines how much carnosine can be manufactured, so supplementation with beta-alanine might increase the amount of carnosine in our muscles artificially. 💡 The thinking in sports circles is that the extra carnosine in their muscles will enable athletes to dodge the detrimental effect of the acidity caused by the hydrogen ions for longer. Does beta-alanine actually work? 💡 There is a vast body of credible research that shows that beta-alanine does indeed enhance athletic performance … in certain sports. Because it is mostly anaerobic exercise that produces the hydrogen ions, beta-alanine supplementation works best for high-intensity events ranging from 30 seconds to 10 minutes , and for team sports that require repeated bursts of high-intensity effort. Examples mentioned in the research are: a cycling race of 4 km a rowing race of 2,000 m swimming races of 100 m and 200 m combat sports and water polo. Beta-alanine works best in sports that require short, hard efforts. Non-trained athletes tend to experience higher performance increases than trained athletes when they take a beta-alanine supplement. Nevertheless, it is widely used by professional sportspeople. A survey in Australia  among professional players of Australian Rules Football, rugby league, and rugby union found that 61% of them used a beta-alanine supplement. However, most of them were not following the recommended usage (see below) and only 35% of the participants were able to correctly identify the potential benefits of beta-alanine supplementation. Beta-alanine – is it safe and legal? 👍 In spite of its performance-enhancing qualities, beta-alanine supplementation is not banned by sporting bodies, probably because research indicates  that it is safe. The International Society of Sports Nutrition regards beta-alanine as safe at recommended doses (see below). Side-effects The only reported side-effect of beta-alanine is that it might cause temporary paraesthesia – also known as “pins and needles” (see below how to avoid this). However, as for the long-term side effects of beta-alanine, a daily dose of 3.2 g for up to 24 weeks did not produce any negative side effects. The research indicates that beta-alanine is safe to use with very few side-effects. My recommendation I’m into (very slow) endurance running, so beta-alanine will not do much for me. But if you participate in the type of event mentioned above (high-intensity and shortish duration), I don’t see any harm in giving it a go. How to take beta-alanine and how much? The durations and recommended doses of beta-alanine supplementation in the research papers I consulted vary from 3.2 to 6.4 grams per day, taken for anything from 4 to 24 weeks. One of the research studies  used a guideline of 65 mg of beta-alanine per kilogram of body weight per day, which would fall within this range of 3.2 to 6.4 grams per day for most adults. If you do get pins and needles (see “Side effects” above), it is recommended that you split the total daily dosage into sub-doses of less than 1.6 grams each, or to split the total daily dosage in three and take it with each meal. It seems that you should supplement daily for at least 4 weeks for the best effect. And I wouldn’t do it for more than 24 weeks before giving it a rest for a while, because we have no scientific data on its safety for periods longer than that. Below are some beta-alanine and sodium bicarbonate options available on Amazon. I selected a small-dosage beta-alanine capsule (750 mg) to make it easier to split up your daily dosage if necessary. Adding sodium bicarbonate into the mix It seems from the research that supplementing with a combination of beta-alanine and sodium bicarbonate improves the muscle acid buffering even more. Sodium bicarbonate is alkaline and has been shown to counter the negative effects of lactic acid build-up during exercise. 💡 So, these two supplements go to work on the muscle acidity in different but complementary ways, and together they are more efficient than either of them on its own. The sodium bicarbonate dosage in the study was 300 mg per kilogram of body weight, taken as a single dose 90 minutes before exercise. This corresponds with the recommendation in our article on how to use sodium bicarbonate as a supplement . Injured? We can help Need help with recovering from an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Kelly, V.G. et al. (2017) “Prevalence, knowledge and attitudes relating to β-alanine use among professional footballers” Journal of Science and Medicine in Sport 20(1): 12-16. Brisola, G.M.P. and Zagatto, A.M. (2019) “Ergogenic Effects of β-Alanine Supplementation on Different Sports Modalities: Strong Evidence or Only Incipient Findings?” Journal of Strength and Conditioning Research 33(1): 253-282. Saunders, B. et al. (2017) “β-alanine supplementation to improve exercise capacity and performance: a systematic review and meta-analysis” British Journal of Sports Medicine 51: 658-669. Georgiou, G.D. et al. (2024) “Effect of Beta-Alanine Supplementation on Maximal Intensity Exercise in Trained Young Male Individuals: A Systematic Review and Meta-Analysis” International Journal of Sport Nutrition and Exercise Metabolism 34(6): 397-412. De Oliveira, E.P. et al. (2023) “Safety of beta-alanine supplementation in humans: a narrative review” Sport Sci Health 19: 757-763. Curran-Bowen, T. et al. (2024) “Sodium bicarbonate and beta-alanine supplementation: Is combining both better than either alone? A systematic review and meta-analysis” Biology of Sport 41(3): 79-87. Woitas, L.R. and Ribas, J.W. (2022) “Major clinical findings of β-alanine in sports performance:a systematic review” International Journal of Nutrology 15(2): 1-6. Bellinger, P.M. et al. (2012) “Effect of Combined β-Alanine and SodiumBicarbonate Supplementation on Cycling Performance” Medicine & Science in Sports & Exercise 44(8): 1545-1551.

