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THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis Self-treatment – overview of the treatment options Self-treatment – stretching Self-treatment – massage (this article) Strength and control exercises for plantar fasciitis Yes, it does. Recent research has found that patients with plantar fasciitis appeared to have superior recovery rates if their physiotherapy treatment included soft tissue release (massage) – not only of the plantar fascia, but also of other tight muscles in the legs. The good news is that the current research further suggests that  self-massage techniques are just as effective as massage  done by a therapist. So, no need to break the bank! Here’s how you can do it in the comfort of your own home. We might earn a small commission on the sale of some of the products listed on this page at no extra cost to you. This article will show you: Which muscles to massage as treatment for plantar fasciitis How to massage the plantar fascia itself We have also made a video about this: It’s important to understand that massage alone will not cure your heel pain. It is only one part of the treatment plan. You can find more information about what treatments have been shown to be effective for plantar fasciitis here. Or if you're looking for a rehab plan, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped to design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. 🎉 Discount Code: MARYKE Massage for plantar fasciitis: Which muscles should be included? All the muscles that run down the back of your legs are connected via thick layers of fascia and tendons. They are in turn connected to the plantar fascia via the Achilles tendon. Tight muscles further up the body can thus potentially cause more strain on the plantar fascia. You should therefore not only massage the plantar fascia but also the other muscles in the back of your legs. Because these muscles are connected, they can influence the plantar fascia. As mentioned before, treatment for plantar fasciitis should include more than just massage, and you may find better results if you combine the massage with  plantar fasciitis stretches . Jump to: How to massage your plantar fascia How to massage your hamstrings How to massage your calves How to massage your glutes Massaging the plantar fascia In the video clip below, I demonstrate three ways to massage your plantar fascia. What method works best for you may depend on how sensitive your plantar fascia is and what tools you have available. A WORD OF CAUTION: It is not a good idea to use very forceful massage on the plantar fascia itself because it usually just ends up irritating the injury and may even bruise and injure the little nerves under the foot. You are looking for comfortable or at most "comfortably uncomfortable" pressure. What you need This depends on the method you decide to use. You can buy several types of tools to massage the plantar fascia. Method 1: Using your hands This method is very convenient because you don't need any extra tools. It is especially useful first thing in the morning when you first sit up in bed, before you start walking. You don't have to worry about doing it exactly right. Just rub your foot in a way that feels comfortable and good to you. It is the rubbing action that gets the circulation going, reduces the stiffness and calms the over-sensitive sensors in the area of the injury so they don't create such an excessive pain response. Spend about 1 to 2 minutes doing this. Method 2: Using a ball A larger ball, like a tennis ball or lacrosse ball, usually provides a gentler massage than a smaller ball (golf ball size). Gently roll the ball up and down the length of your foot arch. Remember not to press too hard - massaging your plantar fascia should bring relief and feel enjoyable. If you feel tingling or stinging sensations it's a sign that you are irritating a little nerve. You can injure your nerves or bruise your foot if you are too aggressive. Spend about 1 to 2 minutes on this. Method 3: Using a frozen bottle of water or mini-roller You can find mini-rollers on Amazon that you can put in the freezer , but a frozen 500 ml bottle of water will also work. This method is especially nice at the end of the day to relieve pain that may have developed throughout the day. Gently roll your foot on the roller. It is usually best to limit any cold treatments to between 7 or 10 minutes at a time. Massaging the hamstrings Your hamstrings attach onto your calf muscles, which in turn are attached to the plantar fascia via the Achilles tendon. That’s why you should include massage for your hamstrings when you struggle with plantar fasciitis. I demonstrate my favourite method in the video clip below. What you need I use a foam roller, but some of my patients prefer a firm ball such as a lacrosse or hockey ball. Method Place the foam roller under your thighs and slowly roll backwards and forwards. Make sure that you cover the whole length of the hamstrings from its origin in the buttock to its attachment at the knee. You can target different parts of the hamstring by rolling your body slightly to the sides. Dosage You can do this once a day for one to two minutes, but two or three times a week is usually enough. Massaging the calves As mentioned before, your calf muscles attach directly to the plantar fascia via the Achilles tendon. Any treatment plan for plantar fasciitis should therefore include massage of the calf muscles. I demonstrate how I massage my own calves using a foam roller and ball in the video clip below. What you need Use a foam roller or any firm massage ball . Method You can use your opposite leg to apply pressure and make the massage more effective. Slowly roll backwards and forwards using your arms to push you. Make sure you cover the full length of the calf muscles from the knee to the Achilles tendon. Dosage You can do this once a day for one to two minutes, but two or three times a week is usually enough. Massaging the glutes (your buttock muscles) Tightness in your gluteal muscles not only contribute to plantar fasciitis due to increasing the tension in the fascia, but also by holding on to your sciatic nerve. The sciatic nerve runs through these muscles, and when it’s not allowed to slide freely it can contribute to pain in the plantar fascia. I demonstrate how I use a ball to massage my glutes in the video clip below. What you need I prefer to use a massage ball because it gives you better point pressure, but you can also use a foam roller . Method Slowly roll over the gluteals while you sit sideways on the ball or roller. You can also just maintain the pressure on painful spots for 30 seconds before moving on. Do this once a day for two minutes. Dosage You can do this once a day for one to two minutes, but two or three times a week is usually enough. This article is the last in my series of four articles on how you can treat your plantar fasciitis yourself. Massage alone will not be enough to fix your plantar fascia pain. So, if you’ve landed on this article first, please consider going back and reading the others as well. This will help you to find the best overall approach to fixing your plantar fasciitis. Learn more: What causes plantar fasciitis and the most common symptoms Plantar fasciitis treatments - complete overview Stretches for plantar fasciitis 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. 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 Robroy, L. et al. (2014) Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

It’s very easy to fall into the trap of thinking that losing your running speed and muscle mass as you age is just part of the natural process and that there’s not a lot you can do about it. And to be honest, this was kind of what I thought when I started researching this article today. Well, it turns out there’s a lot that older runners can do to slow this process down and that the decline in running performance doesn’t have to be that big! In this article: How aging affects an older runner’s physiology and anatomy The biomechanics of older runners The calf muscles and Achilles tendon have a lot to answer for Recipe for running strong and injury free as you get older We also made a video about this: The decrease in endurance and sprint performance that we observe in Masters runners (over age 35!) are due to a combination of physiological and biomechanical changes. Physiological changes has to do with how the heart, lungs and circulatory system works. Biomechanics refer to how your body moves when you run and is influenced by your muscles, tendons, joints and bones. How aging affects an older runner’s physiology and anatomy As we get older our cardiovascular function naturally reduces. Cardiovascular function is influenced by things like how well your heart contracts, how fast it beats, how well your blood is circulated through your body and how easily and effectively your muscles extract the oxygen from your blood. Runners specifically experiences a drop in their maximum heart rate during exercise. Our aerobic capacity (VO2 max) also decreases. Aerobic capacity or VO2 max is defined as the maximum rate at which your heart, lungs, and muscles can effectively use oxygen during exercise. A high VO2 max is directly linked to better endurance performance. But running can dramatically slow this loss of VO2 max down ! The aerobic capacity or VO2 max of lifelong endurance runners in their 80s are reported to be nearly twice as high as inactive age matched adults! This is important because lower VO2 max due to aging is a massive risk factor for developing chronic diseases. In research where they compared highly trained older runners with highly trained young runners, they found that their VO2 max decreased by about 7% during each decade between the ages of 30 and 70. Older runners who maintained both a high training volume and intensity throughout the years experienced a smaller dip in their VO2 max than their peers who trained at lower volumes and intensities. In contrast with endurance athletes, sprinters don’t use oxygen as their main energy source when they run. They rely on their anaerobic energy system where they produce energy directly from glycogen. When you create energy via the anaerobic system, you produce lactate as a by-product which can be measured in your blood. A group of researchers investigated the blood lactate concentrations in a group of male and female masters sprint runners (40-88 years) following competitive 100 m, 200 m and 400 m sprint running. They found that the blood lactate concentrations were significantly lower in the sprinters aged between 70-88 years. This may mean that part of the reason that we see a decrease in sprint performance as we get older could be due to a decrease in our ability to generate energy from anaerobic energy sources. We all have a combination of fast twitch and slow twitch muscle fibres. The fast twitch fibres produce strong, powerful muscle contractions and are used for tasks like sprinting and lifting weights. The slow twitch muscle fibres are used for endurance