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Proximal hamstring tendinopathy (aka high hamstring tendinopathy) can quite literally be a pain in the butt for runners. Learn how to decide whether you can run with proximal hamstring tendinopathy and how to adapt your running so it puts less strain on your injured tendons. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. In this article: Can I run with proximal hamstring tendinopathy? How much pain is OK when I run? How to adapt your training for high hamstring tendinopathy Running form adjustments How we can help I’ve previously discussed in detail what proximal hamstring tendinopathy is and how to diagnose it , but here’s a quick overview: It’s an overuse injury affecting the tendons that attach the hamstring muscles to the sit bone (ischial tuberosity). It’s caused by repeatedly overworking the hamstrings without enough recovery time, often combined with excessive compression of the tendons against the sit bone. It usually affects only a small part of the tendon, which might lose some strength and become easier to irritate. In some cases, the hamstring tendons may not actually lose any strength but just become very sensitive and irritated. Recovery means giving the tendon time to rest, calm down, and then gradually to rebuild its strength (if needed) through a graded rehab plan – which might still include some running. Movements that involve hip flexion (bending the hip forward) often make high hamstring pain worse because they press the injured tendons more firmly against the sit bones – a bit like pressing on a bruise. Can I run with proximal hamstring tendinopathy? It depends on whether you can find a way to adapt your running so it doesn’t aggravate your injury. Once the hamstring tendons are injured, they often don’t have the strength or endurance to cope with your usual training loads. If you ignore the pain and keep running at a level that irritates them, the symptoms will usually get worse and eventually force you to stop running. To help your injury recover, you’ll need to scale back your training to match your hamstring tendons’ current capacity. Research shows that staying active within these limits can actually help recovery better than resting the injury completely for a long time – it's all about getting the balance ⚖️ right. How much pain is OK when I run? The general rule when recovering from proximal hamstring tendinopathy is that it’s fine to continue with an exercise or activity as long as: it doesn’t cause more than a slight increase in discomfort while you’re doing it, or  in the 24 hours afterwards, and any such increased discomfort settles down quickly. If you notice a significant increase in symptoms – especially the day after a training session – it’s best to make the next training session much easier. 🤷‍♂️ But what exactly do I mean by a “slight” vs. “significant” increase? This is where it gets tricky. You’ll sometimes hear physios say that 3 out of 10 or even 6 out of 10 pain is OK. And that’s true – research shows people can recover even if they train with some pain, as long as they don’t push it too far. The challenge is that pain is subjective – my 3 might be your 8. Marathon and ultra-marathon runners often have a high pain tolerance, and I’ve found that if I tell them to limit symptoms to 3 out of 10, they end up pushing too hard because it doesn’t really feel like pain to them. The result? The pain never settles down. That’s why I prefer to tell my patients it’s OK to feel a “slight niggle” in the high hamstring tendon area, but if you start thinking of it as pain it's a sign that you’ve taken things too far. And if you notice that you’re much more aware of your injury the next day – even if it’s not exactly painful – it could mean that you overdid it. Also, if you’ve been training within these low discomfort limits but your recovery has stalled, it can sometimes help to cut back significantly on all activities – not just running but also your rehab exercises – and give the tendon a complete rest for a week or two before easing back into your running and rehab. 👉 It’s worth noting that increased pain does not necessarily mean your injury is getting worse. Pain is not linked to the severity of your injury (this is why we all experience it differently), but if you continue to irritate it, the pain can get so intense that it stops you from training and really takes over your life. Alison explains pain in detail in this article  about Achilles tendinopathy. How to adapt your training for high hamstring tendinopathy The parts of your running training that you can adjust and experiment with include: Running distance  – shorter runs are generally better tolerated than long runs. Speed  – the faster you run, the harder your hamstrings work. Faster running also means more hip flexion, which increases compression of the tendons against the sit bones. Terrain  – uphill running works the hamstrings harder and requires more hip flexion, which again increases compression. Running form  – if you tend to overstride, it can help to shorten your stride slightly (see the section below). Running form adjustments The most important change you can make to your running form if you’re dealing with high hamstring pain is to reduce overstriding. You might find this video useful – I explain the concept of overstriding and how it relates to high hamstring pain in more detail. Why is overstriding a problem? Overstriding is when your foot lands far out in front of your body. This position puts the high hamstring tendon in a spot where it’s more likely to be compressed against the sit bone. As mentioned earlier, that compression can really irritate an injured tendon. How can you reduce overstriding? I go through this in detail in the video mentioned above, but here are some of the cues I find most effective for reducing overstride in my patients: Focus on taking slightly shorter steps – this naturally increases your step rate. Lean your torso slightly forward (while keeping your back straight, not slouched) and aim to make ground contact under your body rather than in front of it. Try to land softly. Increase your step rate slightly ( here’s a guide on how to do this ). Changing your running style can feel like hard work at first, and you’ll probably only manage it for short periods to start with. 💡 It’s best to make the transition gradually, because it forces “new” muscles and tissues to work harder than they’re used to. If you make the change too suddenly, you risk ending up with other 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 . References Barton CJ, Bonanno DR, Carr J, et al. "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion" Br J Sports Med 2016;50:513-526. Brukner P, et al. "Brukner & Khan's Clinical Sports Medicine" Vol 1: Injuries. (2017) McGraw-Hill Education. Goom TS, Malliaras P, Reiman MP, et al. "Proximal hamstring tendinopathy: clinical aspects of assessment and management" Journal of Orthopaedic & Sports Physical Therapy 2016;46(6):483-93.

Find out whether an LCL (lateral collateral ligament) injury needs a knee brace, which hinge‑based braces offer the best side‑to‑side stability, and how long to wear one based on your injury grade. 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: Do I need a brace for my LCL sprain or tear? How a brace helps the lateral collateral ligament to heal What type of brace should you get? These braces are no good When to wear your brace How we can help Do I need a brace for my LCL sprain or tear? Grade 1 LCL tears usually don’t need a brace. If you have a Grade 2 or 3 tear, a brace is necessary to help stabilise the ligament to allow it to heal. You can learn more about how to assess and grade LCL injuries here . How a brace helps the lateral collateral ligament to heal The main job of the LCL is to limit your knee’s side-to-side movement and to prevent it from gapping or turning too far out. Once injured, the LCL loses some of its strength, and it’s quite easy to injure it further just through normal day-to-day activities. The right type of brace will support and protect your injured LCL. It will still allow you knee to bend and straighten within the safe range (this is important to optimise healing) while stopping it from moving too much side-to-side and straining the already injured LCL. A hinged knee brace with metal rods on the side is best for collateral ligament injuries. What type of brace should you get? The best type of brace for LCL tears is one that: Has metal or carbon rods on the sides to prevent side-to-side movement. Has a hinge that allows the knee to bend and straighten. If you have a Grade 3 LCL tear, you will likely need one with a hinge that can be locked at 0 degrees (fully straight leg) for the first couple of weeks. Extends to about the middle of the thigh and the lower leg and fits securely so it stays in place. Examples available on Amazon: These braces are no good Don’t use the following types: Soft knee braces or sleeves. They don’t provide enough stability. Rigid knee braces without a hinge. It is important for recovery to be able to bend and straighten your knee while wearing the brace. In most cases, the longest a knee should be immobilised fully straight is 2 weeks, and this is only if you have a Grade 3 LCL tear. When to wear your brace If you have a Grade 2 LCL tear, you will likely be told to wear your knee brace for 6 weeks, while Grade 3 tears usually need a brace for 8 weeks. If you also have other knee injuries, you may be given different guidelines. During this period, it is usually best to wear your brace whenever you stand, walk, or do your exercises. You may also have to wear it in bed depending on your specific case. Your doctor or physiotherapist should be able to advise on what is right for you. 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 .

