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THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis Self-treatment – overview of the treatment options (this article) Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis Plantar fasciitis is a pesky, painful, and persistent problem, but the good news is that the majority of the most effective treatments identified in the research are all things you can do at home. No having to take time off work and forking out to go and see a physio! This article will give you a complete list of the most effective treatments for plantar fasciitis that you can apply yourself. We might earn a small commission on the sale of some of the products listed on this page at no extra cost to you. First, let’s get something out of the way: what you shouldn’t do when you’ve discovered that you have plantar fasciitis. Treatments that don't work for plantar fasciitis Your first instinct for treating very painful plantar fasciitis might be to reach for the anti-inflammatories. That will be of almost no use, especially if you’ve had the pain for a while. Other injuries usually start with inflammation before the regeneration phase of the injured tissue kicks in. Plantar fasciitis is different. It usually skips the inflammation and goes straight into a degeneration or breakdown phase. Anti-inflammatory medication does not work for plantar fasciitis. Physiotherapists sometimes mete out two other treatments that won’t relieve or fix your plantar fasciitis: ultrasound and electrotherapy. So, what to do about your pain? Plantar fasciitis treatment: What is the most effective? The treatment for plantar fasciitis has to be tailored to you. There will never be a single treatment to cure plantar fasciitis, simply because there can be so many different reasons why you develop heel pain . The plantar fasciitis treatments below can be roughly divided into treatments that reduce tension in the plantar fascia and treatments that strengthen the plantar fascia. The most effective treatments according to the research are: (see details under each section) Relative rest Stretching exercises Strengthening exercises Massage Taping the foot Foot orthotics or supportive insoles in shoes Specific shoes or rotating which shoes you wear Night splints TENS (transcutaneous nerve stimulation) Red light therapy Weight loss Relative rest Once injured, your plantar fascia loses some of its strength and endurance. So now it struggles to cope with the load you place on it when you do your normal daily activities and sport. So, if you try and ignore the pain and just continue as normal, it usually just gets worse. Remember, your plantar fascia supports your foot's arch and has to work whenever you stand, walk, run, or jump. To allow it time to recover, you have to reduce these activities to a level that does not cause your pain to increase significantly. Complete rest is not needed nor is it useful, as it can cause your foot to lose more strength. You just have to limit the time you spend on your feet to what your foot can currently tolerate. So, observe how your pain reacts to the time you spend on your feet standing, walking, etc., and then temporarily limit your activities accordingly. Top tip: Wearing good shoes and orthotics can reduce the strain on your plantar fascia and help your foot tolerate more activity. I discuss what to look out for in these lower down. Stretching for plantar fasciitis The calf muscles are connected to the plantar fascia via a fascia extension from the Achilles tendon, and I always find that they are tight in my patients who complain of heel pain. Actually, all the muscles in the back of your leg are connected. This is why you should not only include stretches for the plantar fascia but also for the rest of the leg and back. A word of caution – you can make the symptoms worse if you over-stretch. Find a detailed explanation and demo of what stretches you should do for plantar fasciitis here. Stretching your calf muscles can help reduce the tension on your plantar fascia. Strengthening exercises for plantar fasciitis The shape of the foot is determined by a passive support system (bones, ligaments, plantar fascia) as well as an active one (muscles and tendons). The plantar fascia is put under extra strain if the muscles in your foot and lower leg are weak or they cannot control your foot properly. Strengthening your foot, ankle, and leg muscle can help to reduce the strain on your plantar fascia. Strengthening and proprioceptive exercises can be very effective in the treatment of plantar fasciitis, but it is important that you do them at the correct intensity for the stage of your recovery. If you would like help with your rehab exercises, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped 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 Massage for plantar fasciitis It is easy to massage your plantar fascia as well as your calf using massage balls and foam rollers . The current research suggests that  foam roller massage  can be just as effective as a massage from a therapist when it comes to pain relief and increasing muscle length. Massage for plantar fasciitis should include all the muscles along the back of your legs – not just the plantar fascia. I've created a detailed article with demo videos of how to massage yourself for plantar fasciitis. Taping for plantar fasciitis There are several taping techniques that you can try. The one thing that they all have in common is that they try and off-load the plantar fascia through supporting the inside arch of the foot and preventing the foot from rolling inwards excessively when you step on it. One of the most commonly used is the Low Dye Taping technique. You can watch my variation of this technique below. Orthotics or supportive insoles for plantar fasciitis Foot orthotics come in various shapes and levels of support. I usually prescribe a medium density off-the-shelf orthotic that supports the inner arch of the foot. This reduces the load on the plantar fascia and gives it a chance to recover. Think of it as a "crutch" for the plantar fascia. Consult a podiatrist if you do lots of sport. I usually advise my patients to test arch-supporting inserts first, but if they find them uncomfortable, soft gel inserts may be useful. The gel inserts don't support the arch but some patients seem to benefit from the extra cushioning under the heel. There is some research that shows that people with plantar fasciitis often also have a thinner fat pad (so less cushioning) under their heel bone - the gel insert may help with this. I’ve selected the products below from Amazon, as they are similar to the ones we use in our clinic and appear to be good value for money. Shoe selection for plantar fasciitis Unsupportive and inflexible shoes provide very little arch support and put a much greater strain on the plantar fascia. Wear shoes with good cushioning and arch support. Here's our article on why it might be a good idea to mix up the types of supportive shoe you're wearing , why these shoes don't have to look boring and ugly, and how even minimalist shoes might play a role in your rehab. Night splints for plantar fasciitis Researchers suspect that the plantar fascia shortens during the night and that the sudden stretch when you stand on it in the morning injures it anew. The theory behind night splints is that they prevent your plantar fascia from shortening during the night, which reduces the pain in the morning as well as the chance of injury. I do find these effective in patients with persistent symptoms. Night splints come in various shapes and range from very rigid to soft. I prefer the  Strassburg sock  for comfort, but I’ve also included an example of a more rigid splint with an arch cushion below. TENS for plantar fasciitis TENS has been shown to reduce pain while you're hooked up to the TENS unit and maybe for a few hours afterwards. But there isn't convincing evidence that it is a treatment method that will speed up your healing. So, TENS can be useful to reduce intense plantar fasciitis pain to enable to you carry on with a treatment method that will eventually heal you. Read more about TENS treatment for plantar fasciitis. These three TENS units come with electrode pads small enough to stick securely even on small feet. Red light therapy for plantar fasciitis Red light therapy might help to reduce pain, but you have to get the settings on your device right if you do this yourself. Here's our guide to red light therapy . Weight loss The less you weigh, the less force is transferred through your plantar fascia when you stand, walk, or run. As simple as that. I hope you found this overview of treatments for plantar fasciitis helpful. Like I said, I’ve written in more detail about how you can treat yourself with stretches and massage – just follow the links below. Read more about: Stretching for plantar fasciitis Massage for plantar fasciitis 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 Morrissey D, Cotchett M, Said J'Bari A, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine 2021; 55: 1106-1118. Belhan, O., Kaya, M., & Gurger, M. (2019). The thickness of heel fat-pad in patients with plantar fasciitis. Acta orthopaedica et traumatologica turcica, 53(6), 463-467. 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. Robroy L.M. et al., (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

Discover which treatments work best for proximal hamstring tendinopathy and which to avoid. This guide explains evidence-based strategies to reduce pain, restore tendon strength, and prevent flare-ups, with practical tips for faster, long-term recovery. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. In this article: The main elements of effective treatment What treatment works best for proximal hamstring tendinopathy? Other treatments that might promote tendon healing Treatments to reduce pain Treatments for specific cases of proximal hamstring tendinopathy Useless treatments for proximal hamstring tendinopathy Treatments that might make your symptoms worse Recovery times How we can help I've also discussed it in this video: The main elements of effective treatment   Yo u can get really technical about w hat happens when you have proximal hamstring tendinopathy, but the key approach to understanding the injury and its treatment can be summarised as follows: Your hamstring tendons get injured when they are overworked in some way (see the most common ways here ). Once injured, your tendons become  irritated and their capacity to tolerate load or work reduces. This means that when you now try to do the things you usually do, it’s too much for the tendons and they become even more irritated.     There is no one-size-fits-all treatment plan that works for proximal hamstring tendinopathy, but the main aims of a successful treatment plan are to: Get the tendons to  calm down and reduce their irritability Restore their load tolerance and capacity  to its previous level Take steps to prevent it  from being overwhelmed and injured in future.   💡 In practice, these three aims can be achieved through many combinations of various treatments, and what works for one person often doesn’t work that well for the next.   So, let’s look at the elements you might include in a treatment plan, starting with the best research-based ones. What treatment works best for proximal hamstring tendinopathy?   These are our Top 3 treatments – supported by the research and that we find produce the best long-term recovery when used together:   Relative rest:  For your injury and pain to settle and start recovering, you must temporarily reduce the loads or forces that go through that area to match its current capacity. But usually you don’t have to rest it completely – more on this below. Progressive loading:  As your pain starts to calm down and settle, you must gradually start increasing activities that load/work the hamstring tendons. This helps to restore the strength and function of the injured tendon and related muscles, and it reduces pain. This includes your  daily activities as well as your rehab exercises (see below) and sport. Addressing other  factors that might be dialing up the pain system  and causing more pain than it should.   1️⃣ Relative rest vs. complete rest Resting your hamstring tendons completely  (not doing any exercise and avoiding sitting) can be a very effective way to get the pain to settle down in the short term. And this is sometimes needed for a short period ( a few days only ).   But rest alone doesn’t restore your tendons’ capacity  for exercise and work. And if you rest for very long periods, your tendons may decondition further (just like your muscles would without any exercise). Research has also shown that overprotecting an injury can also sensitise the pain system  and cause more pain in the long term. Avoiding activities (like sitting) completely can reduce pain in the short term but often makes things worse in the long term. ⚖️ So, like with most things in rehab, it’s about getting the balance right.   👉 What you want to do instead is reduce, adapt, or cut out  only the activities that significantly aggravate your hamstring pain and continue with all the others that don’t.   Then, once your pain has settled down to an acceptable level (as discussed below), you gradually start easing back into those activities, testing short sessions or durations and observing how it affects your symptoms.   👍 We are big proponents of relative rest and teach all our online patients how to apply this concept to their specific case. Being injured and not able to exercise can make you feel rather low. Relative rest is great, as it not only allows you to maintain your fitness through cross-training but also helps to lift your mood.   How much pain is OK? We’re often asked “Should I wait until I have no pain before starting physio?”  – The answer is no, you are unlikely to get 100% pain-free if you just rest and don’t start rehab.   But with rehab I don’t mean exercises that are hard to do or cause your pain to flare up – an experienced physiotherapist will tailor your rehab plan so that it matches your tendon’s capacity, using a variation of the pain guide below. ✅ When you’re dealing with proximal hamstring tendinopathy, the general rule is that you can keep doing an activity as long as: the activity only causes a slight increase in discomfort while you’re doing it or within the next 24 hours, and that extra discomfort settles down fairly quickly.   ⬇️ If your symptoms flare up more noticeably – especially the day after – that’s your cue to make the next session easier. 👉 A significant increase in pain doesn’t necessarily mean that you’re making your injury worse,  but repetitively pushing into high levels of pain can cause the pain system to become more sensitised, which can cause pain to persist long after the tendon tissue has recovered. Read more about the factors that can contribute to ongoing pain here .   