activities. Another reason why we lose some speed as we get older is that some of our fast twitch muscle fibres are replaced by slow twitch ones. Our muscles and how well they contract are controlled by our nervous systems. Getting older also affects how many nerve endings we have in our muscles and how well they fire. The good news is that heavy resistance/strength training can help you build fast twitch muscle fibres and activate your nervous system, but more about this later. The biomechanics of older runners Biomechanics refer to how a runner moves their body when they run – their step length, how much their joints bend, where they land on their feet, how fast they move etc. Besides running slower, older runners tend to also give shorter steps (stride length). Experimental models have predicted that a runner can expect their stride length to decrease by about 20% between the ages of 20 and 80. This is accompanied by a higher step rate or cadence which makes sense because in order to maintain your running speed, when the steps are shorter, you’ll have to give quicker steps. They also tend to have a more flexed knee at footstrike; their ankles, knees, and hips move through a smaller range of motion; and they don’t oscillate (move) up and down as much. Finally older sprinters and endurance runners also demonstrate decreased peak propulsive and vertical ground reaction forces. Researchers believe that these two factor explain why we see the reduced step length and speed in older age. The calf muscles and Achilles tendon have a lot to answer for Your calf muscles contribute more to the forward propulsion force when you run than any of the other muscles in your legs. The stronger your calf muscles are the better you propel yourself forward and the bigger the steps you give when you run. As we age our calf muscles lose some of their muscle mass, cross-sectional area (size) and its ability to produce force. Concentric ankle power during running (when you push off) can reduce by as much as 47.9% between the ages of 20 and 80. The Achilles tendon which attaches the calf muscles to the heel bone also loses some of its stiffness. The Achilles is meant to work like a spring when you run, so the stiffer the better. This reduction in tendon stiffness reduces the Achilles’ ability to propel you forward. With this in mind it will come as no surprise that the research shows that older runners (over 50) are more prone to injuries like calf strains and Achilles tendinopathy. What the research is currently showing is that running can slow this age related decline in lower limb muscle strength down, but it can’t stop it. Interestingly, there is one study that showed that highly trained Masters runners who trained at the same volume and intensity as highly trained younger runners did not show this decline in ankle power. Recipe for running strong and injury free as you get older What this research may suggest is that maintaining high training volumes and intensities could protect against these age related changes (drop in VO2 max and muscle strength). The only problem is that we also tend to recover and heal slower as we get older. High training volumes and intensities may not be possible for everyone and may actually put some people at a higher risk of injury. Not only has strength training been shown to reduce running injuries by up to 50% , but it can also help to preserve your muscle mass, force (build fast twitch fibres) and propulsive power(activate the nervous system) as you get older. Remember that your Achilles tendon also becomes softer and more flexible with age – causing it to lose its spring like properties? Heavy slow resistance training has been shown to improve your tendon stiffness as well. Strength training programmes for runners can come in many forms but I hope it is clear from the above that you have to include exercises for your calf muscles and your Achilles tendon. I discuss this in more detail in the video above. You can also download a general gym-based strength training programme for runners here or a quick-fire routine that you can do at home here . But remember, to get the strength benefits you have to work the muscles hard. If you’re serious about maintaining your strength as you get older, I would suggest that you consult someone who can work out a training programme that is right for you. Let me know if you have any questions . Remember, you can also consult me online via video call for a diagnosis of your injury and a tailored treatment plan. Best wishes Maryke About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate , Facebook , Twitter or Instagram . References: Couppé C, Svensson RB, Silbernagel KG, et al. Eccentric or Concentric Exercises for the Treatment of Tendinopathies? Journal of Orthopaedic & Sports Physical Therapy 2015;45(11):853-63. doi: doi:10.2519/jospt.2015.5910 Delvecchio L, Korhonen MT, Reaburn P. THE EFFECTS OF RESISTANCE TRAINING ON SPRINT AND ENDURANCE PERFORMANCE IN MASTERS ATHLETES: A NARRATIVE REVIEW. Journal of Fitness Research 2016;5(1) Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2014;48:871-877. Mckendry J, Breen L, Shad BJ, et al. Muscle Morphology and Performance in Master Athletes: A Systematic Review and Meta-analyses. Ageing research reviews 2018 Willy RW, Paquette MR. The Physiology and Biomechanics of the Master Runner. Sports medicine and arthroscopy review 2019;27(1):15-21.

I’ve received so many questions about foam rolling recently that I thought it might just save me some time if I wrote a blog post that answers all the questions you may have. In this post I’ve taken a look at the most recent research to find out what foam rolling works for, what the best methods are and why, for some cases, it doesn’t seem to work at all. In this article: What does foam rolling work for? Why foam rolling is sometimes not effective How to foam roll for best effect Foam rolling specific areas of the body What does foam rolling work for? Flexibility Foam rolling can improve your flexibility and range of motion and, unlike passive stretching, it doesn’t seem to have any negative effect on how your muscles function afterwards. This is important because it makes it safe to use shortly before you compete. The only problem is that the effects does not seem to last for a very long time – only about 10 minutes. This means that you may have to combine foam rolling with other techniques if you want to have a more lasting effect on your flexibility. With this in mind a group of researchers from France designed a study to test if foam rolling is as effective as an active warm-up (cycling) at improving hamstring flexibility. The researchers found that combining the cycling and foam rolling produced the best results. Foam rolling on its own was not as effective as cycling on its own, but when they combined the two they saw a large increase in range of motion that lasted more than 30 minutes. DOMS or exercise induced muscle soreness There is strong evidence ( ref , ref ) that show that foam rolling, just like massage , can decrease the muscle soreness that you feel after exercise. You could make your life a lot more comfortable if you get into the habit of using your foam roller after hard training sessions or races. Performance Foam rolling does not seem to have any effect on athletic performance. Early reports that suggested that foam rolling could improve vertical jump height and muscle function have now been disproven . Why foam rolling is sometimes not effective Injury You should avoid foam rolling over injuries that are less than 2 weeks old. At this point the injured tissue is still weak and you risk making it worse if you apply strong pressure to the area. You will likely find that the muscle tightness associated with the injury slowly disappears by itself as your injury recovers. Fatigue This is a common cause I see in practice. Muscles that are fatigued and overworked will feel tight and sore and no amount of massage or foam rolling will get rid of it. What it needs is rest and time to recover. Common training errors that can lead to this include training too often, suddenly increasing your training load or intensity or switching to different training surfaces e.g. Astro turf. Neural tension Our nervous system is continuous from our brains to the tips of our toes and fingers and it should slide freely as we move. If for some reason a nerve gets stuck, it will stretch rather than slide. When this happens we refer to it as increased neural tension. The sciatic nerve (that runs down the back of your leg) often suffers increased neural tension due to issues in the lower back or tight glutes. Nerves don’t like to be stretched and this can lead to injuries in the muscles supplied by the nerve that’s stuck. Increased neural tension of the sciatic nerve has been shown to contribute to hamstring and calf injuries. Get yourself checked out by a good sports clinician if you struggle with persistent muscle tightness e.g. tight calves or hamstrings that does not react to foam rolling or stretching. This is something that we can easily check via video call if you wanted to consult our team of sports physios online . How to foam roll for best effect I’ve deduced these guidelines from the protocols that the researchers have used in their studies and combined it with my own clinical experience. Not enough research has yet been done to produce a gold standard so feel free to use this as a rough guide, to improvise and find the method that works best for you. In this video I summarize the key points and demonstrate the different foam rolling strokes. Type of roller A firm roller works best. You won’t be able to exert enough pressure if it is too soft. The researchers mostly used smooth rollers in their studies, but this does not mean that the spiky ones aren’t effective. Where to roll Make sure that you cover the full length of the muscle. Avoid strong pressure over bony points as you’ll likely just bruise your tendons. Pressure Pressure should be firm but not painful and you should not bruise yourself. When massaging, I find that I get the best results when applying pressure that can be described as being “comfortably uncomfortable” or “uncomfortable but not painful”. Foam rolling and massage are thought to work mainly by calming the nervous system down and thereby decreasing muscle tone. If you are too aggressive (even without bruising), you’ll get the opposite effect. Movement and Duration I would suggest that you use two types of movements when massaging yourself: 1. Long strokes that cover the whole length of the muscle. This is the method that they tend to use in the research studies. Spend about 1 to 2 minutes per muscle. 2. Sustaining pressure on painful spots. I actually find massage balls can be more effective for this as it's easier to apply pressure to a specific point with them. Sustain the pressure for about 30 to 60 seconds before moving on to the next spot. Foam rolling specific areas of the body I've made some videos that show how to foam roll your: Calves Hamstrings Glutes Quads IT band Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate References Capote Lavandero G, Rendón Morales PA, Analuiza A, et al. Effects of myofascial self-release. Systematic review. Revista Cubana de Investigaciones Biomédicas 2017;36(2):271-83. Macgregor LJ, Fairweather MM, Bennett RM, et al. The Effect of Foam Rolling for Three Consecutive Days on Muscular Efficiency and Range of Motion. Sports medicine-open 2018;4(1):26. Morales‐Artacho A, Lacourpaille L, Guilhem G. Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling. Scandinavian journal of medicine & science in sports 2017;27(12):1959-69. Mueller-Wohlfahrt H-W, Haensel L, Mithoefer K, et al. Terminology and classification of muscle injuries in sport: a consensus statement. Br J Sports Med 2012:bjsports-2012-091448. Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Current sports medicine reports 2015;14(3):200-08. Zazac A. Literature Review: Effects of Myofascial Release on Range of Motion and Athletic Performance. 2015