What if runners could use something as simple as baking soda to counteract the lactic acid build-up that slows them down? Sodium bicarbonate is indeed thought to help athletes perform better. But does the science support it? Here's what the research reveals. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: Why would sodium bicarbonate help runners? Does it actually help? Side effects of sodium bicarbonate My recommendation How much sodium bicarbonate to take and when Adding beta-alinine into the mix Injured? We can help We've also made a video about this: Why would sodium bicarbonate help runners? Lactic acid builds up in our blood and our muscles when we exercise – especially at higher intensities and for more than a few seconds. The increased acidity in our muscle cells decreases their ability to convert stored energy into kinetic energy, and this affects athletic performance. This is seen as a natural “brake” to prevent us from over-exerting ourselves , but athletes in various sports would obviously fancy “disabling” that brake from time to time. The alkaline nature of sodium bicarbonate (NaHCO3) – or, more informally, bicarbonate of soda or baking soda – is thought to counter the negative effects of the lactic acid build-up. The potential benefits of sodium bicarbonate might be cancelled out by its side effects. However, sodium bicarbonate also has some effects on our digestive systems that could hamper performance, so it’s not as simple as chugging a glassful of the stuff before competing in sport. Of course, the people in the white lab coats would want to know whether it’s actually beneficial to take sodium bicarbonate for enhanced sports performance and if so, how much and when? So, let’s take a look at the research. Does it actually help? The short answer is that sodium bicarbonate does indeed help to increase athletic performance, but not in all cases . Whether it helps depends on various factors, such as the duration of the exercise and the type of energy that our bodies (mostly) burn during that exercise. There are three main ways for our bodies to produce energy during exercise. In most cases it’s not only one that is used – it’s usually a mix, with one being predominant depending on the type and duration of exercise. The phosphagen system – mostly used for very short, high-intensity anaerobic exercise (8-10 sec of maximum effort), e.g. jumping, throwing, short sprints, and weightlifting. It uses stored adenosine triphosphate and phosphocreatine, which are readily available in the muscles but quickly depleted. The glycolytic system – mostly used for short-duration, medium- to high-intensity anaerobic exercise (30 sec to 2 min), e.g. 100-metre swimming and 400-metre sprints. It breaks down glucose and glycogen anaerobically (without oxygen) into pyruvate, which can be converted to lactate if oxygen availability is limited. The oxidative system – mostly used for medium- to long duration, low- to medium intensity (aerobic) exercise, e.g. endurance running, rowing, and cycling. This process requires oxygen and uses carbohydrates, fats, and occasionally proteins as fuel. In 2020, a group of researchers based in Madrid, Spain, gathered the previous decade’s worth of research into how supplementation with sodium bicarbonate affects these energy systems. After having weeded out the poor-quality studies, they were left with 17 good studies, and they analysed their results . They found that: sodium bicarbonate improves energy production for the first two (so, the anaerobic) energy systems, and especially the glycolytic system . but there were no significant benefits for the oxidative/aerobic syste m. This is not surprising, given that lactic acid is a byproduct of glucose or glycogen being converted into kinetic energy. In 2021, the International Society of Sports Nutrition (ISSN) did a similar review of the research  and issued a comprehensive “Position Stand: Sodium Bicarbonate and Exercise Performance”. Broadly in line with the 2020 study, they said that the benefits of sodium bicarbonate are mostly found in high-intensity bouts of exercise of between 30 seconds and 12 minutes . This is seen in “muscular endurance activities, various