Tibialis posterior tendonitis (also known as posterior tibial tendonitis) is, in my experience, one of the trickier tendon injuries to treat. This article explains what causes tibialis posterior tendonitis, how to figure out whether your foot pain is indeed caused by this injury, and the best treatment approach for it. 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. The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles. In this article: Tibialis posterior tendon anatomy Posterior tibial tendonitis causes Posterior tibial tendonitis symptoms and tests Posterior tibial tendonitis treatment Posterior tibial tendonitis recovery time How we can help I also made a video that focuses specifically on the diagnosis and treatment of tibialis posterior tendonitis: Tibialis posterior tendon anatomy The tibialis posterior (tib post) muscle sits deep inside your calf, and the tib post tendon runs from this muscle down the inside of your ankle (behind the ankle bone) and attaches to the navicular bone on the inside of your foot as well as to several other bones underneath your foot. The main jobs of the muscle and the tendon are to support your foot arch so that it doesn’t collapse and to prevent your foot from tilting inwards (pronating) too much when you run or walk. In addition to this supportive role, they also help to point your foot downwards (plantar flexion) and then tilting it outwards (so that the sole of your foot points inwards, i.e. supination). We’ll get back to these movements later on when we discuss rehab exercises. Your tibialis posterior tendon supports your foot arch when you stand and walk and helps to tilt your foot onto its outer edge (supination) and point it down. Posterior tibial tendonitis causes The main injuring movement is when the foot tilts inwards (pronates) excessively – either too quickly and forcefully in one single incident, or too many times repeatedly. Pronation is part of the normal gait cycle (how we run and walk), so we’re talking about excessive pronation here. Excessive pronation forces the tib post tendon to work a lot harder than it normally does and also compresses it too tightly against the foot bones that it wraps around, and this then injures it. Below are some of the more common activities and situations that can cause your foot to pronate excessively. There are also some related tips on how to prevent tibialis posterior tendonitis in the first place. 1. Poor stability This can be due to weakness in the foot muscles, but also in the leg muscles, right up to the glutes. The glutes come into play when they cannot keep your knees aligned properly when you walk or run; so, when your knee turns inwards excessively each time you take a step, this causes the lower leg to tilt inwards, which causes over-pronation. How to fix this: Do exercises that strengthen your feet as well as the rest of your legs (more on this later). 2. Flexible feet in unsupportive shoes People with rigid feet can usually get away with wearing very flexible shoes (e.g. with memory foam or wobbly, soft foam soles) or flat shoes (like flip-flops) that offer little support, but if your feet are quite flexible (like mine), shoes that are too flexible or offer no support can cause you to over-pronate. Unsupportive shoes can predispose you to getting tibialis posterior tendonitis. What shoes are best for very flexible feet? Supportive walking or running shoes that lace up and don't make you wobble when you wear them. Asics and Hoka are two brands that are good, but you can also test your shoe by twisting it (like wringing water out of a towel) – if you can twist it nearly all the way around it is too flexible. As for sandals, Fit Flops , Megnya , and Powerstep are among the brands that make sandals with arch support. 3. Poor form going down hills If you’re not used to walking or running downhill and overdo it, or you do it towards the end of a long run when you’re tired and can’t maintain good running form, it can cause your feet to pronate excessively. Top prevention tip: Try to keep your steps light when you walk or run down hills. The harder you plonk your feet down, the more force goes through your body, potentially increasing pronation. If you're really tired on a run and have to go down a steep incline, rather walk 4. Running or walking on a camber for too long The foot at the higher end of a camber has to pronate more than usual to accommodate the angle of the surface you’re running or walking on. Top tip: If possible, vary the camber or avoid it during your walk or run. For example, on an out-and-back run, run back on the same side of the road that you did the out part. 5. Having a stiff ankle joint or tight calves If your lower leg can’t tilt forwards far enough on your foot (dorsiflex) to accommodate your walking or running strides, your foot has to pronate more to compensate for this lack of flexibility as you push off. This may happen if you have very tight calves, or some people’s ankle bones are simply shaped in a way that limits their dorsiflexion. Top tip for tight calves: If your calves are the problem, doing calf stretches may help. But please don't do these while your tib post tendon is injured, as it usually makes it worse (see below). Top tip for stiff ankle joints: If you have a high foot arch and your foot bones are restricting your movement, wearing a shoe with a higher heel-to-toe drop can help; the angle reduces the amount of dorsiflexion necessary for walking or running. Posterior tibial tendonitis symptoms and tests What tib post tendonitis feels like Tib post tendonitis usually causes pain around the inside of the foot and ankle, but in severe cases it can also cause an intense ache or burn a bit higher up the ankle. It may also cause swelling over the inner side of the ankle and foot. Where you typically feel the pain from posterior tibial tendonitis. The pain typically sets in gradually over the course of a day or a training session. Sometimes you may not notice it at the time, but wake up with pain the morning after an activity. If your injury started with you feeling a sudden pain when you took a step, or if you felt something snap, you may have torn your tib post tendon and need to get it checked immediately. Things that can increase the pain from tibialis posterior tendonitis include: Standing for long periods. Walking long distances. Although, if your tendon is very irritated, walking short distances may also hurt. Running or jumping will likely hurt. Often, the pain is most pronounced at the start of a run or training session, then it eases off as the tendon warms up, but returns worse than before towards the end of the session or several hours after. In severe cases, the pain may be present throughout the training session or even stop you from running and jumping. Walking or running in unsupportive shoes is usually worse. Wearing shoes or insoles that press directly onto the tib post tendon can irritate it. Calf stretches may feel good in the moment, but usually causes increased pain later because the calf stretch position also causes your tib post tendon to pull tight and compress around your ankle bones. Walking either uphill (because it stretches the tendon) or downhill (because it increases the work on the tendon) may hurt. Walking with the injured foot at the bottom of a camber may reduce your pain, whilst walking with it on the top usually increases it. Standing for long periods usually increases your pain when you have tibialis posterior tendonitis. Posterior tibial tendonitis tests Your physiotherapist will likely use the following tests to check whether you have posterior tibial tendonitis: Pressing on the tendon – The pain has to be located on the tib post tendon. If this is not the case, you likely have a different injury. We guide our online patients on how to do this themselves during our video consultations. Stretching the tendon – An injured tib post tendon usually hurts when you stretch it. You can stretch the tendon through movements that combine dorsiflexion (pulling toes up to the shin) with pronation (turning the foot in). If your tendon isn’t very irritated, this test may not hurt. Working the tendon – Forcing the tib post tendon to work when it is injured usually also reproduces the pain. If your tendon is very irritated, even light work (like when it helps you balance on one leg) may make it hurt. If your tendon is less irritated, your physio may have to test it through more loaded exercises (like calf raises or hopping). Your physio will select the best movement test depending on the rest of the information they gather during your consultation. Scans – Most cases can be diagnosed without scans. However, a scan is needed if your physiotherapist suspects a more serious injury, your symptoms don’t fit the typical pattern for tibialis posterior tendonitis, or you’re not recovering as expected. MRI or ultrasound scans are best. X-rays do not show tendons, but may be appropriate if your physio suspects that you may also have injured a bone. Posterior tibial tendonitis treatment First, we’ll look at ways to give your injured posterior tibial tendon a break to allow the pain to calm down, and then we’ll look at exercises to strengthen the tendon back up to its former state as well as strengthening exercises for other muscles to avoid injuring the tendon again. How to reduce posterior tibial tendonitis pain Limit the time you spend on your feet We’re not even talking about running or other sports in the initial stages of recovery – it’s all about giving your injured tendon a break by paying attention to things like standing and walking. Our patients often find that standing for prolonged periods of time really aggravates this injury – often more so than walking or gentle jogging! Remember that the tib post tendon’s main function is to support your foot arch, so it works non-stop when you’re standing. So, at every opportunity, sit down rather than stand. At work, look at what tasks you can do sitting down, or maybe perched on a high chair or barstool. Whenever possible, sit rather than stand. When I had posterior tibial tendonitis in both feet, I was working a 12-hour shift