We demo six tennis exercises that can be used as part of your warm-up for tennis injury prevention or for final stage rehab when coming back from injury. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: The challenge with tennis exercises Who should do these exercises? Single-leg balance Glutes / lateral stability Balance and core stability Plank variations (core) Side plank (core / lateral stability) Nordic hamstring curls How often? How we can help We've also made a video about this: The challenge with tennis exercises There’s no tried-and-tested injury prevention programme for tennis. However, in some other sports, such as football/soccer, there are very well-researched injury prevention programmes. One such programme is the FIFA 11+ warm-up , which has been shown to reduce injuries significantly. Some of the movements and physical requirements in football/soccer are quite similar to those of tennis, e.g. changing direction quickly, knee stability, hip stability, and balance. Therefore, I have taken the exercises in the programme and tweaked some of them to make them more tennis specific. The exercises can be used as a dynamic tennis warm-up for injury prevention (aka prehab). They can also be used as final preparation for returning to the tennis court after having recovered from an injury. Who should do these exercises? Tennis warm-up / injury prevention Some of these exercises are challenging, so please don't do them if this is not the level of exercise that you are already used to. Ideally, you will have been doing some exercises similar to this already. Tennis injury rehab If you have an injury or you're returning from an injury, you ought to seek professional healthcare guidance to get an accurate diagnosis and advice on what to do instead of blindly following the exercises below. These exercises are to help people with ideas if they are already going through rehab under a supervised programme.   And importantly, none of these exercises should cause you pain during or after you’ve done them. Single-leg balance Footballers need good balance, but unlike you, they don’t also have to swing a racket while balancing. So, get your racket out! This exercise can help to prevent overuse tennis injuries related to alignment issues, but also more severe injuries, such as ACL sprains. 📽️ Watch video demo Instructions: Alternate between standing on your front leg and back leg and between forehand and backhand strokes. While doing this, keep your hips still and your knee over and in line with your foot and toes. Don’t allow your knee to excessively rotate or bend inwards – it is normal to move a bit from side to side. Do about 30 seconds per leg and repeat 2 or 3 times per leg. Glutes / lateral stability Pushing your knee outwards against a resistance band to keep it in line with your foot will add strength and stability to your glute muscles. This will help you to change direction quicker and also to keep a good alignment at your knee when you are changing direction. 📽️ Watch video demo Instructions: Same as for the previous exercise (especially the hip and knee alignment) but standing on both feet. Do 30 seconds of forehands and backhands, rest a bit, and repeat 2 to 3 times for each type. Balance and core stability This one will help to improve your balance and stability when you're on court. 📽️ Watch video demo Instructions: Put your front foot on a BOSU or wobble cushion and bend your knee about 90 degrees. You can also put your foot on a foam roller (placed at a right angle to your foot). Your back leg should be almost straight and only the toes of the foot should touch the floor. For beginners, just rotate your upper body while trying to keep your balance. A more advanced version is to play forehands and backhands with your racket. Your hips, knees, and feet should face forwards all the time. Keep each side’s hip, knee, and foot aligned. Do 30 seconds for each leg. Do 2 to 3 times on each leg. Plank variations (core) From here on, the exercises are exactly the same as in the FIFA 11+ programme, so you won’t need your racket. The plank exercise strengthens your core. 📽️ Watch video demo Instructions: Lie face down on the floor. Raise yourself up so that you are only supported on your toes and forearms, with your upper arms vertical. Keep your body straight (like a plank!). Hold for 20 to 30 seconds. Do 2 to 3 reps. You can make this more difficult by: lifting your legs up alternately and even more difficult by lifting up one leg and holding that position. Side plank (core / lateral stability) The side plank also strengthens your core and adds lateral stability. 📽️ Watch video demo Instructions: Lie on your side on the floor. Bend your bottom leg’s knee to about 90 degrees. Raise yourself up so that you are only supported on your bottom leg (from the knee downwards) and on your forearm, with its upper arm vertical. Keep your body straight. Hold for 20 to 30 seconds. Switch sides. Do 2 to 3 reps on each side. You can make this one more difficult by: supporting yourself on your bottom foot (leg straight) instead of the knee, which is the full side plank. Next, you can go up and down with your hips in the full side plank position. And the most challenging side plank is raising and lowering the leg that’s on top in the full side plank position. Nordic hamstring curls These are to reduce the risk of hamstring strain. It’s a high-level exercise, so only do these if you already have strong hamstrings. 📽️ Watch video demo Instructions: Get on your knees, body upright, and have your feet hooked underneath something sturdy or get someone to hold them down. Lower your body forwards slowly, keeping your hips and back straight and your stomach muscles tightened. Put a chair in front of you so that you can catch yourself if you can’t control the movement all the way to the floor. Do between 5 (beginner) and 15 (advanced) reps depending on your fitness and strength. Do 1 set. How often? You can do these tennis warm-up exercises twice a week, preferably not on consecutive days. How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine 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 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 .

THE PLANTAR FASCIITIS SELF-TREATMENT SERIES: Causes and symptoms of plantar fasciitis Self-treatment – overview of all the treatment options Self-treatment – stretching (this article) Self-treatment – massage Strength and control exercises for plantar fasciitis There is strong evidence that stretching the plantar fascia can help reduce your pain when you have plantar fasciitis, but some people can get even better results by including stretches for all the muscles in the back of their legs. In this article, I'll answer common questions patients have about doing stretches for plantar fasciitis and provide you with general guidelines as well as demonstrations of the stretches I find most useful. We might earn a small commission on the sale of some of the products listed on this page at no extra cost to you. In this article: Questions about stretching and plantar fasciitis General instructions for plantar fasciitis stretches Gentle plantar fascia stretch Stronger plantar fascia stretch Calf stretching for plantar fasciitis Glute and lower back stretch Hamstring stretch for plantar fasciitis We've also made a video about this: Questions about stretching and plantar fasciitis Why does stretching help plantar fasciitis? Although the research has shown that especially calf and plantar fascia stretches can help to reduce plantar fasciitis pain, we don't yet have a clear answer as to how this work. One theory is that by relaxing the muscles, you reduce the pull or tension on the injured part of the plantar fascia, which reduces the irritation. Stretching also has a way of calming the sensors in your muscles and fascia that send messages to your brain about pressure and stretch. When you have plantar fasciitis, these sensors often become too sensitive and overreact to any pressure you put through your foot, causing the brain to create pain that is disproportionate to the severity of your injury. So, calming the sensors down through gentle stretches can reduce the intensity of your pain. Research shows that stretching helps plantar fasciitis but we're not yet sure why. Does plantar fasciitis cause calf or leg pain? If plantar fasciitis carries on for a long time and becomes so painful that it affects the way you walk, it can cause your calves to feel painful or even cause leg pain higher up. Pain in one area of the body can also cause the muscles in the areas next to it to become tense and irritated. However, if you feel that the pain started in your leg and then moved to your heel, then it may be a different injury masquerading as plantar fasciitis. Can tight calves cause plantar fasciitis? No. A recent review of the available research that specifically looked at what risk factors may predispose you to getting plantar fasciitis found no evidence that tight calves cause plantar fasciitis. The most common cause of plantar fasciitis is overuse . However, there is research that shows that people who already have plantar fasciitis often also have tight calves. So, it seems that plantar fasciitis can cause your calves to tighten up over time, but not the other way around. Conclusion: Calf stretching has a role to play in the treatment of plantar fasciitis. but it will probably not prevent you from getting it. All the muscles in the back of the legs are connected to each other and the plantar fascia via layers of fascia and tendons. Can tight glutes cause foot pain or plantar fasciitis? Tight glutes can cause foot pain but not really plantar fasciitis. However, all the muscles that run down your lower back and the back of your legs are connected via thick layers of fascia and tendons. They are in turn connected to the plantar fascia via the Achilles tendon. So, the same applies here as for the calves; once you have plantar fasciitis, tight glutes may irritate it further as it increases the general muscle/fascia tightness in the back of the leg. How can tight glutes cause foot pain? Your sciatic nerve runs through your glutes all the