combat sports, including boxing, judo, karate, taekwondo, and wrestling, and in high-intensity cycling, running, swimming, and rowing”. However, they added that a portion of the performance enhancing effect of sodium bicarbonate seems to be placebo-driven , i.e. it’s all (or at least partly) in the mind. Side effects of sodium bicarbonate Negative side effects of (too much) sodium bicarbonate include stomach ache, nausea, vomiting, and bloating. It is obvious how these symptoms can spoil your 800-metre race or interval training session. Looking at the various pieces of research, the following measures are recommended to counter these side effects: Do not take more than 0.3 grams per kilogram of body weight per day if you are taking a single dose (see below). So, someone weighing 75 kg would take a maximum of about 22 grams. Take the sodium bicarbonate in a gelatine-based capsule rather than dissolving it in water or as a tablet – this releases it more gradually into the digestive system. Take it together with a high-carb meal . Experiment first with how long before having to perform you should take it so that the negative side effects don’t kick in during the event. The ISSN recommends about three hours. Take it over multiple days before the event rather than on the day of the event (see below). You might be able to avoid the negative side effects by taking sodium bicarbonate as a gelatin capsule rather than dissolved in water. My recommendation 👍 Supplementing with sodium bicarbonate might help athletes who need speed and/or power for events longer than very short sprint distances but shorter than, say, a 5K-footrace. 🤔 But we don’t know by how much this improves performance, so it’s difficult to weigh up the potential benefits against the risk of negative side effects. 👎 And sodium bicarbonate for endurance runners and athletes in other endurance sports doesn’t seem to make sense anyway. How much sodium bicarbonate to take and when Single dose before exercise / an event Less than 0.2 grams per kilogram of body weight seems to have no discernible positive effect, whereas 0.3 grams per kilogram of body weight seems ideal. More than that, and the risk of negative side effects starts to kick in. Recommendations for when to take it range from 60 minutes to 180 minutes before the exercise or competition. Experiment beforehand to see what works best for you. Multiple-day dosage The ISSN suggests the following multi-day protocol: daily, for three to seven days before the event, dosage of 0.4 or 0.5 grams per kilogram of body weight per day, split into 3 or 4 separate doses to be taken with meals. Most sodium bicarbonate capsules on the market are marketed as dietary supplements, as opposed to for sports performance. These typically come in 0.65-gram capsules, which is a lot of capsules to gobble down if a 75-kg athlete wants to take 22 grams per day. I found one brand on Amazon with 1.3-gram (1300 mg) capsules, which is a bit better, so I’ve linked to that one below. And if you’d rather take it in powder format, dissolved in water, I’ve linked to an option there as well. (Sodium bicarbonate also comes in tablet and liquid form, but I did not find any in dosages that are useful for the dosages recommended above.) Adding beta-alanine into the mix Research has shown that supplementing with both sodium bicarbonate and beta-alanine, an amino acid that occurs naturally in our bodies, improves performance more then supplementing with either of these on its own. See our article on beta-alanine for better sports performance for more detail. Injured? We can help Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Calvo, J. L., et al. (2021) “Effect of sodium bicarbonate contribution on energy metabolism during exercise: a systematic review and meta-analysis” Journal of the International Society of Sports Nutrition 18(1). Hadzic, M., et al. (2019) “The Impact of Sodium Bicarbonate on Performance in Response to Exercise Duration in Athletes: A Systematic Review” J Sports Sci Med 18(2): 271-281. Grgic, J., et al. (2021) “International Society of Sports Nutrition position stand: sodium bicarbonate and exercise performance” J Int Soc Sports Nutr 18: 61.