on Thursdays. I would get my tendons to calm down through the week, and then that one shift would set them back so far that I realised I needed to do something. There were types of treatment that I didn't have to do standing up, so I would administer them sitting down. Every time I had to chat to a colleague, I would perch on something. If I found myself waiting for the bus, I would sit down, and if I couldn't sit down, I would try and lean on my arms to take some weight off my feet. Measures like these are just temporary, to allow your tendon pain to calm down. You’ll be able to gradually revert to standing as much as you like once your tendon has recovered. And in the meantime you can still do things like swimming and cycling. Get orthotics that support your foot arches Like limiting time on your feet, orthotics (insoles) that support your foot arches give your injured tib post tendon(s) a bit of a rest so that they can recover. It’s like a little mini-crutch in your shoe. Supportive insoles can reduce the load on your tib post tendon. You can have orthotics made for you by a podiatrist, and this may be advisable if you have very flat feet, but most of our patients do just fine with off-the-shelf orthotics. Don’t get ones that are too hard or with very high arches, because they will press on the tendon and aggravate it further. People with normal foot arches should be able to wean themselves off their orthotics eventually, but if, like me, you have very flexible/flat feet, it may be a good idea to wear them even after you’ve recovered from your injury. These orthotics, available on Amazon, would work well for supporting your foot arches: Correct shoes for posterior tibial tendonitis Good shoes go hand-in-hand with orthotics. Shoes that are too flexible won’t give your foot enough support, which means that your injured tendon will have to work harder. However, don’t tie your shoes too tightly in an effort to increase the support for your feet; the shoes may press on the tendon and aggravate it further. Here are examples from Amazon of supportive shoes that work well for standing, walking and running: So, see if you can get away with wearing shoes that's supportive but don't cause too much pressure over that area. At the beginning, you may find that it helps to tie your shoes really loosely. Later on, of course, you need to tie them properly so that you can get the necessary support. If any type of closed shoe hurts, then a sandal with arch support may help. Here are some examples from Amazon: Stretches – be careful! Injured tendons tend to feel stiff at times – this is due to excess fluid build-up inside the tendon. In the case of posterior tibial tendonitis, you will probably feel the stiffness in your calf and inner ankle, and some treatment programmes prescribe calf stretches and even soleus stretches that you do with a bent knee. I want you to be careful with these, especially if you've got a fresh injury and have just aggravated your tib post tendon. Any stretches where your foot moves closer to your shin (like with calf stretches) cause the tib post tendon to compress tightly onto the bones of the ankle and foot. More often than not, I have found that patients actually flare themselves up with those at the beginning. Any stretch where your toes move closer to your shin will likely irritate your tendon and increase your pain. If you've had your tendon pain for a while and you want to try some gentle stretches, go for it, but don't stretch it too hard at the beginning. Ease into it, and check how your tendon reacts in the next 24 hours, because tendons often only tell you the next morning that you've overdone it. Massage for posterior tibial tendonitis For dealing with stiffness, massage or foam rolling are safer options than stretching. However, don’t massage directly on the painful tendon, even though it may feel good in the short term. Again, compression on the injured tendon usually makes it worse. Rather massage your calf muscles and avoid the painful areas, using a massage ball or foam roller. Posterior tibial tendonitis taping The purpose of the taping is to stop over-pronation. This can be especially useful if you want to ease back into running and you’re not sure whether your recovering or recovered tendon is ready to handle it. A show-and-tell video is more useful for demonstrating how the taping is done, and my colleague Steph Davies has made an excellent video about this. You should remove the tape immediately if your skin has an allergic reaction (red, itchy, or blisters) to it. Posterior tibial tendonitis exercises None of the treatment options above, on its own or in combination, will get your tendon to recover totally. All tendons and tendinopathies need to be strengthened up afterwards to regain their full strength. The tib post tendon can be quite fickle when you try to strengthen it. We usually ask our patients to avoid exercises that target the tib post muscles and tendon until the injury has calmed down quite significantly. But while the tendon calms down, it is possible to get going with some exercises to strengthen other muscles. Strengthening the muscles around your ankle and foot has been shown to help people recover from tib post tendinopathy, but you must also strengthen the rest of your leg. Weak glute and core muscles can cause your leg to turn in when you run and walk, placing extra strain on your tib post muscle and tendon. Exercises that strengthen the tibialis posterior muscle and tendon Once your tib post tendon has calmed down somewhat, it is advisable to start off with an isometric exercise – which means that the foot and ankle don’t move – using an elastic exercise band. Keeping the foot in a neutral position avoids compressing the tendon, which may still be quite sensitive at this stage, against the foot bones. I demonstrate this isometric exercise in this video: When your tendon has calmed down some more, you can progress to doing the exercise with the full range of motion of your ankle and foot, i.e. pulling on the exercise band by moving your ankle and foot. Your physio will guide you on when you're ready to start these. Some exercise bands available on Amazon: Or you can go to the TheraBand Store for more options . Exercises that strengthen other muscles You should be able to start with these exercises even while your injured tib post tendon is recovering from the worst of the pain. They help reduce the strain on the tib post tendon by improving the strength and control around your hips and core. Choose exercises that you can do lying down or sitting, e.g.: Clams Side leg lifts Bridges Crunches Russian twist Cross-training options If you can’t run while you recover from your tib post tendonitis, there are other ways to keep fit. Swimming is usually a good option – kicking off the wall can sometimes hurt, so avoid that. Riding a bike with posterior tibial tendonitis can sometimes irritate the tendon more because of the position of your foot on the pedal (dorsiflexion). But this is not true for everyone, so test a gentle bike ride and observe how your tendon responds in the 24 hours after the ride. Riding a bike with posterior tibial tendonitis can sometimes make it worse due to the position your foot is in. Last-resort treatment options Sometimes, even when our patients are really good and follow the treatment recommendations above, their tib post tendonitis still doesn’t want to get better. In such cases, I would say people should seriously consider investing in going to see a sports physician. Why a sports physician and not a GP? Because sports physicians specialise in sports injuries, including tendon problems. They can usually do an ultrasound scan there and then to see what’s going on. And that's important, because other things can feel like a tib post tendinopathy and then actually not be it. For instance, you can have a tear in your tendon, which can feel very similar, but it will need a different approach. They also have quite a variety of other types of treatment they can add for you. Some patients react really well to shockwave therapy to calm the tendon pain down and allow them to resume their rehab exercises. For others, an injection may be useful. Now, we don't want cortisone near tendons , but sometimes the tendon sheath is inflamed or there are bursas involved, and they can tell that with ultrasound. In extreme cases I have seen people have cortisone injections for this; you just have to treat it very carefully afterwards – they’re usually immobilised in a boot for ten days or so to protect that tendon. And then, very slow-level rehab after that. But note that none of these treatments will heal your tendon; they may only reduce the pain. Afterwards, you will still have to do the strength exercises. So you may as well give the pain management methods and exercises I described earlier a proper go before considering any of these treatments. Posterior tibial tendonitis recovery time In our experience, recovery times for tibialis posterior tendonitis depend on: For how long your tendon has been painful before you started with the correct treatments. What type of sport or activity you want to get back to – it takes longer to get back to high-impact sports that involve running and jumping. Other factors, like the menopause and being older can also increase recovery times. In most cases, you can expect the following recovery times: 8 to 12 weeks if your tendon pain only started in the last couple of weeks and you’re able to rest it and apply the correct treatments immediately, 4 to 9 months if you’ve had your pain for more than a month before starting the correct treatment, more than 12 months if you’ve had your pain for several months. 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 Bowring B, Chockalingam N. Conservative treatment of tibialis posterior tendon dysfunction—A review. The Foot 2010;20(1):18-26. Kulig K, Pomrantz AB, Burnfield JM, et al. Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]. BMC Musculoskeletal Disorders 2006;7(1):1. Ross MH, Smith MD, Mellor R, et al. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport & Exercise Medicine 2018;4(1):e000430.