way to your foot. If the glutes are tight, they can sometimes compress the sciatic nerve or stop it from sliding freely, which irritates it, and this then causes referred pain around your heel or under your foot. The sciatic nerve runs through the glutes and down the leg. Pain in heel when stretching hamstrings Typically there are two places around the heel where you may feel pain when stretching the hamstrings: The first is right under the heel or the foot. If this is the case, it may be that the pain is actually coming from your lower back. The hamstring stretch position also stretches your sciatic nerve, and if that is irritated or not hundred percent free to slide, it can cause pain in your heel. The second is pain at the back of the heel, where the Achilles tendon attaches. If you're using a belt or band to pull your ankle back when you stretch your hamstrings, that can also stretch the Achilles tendon. If your Achilles tendon is injured, stretching it in that position may cause pain at the back of the heel. General instructions for plantar fasciitis stretches A WORD OF CAUTION: None of the stretches should be painful to do, nor should they cause you pain or discomfort afterwards. You should not try and stretch as hard as you can, but rather just take it to where you start to feel a gentle stretch and then maintain it for about 30 seconds. These stretches may not be right for you, so please check with your physio before doing any of them. I always prescribe three sets of 30 seconds for each stretch. Hold still while you stretch and do not bounce. It is important to understand that stretching alone will not resolve your plantar fasciitis. It is only a small part of a wider treatment plan. You can learn about the different  components of plantar fasciitis treatment here . If you would like help with your rehab exercises, check out the Plantar Fasciitis rehab plan in the Exakt app . I've helped to design the app to guide you through the rehab process from the moment your foot becomes painful all the way back to your sport. 🎉 Discount Code: MARYKE Gentle plantar fascia stretch This stretch may be more appropriate if your foot is still very painful and sensitive. It often works well if you do it first thing in the morning before you get out of bed. But still be gentle with it. Remember, it should not cause an increase in pain. Instructions Sit on the side of your bed, on a chair, or on the floor. If sitting in a chair, rest your ankle on your opposite thigh. Otherwise, simply have your leg bent up in front of you. Pull your foot and toes back until you feel a gentle stretch under your foot. Hold the stretch for 10 to 30 seconds. Let go of your foot and move it around a bit. Repeat it up to three times. Do this once or twice a day. Stronger plantar fascia stretch Please be careful not to over-stretch the plantar fascia by pushing to vigorously.  This stretch should not be done directly after a sudden injury of the plantar fascia. Instructions Place your toes against the base of a wall as shown in the picture (your toes may likely not bend as much as mine as my foot joints are a bit hyper-mobile). Bend your knee towards the wall. You should feel a stretch underneath your foot and low down in the calf. Hold the plantar fascia stretch for 30 seconds. Repeat three times. You can do this once or twice a day. Calf stretching for plantar fasciitis Research suggests that you should do the calf stretches more than once a day to see results. I would recommend that you test what works best for you. Instructions Stand facing a wall or chair with the foot to be stretched at the back. Your toes must point straight forward. Lean against the wall or hold on to the chair. Keep your back heel on the floor and bend the knee of the front leg until you feel a stretch in the calf of the back leg. Maintain the calf stretch for 30 seconds before switching legs. Repeat three times with each leg. Do these once or twice a day. Glute and lower back stretch Hold on! It’s my foot that hurts. Why do I have to stretch my glutes and back? As mentioned before, all the muscles that run down your lower back and the back of your leg are connected via thick layers of fascia and tendons. They are in turn connected to the plantar fascia via the Achilles tendon. Tight muscles further up the body could therefore irritate the plantar fascia when the latter is injured. Instructions Place the outside of your right ankle just above your left knee. Take hold of your left thigh with both your hands and pull it towards your chest. If you struggle to keep your neck in a comfortable position, you can put a pillow under your head. You should feel the stretch in the right buttock/thigh/back depending on which part is the tightest. Hold the glute stretch for 30 seconds and repeat on the opposite side. Repeat three times on each side. Do this two or three times a week. Hamstring stretch for plantar fasciitis It is important to make sure that the pain in your foot is in fact plantar fasciitis and not due to nerve pain from your back before attempting a hamstring stretch.  Doing the hamstring stretch will make your pain worse if the pain is due to nerve irritation.  The first post in this series tells you how to diagnose plantar fasciitis , but you may want to consult a physiotherapist if you suspect that your back may be the problem. Instructions Sit with your one leg straight and the other bent up. Your knee must remain straight throughout the stretch. Put your chin on your chest and lean forward with both your arms (this will help to stretch a whole lot of muscles down the back of your body). You may not be able to stretch as far as that - that is OK. We're all different, so do what is comfortable for you. Hold the stretch for 30 seconds and repeat three times with each leg. Do this two or three times per week. Like I said previously, stretching on its own won’t fix your plantar fasciitis. Combining it with other treatments like supportive insoles , strengthening exercises , or doing self-massage is often a more effective way of dealing with this injury. If you would like a more structured plan to help you recover, I've included stretches, strengthening exercises, and massage videos in the rehab plan in the Exakt app . The app also adapts the exercise intensities according to your feedback. 🎉 Discount Code: MARYKE How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Hamstra-Wright, K. L., et al. (2021). "Risk factors for plantar fasciitis in physically active individuals: a systematic review and meta-analysis." Sports health 13(3): 296-303. Monteagudo, M., et al. (2018). "Plantar fasciopathy: A current concepts review." EFORT open reviews 3(8): 485-493. 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. Robroy L. Martin, T. E. D., Stephen F. Reischl, Thomas G. McPoil, James W. Matheson, Dane K. Wukich, Christine M. McDonough, Roy D. Altman, Paul Beattie, Mark Cornwall, Irene Davis, John DeWitt, James Elliott, James J. Irrgang, Sandra Kaplan, Stephen Paulseth, Leslie Torburn, James Zachazewski, Joseph J. Godges. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.

In this article, we’ll explain what muscles you should foam roll when your iliotibial band (IT band) feels tight and why foam rolling the IT band itself isn’t that useful. We’ll also point out what areas of the IT band you should best avoid when foam rolling. 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: Why foam rolling the IT band itself isn’t that useful What muscles should you foam roll if your IT band feels tight? How long should you foam roll for? Why foam rolling over the IT band is so painful How to use a foam roller for it band syndrome How we can help Why foam rolling the IT band itself isn’t that useful The IT band is a thick fibrous band of tissue that runs down the outside of your leg and attaches to the side of the knee. It is mostly made up of collagen fibres. Unlike muscle fibres, collagen fibres don’t really stretch or contract. The IT band has no active control over how tight it feels. It’s actually the muscles that attach onto the IT band (the glutes, tensor fascia latae, lateral quads) that can cause it to feel tight when they are in tone and pull it tight. This is why focusing your foam rolling efforts on the IT band itself won’t really make it feel less tight. Instead, you should aim to relax the muscles that attach onto it. What muscles should you foam roll if your IT band feels tight? The muscles to target when you want to reduce the strain on the IT band are the ones that attach onto it. These include glute max, glute med, tensor fascia latae (TFL), and the lateral quad. I prefer to use a massage ball rather than a foam roller when I do my glutes, but this is just personal choice. I demonstrate how to roll these areas in this video: How long should you foam roll for? There is no definitive answer to this yet, but the methods used in the research are as follows: Longitudinal strokes along the muscle belly - spend about 2 minutes per leg Point pressure. This is when you sustain pressure on a painful point for between 30 and 60 seconds. The pressure you apply should be "comfortably uncomfortable" rather than painful. The whole idea is to get the muscles to relax. If a massage is too painful, it actually has the opposite effect. Why foam rolling over the IT band is so painful The IT band itself has lots of little nerve endings in it and not a lot of padding, as that area of your leg naturally has less muscle and fat. The reason it’s so painful to foam roll over your IT band is because you’re basically pinching the poor nerve endings between your thigh bone and the foam roller. More pain does NOT equal more gain. And if you’re too aggressive with the amount of pressure you place through the foam roller in the area close to the knee, you can actually cause a compression injury or, if you have IT band syndrome, you can make it worse. How to use a foam roller for IT band syndrome Foam rolling can help to reduce pain and tightness when you have IT band syndrome, but this relief is transient. To get rid of it permanently and prevent it from coming back, you have to address the underlying cause of your specific case. We’ve written an article dedicated to the different treatments for IT band syndrome . The areas to focus your foam rolling efforts on when you have IT band syndrome are exactly what we discussed higher up in this article: The glutes, TFL, and lateral quads. Our ultimate guide to foam rolling has more general advice on how to use a foam roller. DON’T foam roll the painful area on the side of your knee. IT band syndrome is caused by excessive compression between the IT band and the thigh bone in that area and you will just make it worse by squashing it on a foam roller. 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 Capote Lavandero G, Rendón Morales PA, Analuiza A, et al. Effects of myofascial self-release. Systematic review. Revista Cubana de Investigaciones Biomédicas 2017;36(2):271-83. Friede, M. C., et al. (2021). "Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?" Physical Therapy in Sport. Macgregor LJ, Fairweather MM, Bennett RM, et al. The Effect of Foam Rolling for Three Consecutive Days on Muscular Efficiency and Range of Motion. Sports Medicine-Open 2018;4(1):26. Morales‐Artacho A, Lacourpaille L, Guilhem G. Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling. Scandinavian Journal of Medicine & Science in Sports 2017;27(12):1959-69. Mueller-Wohlfahrt H-W, Haensel L, Mithoefer K, et al. Terminology and classification of muscle injuries in sport: a consensus statement. Br J Sports Med 2012:bjsports-2012-091448. Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Current Sports Medicine Reports 2015;14(3):200-08. Zazac A. Literature Review: Effects of Myofascial Release on Range of Motion and Athletic Performance. 2015