We discuss the various types of tennis elbow brace and their pros and cons. Not everyone with tennis elbow will benefit from wearing a brace, so we’ll look at when and why a brace or tennis elbow strap may be useful. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: Tennis elbow wrist brace (splint) Tennis elbow strap (counterforce brace) Tennis elbow sleeve When to remove your tennis elbow brace immediately How we can help We've also made a video about this: It’s worth noting that braces should not be used as a standalone treatment for tennis elbow. Research  shows that you get better long-term results when you combine a brace with other treatments. Here's our detailed discussion of the best, evidence-based treatments for tennis elbow .   Tennis elbow wrist braces (splints) How a wrist splint might help for tennis elbow It might seem a bit weird that a brace around your wrist can help for your elbow pain. Here’s how it works. The muscles involved in tennis elbow are the ones that bend your wrist back (into extension). For your tennis elbow to settle down and recover, you must temporarily reduce the amount of work those muscles (the wrist extensors) and the tendons that connect them to your elbow do. The problem is that it can be super difficult to properly rest your hand, because we tend to use it without thinking about it.   Wearing a wrist splint that stops you bending your wrist back forces you to rest those muscles, which in turns reduces the strain on the injured tendons, allowing them to recover. Are wrist splints effective? Yes, research shows that wrist splints can help to alleviate tennis elbow pain. There’s also a suggestion  that a wrist splint may reduce pain quicker than a counterforce strap (see below), but they seem to have similar results after about six weeks. One study  found that wrist splints worked better in people over the age of 45; the reasons for this are still unclear.   Wrist braces are most useful for people who have really painful or stubborn cases of tennis elbow.   👍 Pros: They are particularly good at forcing you to rest and settling down your pain. They also make other people aware you have an injury, so they tend to be more considerate. 👎 Cons: Because these braces limit your movement, you may lose a bit of strength. However, you can always restore your strength through rehab exercises. So, this should not be a deal breaker. Some people find them too limiting and restrictive. How to use them In the research studies, participants were required to wear their wrist splint: For six weeks, for all their daily activities, and remove it only when they shower, sleep, or do their rehab exercises.   I tend to be less strict with my patients and may tell them to wear it continuously for a couple of weeks, and after that just when they are doing activities where they are likely to overdo things. But my advice varies a lot between patients. Personalities also play a role – some people just can’t help themselves and really need to be forced to rest it.   What to look for in a tennis elbow wrist splint The wrist splint must: Limit your wrist extension movement , so it must have metal or rigid plastic rods on the top or the bottom – some of them still allow your wrist to flex (bend downwards). Support your wrist in slight extension – the braces used in the studies positioned the hand between 5 and 30 degrees extension. Be secured with Velcro or straps so you can easily adjust it if it feels too tight.     Tennis elbow straps (counterforce braces) How tennis elbow straps might help A tennis elbow strap is worn around the muscle bellies of the wrist extensor muscles, about 2 cm (almost an inch) below the elbow crease. The raised pad must be directly over the muscles, NOT the elbow.   When we contract or use our wrist extensor muscles, they pull on their tendons, which attach into the bones at the outer elbow. When you have tennis elbow, those tendons are injured (usually in the area where they attach to the bone), and this pulling force is what increases your pain.   The thinking on how tennis elbow straps work is that, by applying a compression force to the muscles just lower down from where their tendons attach, it shifts the pulling force away from the injured area . This is why these straps are often called counterforce braces.   One study , performed on cadavers, found that counterforce braces could reduce the force on the tendons by 13%-15%, while another found that the wrist extensors were less active when you wear the strap. Are tennis elbows straps effective? For some people, a tennis elbow strap can reduce their pain immediately  and help them do their daily tasks with less discomfort. However, others may actually experience more pain  when wearing them. So, it can be hit and miss.   There is also some evidence that counterforce braces help to preserve grip strength better than wrist splints, and they may be more useful for people under the age of 45.   👍 Pros: Counterforce braces don’t restrict your movement, so you can carry on with daily tasks as normal. It should not cause you to lose muscle strength. They are cheap, so not a big loss if you buy one to test and it doesn’t work. 👎 Cons: It can make some people’s pain worse – adjusting the position might help, but it may also simply not be the right type of brace for you. If you have nerve irritation or entrapment together with tennis elbow , stay away from elbow straps, as it will irritate the nerve even more. How to use them In my experience, tennis elbow straps work best for people who don’t have a lot of pain when they keep their arm and hand still, whose elbows aren’t super sensitive to being pressed on, and who don’t have nerve irritation.   When it comes to braces, I believe less is more. So, I tend to advise my patients to wear them only when they do tasks that irritate their elbow. In reality, most people start off using them nearly all day long, and then, as their tennis elbow improves, they use them less often.   