👍 Tailoring your activities (exercise, sitting, rehab, work, etc.) to keep your symptoms within this “niggle” level helps to calm the pain system down.   Activities that often require adapting during the early stages include: Any activity that presses directly on the tendon , e.g. sitting – See this article for how to adapt your sitting  and use it as part of your rehab to restore your tendons’ sitting capacity. All activities that use or work the hamstring tendons , e.g. running, cycling, jumping, hill or stair climbing, squats, lunges, deadlifts, etc. Any movement that stretches the hamstring tendons , e.g. bending forward, doing hamstring stretch exercises, sitting with your legs straight out in front of you.   Have a look at our article explaining the causes of proximal hamstring tendinopathy  if you want to understand why these activities might irritate your tendons. If you’re looking for advice on  how to adjust your running with high hamstring pain, this article is the one. An example of relative rest for runners: Simple adjustments to your normal exercise routine (like where your run) can help your hamstring tendons to calm down. 2️⃣ Progressive loading Tendons are made up of collagen fibres, which is an extremely tough type of tissue  – researchers  report it to be 10 times stronger than steel! And you can get the body to produce  more and stronger collagen fibres through training your tendons ,  just like muscle cells strengthen and grow bigger when you train them.   The aim with progressive loading is  to restore your tendons’ strength and capacity to tolerate activities (like exercise and sitting) to their pre-injury levels. If you do this correctly, using your symptoms to guide your loading plan, it can also be a great way of desensitizing the pain system  and getting it to calm down. There are three ways of restoring your tendons’ capacity, and most treatment plans use a mix of them: Specific rehab exercises that strengthen  the hamstring muscles and tendons (like hamstring curls and bridges). Gradually increasing your sitting time. Gradually increasing other activities  and sports that use the hamstrings, e.g. walking, running, and cycling. 👎 Some of the common mistakes  (regardless of the activity) we see which can cause painful flare-ups include starting specific activities too early, doing too much too soon, ramping up activities too quickly, or not progressing exercises to the level required for the patient’s sport.   👍 Here are the steps we follow during our video consultations that help us figure it out where to start a rehab plan, how and when to progress it, and what level to build it up to: First, we have a very detailed discussion with our patients to understand what activities they are currently able to do and how it affects their symptoms – this gives us an idea of what activities they might need to adapt or adjust or do more of. We also discuss what  our patients’ goals  are – that tells us what type, volume, and intensity of activity their plan should build up to. We are also interested in unpacking the details about how the symptoms started  – that tells us what we should get our patients to do to avoid getting high hamstring tendinopathy again. Then we move on to  movement tests  to understand what exercises might be appropriate. We use the same movements we would use in a physical clinic – we demonstrate the movements in front of the camera, then watch the patient do them, and give feedback. We then use this information to create a starter plan  – but this often has to be adjusted after the patient has had time to test it and observe its effect. Our patients then provide us with feedback  in the subsequent consultations and we use that to decide how to proceed – if they should continue at the same level, can progress, or perhaps should take things a bit easier.   Getting your loading plan right is not an exact science and often takes a bit of experimenting because you have to look at ALL the activities in your day/week that impact the hamstring tendons and match that to what your tendons’ can currently tolerate.   Tendons can also be tricky things and  sometimes only tell you hours after an activity or the next day that they didn’t like it. If you find your rehab exercises are irritating your tendons, don’t just give up on it, tell your physio so they can use this new information to further fine tune your plan.   These articles go deeper into the details of how to apply load management for specific activities: Tips for sitting with high hamstring tendinopathy Adapting the bridge exercise for high hamstring tendinopathy Running with proximal hamstring tendinopathy – Tips to help recovery   3️⃣ Address other factors affecting pain Recent research has highlighted how tendon pain can be amplified or reduced by increasing or decreasing our stress and anxiety levels.   We’ve explained it in detail here , but in a nutshell, stress and anxiety cause our bodies to produce more stress hormones (like cortisol) which, if produced over a prolonged period, can cause increased inflammation and tissue hypersensitivity.  This may cause our pain system to overreact to movement and activity and cause excessive pain flare-ups even when the activity is not vigorous enough to injure our  tendons.   If you’re currently experiencing high levels of stress or anxiety, taking steps to address this may help your recovery. Other treatments that might promote tendon healing The treatments in this section are thought to promote tendon healing, and there is some research evidence that they can improve recovery when combined with other treatments.   Red light therapy  – evidence is emerging that it likely stimulates healing and reduces pain. For tendinopathies, it’s been found to reduce pain and improve function – researchers report  even better improvements in function when combined with rehab exercises. Here’s our comprehensive guide on how to use red light therapy . Supplements – There is some evidence that a combination of Vitamin C and collagen, when combined with strength training exercises, may enhance your tendon’s ability to restore and strengthen itself. Find a detailed discussion of supplements for tendon injuries here. Nitroglycerin patches  – There’s currently a lack of high quality  research  for this, and studies show contradictory results, but these patches don’t seem to have any serious side effects. So it might be something worth trying if you find you’re not progressing as expected with your rehab. (Nitroglycerin, trinitroglycerin (TNG), nitro, glyceryl trinitrate (GTN), and 1,2,3-trinitroxypropane are different names for the same thing.) PRP injections  are thought to stimulate tendon healing, but there is no strong evidence to support its use specifically for proximal hamstring tendinopathy. In practice we find that it works for some people and not for others. PDRN injections (popularly known as "salmon sperm injections") are also thought to stimulate tendon healing and help with pain relief, with initial research showing promising results and no serious side effects. But because the studies into this have been small thus far, it should be seen as experimental, and it might or might not work for you. Red light therapy is a promising adjunct treatment with little risk of side effects. Treatments to reduce pain Getting your high hamstring pain to settle down to a manageable level is important. Pain can wear you down, prevent you from getting on with your life, and discourage you from starting or progressing with your rehab.   The following treatments can help to reduce your proximal hamstring pain temporarily,  but they usually don’t have a direct effect on healing and should not be used as a stand-alone solution. For best results, they should be used in combination with a progressive rehab plan that restores your tendon’s exercise tolerance (see above). Massage or  foam rolling ,  if you avoid strong pressure over the irritated hamstring tendons, can help the hamstring muscles to relax and provide temporary pain relief. Dry needling - A 2022 review study found that it effectively reduced pain and other symptoms linked to tendinopathy. Low-level laser therapy  has been proved effective  without any negative side effects. Shockwave  might help  to reduce pain, but it doesn’t work for everyone. In my experience, it often doesn’t produce good results if used too early (a newly flared up injury) but can be useful in chronic cases. Shockwave works really well for some cases but not for others. Ice  can work well for pain relief, but shouldn’t be overused – find a detailed guide here . Heat  is also an option as long as your injury is more than a week old – it’s generally not advised to use heat when there’s inflammation, which might be the case during the first week of tendon pain. TENS (transcutaneous electrical nerve stimulation) has been shown  to effectively reduce pain while the machine is on you, and the effect might last for a few hours after. Losing weight – Research shows  that carrying extra fat – particularly around the waist – can alter blood chemistry, trigger chronic inflammation, and make tendons less healthy and slower to heal. Tenex  may help to reduce pain and improve function by removing the injured part of the tendon and is less invasive than open surgery, but research  specific to high hamstring tendinopathy and long-term effects is still very limited. Treatments for specific cases of proximal hamstring tendinopathy   These treatments are not generally advised, because they might have unwanted side effects or are only effective under certain circumstances. However, used that at the correct time, they can be beneficial.   High-volume injections  consisting of normal saline (clean water) plus anaestetic and a small amount of corticosteroid appear safe and effective for pain relief in tendons. Hormone replacement therapy  (HRT) may improve healing if you’re in the menopause. Oestrogen is one of the main hormones in charge of getting your tendons to produce new and stronger collagen fibres (the main building block of a tendon). The drop in oestrogen levels due to the menopause has been shown to both cause tendonitis and delay healing. Anti-inflammatory medication  might be useful if you have ischial bursitis, inflammatory enthesopathy, or if your tendonitis was caused by antibiotics or an inflammatory condition like gout or arthritis. It is not effective for ongoing hamstring tendinopathy caused by overload and might interfere with your recovery if used for a long time. Anti-inflammatories usually don't really work for ongoing proximal hamstring tendinopathy. Corticosteroid injections  are a bit controversial – the  research  shows that they are very good at reducing pain in the short to medium term but might not be great for long-term recovery. However, some cases of proximal hamstring tendinopathy can be super stubborn and just don’t want to react to any other treatment. If that is the case, corticosteroid injections might be an option to try before considering surgery. Surgery  might be an option in cases of proximal hamstring tendinopathy where no other treatments bring relief. It is currently advised to consider surgery only if you’ve tried a progressive rehab plan (as described above) for at least 12 months. Surgery can be useful in some cases but is not guaranteed to work and should therefore only be considered if other treatments have failed. Useless treatments for proximal hamstring tendinopathy   These treatments are either a waste of time and money and/or might be bad for healing.   Therapeutic ultrasound  – this is a very popular treatment used in clinics and is generally safe to use, but its effectiveness is questionabl e. Animal studies  show it has the potential to positively affect tendon healing, but when tested on real patients and compared to other treatments, it usually fails  to show any benefit.   Corticosteroid tablets  – these should never be prescribed as a treatment for tendon injuries. They are different from injections in that they have a systemic and more long term effect and there is much stronger evidence  for the detrimental effects tablets might have on tendon health. BPC-157 peptides – Although there’s a lack of research into their safety and effectiveness in humans, these peptides are widely promoted online as being helpful for healing. We don’t recommend them, as they are experimental and their long-term safety is unknown. Ultrasound is a popular treatment used in clinics but doesn't appear to improve tendon healing. Treatments that might make your symptoms worse   These treatments irritate or worsen symptoms in most people with proximal hamstring tendinopathy. However, we are all different , and some people will find these treatments don’t affect them or perhaps even beneficial.   Hamstring stretches  – Any movement where you bend your trunk forward while keeping your legs straight will stretch your hamstrings. When you do this movement, it pulls the upper hamstring tendons tight over the sit-bones, which can irritate an injured tendon (a bit like prodding a bruise). I discuss hamstring stretching, as well as what to do instead here . Cross-friction massage  – With this type of massage, the therapist really digs into the upper hamstring tendons and strongly rubs over it, sometimes using massage tools. The thinking is that this stimulates healing, but there is no evidence to support this, and if your tendon is very irritated, it often just makes things worse.   Prolonged periods of rest  – Resting your tendon for short periods when needed is important. But long periods of rest with very little activity can actually make it feel more uncomfortable (due to reduced circulation) and cause your tendon to lose even more strength. Applying the concept of relative rest is much more effective in the long run.   Recovery times   The recovery time for most cases of proximal hamstring tendinopathy is typically between 3 and 6 months, but it’s not uncommon for it to take more than a year.   Every case is different, and recovery time is influenced by several things, including: How long you've had your symptoms – the longer you have pain, the more sensitised the pain system becomes and the longer it takes to get it to calm down again. Your  tendon’s stage of injury  – tendon injuries in Stage 1 (reactive tendinopathy) recover more quickly than ones in Stage 3. How effectively you can implement the correct balance  between rest and loading – sometimes one's work or daily tasks mean that you have to continue with things that irritate the tendon, which can make recovery take a bit longer. How well you’re addressing the “extra” factors  that can impact pain, e.g. stress and anxiety – these factors can sometimes cause pain to persist long after the tendon has already regained its capacity. 