We answer your questions about foam rolling your quads. When can it help for knee pain? When is it best not to foam roll your quads? Why does it hurt so much to foam roll your quads? What is the best method to use? 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: Foam rolling quads for knee pain Why is foam rolling your quads so painful? Never foam roll a freshly pulled or strained quad muscle When can I foam roll my quads? How to foam roll your quads How we can help We also made a video about this: Foam rolling quads for knee pain Foam rolling your quads can sometimes work wonders for knee pain, but in other cases it has little effect. It depends on what is causing your knee to be sore. If your knee pain is being caused by something in or around the knee joint being irritated or injured (meniscus, ligaments, joint capsule, cartilage), then foam rolling your quads won’t make a big difference. Your quads may feel tight because they are trying to protect your injured knee, but it’s not the quads that are causing the pain. In these cases, foam rolling your quads may make them feel less tight for a while, but the tightness is likely to return and your knee pain won’t be alleviated. It will only finally improve once your knee injury has healed. In other cases, your knee may ache because your quad muscles are super tight or have trigger points that are referring pain into your knee. So, your knee hurts, but it is actually the quad muscles that are causing the pain. If this is the case, then foam rolling your quads may help to alleviate the pain. However, foam rolling your quads isn’t a silver bullet. You also have to figure out why the quad muscles are so tight and sore in the first place. If you continue to overtrain or continue with the activities that are causing your quads to be sore and painful, the pain relief provided by the foam rolling will not last, and you may end up further injuring your knee and/or quads. So, make sure that you adapt your training accordingly. Why is foam rolling your quads so painful? If you’ve ever tried to foam roll your quads, you’ll probably know that it can be extremely sensitive or even painful to roll certain parts. It’s usually the outer quads or the areas close to the knee that are more painful. This is because you have less padding (fat and muscle) in those areas. So, it’s easy to squash the fascia and little nerve endings in your thigh against your thigh bone, which makes it hurt more. Never foam roll a freshly pulled or strained quad muscle When you pull or strain a muscle, you tear some of the muscle cells and fibres and usually also a few blood vessels. The body has to repair that injured area by first cleaning it up (getting rid of the dead blood and cells) and then by forming new cells. You can read more about the treatment of quad strains here . The injury site is really quite fragile for the first few days or weeks (depending on how severe the injury is) and if you go and hammer it with a foam roller, you can make the injury worse. Your quad may feel tight and as if it needs a good roll or stretch, but that tightness is not something you can stretch or roll out of it. It is caused by the swelling and/or accumulation of dead blood in that area and also by the quad muscle tensing up to protect the injury. This will improve by itself as your injury heals. When can I foam roll my quads? Foam rolling your quads is most useful: When you want to improve your flexibility and reduce the normal tightness that develop after a training session. When you want to reduce the normal pain or discomfort you feel a day or so after a hard training session, i.e. delayed onset of muscle soreness (DOMS). As mentioned above, to alleviate knee pain caused by tight quads. How to foam roll your quads The research has so far not identified an ideal method. In most studies, they used longitudinal strokes (towards and away from the knee) and rolled each muscle group for about two minutes. They alternated this with sustained pressure on specific spots for about 30 to 60 seconds. I demonstrate this in the video above. Don’t push too hard. You should be aiming for it to feel “comfortably uncomfortable”. If you end up with bruises, it’s a clear sign that you’re being too rough on your quads. We’ve previously summarised all the current research on how to foam roll in this article . How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Capote Lavandero G, Rendón Morales PA, Analuiza A, et al. “Effects of myofascial self-release. Systematic review” Revista Cubana de Investigaciones Biomédicas 2017;36(2):271-83 Macgregor LJ, Fairweather MM, Bennett RM, et al. “The Effect of Foam Rolling for Three Consecutive Days on Muscular Efficiency and Range of Motion” Sports Medicine - Open 2018;4(1):26 Morales‐Artacho A, Lacourpaille L, Guilhem G. “Effects of warm‐up on hamstring muscles stiffness: Cycling vs foam rolling” Scandinavian Journal of Medicine & Science in Sports 2017;27(12):1959-69 Mueller-Wohlfahrt H-W, Haensel L, Mithoefer K, et al. “Terminology and classification of muscle injuries in sport: The Munich consensus statement” Br J Sports Med 2012:bjsports-2012-091448 Schroeder AN, Best TM. “Is self myofascial release an effective preexercise and recovery strategy? A literature review” Current Sports Medicine Reports 2015;14(3):200-08 Zazac A. “Literature Review: Effects of Myofascial Release on Range of Motion and Athletic Performance” The University of Akron: Honors Research Projects 2015 ;67

Whether or not to use ice for a hamstring tendinopathy is a hotly debated topic. We explain how this came about and why it is fine to use ice to get relief from the debilitating pain that high hamstring tendinopathy can sometimes cause. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Arguments for and against ice for high hamstring tendinopathy (Mis)interpreting the research Why and how you can use ice for a hamstring tendinopathy How we can help We’ve also made a video about this: 👉 Read more about other aspects of high hamstring tendinopathy here . Arguments for and against ice for high hamstring tendinopathy Most people who have had high hamstring tendinopathy will tell you that it is an extremely painful condition, and that sitting is especially challenging and painful. It is generally known that ice can be used for pain relief for many types of sports injury. Many of my high hamstring tendinopathy patients have found that sitting on ice or applying ice when the pain gets very bad gives them some much needed comfort and relief. However, there are many people on the Internet who argue against ice for this condition and other sports injuries. They say that ice prevents or inhibits inflammation , and that inflammation is necessary for healing to take place. Therefore, the argument goes, using ice for a painful high hamstring tendinopathy will slow down your recovery process. (Mis)interpreting the research The problem is that the anti-icers are taking research that has very little to do with high hamstring tendinopathy pain relief and healing and using it to “prove” their point. The research they are referring to has been done on uninjured professional cyclists and other high-level athletes to see whether full-body immersion in ice baths directly after training sessions is beneficial or detrimental to the training effect on their bodies. It makes sense to research this, because inflammation also plays a role in recovery after exercise. Some of these studies found that this way of using ice after exercise does indeed inhibit inflammation and decreases (but doesn’t totally nullify) the positive training effect, whereas other similar studies found that it had no detrimental effect. 💡 But the inflammatory response after exercise is a very different process to the injury process involved in ongoing hamstring tendinopathy. It’s like comparing apples 🍎 and orangutans 🦧 – they’re not even in the same category. Why and how you can use ice for a hamstring tendinopathy First, a tendinopathy is an injury that has been going on for several months or more, so there is very little or no inflammation for the ice to inhibit. Read more about the difference between tendinopathy (no inflammation) and tendinitis (lots of inflammation) . Also, icing a high hamstring tendinopathy is about pain relief, not the influence it might or might not have on training effects after exercise (rehab exercises, in this instance), as we shall see below. Pain vs. progress With high hamstring tendinopathy, pain can really ruin your progress much more than a bit of ice can. Pain stops you from moving, pain stops you from going for walks, pain stops you from sitting down, pain can stop you from doing your rehab exercises. So, if ice is effective at bringing your pain levels down so that you can move more and do your rehab exercises properly, it is a no-brainer to use it, and it might indeed contribute to a faster recovery. No ice baths Unlike in the research studies mentioned above, none of our high hamstring tendinopathy patients are getting into an ice bath. The ice is applied only to the painful area, so the hamstring muscles aren’t affected at all. Timing might matter If you are still concerned that applying ice to your injured high hamstring tendons will inhibit the training effect of your rehab exercises, then don’t apply it after you’ve done your exercises. Also, if your pain shortly after having done your rehab exercises is so severe that you need ice for it, the exercises are probably too challenging for the stage of recovery you are in. Rather apply the ice when you really need pain relief and any "beneficial" inflammation is totally out of the picture, e.g. after you have had to sit for an extended period of time or had to drive a long way. How to apply ice Don’t apply the ice pack directly on your skin – place a towel or something similar between the ice and your skin. And remember, our bodies function best at a temperature close to 37 degrees Celsius. So, you don’t want to go overboard with the ice and sit on it all day long 🥶 – that could be counterproductive. 💡 Instead, apply the ice for 10 minutes, remove it and wait 10 minutes, and apply it for another 10 minutes. This is one session. You can do up to three sessions per day. 👉 This article of ours has some more detailed guidance on how to use ice for injuries . 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 .