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.

Foot pain in runners can present in two ways. It can develop suddenly, e.g. you go over on your ankle or you feel a sudden sharp pain while running – also known as traumatic injuries. It can also develop slowly over time, and the cause of this type of injury is often not that clear. In this article, we're going to focus on the second group of foot injuries – the ones that seem to develop for no apparent reason. We'll also share the top three treatments that we find work best for treating each of these foot injuries. Remember, if you need more help with an injury you're welcome to consult our team of sports physios 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: Pain on the outside of your foot Pain on the inside of your foot Pain over the front of your ankle Pain under your heel Pain in the front of your foot Getting any tingling in your ankle or foot? Stress fractures We've also discussed this topic in this video: Pain on the outside of the foot Sinus tarsi syndrome Despite its impressive name this condition is more painful than harmful. It is caused by chronic inflammation in the soft lining of the ankle joint. The pain is usually located  just in front of the lateral malleolus (ankle bone), in a very similar place to where your ankle ligaments run and it often gets mistaken for a ligament sprain. Here's a video where we discuss Sinus Tarsi Syndrome in a lot more detail: Causes: It often develops after you’ve sprained your ankle . Ankle ligaments usually take about 8 to 12 weeks to heal so if your pain continues for longer than 12 weeks, sinus tarsi syndrome may be to blame. Another common cause is if your foot rolls in excessively (over-pronation) when you walk or run. When this happens you tend to squash the outside of the ankle joint which can cause it to flare up. Some of the most common things that can cause your foot to roll in too much include muscle weakness around your ankle or hips, wearing trainers that are too soft or running on a camber. Our Top 3 fixes: The main goal with treatment is to improve the foot’s position and stop it from rolling in excessively while walking and running. You can achieve this through: Wearing supportive shoes ALL DAY LONG. This injury may have been caused by running, but if you want it to recover you’ll have to look after it throughout the day. We usually also prescribe supportive insoles for our patients (see examples below). In severe cases they may even benefit from wearing an ankle brace for 4 to 6 weeks while we strengthen up the muscles. Again, the aim of this is to stop the foot from rolling in. Foot arch strengthening exercises as well as strengthening the stability muscles around the hips are important to prevent this from recurring. You can find a more detailed discussion about the treatment of sinus tarsi syndrome here . Peroneal Tendinopathy Your peroneal muscles run along the outside of your lower leg. Their main function is to turn your foot out. Their tendons wrap around the back of the bone on the outside of your ankle. If these guys are to blame for your foot pain, you’ll often feel the pain over the outside of the foot – below the ankle bone or towards the outside border of the foot. Here's a video where we discuss Peroneal Tendinopathy in a lot more detail: Causes: The main cause for this type of injury is usually something that makes your foot roll out more (excessive supination) while running. Our Top 3 fixes: Check your running shoes – is it time to lay them to rest and get a new pair? How tight are your calves? Tight calves (especially soleus) can make your peroneal muscles take more strain. Have you been running on cambers that made your foot roll out more? Change your running route so that you run on the flat. You can find more information about the treatment of peroneal tendinopathy here. 5th Metatarsal stress fracture Your 5th metatarsal is the little bone that runs along the outside of your forefoot. The little bump that you can feel on the outside of your foot is the head of the 5th metatarsal bone. This is by far the most common area for stress fractures, but it can develop in any part of the bone. The pain is located on the outside of the foot and can sometimes be mistaken for peroneal tendonitis. It's also possible to have both conditions at the same time. I discuss the diagnosis and treatment in detail in this video: Causes: Stress fractures are overuse injuries that develop when your bones can't recover quickly enough after exercise, either because you are training too hard, or not eating enough, or sometimes due to other conditions or deficiencies. Find out more about the causes of stress fractures here . Our Top 3 fixes: Have it assessed by a sports doctor or a medical professional who is experienced in dealing with stress fractures. If you don't follow the correct treatment regime, it can delay healing and even mean that you may require surgery. You will have to take your weight off your foot to allow the bone to heal. Depending on how bad your case is, your doctor may still allow you to walk around on it, but you'll likely be required to wear a boot and not place much weight through it. Make sure that you eat a healthy diet and that your Vitamin D levels are adequate. Your bones can only repair if you provide them with the tools to do so. Pain on the inside of the foot Tibialis posterior tendinopathy Your tibialis posterior muscles (tib post) is one of the main muscles that support your arch and stop your foot from rolling in or pronating excessively. Tib post tendinopathy causes pain on the inside of the heel and along the inside of your foot’s arch. The muscle belly of the tib post lies in your calf and it can sometimes even produce pain along the inside of your shin bone. Here's a video where we discuss tib post tendinopathy in a lot more detail: Causes: The main cause of tib post tendinopathy in runners is when your foot rolls in too much while running (over-pronates). As mentioned above, over-pronation can be caused by several different things including the wrong running shoes, lots of downhill running, muscles weakness around the ankle or higher up in the leg etc. Our Top 3 fixes: Check your running shoes (starting to see a pattern here??) – are they too soft or are they worn out? Do they provide enough support? Use supportive insoles or orthotics to take some of the strain off the tib post tendons. (See examples below) Strengthen your muscles in your foot and ankle as well as the stability muscles around your hips. Here are some examples of supportive insoles that we found on Amazon – similar to the ones we use in clinic: You can find more information about the treatment for tibialis posterior tendinopathy here. Navicular stress fractures Navicular stress fractures produce pain over the inner part of the bridge of the foot, but it can also feel as if it is at the top of the foot. We've discussed navicular stress fractures in this video: Causes: The most common causes are overtraining and not getting the nutrients or vitamins your need (often it's a combination of the two). Treatment: These stress fractures are slow to heal and may require surgery, so it is really important to get them seen to immediately. We've discussed how to treat navicular stress fractures in detail here, but it can be summarised in three steps: Immobilisation in a boot. Not placing any weight through your foot for 6 to 8 weeks. Then, once the boot is removed, very slowly increasing the load and strength in your foot. Pain over the front of the ankle Tibialis Anterior tendinopathy This tendon runs down the front of the ankle joint and wraps around the inside of the foot. It flexes your foot upward but also helps to stop your foot from rolling in too much. If the pain in your foot is coming from this tendon, you usually feel it in the area where your foot joins your ankle. Causes: The number one cause for Tib Ant tendinopathy that we see in clinic is when runners tie their laces too tight, causing the tendon to rub as they run. Running in shoes that are a lot heavier or doing a lot of downhill running can also cause the Tib Ant to flare