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 Naterstad, I. F., Joensen, J., Bjordal, J. M., Couppé, C., Lopes-Martins, R. A. B., & Stausholm, M. B. (2022). Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis of randomised controlled trials. BMJ Open, 12(9), e059479. Tripodi, N., Feehan, J., Husaric, M., Sidiroglou, F., & Apostolopoulos, V. (2021). The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. BMC Sports Science, Medicine and Rehabilitation, 13(1), 91. Nasser, A. M., Vicenzino, B., Grimaldi, A., Anderson, J., & Semciw, A. I. (2021). Proximal hamstring tendinopathy: a systematic review of interventions. International Journal of Sports Physical Therapy, 16(2), 288. Dizon, P., Jeanfavre, M., Leff, G., & Norton, R. (2023). Comparison of conservative interventions for proximal hamstring tendinopathy: A systematic review and recommendations for rehabilitation. Sports, 11(3), 53. Rau, O. R., Cheng, J., Jivanelli, B., Tenforde, A. S., & Wyss, J. F. (2025). Extracorporeal Shockwave Therapy for Tendinopathies Around the Hip and Pelvis: A Systematic Review. HSS Journal, 15563316251332189. Paley, C. A., et al. (2021) "Does TENS reduce the intensity of acute and chronic pain? A comprehensive appraisal of the characteristics and outcomes of 169 reviews and 49 meta-analyses" Medicina 57(10): 1060. Johnson, M. I., et al. (2022) "Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: A systematic review and meta-analysis of 381 studies (the meta-TENS study)" BMJ Open 12(2): e051073. Hassan, R., Poku, D., Miah, N., & Maffulli, N. (2024). High-volume injections in Achilles tendinopathy: a systematic review. British Medical Bulletin, 152(1), 35-47. Challoumas, D., et al. (2019). "Topical glyceryl trinitrate for the treatment of tendinopathies: a systematic review." British Journal of Sports Medicine 53(4): 251-262. Saltychev, M., et al. (2022). "Effectiveness of topical glyceryl trinitrate in treatment of tendinopathy–systematic review and meta-analysis." Disability and Rehabilitation 44(20): 5804-5810. Vajapey S, Ghenbot S, Baria MR, Magnussen RA, Vasileff WK. "Utility of Percutaneous Ultrasonic Tenotomy for Tendinopathies: A Systematic Review." Sports Health. 2021 May-Jun;13(3):258-264. Maag, Logan, Susan Linder, Loren Hackett, Matthew Mitchkash, Tyler Farley, Duncan Lamar, Nolan Fisher, and Ben Burnham. "Effectiveness of percutaneous needle tenotomy for tendinopathies: a systematic review." Sports Health 17, no. 4 (2025): 834-842.

Patients sometimes ask me “Will TB-500 help my injury to heal quicker?” and then I have to explain to them that it is not a clever idea to self-medicate with a horse-doping substance. So I decided to write this article to clarify what TB-500 is all about. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What is TB-500? What are the claims about TB-500? Research on about TB-500 and thymosin beta-4 Are TB-500 and thymosin beta-4 legal? Injured? We can help We've also made a video about this: 👉 We don't have total control over what ads are being shown on this page. If you see ads selling TB-500 here, follow the advice in this article and ignore them. What is TB-500? TB-500 is a lab-produced peptide. Peptides occur naturally in our bodies (and in those of other mammals) and have various functions. TB-500 mimics a section of the natural peptide thymosin beta-4 (TB4) , which is involved in producing growth hormones. These growth hormones, in turn, help with things like muscle growth and tissue repair. TB-500 was originally developed for veterinary purposes. Soon it was used to enhance the performance of race horses and was duly banned in the horse racing industry . What does TB-500 do? Nowadays, humans can buy TB-500 online to use on themselves. The people who sell TB-500 for human use claim that it enhances sports performance. The thinking is that it helps athletes’ muscles and tendons to recover quicker from training and that they can therefore get more training done without risking overtraining. The other claim, aimed at people who want to look ripped without much effort, is that it will give you bigger muscles and help you to lose fat. But are these claims valid? Research on TB-500 and thymosin beta-4 Medical purposes The research on thymosin beta-4 as a drug for medical purposes for humans has not gone beyond Phase 2 clinical trials . These trials have focused on treating people with dry eye syndrome (a condition that affects the cornea) and treating people with epidermolysis bullosa, a rare disease that causes tears and sores on the skin when it bumps or rubs against something. It should be noted that the thymosin beta-4 in these trials were applied externally to the problem areas, so it didn't affect other areas of the body. People using thymosin beta-4 and TB-500 on themselves, however, mostly take it as a nasal spray, powder, or an injection. A drug has to make it past Phase 3 clinical trials to be considered safe for humans and for approval by the USA’s Food and Drug Administration (FDA) and similar bodies elsewhere. There have also been studies on animals that suggest that thymosin beta-4 might be useful for repairing damage to the heart muscle, and it has been shown to have anti-inflammatory properties. So, given the state of research on thymosin beta-4, we don’t know yet whether it’s effective and, more importantly, whether it’s safe for humans to use. Sports performance Neither TB-500 nor thymosin beta-4 has been researched for their effect on any aspect of sports performance, as far as I could ascertain. However, scientists have been scratching their heads about how to detect TB-500 and thymosin beta-4 use in sportspeople. Which brings us neatly to our next topic. Are TB-500 and thymosin beta-4 legal? Thymosin beta-4 is registered with the FDA as a drug still undergoing clinical trials. So, it is not an approved drug in the USA (and elsewhere) and cannot be prescribed by medical doctors. TB-500, which has the same properties as thymosin beta-4 , is also not approved for use. TB-500 as well as thymosin beta-4 are banned by the World Anti-Doping Agency . Despite the lack of research, it is considered a performance-enhancing drug, likely due to what was observed in horse racing As far back as 2015, Australia’s Department of Health, in a submission to the Therapeutic Goods Administration  (the Aussie version of the FDA), pointed out how easy it was to get hold of TM-500 and thymosin beta-4. They expressed their concern about its misuse in sport, especially by “sub-elite athletes … due to the highly competitive nature of their events, the perceived advantage provided by these substances and the less stringent doping scrutiny to which they are subject.” In 2016, in a case that went all the way to the Court of Arbitration for Sport , in Switzerland, 32 players of the Australian Football League club Essendon were banned from the sport for two years after having used thymosin beta-4 as part of the sports supplements regime they were prescribed. And now, almost ten years later, not much has changed. The Internet is still awash with websites and YouTube, Instagram, and TikTok videos touting TB-500 as a safe and legal way of getting bigger muscles and losing fat. Regulatory bodies don’t seem to do much about it. A search for “TB-500” on the FDA’s website produced one result: It is a warning letter  written in June 2023 to the owner of a website that sold TB-500 (injections and nasal spray) as well as SARMs and other illegal drugs. My take on TB-500 We’re not horses. We don’t know whether it is safe to use in humans nor do we know the long-term effect it might have on your health. Like other banned substances, it might turn out to have detrimental effects on your kidneys, liver, or other organs. I would stick to proven treatments. Injured? We can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine 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 Court of Arbitration for Sport (2016) “World Anti-Doping Agency vs. Thomas Bellchambers et al., Australian Football League, Australian Sports Anti-Doping Authority" Emmie N.M. Ho et al. (2012) "Doping control analysis of TB-500, a synthetic version of an active region of thymosin β4, in equine urine and plasma by liquid chromatography–mass spectrometry” Journal of Chromatography A 1265: 57-69. McGill University (2023) “The Human Lab Rats Injecting Themselves with Peptides” National Library of Medicine (2015) “Safety and Efficacy of Thymosin Beta 4 Ophthalmic Solution in Patients With Dry Eye” Thevis M et al. (2024) “Annual banned-substance review 16th edition—Analytical approaches in human sports drug testing 2022/2023” Drug Test Anal. 16(1): 5-29. U.S. Food & Drug Administration (2023) “WARNING LETTER – Warrior Labz SARMS – MARCS-CMS 655280 – June 12, 2023”  World Anti-Doping Agency (2013) “Investigation of in vitro/ex vivo TB-500 metabolism, synthesis of relevant metabolites and detection limits in urine and plasma”

This article explains why a steroid injection for an injury should only be used in very specific circumstances. It also discusses the steroid injection side effects, such as the risk of rupturing your tendon, you should consider when deciding whether to have one. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: How does a steroid injection work? Sometimes used with local anaesthetic Short-term vs. long-term use Risk of tendon rupture Other negative steroid injection side effects A steroid injection is not a magic fix How we can help We’ve also made a video about this: How does a steroid injection work? A steroid injection consists of corticosteroid, which contains cortisone, which is a synthetically produced substance that mimics the effect of the cortisol that our bodies produce naturally in response to stress. It dampens down our immune response as well as our bodies’ inflammatory reaction to injuries. So, the cortisone is usually injected when an injury has resulted in inflammation that causes pain and maybe also some other issues. However, many musculoskeletal injuries are not very inflammatory, so the positive effects of cortisone on these conditions won’t be significant. Sometimes used with local anaesthetic Some steroid injections contain a local anaesthetic, which obviously also provides pain relief, but much quicker than the cortisone. So, if you get almost immediate pain relief after such an injection, it is a good indication that the injection was done in the right spot – where your pain is actually coming from. For example, if you get a steroid injection containing a local anaesthetic in the knee joint and the pain goes away almost instantly, then it is the joint that is causing your issue and not any of the structures around it. Short-term vs. long-term use For most injuries to heal, you need an inflammatory response; it’s part of your body’s process of getting rid of damaged or dead cells and replacing them with new ones. So, you don't want to dampen your inflammatory response if you can help it. However, sometimes the inflammation from an injury causes a patient so much pain that they can’t do their rehab exercises. This is where the sensible use of a steroid injection would provide them with sufficient short-term pain relief to get going with their exercises; and it’s those exercises that will get their injury better in the long run. The least sensible way to use steroid injections is to try and manage an injury in the long term. It will become clear from the side effects discussed below why long-term use is a no-no, and also why you should think twice about even its short-term use in certain instances. Risk of tendon rupture Most tendinopathies do not have a lot of inflammation, so for this reason alone a steroid injection won’t be of much use. But also, one of the side effects of cortisone is a risk of tendon rupture. It is a small risk, and it doesn’t affect everyone, but it’s there. So, it’s better to address things like the loads that the injured tendon is being subjected to and getting it stronger through exercise than to inject it with something that could potentially cause it to rupture. Steroid injections are not that good for tendons Other negative steroid injection side effects Corticosteroids are immunosuppressive, so you would not want to have it before you’re having a vaccine, for example, or when you are ill or have some sort of infection. You might not want to have the cortisone injection done if you’re on other medication that it's likely to interact with. For example, if you’re taking diabetic medicines, cortisone will cause your blood sugar levels to fluctuate for a while after. An injection obviously breaks the skin, so there's a small risk of infection. It's common to have a bit of redness and soreness after the injection, but if there’s a worsening redness and/or worsening pain after 24 hours, then obviously that is a sign that there's an infection that needs immediate medical treatment. Another possible side effect is fat atrophy. The skin has a layer of fat just beneath it, and sometimes a steroid injection can cause some of that fat to disappear, which will leave you with a little bit of a dent in the skin. It can also cause skin depigmentation, leaving you with a spot that is lighter than the rest of your skin. A steroid injection is not a magic fix I hope it is clear from the above that it’s not just a case of turning up at your GP and going, “Hey, I’ll have myself a steroid injection! Happy days!” You do need to think about why you would want to have the steroid injection. Is it to provide you short-term pain relief in order to do your rehab exercises, or are you expecting some miracle cure? Like I said, it can be really helpful for short-term pain relief to get you going with your rehab. And what you need to do then, is to get the right rehab plan so that you can benefit fully from the effects of the injection, using the injection as an adjunct to help you get better and not as a magic fix. If you've got, for example, a tendon issue, then you need to address the loading, the exercises, the strength of the tendon, and the activities that you're doing; you need to address all those things whether you have a steroid injection or not. 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 Steph is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports and Exercise Medicine. You can read more about her here , and she's also on LinkedIn . References: Coombes, B. K., et al. (2010). "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376(9754): 1751-1767. Del Valle Soto, M., et al. (2016). "Consensus on the use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine." Orchard, J. W. (2020). "Corticosteroid injections: glass half-full, half-empty or full then empty?" British Journal of Sports Medicine 54: 564-565.