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 .

Many people recovering from high hamstring tendinopathy feel despondent if their prescribed bridge rehab exercises are painful. The bridge is the classic strengthening exercise for this condition, so they feel they’re not going to get better if they can’t do them. If this is you, don’t despair – there are ways around this problem. 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 much pain is acceptable? How to adapt bridges for high hamstring tendinopathy An alternative to bridges for high hamstring tendinopathy Be flexible How we can help We've also made a video about this: 👉 Read more about other aspects of high hamstring tendinopathy here . How much pain is acceptable? A certain amount of pain and discomfort during your bridge exercises is to be expected. Researchers agree that pain up to a level of 3 out of 10 is acceptable during and after the exercises as long as it calms down within a few hours. 💡 But it can be difficult to decide what a 3, 5, or 8 out of 10 really means. So, in our clinic we tend to advise that “a bit” or “niggle level” more than your usual pain is acceptable. If the pain is significantly more or to such an extent that it really annoys you, it is likely too much. You might not necessarily worsen your injury, but your pain will increase, and this as such might prevent you from getting better. It’s like prodding a bruise all the time – the injury won’t get worse, but the pain isn’t going to settle down any time soon either. Also, if the increased pain (regardless of the intensity) caused by the exercise session hasn’t settled down to its pre-session level within 24 hours, you should also do something about it. Here are some things you can try. How to adapt bridges for high hamstring tendinopathy Reduce the repetitions and/or how long you stay up The number and intensity of rehab exercises have to be right for where you are in your recovery journey and for what your injured tendon can handle at each stage. 💡 It’s not just about how strong your tendon is – it can be very strong but also super sensitive , in which case the pain gets triggered if you go above a certain level. The good news is that this hypersensitivity will also calm down if you pitch your rehab exercises and other activities at an acceptable level. Starting with very short holds, long rest intervals, and very few repetitions is often a good way to avoid flare-ups and establish a baseline. Once you’ve established a baseline of exercise that doesn’t irritate your tendons, you can gradually build up to more challenging sessions. It works best to start with a very easy bridge session, observe how your pain responds, and gradually build the intensity. Don’t go for the “perfect bridge” at the start Also, you don’t have to do the “perfect” bridge right from the word go. Many of my patients find that trying to force that last bit of movement to get their hips fully straight really aggravates their pain. When this happens, I tell them to stop just before they reach that point. This allows their injured hamstring tendons to get used to it gradually. As it becomes less sensitive, they can usually progress to doing a full bridge. Here’s a video demo of what I mean. Foot placement See whether placing your feet closer to your bum makes things easier. The further away from your bum your feet are, the more your hamstrings work; the closer they are, the more your glutes have to work. As your injured tendon becomes stronger, you can gradually move your feet further away to make things more challenging. Don’t squeeze too hard Some people feel that they don’t get value from doing bridges if they don’t feel it in their glutes (their butt muscles). However, squeezing too hard with your glutes might cause you some unnecessary pain. 💡 Don’t worry if you can’t “feel” your glutes working – it’s impossible to get into the bridge position without using your glutes. So, instead of thinking about getting a squeezing feeling, think about, “Can I feel that I'm doing the movement right? Can I feel that I'm going up, and I feel my hips get to a point where they're not gonna go higher, and that's where I stay; I'm not bothering with squeezing anything, I'm just looking to sustain the position.” An alternative to bridges for high hamstring tendinopathy There is a significant portion of our high hamstring tendinopathy patients that just cannot do a bridge – it sets off their pain no matter what. In these cases, hamstring curls can work well. 💡 Hamstring curls are in any case useful to include in your rehab (in addition to the bridge exercise if it doesn't give you trouble) for high hamstring tendinopathy, because it works the hamstring muscles eccentrically which resembles how these muscles work when we move. This is what a hamstring curl looks like: The best option is to do these on a hamstring curl machine in the gym. They allow you to select the weight quite accurately and then increase it gradually as your injured tendon gets stronger. If you don’t have access to a gym, lying on your front and doing the hamstring curls against the resistance of an exercise band is the way to go. (I once had a patient who found the exercise band annoying, so he taped a weight to his boot instead!) As with many rehab strengthening exercises, you can start off with doing isometric holds if you find that doing an actual curl is too painful. So, you just hold your leg still against the resistance of the weight or exercise band. Be flexible 👉 I mean flexible in the figurative sense here. I find that rehab programmes should be a fluid thing. In very few cases the type of exercise and the level of difficulty at which it has to be done is the best combination right from the outset. 💡 Quite often, there are little niggles that come out, and you have to change the exercise or adapt the level of difficulty up or down. The rehab plan also has to increase in intensity as the injury recovers. That’s why having review sessions with your physio at regular intervals is important. If you're stuck on an exercise for your high hamstring tendinopathy and it’s painful, discuss it with them so they can adapt your programme. You can find examples of bridge progressions in this article. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine 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 .

In this article I’ll walk you through the two most commonly used taping techniques for tennis elbow – using Kinesio tape and zinc oxide tape – and how you can tell whether they’re useful for your specific case. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Testing for tape allergy Kinesio tape for tennis elbow Zinc oxide diamond taping technique for tennis elbow How to know whether your taping is working How we can help We've also made a video about this: Testing for tape allergy Why bother testing? If you’re allergic to the tape, this test will cause a reaction in a small area only, which is better than having your whole arm red and itchy! If you know you’re allergic to tape, don’t use it. Rather check out our article about braces and splints for tennis elbow . The test: Decide whether you’re going to use Kinesio tape or zinc oxide tape (see below). Clean the skin of your inner forearm with soap and water – the tape won’t stick if there’s oil or cream on your skin. Cut a small piece of tape (1 cm by 1cm) and stick it to your inner forearm. Leave it on for up to 24 hours to see whether it causes redness, itchiness, or blistering. But remove it immediately if you experience any of those symptoms. If your skin showed no reaction, you’re likely not allergic to the tape. If it did show a reaction, go for a brace or tennis elbow strap  instead. Applying Kinesio tape with too much stretch on it can cause blisters at the edges, and then people might mistakenly think they are allergic to the tape. Other taping precautions Never apply tape over skin that is already irritated, nor over wounds or blisters. Remove the tape immediately if you develop any itchiness, redness, burning, or blisters. Leave at least 24 hours between tape applications to allow your skin to breathe – this reduces your chances of skin irritation. 1. Kinesio tape for tennis elbow   How it is thought to work The ways in which this Kinesio taping technique is thought to work include: Inhibiting the wrist extensor muscles (reducing how much they work). Improving circulation by lifting the skin micro-millimetres. Through the “pain gate” mechanism – the sensation of the tape on the skin reduces the brain’s focus on the pain. It’s similar to when you rub a body part that you’ve just knocked against something – by rubbing it, you distract the brain or reduce the signals being sent about the painful area. Is there evidence  to support any of these claims? Not at the moment. The research shows that this taping technique can reduce tennis elbow pain compared to “fake” or placebo taping, but there isn’t any evidence for how it actually achieves this. So, we don’t know whether it is working in the way that the people in the white lab coats believe it works. What you’ll need Scissors Kinesio tape – 5 cm (about 2 inches) wide An assistant – it’s difficult to perform this taping technique on your own. 