up. Our Top 3 fixes: Check if your shoelaces are a problem. You may have to tie them extremely loosely to help your tendon recover. I caused mine to flare up while hiking in Scotland a few months back and it took about 4 weeks of careful management before it settled down again. If you’ve recently changed running shoes you may have to check that they’re not too heavy. Check if it’s better if you run on flatter terrain for a while. Pain under your heel Plantar Fasciitis We have a whole series of blog posts on how to treat this pesky problem , but here are the highlights. The plantar fascia is a thick fibrous band of tissue that runs from your heel to your toes. Its main function is to support your foot’s arch and stop it from collapsing when you put weight on it. Plantar fasciitis is essentially an overuse injury that develops when you strain the plantar fascia where it attaches to the heel bone. It can be extremely painful and stop you from running and walking. Here's a video where we discuss plantar fasciitis in a lot more detail: Causes: Anything that puts extra strain on the plantar fascia e.g. unsupportive shoes, gaining weight, upping your running distance or intensity too dramatically. We’ve explained the causes of plantar fasciitis in more detail before. Our Top 3 fixes: Wear supportive shoes with arch support inserts ALL THE TIME. You may have developed this injury through running, but you will have to nurse it all day long if you want to make a quick recovery. Identify what’s making it worse and try to avoid it while you strengthen your foot arch and other leg muscles. Do not go back to running too soon. You should have at least 4 pain free weeks and be able to walk 10km pain free (and without pain the next day) before you go back to running. These arch support insoles are made with NASA foam technology: Read the complete guide to treating Plantar Fasciitis here . Pain in the front of your foot Metatarsalgia This is pain under the ball of your foot. Our patients often also describe it as feeling as if they are walking on a pebble. It is caused by inflammation in the little joints where your toes attaches to your foot. We discuss metatarsalgia in much more detail in this article . Causes: These little joints become painful and sore when they are put under too much pressure for too long. In our experience (unless you’re a dancer) the main cause for this condition is wearing the wrong shoes. And we're not necessarily talking about running shoes. Regular work shoes or leisure shoes are often the culprits. Examples include ballet pumps, men’s dress shoes, minimalist running shoes or old trainers. Our Top 3 fixes: Switch to wearing soft trainers ALL DAY LONG until your foot has fully recovered. This may mean that you’ve got to commute in them as well. If you’re running in minimalist shoes (with very thin soles) you may have to switch to more cushioned shoes. Minimalist shoes are often touted as being the key to injury prevention, but they can cause their own injuries and metatarsalgia as well as metatarsal stress fractures are 2 examples. Using orthotics with a metatarsal dome (see examples below) can often help to relieve some pressure on these painful joints. It fits just behind the metatarsal heads and lifts the little joints slightly. Morton’s neuroma You have little nerves that run between the bones in your forefoot. When these nerves get squashed they swell and become irritated causing pain in your forefoot that often also refers into your toes. Because it’s caused by irritated nerves, you may also feel tingling or numbness. Causes Wearing shoes that are too tight is an obvious cause for Morton’s neuroma. But anything that causes the bones to move and squash together excessively can contribute e.g. if you have very flexible feet or your feet roll excessively while you run (pronation or supination). Our Top 3 fixes: Make sure that you avoid all tight shoes. Wear supportive shoes that limit excessive movement. Use insoles with a metatarsal dome that can help to spread the little bones in the forefoot, creating a bit more space for the nerves. Here are some examples of orthotics that have arch support and metatarsal lifts. What we like about them is that they seem to have adjustable domes. Remember the dome has to sit BEHIND THE BALL OF YOUR FOOT – not on it. Getting any tingling in your ankle or foot? Tingling, numbness, a sensation of pins and needles or any strange sensations are usually a sign that your injury involves a nerve. Tingling etc. in the ankle and feet can be caused by injuries in the lower back or the leg or in the foot/ankle. It's best to consult a physio or other sports medicine professional if you’re experiencing these type of symptoms. They’re not necessarily more serious injuries, but they can be tricky to get better by yourself. This is also something that we can assess via video call . Stress fractures Stress fractures are rare, but they are a risk for anyone who does a lot of running. The most common areas where runners develop stress fractures are in the navicular bone , calcaneus (heel bone) , and 5th metatarsal . Bones normally first develop a stress reaction, during which time they’re very painful but nothing is broken. If you can catch this injury early and do the right things, it can settle down in as little as 4 to 6 weeks. If you neglect the signs and symptoms and continue to train, it may develop into a full-blown fracture, which can take months to heal. Causes: Very high training loads, usually combined with not enough recovery time, and often also a restricted diet. You can get a better understanding of how stress fractures develop in our previous blog post . Diagnosing stress fractures can be tricky, as they often don’t show up on regular X-rays. An experienced sports physio should be able to diagnose this for you. Our Top 3 fixes: Immediately cut out all aggravating activities and rest the body part from all impact. This may include immobilising it in a boot for a few weeks. It is best to get guidance on how to best do this from a healthcare professional. Analyse your training programme, including your diet and recovery to see where things have gone wrong. Ask your GP to check your general bone density and Vitamin D levels. Need more help? Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. You can read more about her here. Follow her on LinkedIn or ResearchGate . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. López-Valenciano, A., et al. (2016). "Impact of dynamic balance and hip abductor strength on chronic ankle instability." European Journal of Human Movement 36: 137-149. Mansur, N. S. B., et al. (2019). "Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series." Revista da Associação Médica Brasileira 65(3): 370-374. Tu, P. (2018). "Heel pain: diagnosis and management." American family physician 97. Bowring B, Chockalingam N. Conservative treatment of tibialis posterior tendon dysfunction—A review. The Foot 2010;20(1):18-26. Kulig K, Pomrantz AB, Burnfield JM, et al. Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630]. BMC musculoskeletal disorders 2006;7(1):1. Ross MH, Smith MD, Mellor R, et al. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ open sport & exercise medicine 2018;4(1):e000430. McKeon, P. O., Hertel, J., Bramble, D., & Davis, I. (2015). The foot core system: a new paradigm for understanding intrinsic foot muscle function. British Journal of Sports Medicine, 49(5), 290. Robroy L.M. et al., (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33. Bentall, D. (2020). "RED-S: not just a female phenomenon." British Journal of Sports Medicine: bjsports-2019-101868. Herbert, A. J., et al. (2019). "The interactions of physical activity, exercise and genetics and their associations with bone mineral density: implications for injury risk in elite athletes." European Journal of Applied Physiology 119(1): 29-47. Mountjoy, M., et al. (2018). "IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update." British Journal of Sports Medicine. Wright, A. A., et al. (2015). "Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis." British Journal of Sports Medicine 49(23): 1517-1523.