PRP stands for platelet rich plasma. These types of injections have gained popularity over the last few years as a treatment option for a variety of musculoskeletal injuries / conditions including tendinopathies, muscle injuries and osteoarthritis. In this article, I’ll discuss how PRP injections work, what factors may affect how well they work and also what the research is showing with regards to what conditions they may be useful for. In this article: How they prepare the PRP solution Why PRP injections are used Factors that may affect how well they work What conditions do PRP injections work for? When should you consider having a PRP injection? How we can help I've also discussed it in this video: How they prepare the PRP solution They prepare the platelet rich plasma solution from your own blood. The blood is drawn and then spun at a high speed. By spinning it, you can separate the blood into it’s different parts. The layer of plasma that contains a high concentration of platelets is then drawn off and injected into the injury site. Why PRP injections are used Why do they do these injections? Platelets release lots of bioactive substances which include pro- and anti-inflammatory mediators as well as a variety of growth factors. Studies on animals have shown that through releasing these substances, high concentrations of platelets can decrease pain and stimulate healing – especially collagen growth. In short, they use PRP injections in the hope that it will kick-start the healing process for injuries where healing is slow or not really happening like for instance in tendinopathies and osteoarthritis. You may notice that I say “in the hope” that it will help – this is because things are never quite as simple and there appear to be quite a lot of factors that can affect how well PRP works. Factors that may affect how well they work How they prepare the PRP solution can cause a large variation in how many platelets the solution contains and also how well the platelets release their bioactive substances (like growth factors). It’s no use having a large number of platelets, but they’re not willing to release the stuff that are needed to get the healing process going. There are currently more than 16 types of machines available that can be used to prepare the PRP and they have all been shown to produce different concentrations of platelets. Some clinicians spin the solution once and others twice. There are also a variety of different substances that they can mix into the PRP to stimulate the platelets to release their bioactive substances. At this point in time, researchers don’t actually know what preparation method is the best. The interesting thing is that the PRP solution can also vary on different days, even if it is prepared in exactly the same way for the same patient. This is because the patient’s own health and nutrition can affect how many platelets they have in their blood, the quality of their platelets and how readily the platelets will release their growth factor and other substances. The following lifestyle factors have been shown to influence platelet quality and function in patients: Mental stress (like public speaking or doing a maths exam) and physical stress (like exercise) have been shown to cause platelets to release their bioactive substances. This means that if you’re subjected to either mental or physical stress before your blood is drawn, your platelets may already be depleted and won’t have much left to give to your injury site. Diets that are high in saturated fats, sugar, simple carbohydrates or that contain caffeine, quercetin (a flavonoid present in high levels in onions, apples, tea and wine) and isoflavones (present in chickpeas and soybeans) can affect your platelets. Alcohol and smoking aren't good Certain drugs can also affect your platelets of which the most commonly used include NSAIDS, antihistamines and antibiotics. If you're due to have a PRP injection, you may want to see if you can manage your stress and diet during the week leading up to your injection. For what conditions do PRP injections work? With all these factors capable of affecting the PRP solution's quality and effectivity, it’s no wonder that the current research is showing quite a lot of conflicting results. According to the most recent research, PRP appears to be a useful adjunct to treatment for the following conditions ( Reference 1 , Reference 2 , Reference 3 ): Greater Trochanteric Pain Syndrome, also referred to as Gluteal Tendinopathy Patellar tendinopathy Plantar Fasciitis Lateral Epicondylitis also known as Tennis Elbow Osteoarthritis of the knee There is currently some low level evidence that it may be useful for ( Reference 1 , Reference 2 ): Rotator Cuff Tendinopathy; Osteoarthritis of the hip ; Donor site pain in Anterior Cruciate Ligament (ACL) reconstruction with Patellar Tendon Autograft; High Ankle Sprains. PRP is currently not being recommended for the following conditions ( Reference 1 , Reference 2 ): Achilles tendinopathy Acute fracture or non-union Surgical augmentation with PRP in Rotator Cuff Repair, Achilles Tendon Repair and ACL reconstruction. When should you consider having a PRP injection? PRP is by no means a magic cure and I think this is partly down to the fact that we just don’t yet know how to prepare the best possible PRP solution with the most active platelets. I suspect that PRP procedures will still improve a lot over the next few years and may even become useful for conditions like Achilles tendinopathy. Currently I would advise patients to first try at least 12 weeks of a progressive rehab programme before they consider any other interventions. Rehab exercises have been shown to be very effective for the treatment of tendinopathies etc., but it has to be tailored to your specific injury and your specific ability. Doing the same exercises at the same level for 12 weeks does not count as rehab! How 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. 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 , Facebook , Twitter , and Instagram . References Kuffler, D. P. (2019). "Variables affecting the potential efficacy of PRP in providing chronic pain relief." Journal of pain research 12: 109. Le, A. D., et al. (2018). "Current clinical recommendations for use of platelet-rich plasma." Current Reviews in Musculoskeletal Medicine 11(4): 624-634. Le, A. D., et al. (2019). "Platelet-rich plasma." Clinics in sports medicine 38(1): 17-44. Lin, M.-T., et al. (2018). "Meta-analysis comparing autologous blood-derived products (including platelet-rich plasma) injection versus placebo in patients with Achilles tendinopathy." Arthroscopy: The Journal of Arthroscopic & Related Surgery 34(6): 1966-1975. e1965. Oderuth, E. (2018). "The use of platelet-rich plasma in the treatment of greater trochanteric pain syndrome: a systematic literature review."