💡 There are many cheap brands of Kinesio tape on Amazon, but I’ve found them to be a waste of money – they simply don’t stick well enough . It is worth buying a slightly more expensive brand, e.g. Rock Tape. Prepping the tape and your arm Clean your skin using water and soap. If there is cream or oil on it, the tape will not stick and pop off almost immediately. If you’re very hairy, you will likely have to shave the area for the tape to stick. Cut a piece of tape, measuring from the middle of the back of your hand to about 1 cm (just under half an inch) above the crease of your elbow. Then, cut this piece lengthwise down the middle so you have two long “tails”, leaving the last 3 cm (about 1 inch) intact (this is your anchor). Cut a second piece of tape, long enough to wrap halfway around the thickest part of your forearm. Again, cut this piece lengthwise down the middle, leaving about 3 cm intact (this is your anchor). Trim the corners of the tape so that they’re round – this prevents them catching on clothes and coming off prematurely. Start by tearing the paper crosswise at the anchor. Applying the Kinesio tape Long strip Tear the paper that covers the sticky side crosswise where the tails meet the 3 cm anchor but don’t remove it. Straighten your arm and make a loose fist. Turn your fist so the back of your hand faces upwards and is in line with your forearm. Remove the paper from the 3 cm anchor and stick the anchor to the back of your hand, with the end angled slightly towards your thumb. Rub the tape to make sure it sticks. Now, maintaining the fist, bend it down and to the outside (little finger side). Your hand must remain in this position while applying the rest of the tape. Apply the two thin tails so that they run along the outer edges of the wrist extensor muscle group with very light stretch. It’s best to remove the paper backing from one tail at a time. Don’t touch the glue side or it won’t stick. Stick the last 2 cm of each tail down without any stretch on it. If you apply stretch to that part, it will either cause your skin to blister, or the tape will pull off when you start moving. Short strip Again, tear the paper that covers the sticky side crosswise where the tails meet the 3 cm anchor but don’t remove it. Keeping your elbow straight and palm facing down, stick the anchor part about 2 cm below the elbow and just outside of the outer piece of tape you’ve applied previously. The two tails should face inwards, towards you. Leaving at least 2 cm for the final anchor, stretch the upper tail by about 50% and stick it to the skin at a slight upward angle (towards the shoulder). Apply the final 2 cm bit without any stretch. Do the same with the second tail, this time at a slight downward angle (towards your wrist). These two tails, together with the inner tail of the first piece of tape should now have a triangular gap between them. 👉 Both types of tape are meant to be water resistant, so you should be able to shower with it on. In my experience, Kinesio tape stays on better in wet conditions than zinc oxide tape. 2. Diamond taping technique with zinc oxide tape for tennis elbow How it is thought to work Some clinicians think the diamond taping technique reduces the strain on the injured area, while others reckon it simply reduces the perception of pain (the “pain gate” mechanism again). Similar to the Kinesio tape situation, there is evidence  that the diamond taping technique can reduce tennis elbow pain. But the mechanism by which it works has not yet been investigated. What you’ll need Scissors Zinc oxide tape – 3.8 cm (about 1.5 inches) wide An assistant – this is definitely not a one-person job. Prepping the tape and your arm Clean your skin using water and soap. If there is cream or oil on it, the tape will not stick and pop off almost immediately. If you’re very hairy, you will likely have to shave the area for the tape to stick. Cut eight pieces of tape, each about 8 cm to 10 cm long. Try not to touch the glue side too much. Applying the tape The aim is to create a “puffy diamond” over the painful area where the tendons attach. Locate the painful area so you can picture the diamond you want to create around it – this is usually near the outer elbow. Your elbow should be resting comfortably, bent slightly (to about 20 degrees). The person applying the tape should first stick one end of the tape down, then pull the skin gently (not as hard as they can!) to where the centre of the diamond will be and apply the rest of the tape while maintaining the skin stretch. Do this with four pieces of tape, sticking them down in a diamond formation with overlapping ends. Then apply one more strip of tape in each direction and a bit further away from the diamond – overlapping the first strips by about two thirds. How to know whether your taping is working First observe what your pain normally feels like when you’re not taped up – it will likely fluctuate during the day. Make a note of what activities are most uncomfortable and rate your pain during these. Then apply the tape and observe how you feel afterwards. Do those activities that previously caused pain now feel more comfortable? 👉 In my opinion, tape is only worth using if it reduces your pain enough to notice a significant improvement. If you’re not sure whether it is helping, then it’s likely not helping and I would discard it. 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 Dewir, I. (2021) "Diamond McConnells' Taping Technique versus Counterforce Elbow Orthosis in the Treatment of Lateral Epicondylitis: a Randomized Controlled Trial" Medical Rehabilitation 25: 9-14. Li, Y. et al. (2024) "The efficacy of kinesio tape in patients with lateral elbow tendinopathy: A systematic review and meta-analysis of prospective randomized controlled trials" Heliyon 10(3): e25606. Zhong, Y. et al. (2020). "Kinesio tape reduces pain in patients with lateral epicondylitis: a meta-analysis of randomized controlled trials" International Journal of Surgery 76: 190-199.

Detailed LCL (lateral collateral ligament) exercise descriptions with recommended sets and reps, as well as video demos, to help you recover from your LCL sprain. Also, what you need to avoid doing to prevent further injury to your LCL. 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: Basic LCL exercise principles 1. Leg slides 2. Crunches 3. Russian twists 4. Glute bridges 5. Balance exercises 6. Calf raises 7. Double-leg box squats 8. Single-leg mini-squats with band Exercises to avoid Further reading How we can help We've also made a video about this: Basic LCL exercise principles   Your LCL is on the outer side of your knee, and its main job is to stop your knee from gapping on the outside. When it's injured, some of its fibres are torn. If you want it to recover, you've got to: Remove that gapping strain for a little bit so that the fibres can grow together again, and then you want to strengthen those new fibres as well as the supporting muscles.   The eight LCL exercises below are arranged more or less from early rehab to later rehab, and they aim to achieve the following: Restore the range of motion in your knee , so that it can bend and straighten fully. Regain control of your leg by improving your balance and strengthening the muscles (mainly your core and glutes) that keep your leg stable. Strengthen the muscles that support your knee  and lighten the load on your LCL. 1. Leg slides   A good first exercise is simply bending and straightening your knee. Aim: Improve range of motion and feed the joint 📽️ Play video demo Instructions: If you have been prescribed a knee brace , do this exercise with the brace on . For a serious LCL sprain, your brace will have been set for the first part of your rehab so that you can’t bend or straighten your knee beyond a certain range. Sit on a flat surface with your legs in front of you. Your uninjured leg can be straight or bent, whichever is more comfortable. Slowly bend and straighten your injured leg. Depending on the grade of your LCL sprain, it may be painful to straighten your knee fully at this stage. Only go as far as it is comfortable ; don’t bend and/or straighten your knee into a painful position. Once you can get your leg fully straight, you can also then start tensing your quad muscles to help you get that last bit of range of motion. This starts to get your quad muscles activated. You want to hold that for about 10 seconds before you relax it, but only if it's comfortable.   Dosage: 10 to 20 reps 1 set 2 to 3 times per day   💡Top tips: Sit on a bed or a couch – it will be kinder to your injured knee than having to lower yourself down to the floor. It can be useful to have one hand free to help your leg if you find it difficult to move it on its own. Especially at the start, the first few times can be really uncomfortable , and then, as it warms up, it gets easier.   2. Crunches Aim: Improve core strength. A strong core helps improve your control and movement patterns. 📽️ Play video demo Instructions: Lie on your back, feet on the floor, with your uninjured leg bent about 90 degrees. If your injured leg is happy to be in same position, good. If not, have it in any position that’s comfortable. Tighten your stomach muscles and press your lower back into the floor. Place your hands behind your ears – just for a bit of support, not to pull your head up. Curl up by first lifting  your head and looking at your toes. Then lift your shoulders and upper back off the floor. Your lower back must remain flat and in contact with the floor. Hold this for a second, and then reverse the position slowly, lowering first your upper back, then your neck, and lastly your head. Keep your stomach muscles contracted as you lower down; don’t just plonk down onto the floor.   Dosage: 12 to 15 reps 3 sets 2 to 3 times per week At least one rest day between sessions   💡Top tips: Don’t strain to do the full recommended sets and reps in the first session; start with what you can manage and then gradually build it up. On the other hand, if you find the exercise too easy right from the word go, you can make it harder by placing a weight on your chest. 3. Russian twists Aim:  The Russian twist targets especially the oblique muscles (the muscles either side of your “six pack”) of your core. 📽️ Play video demo Instructions: Sit on the floor with your uninjured leg bent and your injured one in whatever position is comfortable – you can put something like a rolled-up exercise mat under your knee for support if needed. Tighten your stomach muscles and lean slightly backwards so that your back is about 60 degrees to the floor. Place your hands on their opposite shoulders. Slowly twist your upper body to the left as far as it will comfortably go, come back to the centre, and then the same to the right – that is two reps.   Dosage: 12 to 16 reps 3 sets 2 to 3 times per week At least one rest day between sessions   💡Top tip: If you find this too easy at the recommended sets and reps, take a weight and touch it to the floor as you twist.   4. Glute bridges   Aim: Glute, hamstring, back, and core strength. 