A cool-down includes all the activities that you do in the hour after exercise. It can broadly be divided into an active cool-down and a passive cool-down. An active cool-down is commonly believed to be better than a passive cool-down for recovery from training and preventing injuries, but is it really? I have to admit that I very rarely do any activity that counts as an active cool-down and I can’t really say that I’ve noticed any negative effect. So what does the research say? Am I missing a key part of the injury prevention puzzle or is it something that’s only relevant to elite athletes? In this article: What's an active cool-down? What's a passive cool-down? Effects of an active cool-down on performance Removal of lactic acid DOMS and muscle damage Stiffness and range of motion Heart and Lungs Injury prevention Static stretching Foam rolling What's an active cool-down? An active cool-down is often referred to as active recovery. It usually consists of low to moderate intensity exercise that is performed within 1 hour of the main training session or competition. It’s commonly believed that an active recovery or cool-down is beneficial because it helps your body get rid of the chemical by-products caused by exercise (e.g. lactic acid) more quickly than when you just lie or sit around. This, in theory, would mean that you recover more quickly, perform better and could possibly even help you avoid injury. Researchers from the Netherlands and Australia   recently reviewed all the studies that they could find on the topic and it would seem that an active cool-down may not be as effective as we would like to think. I discuss their findings below. What's a passive cool-down? Activities like static stretches and foam rolling counts as a passive cool-down because they don’t involve any exercise. Effects of an active recovery on performance In theory one would think that if an active recovery gets rid of all the toxins etc. formed during exercise, it should help you recover better and therefor help your performance. But this does not actually seem to the case. The research have so far not produced any consistent evidence that an active recovery is any better than a passive recovery when they looked at how athletes perform on the same day as well as the following day. Removal of lactic acid Lactic acid must be one of the best known by-products of exercise and has traditionally been associated with fatigue. These days we understand that fatigue in exercise is caused by a lot more than just lactic acid and its relevance to performance is even being questioned. That said, one of the main reasons that people advocate an active cool-down is due to the belief that it allows your body to get rid of lactic acid much more quickly than if you just sit around. Spoiler alert! Your body naturally gets rid of all extra lactic acid within 20 to 120 minutes after exercise REGARDLESS of what you do. In studies where participants did get rid of their lactic acid more quickly than others, this also did not give them any performance benefits. In some studies the researchers found that an active cool-down even slowed the process. This may be down to the low fitness levels of the participants. If you’re not very fit an active cool-down may actually just add to your training load and cause more lactic acid to build up! Verdict: An active cool-down does not get rid of lactic acid any quicker than a passive cool-down. DOMS and muscle damage DOMS stands for Delayed Onset Muscle Soreness. It can be defined as the soreness that you develop in your muscles in the days after doing a hard bout of exercise. There is some evidence that an active cool-down can decrease the effects of DOMS in professional and highly trained athletes. But it doesn’t seem to have the same beneficial effects for recreational athletes. Researchers are able to tell how much muscle damage you’ve developed during exercise by testing for certain markers in your blood. An active cool-down does not seem to influence these markers nor does it allow athletes to regain their maximum muscle strength any quicker compared to a passive cool-down. Stiffness and range of motion Exercise (especially eccentric exercise) causes micro-damage in your tendons and muscles. This is part of the natural process that allows the body to rebuild itself stronger in response to exercise. This micro-trauma is the main reason why you often feel stiff in the days after a hard bout of exercise. A common belief is that an active cool-down decreases this stiffness, but you’ve guessed it – the research have shown that it doesn’t actually have much of an effect on how stiff you feel. Something that I would love to know and that's not yet been researched is what the effect of a long period of inactivity immediately after exercise is on the recovery of your joints and muscles. I definitely find that I stiffen up dramatically if I sit and work at my desk after I've gone for a run. Whereas I never feel as stiff when I potter around afterwards. I would love to know if this has any detrimental effect the next day or is it just a transient nuisance that I have to put up with for that day? Heart and Lungs There is strong evidence that an active cool-down helps your cardiovascular system (heart) and respiratory system (lungs) recover quicker. I don’t know if you’ve ever noticed how wobbly marathon runners can look when they cross the finish line. Yes, this is partly due to the fact that they’re knackered but if you suddenly stop exercising the blood can pool in your legs. This can cause light headedness, tunnel or blurred vision or may even make people pass out. An active cool-down can also decrease this effect. Injury Prevention It’s not currently clear if an active or passive cool-down has any effect on injury prevention. Static Stretching Static stretching can help you regain your range of motion and decrease the feeling of stiffness after exercise. It doesn’t have any effect on DOMS (the pain you feel after exercise). The research has also found that it may play a role in preventing muscle strains. I find in practice that children often benefit from it more than adults. They tend to struggle with excessive stiffness when they go through growth spurts which makes them vulnerable to injuries like Osgood Schlatters . Including static stretches as part of their cool-down can have a very beneficial effect on their flexibility. Foam rolling Foam rolling appears to be a useful activity to include in your cool-down as it’s been shown to effectively reduce the amount of muscle pain you feel after exercise (DOMS). The verdict: Highly trained athletes may benefit more from doing active cool-downs than recreational athletes. That said, all of us can benefit from the positive recovery effect it has on your heart and lungs. Static stretching and foam rolling are also useful modalities to include in your cool-down. Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate References: 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. Dupuy O, Douzi W, Theurot D, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue and inflammation: a systematic review with meta-analysis. Frontiers in physiology 2018;9:403. Loughran, Martin, et al. “The effects of a combined static-dynamic stretching protocol on athletic performance in elite Gaelic footballers: A randomised controlled crossover trial.” Physical Therapy in Sport 25 (2017): 47-54. 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. Van Hooren B, Peake JM. Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response. Sports Med 2018:1-21.

With companies keen on selling you their protein powders and protein shakes, it is often difficult to know whether nutrition advice on the Internet is grounded in solid research or just a ploy to get more sales. We take a look at the research into using protein for recovery after running and to speed up injury healing. And we weigh in on the debate about natural foods vs. supplements as a source of protein. 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: How much protein is needed after exercise to best stimulate muscle growth? Is there any benefit in taking protein supplements during exercise? Is there a “best time” to ingest protein to help build muscle? What is the best source of protein for athletes? Should you have a high-protein diet when trying to lose weight? When you're recovering from injury, can a high-protein diet prevent loss of muscle mass? Protein intake and your immune system Are protein supplements better than food sources of protein? Injured? We can help How much protein is needed after exercise to best stimulate muscle growth? We know that exercise is a potent stimulus to build muscle, but this can only happen if you have the right nutrients available . Your muscles first go through a breakdown phase after exercise and then has to use the proteins that you have eaten during the day to rebuild themselves stronger. It turns out that the average person only needs about 20 g to 25 g of high-quality protein after an exercise session, but this should be consumed within two hours after exercise to get the most benefit.  