It is quite common for injuries to flare up during their rehab, especially tendon injuries like patellar tendonitis or Achilles tendonitis . And it’s natural to then worry about whether you’ve made your injury worse and how far you’ve set back your rehab programme. In this article, I explain why injury flare-ups happen, why it does not necessarily mean that your injury is now worse, and how to get your rehab back on track after a flare-up. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: Why do injury flare-ups happen? Have I made my injury worse? What to do about a flare-up How we can help We’ve also made a video about this: Why do injury flare-ups happen? With an injury flare-up, it’s always useful to try and get to the bottom of why it happened. It will tell you how to avoid it in future. It can also tell you where there might have been a gap in your rehab. Where have you not done enough work? Exercise or activity that your injured part wasn’t yet strong enough to handle Whenever you're injured, the injured part (e.g. a muscle or tendon) is weakened and doesn’t have the strength to cope with all the load that you put through it when you do your normal sport or other activities. Its capacity increases gradually as you progress your strength training as part of your rehab, but sometimes we misjudge things. It can be too much weight or intensity, but also volume or duration or frequency A flare-up happens whenever you progress your rehab exercises too quickly. It can be the total volume of exercise and/or the intensity of one or more exercises, such as the number of repetitions, the duration, or the weights. It can also be due to the type of activity you did. For example, you could have been doing slow repetitions of an exercise, but now you’ve changed to doing quick, explosive movements. Doing your exercises too often can also cause trouble. Your body requires time to rest and recover and adapt after each training session. If you do your rehab exercises before your body has fully recovered from your previous session, it can cause a flare-up. Example of a flare-up and what could have gone wrong This article and its accompanying video were inspired by a question that someone posted on our YouTube Channel . He’s a basketball player with patellar tendinopathy , i.e. a tendinitis or tendinosis in the patellar tendon, which is at the front of the knee. In this case, he had it in both tendons. He wrote that he was able to do really good squats with weights as part of his rehab programme. So, he decided 'to try my luck' by once again playing the sport that he loves, basketball. He felt OK during play, but several hours later his injury became more painful than before, to the extent that the rehab exercises that he could previously do without any problems were now causing him pain. (Before we go any further, it must be noted that I didn’t have a consultation with this person, so the analysis that follows is based only on the information at my disposal. It could be that there is other relevant information of which I'm not aware.) So, where might he have gone wrong? It may be that the weights he used for his squats were not heavy enough yet. When we jump, it sends forces of up to six times our body weight through our legs. So, you have to do quite a significant amount of squat weight to prepare your tendons for that. It may be that he has not yet built explosive strength through plyometric training. Doing slow squats with weights is different from loading the tendons quickly under force, as you would do when you jump while playing basketball. The faster you load a tendon, the higher the forces. From what our basketball player wrote, I'm not sure that he did any plyometric training before he went back to playing. It may be that the volume and intensity of play was simply too much. Maybe his tendons were able to cope with, say, ten minutes worth of playing basketball, but not yet an hour. Also, it is better to ease back into full-on sport with gentle sessions at first. It could be that this person immediately went into top-gear basketball, with the jostling and jumping that it entails. Lastly, it is important to understand that tendons usually take longer than expected to heal. A tendon can take up to 12 weeks just to get back to base-level strength, and this is before you even get to stuff like plyometrics. If you've had the tendon injury for longer than a year, it may take a year or longer to fully rehab it again. Have I made my injury worse? The big questions for our basketball player are how to know how much damage he did to his injured tendons and how far this has set back his rehab. When you’ve had a flare-up, it’s natural to think, ‘Oh man! Now I've made it worse, and it's going to take longer to recover!’ I’ve been there myself. A flare-up doesn’t always mean you’ve made your injury worse It’s counterintuitive, but the amount of pain you experience is not directly correlated to the severity of your injury. We used to think that the more painful an injury is, the more severe it should be. But then we started getting fancy machines like MRI scanners, which showed us that it is not quite that simple. What we saw was that some people with severe injuries have very little pain, while others with very little tissue damage are in a lot of pain. This made us realize that pain is just the alarm system of the body, and it's affected by many factors. One of these is, at a subconscious level, how dangerous the body perceives the situation to be. If it perceives it to be very dangerous, it increases the amount of pain. Therefore, your thoughts, feelings, and fears about the flare-up can feed into this and make your pain feel worse. So, if there's only a bit of aggravation of the injury but your mind goes, ‘Oh man! I've made this worse! This is going to take forever!’, immediately it feels worse because your subconscious then goes, ‘Oh, this is a bad injury! These are bad circumstances!’ If, however, you tell yourself, ‘Ah, stop worrying! I know the activity I did wasn't that much; I've just irritated it again. It will calm down a few days from now,’ you'll be surprised how much less painful it can feel. How to gauge whether you've aggravated your injury Ask yourself how much more intense the aggravating activity was than the activities you've been doing in the last four weeks. The volume and intensity of the activities you've been able to do pain-free previously are an indication of how strong the injured body part was before the flare-up. If the flare-up activity was just a little bit harder than what you’ve been doing before, it's very likely that you haven't made your injury worse; you've just flared up the pain signals that tell you it’s a bit more sensitive now. However, if you did do a session that was a lot harder than what you’re used to, for example, going from no jumping at all to an hour's worth of being really active and jumping, you may have made it a bit worse. But if it was only one session, there won't be that much more structural damage. It would rather be a case of the injury having become a lot more sensitive. There’s one exception to this guideline. If you feel a sharp, sudden pain while you were doing the activity and then your pain increases afterwards, it may mean that you've torn something. If that's the case, you definitely need to get it looked at. What to do about a flare-up Do not try and train through it Initially, you should treat the flare-up like an acute injury, even if you’ve come to the conclusion that you haven’t made it much worse. If you don’t force it to work into pain during the first few days, it will calm down much quicker. It should only take a week or two and you'll be back to your normal rehab routine from before you had the flare-up. Do what you can to reduce the pain Secondly, use everything you found useful previously to calm the pain. Applying ice to the painful area usually helps. Don’t use the ice for more than ten minutes at a time, and take ten-minute breaks in between, otherwise you might damage your skin. See whether you can somehow take the strain off the injured body part. For example, injured Achilles tendons take less strain if you wear shoes with a bit of a heel or if you use heel-raising inserts in your shoes . Often, a bit of movement that does not cause pain can be useful for pain management, so try and find low-intensity, pain-free activities. Using the Achilles tendon as an example again, it may like low-load calf raises. The basketball player's knees may like him to actually do some isometric squats or go for a little bit of a walk or an easy cycle ride or rather than keeping them still all day long. Reduce your rehab intensity and increase it from there Once that flare-up pain has calmed down after two or three days, take a look at your pre-flare-up exercises and then halve them. If you were using 20 kg with your squats, try 10 kg. And if you want to be more conservative, there’s nothing wrong with starting at 5 kg. Just do a gentle set and fewer repetitions than before. If this feels absolutely fine, wait to check the 24-hour response – you should not have more pain than before you did the previous day’s exercises. Tendons especially are sneaky things that don’t tell you during an activity that you’re asking too much of them; they wait until the next day before they complain. If there are no issues, you can increase the weight and reps quite significantly for the next training session, because we know that just a few days back, before the flare-up, you had the strength to deal with 20 kg. So, if you were doing 5 kg, try 10 kg for this session and check your response again. If it's not quite OK, then this can be your new limit for now. It's really important to start easier rather than harder and then increase it from there. If you start too hard, you're just going to annoy the flared-up injury further, and then you’ll have to wait even longer for it to calm down. In summary: It doesn't necessarily mean that you've made your injury worse if you have a flare-up; flare-ups are really common. Try and figure out why the flare-up happened and what part of your rehab wasn't adequate. And then, treat it aggressively by trying to calm it down, not overdoing it, and then slowly increasing your rehab. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References: Hanlon, S. L., et al. (2021). "Beyond the Diagnosis: Using Patient Characteristics and Domains of Tendon Health to Identify Latent Subgroups of Achilles Tendinopathy." J Orthop Sports Phys Ther 51(9): 440-448.

Increased neural tension in the sciatic nerve can cause pain along the back and outside of your legs and feet, but it may also predispose you to getting injuries like calf strains , hamstring strains, and Achilles tendinopathy . In this article, we explain what neural tension is, what causes it, how to test for increased neural tension in your sciatic nerve, and what exercises or treatments may help. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What is neural tension or increased neural tension? Where is the sciatic nerve? Causes of neural tension Symptoms indicating increased neural tension in the sciatic nerve Test for sciatic nerve tension Neural tension treatment - Common mistakes Exercises for increased sciatic neural tension How we can help Please note that this article is not about sciatica , which is a different condition. We've also made a video about this: What is neural tension or increased neural tension? Our nervous system consists of our brain, spinal cord, and the nerves that run into all parts of the body, all the way to the tips of our toes and fingers. When we move, our spinal cord and nerves are meant to slide and glide. Neural tension (or increased neural tension) is when a nerve is prevented from sliding (we’ll discuss what causes this lower down) and is stretched instead. Nerves don’t like being stretched; when this happens, they can cause pain or funny sensations or simply not perform their job very well. Where is the sciatic nerve? Our spinal cord is housed within the spinal canal, which is formed by our vertebrae that are stacked on top of each other, forming the backbone. There’s a disc made of strong cartilage between the vertebrae and also small openings to the sides (where the vertebrae rest on each other) where the spinal nerves branch out from the spinal cord. These spinal nerves then combine and fuse to become the nerves that run into the various parts of our body. By Debivort: Anatomy of the spine - https://commons.wikimedia.org/wiki/File:ACDF_oblique_blank.png#/media/File:ACDF_oblique_blank.png The sciatic nerve is formed by the spinal nerves that exit right at the lower part of the back as well as from the sacrum (L4 to S3 spinal nerves). It’s quite thick, as nerves go – about as thick as your thumb. The sciatic nerve is formed by you lower spinal nerves (L4 to S3). It runs through the buttock area, either underneath or through the piriformis muscle, and very close to the hamstrings along the back of the thigh. It splits at the back of the knee to form the tibial and common fibular (also called peroneal) nerves. These nerves then further split into several branches that serve the back, sides, and front of the lower leg and foot. Causes of neural tension Our spinal cord and nerves slide through openings in our bones, past our joints, in between our muscles, and often over or close to our tendons. Various injuries or circumstances can cause them to get a bit stuck at any of these points: The most common cause is simply having tight muscles and fasciae, which then don’t allow the nerves to slide freely. This can happen due to spending long periods of time in the same position or repeating the same movement. It can also happen if you train very hard without doing any mobility work. An injury to the nerve itself will cause it to swell and generally not tolerate much tension. Disc bulges or