📽️ Play video demo Instructions: Lie on your back, feet flat on the floor, knees bent. If your injured knee is not happy to bend all the way, you just have it straighter, to where it's comfortable, and place most of your weight through the other leg as you do the exercise. Tighten your stomach muscles, tighten your glutes, and squeeze your bum to push your hips upwards until your stomach and the front of your thighs are more or less in a straight line. If you go further than this, it means that you are overusing your back muscles, which is wrong. Another sign that you’ve gone too far up is if your neck hurts. Hold the position for about a second, and come back down slowly.   Dosage: 12 to 15 reps 3 sets 2 to 3 times per week At least one rest day between sessions   💡Top tips: If your hips are not flexible enough to straighten all the way, place something under your feet – this will give your glutes a bigger range of motion to work through. And of course, if it's too easy , you can place a weight over your hips, or later on you can start doing it on one leg. 5. Balance exercises   As soon as your leg is happy to be fully straight and you can place your weight on it , it's time to start with balance exercises. These are important because when we injure a knee, the connection between it and your brain gets a little bit scrambled; so, you're not as good at controlling it as usual. We need to reteach that control so that the LCL doesn't take too much strain. Aim: Improve control 📽️ Play video demo Instructions: Hold on to something solid at the beginning , for two reasons. First, you may not trust your injured leg and may worry that you may re-injure it, so holding on will help you overcome that fear. And secondly, you don’t want excessive side-to-side movement of the knee, which may actually re-injure it. Stand on both feet with the support that you hold on to opposite to your injured side. Stand up tall, tighten your stomach muscles, and bend your knees slightly. Slowly shift your weight to your injured side, slowly lift your foot on the uninjured side off the floor, and hold the position. Concentrate all the time on what you feel on your injured side and what corrections you have to do to maintain your balance. If you’re happy with your balance, let go of your hold a little. If you’re stable enough to let go altogether, great! But if you start to feel wobbly, rather hold on and wait for your strength and control to improve over time before letting go.   Dosage: Hold for 10 to 30 seconds 2 to 3 reps Once a day   💡Top tips: Keep your foot stable. You want equal pressure on the big toe side and the little toe side of your balancing foot. You don’t want it rolling in our out excessively. If/when you find the exercise too easy , you can make it harder by moving your head side-to-side or up-and-down, or by moving your arms. Even harder is closing your eyes, but first get the go-ahead from your physio that you’re stable enough, because it can be quite tricky.   6. Calf raises   Another important muscle group to start strengthening is the calves, because the gastrocnemius (the big one of the two) comes up behind the knee and attaches above it. So, in addition to propelling you forward when you walk or run, it helps to stabilise the knee joint .   Usually, you can start doing the calf raises quite early on – as soon as you're allowed to weight-bear and you're comfortable weight bearing. Aim:  Strengthen the calf muscles and improve stability in the outer back corner of the knee. 📽️ Play video demo Instructions: This is not a balancing exercise, so you have to hold onto something for stability. Stand with your feet hip distance apart. Go up onto your toes, and then slowly lower yourself down in a controlled way. Check that your feet move in a straight line, with equal pressure under the big and little toes, so that your feet don’t end up turning outwards or inwards, especially when you get to the top.   Dosage: 12 to 15 reps 3 sets 2 to 3 times per week At least one rest day between sessions   💡Top tips: If/when you find the double-leg calf raises too easy at the recommended sets and reps, rather add some weight (carry it in a backpack) and continue with the double-leg exercises, than switch over to single leg. Please do these exercises in running shoes. Doing them barefoot on a hard surface can cause an injury to the balls of your feet  – one that is much harder to get rid of than an LCL sprain!   7. Double-leg box squats   Squats are very good for exercising the muscles we use for running and walking, and for simulating those motions. It strengthens your quads, which are important for stabilising your legs and knees, taking strain off your LCL, and it also works your glutes and hamstrings. Aims: Strengthen quads, glutes, and hamstrings Teach running and walking movement patterns 📽️ Play video demo Instructions: We’re using box squats, because the box prevents you from squatting down lower than you should at any given stage, either because your knee doesn’t want to bend that far yet or because you have an LCL knee brace that allows only a certain range of motion. If you don’t have access to a gym box, use something else, e.g. a chair with cushions piled on to the desired height. The idea is not to put all your weight on the box (or cushions), it is just there as a reference point to tell you where to stop. Stand in front of the box (or chair) with your feet about hip distance apart. It doesn’t matter if your feet don’t point straight forward, but your knees must stay in line with the middle of your feet during the whole squat movement. Stick your arms out in front of you for balance. Then, slowly squat down, sticking your bum out to the back as far as possible (this works the glutes better). Touch the box gently with your bum and come back up slowly.   Dosage: 12 to 15 reps 3 sets 2 to 3 times per week At least one rest day between sessions   💡Top tip: If/when the recommended sets and reps are too easy, rather start adding some weight and continue with this exercise on two legs than going straight on to single-leg squats.   8. Single-leg mini-squats with band   What single-leg squats bring to the party that double-leg ones don’t is that they help to teach you good balance and leg control in addition to the strength training. But it is good to strengthen up properly with the double-leg squats before moving on to single ones in the later stages of your rehab.   By doing squat with an exercise band around your legs, it trains your glute med muscle to stabilise and control your leg better Aims: Strengthen quads, glutes, and hamstrings Improve balance and leg control 📽️ Play video demo Instructions: Stand with your feet together and tie the exercise band around your thighs – start with an easy tension. Go into a shallow double-leg squat and move your feet about hip distance apart. The band will try and pull your knees in, don’t let it. Turn your knees out against the resistance so they remain pointing in line with your feet.. Shift your weight over to one leg, lift the other leg off the floor. Straighten the leg you’re standing on while maintaining the tension on the exercise band. And then go slowly back down into a mini-squat – that is one rep. The knee of your squatting leg must stay in line with your foot. When you’re done with the reps for one leg, rest at least a minute before switching to the other leg, because the latter has also worked to keep the tension on the exercise band. If you switch legs too quickly, the leg that must now do the squatting will be too tired and you won’t have good form. Rather go for quality than rushing to get all the reps in.   Dosage: 10 reps 3 sets each leg 2 to 3 times per week At least one rest day between sessions   💡Top tips: Make sure the exercise band doesn’t press on the injured part of your knee, and have it flat rather than scrunched up, so that it doesn’t dig into your leg. If you struggle to balance , it’s OK to have a finger on something stable until your balance is better. ⚠️Exercises to avoid   You want to avoid any exercise that causes a gapping force on the outside of the knee . Examples  include: The classic glute strengthening exercise of side leg lifts . If your LCL is injured and you do a side leg lift, gravity will pull your leg down, and that will create the gapping force on the outside of your knee that injured your ligament in the first place. Side planks with your legs extended. 👉These exercises are absolutely fine to do once your ligament has recovered, and they may even help it regain the final strength it need. The key lies in introducing them at the correct time in your rehab.   Further reading   LCL sprains – the bigger picture If you want to understand better how LCL sprains happen, what the recovery times will be, and how you can assess it or understand whether this is what you've injured, I've written a detailed article about that: Lateral collateral ligament (LCL) tears or sprains – Symptoms, treatment, recovery times .   LCL braces Not all LCL sprains need a knee brace . Learn which LCL injuries require a brace, which type of knee brace is best and when to wear it, and which types of brace to avoid: Knee braces for lateral collateral ligament (LCL) injuries – What works best . Examples available on Amazon: 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 Bushnell, B. D., et al. (2010). "Treatment of magnetic resonance imaging-documented isolated grade III lateral collateral ligament injuries in National Football League athletes." The American Journal of Sports Medicine 38(1): 86-91. Davenport, D., et al. (2018). "Non-operative management of an isolated lateral collateral ligament injury in an adolescent patient and review of the literature." BMJ Case Reports 2018: bcr-2017-223478. Petrillo, S., et al. (2017). "Management of combined injuries of the posterior cruciate ligament and posterolateral corner of the knee: a systematic review." British Medical Bulletin 123(1): 47-57. Ramos, L. A., et al. (2019). "Treatment and outcomes of lateral collateral ligament injury associated with anterior and posterior cruciate ligament injury at 2-year follow-up." Journal of Orthopaedics 16(6): 489-492. Sikka, R. S., et al. (2015). "Isolated fibular collateral ligament injuries in athletes." Sports Medicine and Arthroscopy Review 23(1): 17-21. Yaras, R. J., et al. (2022). "Lateral collateral ligament knee injuries.” StatPearls Publishing.