If you are a masters athlete (above 50 years of age), you may have to take higher doses of protein to allow your muscles to recover at the same rate as those of your younger self. This does not have to be in the form of a protein shake or bar. It can simply be whatever protein you are eating with your next meal (see the list below for natural protein sources). This is good news for me, since I really struggle with consuming anything with the word "supplement" in it – I think my brain files it in the same category as medicine 🙃. The more the better, right? Well, actually no. Researchers have not found any extra benefit if you take greater amounts of protein supplements within that period of time (see the following section for more details on how to use protein supplements throughout the day). Endurance athletes may be interested to know that protein intake after exercise can also help to increase mitochondrial proteins. Your mitochondria can be seen as the battery boxes of your cells. Eating enough protein after exercise may allow your muscles to become better at using the oxygen that is available to them during your next exercise bout. Ensuring you get enough protein after your endurance runs can boost your aerobic capacity. Foods and beverages providing 20 g of high-quality protein You can check the protein content of different food sources on the USDA website . I've calculated the most obvious ones below. Fluid 1% low-fat milk (plain or flavoured) - 591 ml Low-fat yogurt (plain) - 454 g Low-fat Greek style yogurt (plain) - 227 g Soy milk, plain - 680 ml Lean beef or pork - 85 g Lean ground beef patty - 85 g Poultry - 85 g Eggs, whole - 3 large Eggs, white - 6 large Cheese, cheddar - 85 g Cheese, low-fat string cheese - 85 g Cottage cheese - 43 g Tuna, light canned in water - 85 g Salmon, farm-raised - 85 g Broadbeans (raw) - 80 g Red Kidney beans (raw) - 80 g Lentils (raw) - 85 g Is there any benefit in taking protein supplements during exercise? Not unless you are an endurance athlete! Research has shown that athletes are unlikely to experience performance benefits from consuming protein during events. However, they may recover better if they consume protein during events that are longer than three to five hours. Ultra-endurance athletes may be less able to digest and absorb protein after exercise of this duration, because of the blood being shunted away from the gut to the muscles. Taking on some protein during endurance events can help them reach the optimal levels within the right time frame and may thus hold an advantage for their recovery, especially in multi-day events. Protein supplements may be a better choice in these situations, because they are easier to digest. Is there a “best time” to ingest protein to help build muscle? The current research seems to suggest that: The average person should aim to consume about 30 g of high-quality protein in five small meals , or if you're not average size, 2.5 g per kilogram of bodyweight, divided by 5 , spaced evenly throughout the day to get the most benefit. 💡Researchers have also found that consuming an additional 40 g of protein before bedtime allows your body to continue building muscle while you sleep. If you are over the age of 55, you may have to follow a slightly different approach. Older athletes require more protein and should take it at different times to get the same benefits as younger athletes. Consuming protein before you go to bed can allow you to continue building muscle while you sleep. What is the best source of protein for athletes? When you eat protein, your stomach and gut break it down into various amino acids (the basic building blocks of protein). Your body then uses these amino acids to form your own muscle proteins. So, it makes sense that the best protein to eat is that which provides all the essential amino acids. The research has shown that: Milk protein may have the advantage over single-source proteins, like soy, because milk contains both whey and casein. Whey protein appears to be more effective than casein alone. Soy is slightly less effective than whey. Whey protein’s superior effect is thought to be due to the amino acid leucine (1.8 g of leucine post-exercise appears to get the best results). Do take care when you buy whey protein, since not all preparations contain the same amount of protein. Milk is a good natural source if you don't like supplements — 600 ml of the white liquid not only contains 20 g of protein (whey and casein) and plenty of leucine, but also other vitamins and minerals that your body needs. But maybe you do prefer taking supplements instead. I've rummaged around on Amazon and found these protein supplement options from brands that look trustworthy. Of course, you are responsible for what you buy in the final instance. Should you have a high-protein diet when trying to lose weight? The short answer is yes , but as usual, it is a bit more complicated than that. It may really be worth discussing your diet and exercise volume with a dietitian to get the best results. If you want to preserve your lean muscle mass while enhancing fat loss, the research suggests the following regime: A 500 calorie deficit per day. This means that you should work out how many calories you burn with exercise and normal activities per day, and your total daily intake should be 500 less. Eat 1.8 g to 2.7 g of protein per kilogram of bodyweight per day (or at the higher end of the Acceptable Macronutrient Distribution range of 30% to 35%). 30% of your calories should come from fat and the remainder from carbohydrates (total calories minus calories from protein minus calories from fat = how much carbs you should eat). And finally, combine this diet with resistance training. When you're recovering from injury, can a high-protein diet prevent loss of muscle mass? Remember that you need a combination of exercise and enough protein in your diet to gain muscle mass. Exercise + Protein = More Muscle Unfortunately, this means that you will lose muscle mass if you cannot exercise that muscle, despite eating adequate amounts of protein. You may be worried about getting fat when you can’t train and therefore restrict your calories during injury. Your body can, however, only repair if you actually provide it with all the nutrients it requires to get the job done. While consuming protein will not prevent muscle loss, it still plays an important role in your healing and recovery. The research suggests that you should aim for 1.6 g to 2.5 g protein per kilogram of bodyweight, spaced evenly throughout 4 to 6 feedings a day. And all is not lost! There may be a way of getting the "exercise" component done without causing further harm. Neuromuscular electrical stimulation (NMES) is a very effective tool that we use in practice to exercise muscles when the joints, ligaments, or tendons do not allow us to do traditional strength training. Many clinics use the Compex machines . They are small and portable and stimulate strong muscle contractions that produce the same results you get from lifting weights, but with no pressure or force in the joints or ligaments. 👉 If you are worried about losing muscle mass while injured, my advice would be to: Eat adequate amounts of protein. Get a Compex machine to exercise the muscles around your injured body part. Continue your strength training programme for the rest of your body as normal. Here's a selection of NMES units on Amazon. Or you can go to the Compex Store . Protein intake and your immune system A high-protein diet (3 g per kilogram of bodyweight per day) for athletes has been shown to help restore their immune systems after training. Athletes who undergo high volumes / intense training programmes reported fewer upper respiratory illnesses (head colds, coughs, and sinus infections) when they ate high amounts of protein daily. Are protein supplements better than food sources of protein? There is no evidence that protein supplements are superior to food sources. Using protein powders and bars may be more convenient than lugging food around, but it is important to realise that protein supplements are not regulated by the likes of the US Food and Drug Administration. Some of these products have been shown to: not contain the active ingredients stated on the label; contain harmful substances , including toxic agents and prescription-only pharmaceuticals; contain illegal substances that can lead to doping bans. In 2021 and 2022, a group of Spanish researchers bought 47 different whey protein supplements online and from pharmacies, gyms, sports stores, and supermarkets. They compared the actual protein content of each and compared this to what was claimed on the label. The average actual protein content was 70.9% and the average claimed content was 74.3%. However, eight of these supplements had more protein than what the label said. (Unfortunately, the authors didn't name and shame the products in their report.) Another advantage of getting your proteins through regular food is that many foods also contain other essential nutrients that aren't present in supplements. Eggs, for instance, contain Vitamin D , which is essential for healthy bones and muscles. My advice would be to eat whole foods most of the time, and if you do buy protein supplements, shakes, and bars, go for reputable brands. Injured? We can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call  for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Doering, T (2016) "The masters triathlete: Protein intake, muscle protein synthesis response and recovery from muscle-damaging exercise" Doctoral Thesis, CQ University, Australia . Moore, DR et al. (2014) "Beyond muscle hypertrophy: why dietary protein is important for endurance athletes" Applied Physiology, Nutrition, and Metabolism 39(9): 987-97. Rosenbloom, C (2015) "Protein Power: Answering Athletes’ Questions About Protein" Nutrition Today 50(2): 72-77. González-Weller, D et al. (2023) "Proteins and Minerals in Whey Protein Supplements" Foods 12(11): 2238. Sepandi, M et al. (2022) "Effect of whey protein supplementation on weight and body composition indicators: A meta-analysis of randomized clinical trials" Clinical Nutrition ESPEN (50): 74-83.