injuries in the back can press directly on the nerve, or swelling around the injury can increase the pressure on the nerve. If our bones change shape, e.g. the openings in the vertebrae narrow, or perhaps you get a little bone spur (osteophyte), e.g. on your knee joint, that irritates the nerve. The swelling and muscle tension caused by acute injuries like muscle tears or sprains can cause a temporary increase in pressure on the nerve. This is normal and usually resolves by itself if you follow the correct treatment regime for the injury. Scar tissue or adhesions that form in reaction to other injuries, e.g. between the hamstrings and the sciatic nerve when you have high hamstring tendinopathy , can attach to a nerve and prevent it from sliding freely. This often happens in chronic injuries where someone is trying to ignore the injury and train through it, or they just rest it and don’t do any exercises to train and remodel the scar tissue. Doing the correct strength training exercises not only strengthens the area but also prevents adhesions and helps the scar tissue to form in a functional way. Symptoms indicating increased neural tension in the sciatic nerve None. You can have increased neural tension without it causing any symptoms. It only becomes a problem when you try and move your body into positions that actually require the nerve to slide. Feeling of tightness or discomfort, e.g. calf or hamstring tightness that doesn’t want to resolve. Referred pain (sharp, dull, or burning). Nerves often cause pain quite far away from the actual problem. Strange sensations like tingling, pins and needles, or reduced sensitivity. Suffering repetitive calf or hamstring injuries without any clear cause. These symptoms can be felt anywhere along the line of where the sciatic nerve and its branches run. The symptoms are often mistaken for other injuries, e.g. the fibular nerve can cause pain in the area where it wraps around the head of the fibula, which is often misdiagnosed as IT band syndrome or lower hamstring tendonitis . Test for sciatic nerve tension To test if the sciatic nerve is free to slide, we want to tension it all the way from the spinal cord to the toes. The simplest test is the slump test. There are many variations that a therapist can use to further pinpoint the problem, but I find that the standard test is good enough in most cases. There is no perfect test score or gold standard that has been identified in research. The test can highlight large decreases in range of movement and differences between your left and right side, but the results should always be interpreted in combination with your other signs and symptoms. This is how I do the slump test This method is not appropriate for back injuries. Do not force any movements through pain – it will just make things worse. Step 1: Sit on a sturdy chair (like a dining room chair) with your back straight and your thighs fully supported. Step 2: Place your hands behind your back. Step 3: Now slump forward slowly by placing your chin on your chest, then bending your upper back, and then your lower back. What I’m looking for: At this point, I would be looking if my patient can get a nice rounding of the spine. If you notice that you struggle to keep your neck flexed when you bend the rest of your spine, or that your upper back remains straight rather than curved, it might indicate that you would benefit from mobility exercises for your back. Step 4: Maintain this slumped position and slowly straighten one leg as far as possible while pointing your toes like a ballet dancer (plantar flexion). Observe how stiff your leg is (how far straight or not your knee can go) and whether you feel any pulling or pain in your leg, buttock, or back. If you are able to fully straighten your leg without much pulling or pain, go to Step 6. If you aren’t able to get your leg straight and/or feel significant pulling or discomfort in your leg, buttock, or back, go to Step 5. Step 5: Maintain the position with your leg as straight as possible and slowly raise your head to look at the ceiling. Try not to move your back too much. Does this allow your leg to go straighter or decrease the amount of pulling you feel? If yes, it’s a sign that you have some increased neural tension in that leg. Stop the test for this leg. Repeat it with the other leg for comparison. If looking up doesn’t change anything, it’s a sign that the tightness, pulling, or discomfort is likely NOT caused by neural tension but rather by tight muscles. Move on to Step 6. Step 6: Lower your leg to the floor. Make sure your chin is still on your chest and your spine still rounded. Now flex your foot and ankle up into dorsiflexion (so your toes move toward your shin). Maintain that position and straighten your leg out again. Once again, observe what you feel in your leg, buttock, and back and how straight your leg can go. Test whether looking up changes anything for you (like in Step 5). If looking up changes things, it’s a sign that you have some increased neural tension in that leg. If it doesn’t change anything, it’s a sign that the tightness, pulling, or discomfort is likely NOT caused by neural tension but rather by tight muscles. Step 7: Do the test from Step 1 with the other leg for comparison. Neural tension treatment - Common mistakes Trying to stretch or slide the nerve when it is still stuck It is really important to identify the most likely cause of your increased neural tension before jumping straight into doing exercises. For example, if your neural tension is secondary to an acute disc injury or muscle tear that is causing increased swelling and pressure in that area, you should first target your treatment at those injuries. In most cases, doing the correct exercises for your back or muscle injury will also help to resolve the neural tension, and no further intervention will be needed. You don’t need any special scans for this; an experienced sports physiotherapist will be able to identify the cause by listening to how your injury started, what your current signs and symptoms are, and getting you to do a variety of movement tests. These test can even be done via video call, and we use them regularly in our assessments. Overstretching You don’t need to be super flexible, and you can really aggravate your nerves by overstretching and pushing too hard. It is absolutely normal and expected to have some level of increased neural tension; this often varies depending on the time of day or the activities you’ve just done (e.g. sitting still vs. moving around). It is also normal for your right and left sides to not be exactly the same. When we do the slump test, we look for significant differences and whether it recreates symptoms that feel similar or are located in the area of your injury. Slight differences can often be ignored. Exercises for increased sciatic neural tension Whom these exercises might benefit: These are usually appropriate for people who are in the mid to later stages of rehab for acute injuries or have neural tension due to a more chronic cause. But this still doesn’t mean that these exercises are necessarily right for you, so discuss it with your physio before trying any of them. This exercise routine is NOT appropriate for anyone: With a recent or acute injury. Who has something pressing directly on the nerve, e.g. disc bulge, spinal stenosis, narrowing of the openings where the spinal nerves exit, etc. Neural tension exercise routine I usually introduce the exercises in stages, e.g. in the first few weeks we may work on getting good mobility in the spine and around the pelvis and see how that improves things. Then we slowly work towards movements that specifically tension the nerve. How quickly we progress and what we do will always depend on what I found when I assessed my patient. I advise doing these exercises in the following sequence, because it allows you to first loosen off the parts that could potentially hold on to the nerve before you then ask it to slide. This way, it is more likely to move without restriction. Standing calf stretch Roll-down Arm opener Piriformis stretch Figure 4 stretch Supine knee extension Straight-leg plantar flexion / dorsiflexion Seated slump slider I may ask some patients to do this daily, and others will only have to do it two or three times per week. Standing calf stretch Stride stand with the leg to be stretched at the back. Your toes must point straight forward. Keep the heel of your back foot on the floor and that leg straight at all times. Slowly bend the knee of your front leg until you feel a stretch in the calf of your back leg. Hold the position for 30 seconds. Switch legs and repeat on the other side. Do twice with each leg. Roll-down Breathe normally throughout the movement. Stand with your feet hip distance apart and your knees slightly bent. Your knees must remain bent throughout the movement to reduce the tension on your sciatic nerve. Tuck your chin into a double-chin and then drop it all the way onto your chest. Curl your spine down, starting from the top, until you’re hanging from your hips. Allow your arms to hang loosely as you bend forward. While in this position, wiggle your buttocks a few times from side-to-side and feel your neck and spine relax. Take a nice deep breath and let it all out – feel how this further relaxes everything. Reverse the movement by pulling in your stomach muscles and gently curling back up, starting from your lower back and ending with your neck until you’re upright. Do 3 repetitions. Arm opener Lie on your side with your hips and knees bent to 90 degrees and your arms straight out in front of you, palms facing each other. Lift your top arm up to the ceiling and follow it with your head as you drop it behind you. This should cause your upper body to rotate, but your hips should not roll back. Only move to your natural restriction. Don’t try and cheat to go further by letting your arm drop towards your feet – your hand should be in line with your shoulders or higher up as you move. You will likely feel the main stretch over the front of your chest or in the middle of your upper back. Take a deep breath and drop your arm further down behind you as you breathe out. Now rotate back to the starting position. Do 3 times, then switch sides. Piriformis stretch Lie on your back with your legs bent and cross your right leg over your left leg. Place your right hand on your right knee and your left hand on your right shin. Pull with both hands so that your right knee moves diagonally towards your left shoulder. You should feel a stretch in your right buttock. Make sure that your knee moves across your body (not straight up) and check that you also pull with the hand that is on the shin – this twists the hip and increases the stretch. Hold the position for up to 30 seconds. Do twice with each leg. Figure 4 stretch Lie on your back with your legs bent. Place a pillow under your head if you struggle to keep your neck and upper back flat on the floor. Place the outside of your right ankle on your left thigh, just above the knee. Hook both hands behind your left thigh and pull it towards your chest. You should feel the stretch in your right buttock, thigh, or lower back, depending on which part is the tightest. Hold the position for up to 30 seconds. Do twice with each leg. Supine knee extension Lie on your back with your legs straight. Bend your left leg up so that your thigh is perpendicular to the floor and your knee is pointing at the ceiling. Hold your thigh with your hands, but be careful not to pull it too far towards you. Keep your foot POINTED away from you (plantar flexed, like a ballet dancer) throughout the exercise. Slowly straighten your leg until you feel a gentle stretch – it doesn’t matter if it can’t go fully straight. Pause for a moment and then bend your leg again (your thigh should remain perpendicular to the floor). Do this 12 times, then switch legs. Do 1 or 2 sets per leg. Straight-leg plantar flexion / dorsiflexion Lie on your back with your legs straight. Bend your left leg up so that your thigh is perpendicular to the floor, then straighten your leg to where you can and hold it there. Slowly bend your ankle back into dorsiflexion (toes move towards your shin) until you feel a gentle stretch in your calf. Hold that position for 2 seconds. Point your toes away from you, so that your ankle moves into plantar flexion. Hold that position for 2 seconds. Do this 12 times, then switch legs. Do 1 or 2 sets per leg. Seated slump sliders The aim here is to slide your sciatic nerve, NOT to stretch it. So, you alternate between tensioning it at the top (neck and back), which causes the sciatic nerve to slide up, and then transferring the tension to the legs while releasing it at the top, causing it to slide down. Sit on a sturdy chair with your back straight, your thighs fully supported, and your feet resting on the floor. Place your hands behind our back, your chin on your chest, and flex your spine (slump position like in the test above). This tensions the nervous system at the top. Slowly straighten one leg out in front of you (tensioning the sciatic nerve in the leg) and at the same time lift your head up to look at the ceiling (releasing tension at the top). This causes the sciatic nerve to slide down. Lower your leg (releasing the tension in the leg) while at the same time placing your chin back on your chest (so tensioning at the top, causing the nerve to slide up). Repeat 6 times per leg. 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: Majlesi, J., Togay, H., Ünalan, H., & Toprak, S. (2008). The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. JCR: Journal of Clinical Rheumatology , 14 (2), 87-91. Coppieters MW & Butler D. (2008). Do "sliders" slide and "tensioners" tension? An Analysis of Neurodynamic Techniques and Considerations Regarding Their Application. Manual Therapy 2008 13(3): 213-221. Web. 26 October 2013.