I would always take them off when you do your rehab exercises, otherwise your exercises may not have the desired effect on the injured area.   What to look for in a tennis elbow strap It needs to have a strap that you can easily adjust. It must have a firm, raised area (typically a hard foam strip or bubble) to apply pressure over the wrist extensor muscles. Tennis elbow sleeve How tennis elbow sleeves might help A tennis elbow sleeve keeps your elbow warm, and some people find that this helps for their pain. The sleeve also stops you from bending your elbow fully – sitting with your elbow bent for extended periods often makes it hurt more.   And finally, it can act as a reminder to take things easy. Are tennis elbow sleeves effective? Tennis elbow sleeves have not been researched, and to be honest, it’s not something that I would prescribe for a patient. That said, I’ve had patients who bought them of their own accord and reported that it helped to wear them. So, it might be something to try.   How to use them There really isn’t a right or wrong way to use these. It should be fine to wear one even when you’re doing your rehab. You might find that it starts to irritate your skin if you wear it too often and/or too long.   What to look for in a tennis elbow sleeve The main thing is to get the size right. It should feel like a comforting hug when you have it on – not too tight, nor too loose.   There are ones that combine an elbow sleeve with a compression strap for tennis elbow. However, I wouldn’t go for them, because you can’t be sure that the compression strap will sit in the right place for you.   When to remove your tennis elbow brace immediately Tennis elbow braces don’t work for everyone and can make things worse in some cases. The golden rule for wearing a tennis elbow brace is: A brace that is uncomfortable or increases your pain is useless. If adjusting it doesn’t help, ditch it. You should remove your brace immediately if: It makes your pain worse and adjusting the position doesn’t help. It causes tingling, numbness, or weird sensations – those are signs that the brace is irritating a nerve, or it is too tight. Your hand or forearm turns blue, or swells, or throbs – those are signs that the brace is too tight and restricting your circulation. Any part of your arm or hand suddenly turns red, or throbs, or swells, or becomes a lot more painful – those are signs that you may have a blood clot; you should consult a doctor as soon as possible.   If any of these symptoms persists for more than a few minutes after removing the brace, consult a doctor. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Ozden, E. and M. Guler (2023) "Comparison of conservative treatment of lateral epicondylitis with wrist splint and epicondylitis band: assessing patient compliance and clinical outcomes" Annals of Medical Research 30(9): 1096-1099. Shahabi, S. et al. (2020) "The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials" Prosthetics and Orthotics International 44(5): 341-354. Heales, L. J. et al. (2020) "Evaluating the immediate effect of forearm and wrist orthoses on pain and function in individuals with lateral elbow tendinopathy: a systematic review" Musculoskeletal Science and Practice 47: 102147. Vellilappilly DV et al. (2017) “Counterforce Orthosis In The Management Of Lateral Epicondylitis” J Ayub Med Coll Abbottabad 29(2): 328-334. Rishi Garg et al. (2010) “A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis” Journal of Shoulder and Elbow Surgery 19(4): 508-512.

There is no "cure" for DOMS (delayed onset muscle soreness), but there are some proven methods for DOMS pain relief. There are also some popular methods that don’t work. This article explains which is which. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: What is DOMS? What causes DOMS? DOMS pain relief How we can help We've also made a video about this: What is DOMS? DOMS is the delayed onset muscle soreness you get after exercise – usually exercise that you're not used to. The fitter you are and the more used you are to exercise, the less likely you are to get DOMS. DOMS doesn't start immediately – the clue is in the word “delayed”. It only starts to develop after about 24 hours, and then it often gets worse; it's usually at its worst after about two or three days. Research on people with DOMS has found that it can last for five to seven days. I often get people telling me on social media, “Oh, I’ve had a massage and now I’ve got terrible DOMS! What can I do for it?” That is not DOMS. If you've got soreness from a massage, that is simply because your muscles have been bruised in the process. Also, if your muscles are sore immediately or soon after exercise, it’s very likely an injury that's rearing its head and not DOMS. What causes DOMS? DOMS typically sets in after a heavy exercise session that involved eccentric muscle contractions. This is when you contract a muscle while it lengthens. Examples are slowly lowering a dumbbell after a bicep curl (biceps), slowly going down into a squat position (quads), and jumping and hopping (calf muscles when landing). Some runners will know that you can easily get DOMS from running downhill fast (quads and glutes). People used to think DOMS is caused by a build-up of lactic acid in the muscles. But we now know that it definitely isn't. The lactic acid that forms in your muscles when you exercise is cleared out within an hour afterwards, even if you just go plonk yourself down on the couch without even doing a cool-down routine. However, the people in the lab coats still haven’t quite figured out how DOMS is caused, because it's about subtle changes that happen in our bodies. Some of the suggested explanations involve the well-understood concept of “micro-damage”. Exercise causes micro-damage to various types of tissue in our bodies, including in our muscles, and that micro-damage is then repaired to a more robust state than before. This is how exercise makes us stronger. Some think that DOMS happens when the micro-damage in the muscles goes just a little bit