I really struggled to keep a straight face when I heard that one of our patients had had a “salmon sperm” injection for their tendonitis. But then I became curious and had a look at the research, and it turns out that it is actually a promising treatment – called polydeoxyribonucleotide (PDRN) therapy in medical circles. Here’s the state of play with regards to PDRN injections and tendon injuries. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. In this article: Where does the salmon sperm come from? Proven uses of PDRN What about PDRN for tendon injuries and plantar fasciitis? Is a PDRN injection safe? Our recommendation How we can help Where does the salmon sperm come from? OK, I’ll be honest – one of the first questions that popped into my head when I heard about this was, “How do they collect the salmon sperm?” It turns out that the process is reassuringly simple and clean. Polydeoxyribonucleotide (PDRN) therapy uses DNA extracted from the sperm of farmed salmon (usually chum salmon or salmon trout) that are killed anyway for food.   💡 The sperm is purified and sterilized to isolate DNA fragments while removing proteins or peptides that could trigger immune reactions. The result is a clear, DNA-rich solution, so nobody is being injected with actual salmon sperm.   When injected, these DNA fragments are thought to stimulate tissue repair. Scientists believe PDRN works by activating the body’s cellular healing pathways – for example, it interacts with specific receptors that increase blood flow and growth factors at the injury site, helping tissues regenerate more effectively.   In short, a “salmon sperm” injection is believed to be a regenerative shot packed with DNA, aimed at kick-starting recovery in injured or damaged tissues. But does it actually work? 🤷‍♀️ Proven uses of PDRN   PDRN injections have been studied and successfully used in several medical areas. In wound care especially, PDRN has been shown to help tissue regenerate when standard treatments alone weren’t enough. Chronic wound healing  (e.g. diabetic foot ulcers). Peripheral circulation problems : PDRN has been used to improve blood flow in areas where circulation is poor, helping damaged tissue heal. Skin rejuvenation in dermatology : PDRN has made a splash in the cosmetic world as the so-called “salmon DNA” skin treatment. Doctors inject it into the skin to improve hydration, elasticity, and texture – in clinical and “beauty treatment” situations.   Its success in these domains is what led researchers to ask: could the same PDRN injections help repair injured tendons, ligaments, or other musculoskeletal tissues?   What about PDRN for tendon injuries and plantar fasciitis?   Tendon and plantar fascia injuries – from acute tears to chronic tendinopathies – are notoriously stubborn to heal. Traditional care like physiotherapy, eccentric exercise, or shockwave therapy can help, but often the recovery is slow and incomplete. This is where the salmon-sperm-derived PDRN injections have sparked interest.   Over the last few years, a number of studies on animals and humans have tested PDRN for tendon and plantar fascia injuries.   Tendon injuries PDRN has been tested on various tendon issues – and although studies are still relatively small, the results have been promising. Two   reviews of the available research have shown reduced pain and improved function in patients with common tendon ailments who received PDRN injections. These include: Achilles tendinopathy and tears :  In animal experiments, PDRN injections sped up healing of a ruptured Achilles tendon – reducing inflammation and improving the quality of new tendon tissue. On the human side, case series have noted pain reduction in chronic Achilles tendinopathy after a course of PDRN shots. Tennis elbow (lateral epicondylitis) :  Small studies indicate PDRN might help this chronic elbow tendon pain. Patients with epicondylitis experienced significant pain relief after PDRN injections, similar to improvements seen with platelet-rich plasma in some cases. Rotator cuff tendinopathy:  One pilot study reported that PDRN injected into the shoulder joint led to “remarkable pain reduction and functional recovery” in people with rotator cuff tendinopathy. Pain scores dropped substantially over a few weeks, and shoulder movement improved. Pes anserine tendinopathy/bursitis:  The pes anserine (inner part of the knee) is another site of tendon-related pain often seen in runners or people with arthritis. PDRN has been tried here too, with reports of symptom improvement. 👉 This all sounds positive on the surface, but it’s important to point out that all of these studies were quite small and not of very high quality. Plantar fasciitis This painful heel condition  has been a key focus. One randomized trial  in chronic plantar fasciitis found that PDRN injections provided significantly more pain relief after twelve weeks than for people who were injected with a placebo (fake) substance. 💡 This study is of better quality than the tendon research mentioned earlier, so it carries a bit more weight in my opinion. However, even though it suggests that PDRN might be a viable option for persistent plantar fasciitis, we need several studies to confirm these results to know that they are actually legit. I designed the rehab plans in the Exakt app. Use my name to claim your discount: MARYKE 🙌 Is a PDRN injection safe? One of the appealing aspects of PDRN therapy is that it appears to be quite safe and well-tolerated . In the clinical studies  on tendon and plantar fascia injuries, no serious adverse effects have been reported. Unlike some medications, PDRN doesn’t provoke systemic side effects like stomach upset or elevated blood sugar, because it works locally at the injection site (and the injected DNA fragments are eventually broken down naturally by the body).   Of course, with any injection, there are general risks: slight pain, redness, or bruising at the needle site, and a very small risk of infection. Our recommendation   So, should you try a salmon sperm (PDRN) injection for your tendon or plantar fascia injury?   Our stance is one of cautious optimism. The science so far is encouraging – these injections could potentially speed up healing in stubborn tendon injuries or plantar fasciitis where other treatments haven’t fully worked.   That said, the research is still in early stages. We do not  yet have large clinical trials proving that PDRN injections are the magic bullet for tendon tears or chronic tendinopathy. These injections are also not cheap – a course can add up to £500+ in total.   💡 Therefore, we do not currently recommend PDRN injections as a first-line treatment  for tendon or plantar fascia problems. If you have a chronic injury that isn’t improving despite doing all the right things, and you’ve consulted with a specialist who has experience with PDRN, it could be something to consider – but with managed expectations . Essentially, you’d be volunteering to try a novel therapy that might help or might do nothing, and will cost you out of pocket.   For most patients, the foundation of recovery should remain the proven therapies which consists of a structured plan combining: An appropriate amount of rest, exercises that progressively load and restore the tendon or plantar fascia’s strength and endurance,  and, depending on the specific case, adjuncts like specific shoes or insoles or shockwave therapy. 👉 We have written detailed articles discussing the best research-based treatments for these injuries which you can find by selecting the relevant topic on this page . 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 Luo S, Huang S, Li S, et al. Review of preclinical and clinical studies supporting the role of polydeoxyribonucleotide (PDRN) in the treatment of tendon disorders . Med Sci Monit. 2025;31:e945743. Bizzoca D, Brunetti G, Moretti L, Piazzolla A, Vicenti G, Moretti FL, Solarino G, Moretti B. Polydeoxyribonucleotide in the Treatment of Tendon Disorders, from Basic Science to Clinical Practice: A Systematic Review . International Journal of Molecular Sciences. 2023; 24(5):4582. Squadrito F, Bitto A, Irrera N, et al. Pharmacological activity and clinical use of PDRN . Front Pharmacol. 2017;8:224. Nam T, Lyu J, Kang Y, et al. Polydeoxynucleotide (PDRN) pharmacopuncture for musculoskeletal disorders: a scoping review of treatment protocols and clinical efficacy . Innov Acupunct Med. 2025;18(1):19. Kim JK, Chung JY. Effectiveness of polydeoxyribonucleotide injection versus normal saline injection for treatment of chronic plantar fasciitis: a prospective randomised clinical trial. International Orthopaedics. 2015;39(7):1329–1334. Dong-Oh Lee, Jeong-Hyun Yoo, Hyung-In Cho, Soonghwan Cho, Hyung Rae Cho. Comparing effectiveness of polydeoxyribonucleotide injection and corticosteroid injection in plantar fasciitis treatment: A prospective randomized clinical study.  Foot and Ankle Surgery, 2020;26(6):657-661. Lee KWA, Chan KWL, Lee A, et al. Polynucleotides in Aesthetic Medicine: A Review of Current Practices and Perceived Effectiveness . Int J Mol Sci. 2024;25(15):8224. Published 2024 Jul 27. Nam, T., Lyu, J., Kang, Y. et al.  Polydeoxynucleotide (PDRN) Pharmacopuncture for Musculoskeletal Disorders: A Scoping Review of Treatment Protocols and Clinical Efficacy.  Innov. Acupunct. Med .  18, 19 (2025). Domenica Altavilla, Alessandra Bitto, Francesca Polito, Herbert Marini, Letteria Minutoli, Vincenzo Di Stefano, Natasha Irrera, Giulia Cattarini, Francesco Squadrito.  Polydeoxyribonucleotide (PDRN): A Safe Approach to Induce Therapeutic Angiogenesis in Peripheral Artery Occlusive Disease and in Diabetic Foot Ulcers . Cardiovascular & Hematological Agents in Medicinal Chemistry. (2009);7(4): 313-321.

Explore evidence‑based options for tennis elbow pain relief – wrist splints, counter‑force straps, and compression sleeves, with advice on when to use or stop using each brace for optimal recovery. 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.

Walking on a sprained ankle is actually good for its recovery if you go about it the right way and give it the necessary support. However, walking on a sprained ankle can make it worse if you limp on regardless of the pain signals and other symptoms that tell you you’re overdoing it. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. Some of the links in this article are to pages where you can buy products discussed or mentioned here. We might earn a small commission on sales at no extra cost to you. In this article: Getting the balance right When to start walking on a sprained ankle Crutches Ankle brace Supportive shoes Taking the final step – walking for exercise How we can help We’ve also made a video about this: This article is about ankle sprains involving the lateral (outer) and medial (inner) ankle ligaments. High ankle sprains require a different type of treatment. Getting the balance right Unlike our muscles, our joints (such as the ankle) don’t have arteries and veins going into and out of them to supply nutrients and remove bad stuff. Synovial fluid fulfils this function in our joints, but it needs the joint to move to be able to flow around the joint to do its work. So, walking on the sprained ankle is a good way to get it moving to enable the synovial fluid to play its part in the healing process, but obviously this shouldn’t make your injury worse; the trick is to get the balance right. Also, the research indicates that the quicker you can get to the point where you start to put some weight on your sprained ankle, the better your recovery will be. Of course, this has to be done within the limits of pain; it doesn't mean “push through pain at all costs”. This principle also applies to the general rehab of your injured ankle, which should go hand-in-hand with your attempts to get walking again. (Read more about the treatment of ankle sprains .) It’s all about how much walking and standing you can do without increasing your current pain and discomfort in the moment and in the subsequent 24 hours. Injuries often don’t complain while you’re overdoing something, but then they flare up hours later or even the next morning. So, whenever you’ve been walking inside or outside the house on your sprained ankle, with or without support, remember to check that your ankle isn’t more sore and/or swollen up to 24 hours afterwards. If it is, you’ve been overdoing it and should scale back on your walking for the time being. When to start walking on a sprained ankle You should be able to walk short distances inside the house, without discomfort, before going out for longer walks, whether it’s for errands or for exercise. It’s okay to be aware of your recovering ankle, but your gait pattern should be relatively normal – rolling forwards over your foot as you walk – whether you’re walking with or without support. Below, I will discuss various ways to support your ankle, whether it’s inside the house while your ankle is still painful and swollen, or out and about when you’re walking longer distances and may encounter more challenging situations such as uneven terrain or getting jostled in crowds. In severe cases, you will probably have to start off with crutches, an ankle brace, and supportive shoes. As your sprained ankle heals and you can walk with a normal gait pattern, you should be able to ditch the crutches, the ankle brace, and then the shoes, in that order. With a mild sprain, you may get away with starting without crutches or even an ankle brace. If you have a severe ankle sprain, you may have to use crutches and a brace to walk. Crutches If your ankle is really painful and swollen, you may have to start off by walking around the house on crutches and putting just enough weight on it that it still feels relatively comfortable. (Here’s our step-by-step guide to walking with crutches .) When walking outside with crutches, stay away from uneven terrain, because you can easily lose your balance and end up suddenly having to place all your weight on the injured ankle. The same goes for crowded places where people can bump into you. Ankle brace If you have a severe ankle sprain and you've torn quite a significant number of your ligaments or portion of the ligament, wearing an ankle brace is a good option. The right type of brace allows for the up-and-down movement of the ankle that’s necessary for walking (and gets that synovial fluid to move around the joint) but prevents side-to-side movement. The latter will put strain on the injured ligaments and mimics the movement through which the ankle probably got sprained in the first place. You don’t want an ankle brace that’s too soft, but also, you don’t want one that’s so rigid as to stop all movement of the ankle. Here's a few examples of useful braces: Our article that focuses specifically on ankle braces for sprains has some more examples and guidance on what level of stability your ankle sprain might need. Supportive shoes I know many people prefer not to wear shoes inside the house, but if you feel really uncomfortable walking around barefoot, supportive shoes may be the way to go. And I would definitely recommend them when going outside. Flip-flops, sandals, or really flexible shoes like some of those Nike ones that feel as if you're walking on jelly will not give your sprained ankle the necessary support. In fact, shoes with thick, wobbly soles will make your ankle work harder than when you’re barefoot, because you’ll have to “balance” to stay on top of the shoes. Avoid walking long distances in unsupportive shoes. Taking the final step – walking for exercise on a sprained ankle It doesn't make sense to walk for exercise if you can't walk comfortably around the house yet. Start with short, slow walks, and then gradually increase the speed and distance as your ankle recovers. The faster you walk, the harder everything has to work and the more likely it is to irritate the injured bits. Fast walking is more likely to irritate your ankle than slow walking. If your discomfort is more than 1 out of 10 while you’re walking for exercise, you’re overdoing it. And definitely check the 24-hour response. What does my ankle feel like tonight? Is it significantly more uncomfortable than it was last night when I didn't go for a walk? If the answer is yes, it's not ready for the distance you walked, and you will likely have to make that shorter. The same applies if it's more swollen or you have more pain the next day. 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 . Reference 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 .

Understand when an ankle sprain requires a brace, compare support options from high-stability to medium-stability designs, and know how long and during what activities to wear it for optimal healing. Remember, if you need help with an injury, you're welcome to consult one of our 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: 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. 👉 Read more about how to treat your ankle sprain . 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 might 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).

If you’ve been dealing with plantar fasciitis, chances are you’ve been told you must  wear supportive, cushioned shoes with good arch support – and that minimalist or barefoot-style shoes are a recipe for disaster. But recent research is starting to challenge that one-size-fits-all advice. In this guide, we’ll break down what the latest studies say about shoe types, how to figure out what might work best for your feet, and why you might want to rethink the notions of “always” and “never” when it comes to picking shoes for plantar fasciitis. Plus, we’ve tracked down some not-so-boring shoe options that are both foot-friendly and stylish (scroll down for pictures and links). 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 might earn a small commission on sales at no extra cost to you. In this article: The classic advice: Cushioning + arch support What about minimalist shoes or going barefoot? Why shoe rotation might be the missing ingredient So, what types of shoe should you wear? Good news: Arch support doesn’t have to be boring Good shoes are usually not enough How we can help We've also made a video about this: The classic advice: Cushioning + arch support There’s good reason why most podiatrists and physiotherapists (myself included) have been recommending cushioned shoes with arch support. Several high-quality studies have shown that these features can reduce heel pain and improve function: A 2015 clinical trial  found that contoured sandals (with built-in arch support and decent cushioning) worked just as well as custom-made orthotics to reduce plantar heel pain – and both were far more effective than flat, unsupportive sandals. Two research review studies ( 2018  and 2019 ) confirmed that using arch-supporting insoles can provide moderate pain relief in the short term, especially when compared to having no support at all. 💡 So yes – arch support still matters , and it might be the most important shoe feature for managing plantar fasciitis. But it turns out that that’s not the whole story. What about minimalist shoes or going barefoot? If you’ve been told to avoid anything flat or flexible at all costs, the following might surprise you. 👉 Recent studies suggest that some people with chronic plantar fasciitis may actually benefit from barefoot walking programmes or wearing minimalist shoes – as long as it’s done carefully and with proper support: A 2024 trial  found that people with long-term heel pain who followed a structured barefoot walking programme (compared to walking in shoes) had greater improvements in pain and function. It’s worth noting that they did the barefoot walking as a strength training session for their feet on a treadmill (so, a soft surface) and that they increased the time very gradually – they didn’t walk barefoot all day long or on hard surfaces. Another study  showed that flexible, minimalist shoes – especially when worn with arch-supporting insoles – significantly improved symptoms for women with plantar fasciitis. Again, these shoes were worn for no more than six hours per day. Unfortunately, quite a large number of people dropped out of the study; so, we shouldn’t view this as a definitive result, because not everyone’s data were analysed. 💡 The key takeaway here? Arch support is still helpful, even in minimalist shoes.  Yet minimalist shoes might not be as taboo as previously thought, while it should be noted that these studies used them in a restricted way for a strengthening regime. Incorporating barefoot walking sessions into your day might help to strengthen your feet and reduce plantar fasciitis pain in the long term. 🐟 What’s a bit fishy about these results is that neither study reported anyone saying their pain got worse due to the minimalist or barefoot walking. This sounds a bit too good to be true , because other studies found that people who wear non-cushioned shoes report higher pain levels. So, I think we should wait for more high-quality research to properly put this to the test before we start recommending it to everyone. This advice might also apply only to chronic cases (that has been present for several months). Acute (or recent onset) cases, in my experience, react much better to cushioned shoes with arch support. Why shoe rotation might be the missing ingredient Here’s the most interesting new insight (for me) from recent research. A small study  found that people who rotated between different types of shoe – instead of wearing the same pair every day – had slightly better outcomes than those using only orthotics or only doing physio. It makes sense when you think about it: Different shoes load your feet in different ways. Varying your footwear might help to reduce repetitive strain on the same structures (like your plantar fascia) and give certain tissues time to recover. 💡 So, maybe the magic isn’t just in which shoe you wear – but in switching things up regularly . However, it is worth pointing out that this was a small study and not a randomized controlled trial (so, not super strong evidence). Again, we need more research to know how effective this truly is. Varying your shoes might help to reduce repetitive strain. So, what types of shoe should you wear? Here’s the practical bottom line from the research: ✅  Look for shoes with arch support.  Whether you prefer sporty or stylish, arch support helps to reduce plantar fascia strain and is consistently linked to less pain. ✅  Cushioning likely helps.  Research shows that this probably matters, and it is also something I’ve observed in practice, especially if you’re having to stand or walk on hard surfaces. ✅  Minimalist shoes might have a role to play in some chronic cases. View this more as strength training and limit how long and on what surfaces you use them. ✅  Rotate your shoes.  Avoid wearing the same pair day in and day out. Mix things up with supportive sneakers, sandals with arch support, and even occasional barefoot time if appropriate for you. ✅  Replace worn-out shoes. Shoes, especially ones with soft foam soles, lose their support and change shape over time. They may still look pristine on the top but if your feet suddenly starts to hurt  in shoes that used to be comfortable, they likely need to be replaced. ✅  Consider adding orthotics.   Off-the-shelf arch-support insoles have been shown to work just as well  for most people as custom-made ones. So, don’t feel pressured to spend hundreds on custom insoles – there are excellent, affordable options available. Good news: Arch support doesn’t have to be boring I know that many of the “recommended” plantar fasciitis shoes can look a bit … uninspiring. That’s why I’ve gone onto Amazon and curated some modern, stylish, and comfortable shoe options that offer proper support without looking “orthopaedic”. Whether you’re into streetwear, sporty, or classic looks – there’s something here for you, and in most cases not only in the colours in the illustrative images below. Running shoes for plantar fasciitis Brooks has several models of running shoe with good arch support and cushioning. Those shown below have versions for men and women. HOKA and ASICS are two more runnings shoe brands with plantar fasciitis-friendly models. Again, these models come in men's as well as women's versions. Hitting the trails with plantar fasciitis? The ASICS Gel-Venture trail running shoe will provide your feet with good arch support. Sneakers / walking shoes Obviously the running shoes listed above can also work for walking, but here are more options for non-runners when they're out and about. Men Women Sandals and flip-flops First up, a few activewear sandal options with arch support. And now for something a bit more stylish and less sporty. 👉 Speaking of FitFlop – they're a company that specialises in women's footwear with arch support, so check out their other sandal and flip-flop styles and options here . Dress shoes / formal / everyday So many styles to choose from! I won't reveal my personal taste here by selecting pictures of shoes that I reckon are cool and stylish. Rather follow the links below and see what you like best. ⭐ Dansko is my top pick  for a shoe brand with a wide range of men's shoes  and women's shoes  for everyday wear that all provide arch support. For a good selection of comfortable men's dress shoes with arch support , head to OrthoComfoot's Amazon store . For women, FitFlop again has a big selection of formal and everyday offerings. Have a look at their range of boots on Amazon, and here are their options for flats . (💡I would steer clear of the ballet pumps and go for the more sturdy options.) And men and women such as nurses, chefs, and sales assistants who are on their feet all day could consider Dankso's range of clogs and mules for work . Slippers When you come home from work, kick off the work shoes and slip your feet into a pair of these. They all have good arch support and non-slip outer soles. Minimalist/zero-drop shoes All of the options below have removable arch support insoles. Please refer to our advice above on how best to use minimalist shoes for plantar fasciitis. Tennis and pickleball These Asics Gel-Resolution tennis and pickleball shoes provide good arch support and cushioning. There are many more colours available – from classic off-white to more colourful combinations. Good shoes are usually not enough Yes, the right shoes can help to reduce pain from plantar fasciitis – especially when they offer good arch support and you rotate between pairs. But shoes alone are not a cure . If you’re serious about getting rid of your plantar fasciitis for good, research shows that a more complete approach is needed. That means combining supportive footwear with treatments like strength training, stretching, and load management . I've put together some helpful guides to walk you through it: Causes and symptoms of plantar fasciitis Self-treatment – overview of all the treatment options   Self-treatment – stretching Self-treatment – massage Strength and control exercises for plantar fasciitis 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 Vicenzino, B. et al. (2015) "Orthosis-shaped sandals are as efficacious as in-shoe orthoses and better than flat sandals for plantar heel pain: a randomized control trial" PLoS One 10(12): e0142789. Whittaker, G.A. et al. (2018) "Foot orthoses for plantar heel pain: a systematic review and meta-analysis" British Journal of Sports Medicine 52(5): 322-328. Schuitema, D. et al. (2019) "Effectiveness of mechanical treatment for plantar fasciitis: a systematic review" Journal of Sport Rehabilitation 29(5): 657-674. Reinstein, M. et al. (2024) "Barefoot walking is beneficial for individuals with persistent plantar heel pain: A single-blind randomized controlled trial" Annals of Physical and Rehabilitation Medicine 67(2): 101786. Ribeiro, A.P. and João, S.M.A. (2022) "The effect of short and long-term therapeutic treatment with insoles and shoes on pain, function, and plantar load parameters of women with plantar fasciitis: a randomized controlled trial" Medicina 58(11): 1546. Koo, S.-W. et al. (2024) "Effectiveness of Shoe Rotation in Managing Plantar Fasciitis in Patients" Journal of Clinical Medicine 13(16): 4624. Umar, H. et al. (2022) "Impact of routine footwear on foot health: A study on plantar fasciitis" Journal of Family Medicine and Primary Care 11(7): 3851-3855.