too far. Others think that DOMS might be caused by micro-damage to the fascia – the white, sinewy sheaths that envelop our muscles. And others think it may be a combination of micro-damage to the muscles and the fascia. Personally, I think it’s a combination of the above, plus perhaps some irritation of the nerve endings in the muscles. DOMS pain relief First, we’ll look a things that may work, followed by things that won’t work, some of which may actually be detrimental to your recovery. Compression garments There is some evidence that compression may decrease the intensity of DOMS. They're not entirely sure why yet, but it seems that compression garments can help with lymph drainage. Lymph glands help to get rid of the chemicals that build up in our muscles when there is damage. It may also be thanks to the physical pressure of the compression garment. We know that low-level pressure can desensitise areas that feel painful. A compression garment has to be firm, but comfortably firm. Too tight, and you get the opposite effect; too loose, and you don't really get the compression effect. Here are some options on Amazon: DOMS massage? Massage is over-hyped as a silver bullet for healing many injuries, but in this instance, research has shown that it is actually quite a useful adjunct for recovery and that it can decrease DOMS. The pain caused by DOMS means that the pain receptors in our muscles are now on high alert – it’s part of our body’s survival mechanism – and at the slightest provocation they will send alarm signals to the brain to create pain sensations. The constant, gentle pressure from a massage (if it is done right) desensitises the pain receptors and causes them to calm down. DOMS not only causes muscle soreness but also a decrease in muscle function, i.e. the muscle can’t contract as well as usual. Despite massage decreasing your pain, research shows that it doesn't help to restore your function more quickly. So, for instance, you can't jump better within a few hours or a few days after you’ve had a massage versus if you hadn’t had one. What about foam rolling? Foam rolling is basically a form of self-massage, so for the same reasons as above, foam rolling has been shown to decrease DOMS pain. Here are some foam rolling options on Amazon: Anti-inflammatories There's a prevailing mindset that whenever somebody has pain, either from an injury or from DOMS, they should swallow some tablets, because the quicker they can get the pain to go down and the quicker they can get the inflammation to calm, the quicker they will recover. Inflammation has been and is being unduly demonised. It is an important part of the healing process of any injury and of the micro-damage caused by DOMS. If you have an injury or micro-damage, there are damaged cells that need to be absorbed and there are chemicals involved in the healing process that need to be moved around. Guess what is responsible for this? The inflammatory cells. Excessive inflammation in a wound isn't good, but normal inflammation that is a part of the healing process and a part of DOMS is good, and it's needed. So, don’t take anti-inflammatories like Ibuprofen, Voltaren, or Naproxen for DOMS; you're messing with the healing response that repairs the micro-damage to make you stronger than before. If you feel the DOMS pain is overwhelming, speak to your GP about other types of medication, like paracetamol. Ice baths We sometimes marvel at the bravery and dedication of professional athletes who immerse themselves in ice baths after a hard training session, race, or match. It is supposed to speed up their recovery. The research into the effect of cold therapy on DOMS has produced some contradictory results, but a recent meta-analysis of the combined results of 32 studies showed that it may offer some benefit. However, this does not mean that you should start doing ice baths after every training session. In fact, there is good evidence that if you get into that ice bath within an hour or so after you've done your exercise, you may actually deny your body the benefit of the exercise. This is because ice, like the anti-inflammatory drugs I’ve discussed above, decreases the inflammation – at least not for as long as the medication does. Does this mean that ice baths should be avoided? No. They can be useful (for instance if you're competing and recovery is your main aim rather than strength gains), but you have to use them with discretion. You can find more information about when and how to use ice baths here . DOMS stretching It’s strange, the guilt trip some people go on when they get DOMS. I’ve often had patients say, “Ah, I’m really bad. I never stretch after exercise and now I’ve got this DOMS!” But they forget that they haven't stretched after exercise for the last 20 years! So, the fact that they've now got DOMS is likely not because they've not been stretching. The research shows that you can stretch until the cows come home, it doesn't help to decrease the pain of DOMS, and it doesn't restore your muscle function more quickly. If stretching makes you feel more comfortable because your muscles feel stiff and you feel more flexible and mobile afterwards, by all means go for it. It's just that it doesn't help for the pain or anything else that you feel due to DOMS specifically. 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 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Gregory E. P. Pearcey, David J. Bradbury-Squires, Jon-Erik Kawamoto, Eric J. Drinkwater, David G. Behm, Duane C. Button; Foam Rolling for Delayed-Onset Muscle Soreness and Recovery of Dynamic Performance Measures. J Athl Train 1 January 2015; 50 (1): 5–13. Guo, J., et al. (2017). "Massage alleviates delayed onset muscle soreness after strenuous exercise: a systematic review and meta-analysis." Frontiers in Physiology 8: 747. Nahon, Roberto Lohn, Jaqueline Santos Silva Lopes, and Aníbal Monteiro de Magalhães Neto. "Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis." Physical Therapy in Sport 52 (2021): 1-12.