Just chugging lots of water to rehydrate after a workout won't replace the salt you lost and might even worsen the electrolyte imbalance in your body. Here's our guide to the optimal mix of sodium, carbohydrates, and protein in your post-exercise rehydration drink, based on the latest research. In this article: Water is not enough What else is needed, and how much? How much fluid after exercise? Download the post-exercise hydration guide Other nutrients that are important after exercise How we can help Water is not enough Recent studies confirm that water alone is less effective for rehydration than drinks containing electrolytes and, in some cases, protein. This is because electrolytes and protein improves the absorption of fluids in your gut. In fact, if you drink a lot of water quickly, your body naturally increases the rate at which it produces urine (you just pee most of it out again). You also run the risk of causing yourself harm if you only replace water and not salts and minerals. This can lead to cramps or hyponatremia (a condition that can be fatal). However, many sports drinks have an electrolyte concentration that is too low and no protein at all. What else is needed, and how much? 👉 For efficient fluid replacement, beverage composition – especially its electrolyte and carbohydrate content, and to a lesser extent the protein content – matters as much as volume. The concept of osmolality is useful here. Osmolality is a way of measuring how concentrated a liquid is – specifically, how many dissolved particles (like salts and sugars) are in it. The more particles in the liquid, the higher its osmolality. In the context of hydration drinks, osmolality affects how quickly the liquid moves from your gut into your bloodstream. Drinks containing electrolytes and carbs with an osmolality close to that of your body’s natural fluids (called isotonic drinks) are generally absorbed faster and help with rehydration more effectively than drinks that are too concentrated (hypertonic) or too diluted (hypotonic). How to check the osmolality of a sports drink To assess osmolality from a sports drink label, you should look for the osmolality value in milliosmoles per kilogram (mOsm/kg), or check for clues based on carbohydrate and electrolyte content. (Carbohydrate replenishment after exercise is another topic, but it is important here because the amount of carbs in a drink affects its osmolality and therefore how well your body will absorb the fluid and much-needed electrolytes.) Bodily fluids have an osmolality of 275–295 mOsm/kg . If the osmolality is listed directly: Look for values in the 275–295 mOsm/kg  range: Isotonic  = ideal (≈285 mOsm/kg) Hypertonic  = too high (>330 mOsm/kg) → slower absorption Hypotonic  = low (<250 mOsm/kg) → fast absorption, less electrolyte replenishment If the osmolality is not listed: Sodium content: Isotonic drinks usually contain ~400–700 mg sodium per liter Below 300 mg/L = less effective for rehydration Over 800 mg/L = potentially hypertonic unless carb content is low Carbohydrate content: Isotonic drinks typically contain 4–8 g of carbs per 100 ml  (4–8%) >8% = likely hypertonic (e.g. undiluted fruit juice) <4% = likely hypotonic (e.g. very diluted electrolyte drinks) If, like me, you feel your 🧠 brain wants to go on ✈️ vacation when you look at all of these numbers, download our hydration cheat sheet here . 👉 Of course, you can also use these guidelines if you want to mix your own post-exercise rehydration drinks. Below is an example of a ready-to-drink rehydration drink with a useful osmolality, as well as a powder for self-mixing your rehydration drink that will also have the right osmolality when used as directed. How much fluid after exercise? How much rehydration fluid to take after exercise should be determined by two factors. 1. How much fluid you have lost You can get an idea of how much fluid you have lost during exercise by measuring your body weight before and after the race or activity. Learn more about how you can use your weight loss, thirst, and urine colour to determine whether you are dehydrated . 2. The time interval before your next exercise session If you have more than 24 hours until your next session Research has shown that athletes naturally take in enough food (that include salts and electrolytes) and fluids during a 24-hour period to fully replace all the fluids lost during exercise. You do not have to follow any special guidelines. Just eat a balanced diet and drink fluid according to thirst. If you have to exercise within 6 hours of your previous session In this case, you will have to ingest a combination of water and sodium  in excess of your existing body weight deficit (more than the weight that you've lost). This will ensure that you replace all your fluids and allow for the amount you'll lose to the toilet. The ACSM recommends that: you aim to replace 125% to 150% of your decrease in body mass, and   divide the fluid into 500 ml portions, and take it about 30 minutes apart. Taking the fluid in portions is important, because drinking a large volume of fluid in one go stimulates urine production, so you'll pee out most of the stuff you've drunk. 💡 Example: If you found that you had lost 2 kg of body weight during exercise, you would aim to drink about 2.5 L to 3 L of fluid. 🚨 Get your doctor's advice if you're supposed to follow a low-salt diet. Download the post-exercise hydration guide 👉 We’ve put the key advice from this article into a handy PDF you can download . Other nutrients that are important after exercise Research has shown that it is also important to restock on protein after exercise to ensure a full recovery. I have previously written about  exactly how much protein you should eat  and when for best recovery. Research has also shown that milk-based drinks improve fluid retention more effectively than standard sports drinks or water alone. The osmolality of milk and milk-based drinks might be somewhat higher than drinks containing only electrolytes and carbs, which means that the fluid is absorbed somewhat slower, but the fluid retention is better. 👉 Because of the slower fluid absorption rate, using milk-based drinks during exercise is not recommended. It’s best to save them for afterwards. Milk is absorbed more slowly but helps your body retain the fluid better. The American College of Sports Medicine (ACSM) guidelines state that caffeine and low alcohol content drinks (such as beer) are OK to drink in moderation if you are aiming to rehydrate over 24 hours. It might be best to avoid them if you want to rehydrate quickly, since they have a mild diuretic action. Strong alcohol (spirits) is not advised , because it acts as a strong diuretic (makes you lose a lot of fluid). While sodium is the most important mineral to replace, other minerals such as potassium and magnesium might also play important roles in dehydration at a cellular level. 🍌 Natural sources of potassium and magnesium  are asparagus, bananas, leafy greens such as spinach, Swiss chard, kale, white and sweet potatoes with skin on, citrus fruits, tomatoes, kiwi, papaya, squash, almonds, cashews, peanuts, and walnuts. You can get most of the nutrients you need from natural sources. Bonus video: We interview former athlete Jesse Funk about how people have different sweat rates and the best way to go about replacing lost electrolytes. 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 Masters Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Sawka M, Burke L, Eichner E, et al. "American College of Sports Medicine position stand. Exercise and fluid replacement" Medicine and Science in Sports and Exercise 2007;39(2):377 Maughan RJ, Shirreffs SM. "Dehydration and rehydration in competative sport" Scand J Med Sci Sports. 2010 Oct;20 Suppl 3:40-7 Seery S, Jakeman P. "A metered intake of milk following exercise and thermal dehydration restores whole-body net fluid balance better than a carbohydrate-electrolyte solution or water in healthy young men" Br J Nutr. 2016 Sep;116(6):1013-21 James LJ, Evans GH, Madin J, et al. "Effect of varying the concentrations of carbohydrate and milk protein in rehydration solutions ingested after exercise in the heat" British Journal of Nutrition. 2013;110(7):1285-1291

One of the most common questions runners ask me is, how can they optimise running recovery? Most runners know to take recovery days, but the best thing you can do is to also build recovery weeks into your training. This article explains how recovery weeks can help you to train smarter and avoid injuries, using my current training programme as an example. 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: Running recovery days are not always enough What does a recovery week look like? Maintaining training gains during your recovery week How we can help I've also made a video about this: Running recovery days are not always enough Whenever you go for a run or do any other type of workout, various parts of your body, including your muscles, accumulate micro-damage. This is normal, and it's part of the process by which your body grows stronger. The micro-damage sends a signal to your brain that this needs to be repaired to a somewhat stronger state than before the exercise session. This is how we become better, stronger runners with consistent training. Our bodies need sufficient time between training sessions to repair the micro-damage to a stronger state than before, and this is where the well-known training principle of recovery days comes into play. However, there isn’t always enough time available for full recovery before the next run, especially if you’re pushing your training to the limits. For instance, I'm currently trying to improve my 5K time. I'm following an eight-week programme where I'm adding lots of tempo runs, speedwork, and interval sessions, as well as longer runs. Last week was my third week of the programme, and I could really feel I was pushing those sprint intervals to the limit. And if I had done any more reps than I did, I think I might have pulled a quad muscle. So this week, my fourth week, is a recovery week. And what a recovery week does is, it helps your body to catch up on that repair that it didn't fully get to during recovery days, when you were pushing your training hard for a few consecutive weeks. Therefore, a recovery week buys you some insurance against getting overuse/overtraining injuries. What does a recovery week look like? The idea is to reduce your training load by about 20% to 30%. Training load doesn't just refer to the distance you're running, it's also how fast you're running. So, if you do an interval session where you run short distances but really fast, that training load can be equal to that of a very long run. Other factors can play a role as well. I’m in Bali as I’m writing this, and it's super humid and really hot. When I do my runs after eight in the morning, I sometimes feel like it’s just too hot to continue. And this means that the training load is higher. For instance, this morning I went for the first run of my recovery week. Last week I did 3 x 600 metre sprint intervals, and I did it when it was already quite hot. So today I only did 3 x 400 metres, and I went out before seven, when it was still relatively cool. I still felt that I worked hard, but I wasn't at all near my limits. Maintaining training gains during your recovery week So, why am I not just doing easy runs the whole recovery week? Because my aim is to increase my speed, and I don't want to lose the gains that I've made in the preceding weeks. If you’re doing a training programme where speed is your focus and getting the intensity up is your focus, then instead of stopping all high intensity in your recovery week, you just reduce the intensity sessions to short, sharp ones. You can maintain your speed during recovery weeks by doing short, sharp sessions that don't push you into complete fatigue. So, you're keeping that speed, keeping that intensity, having that stimulus, but you’re not pushing yourself to the extreme, and you’re stopping long before you’re really exhausted. As for the easy runs, I will just reduce the distance to be somewhat shorter than it was in the last three weeks. For my tempo run, I will maintain the same pace as before, but go a shorter distance as well. And then next week is Week 5, and I can push my speed, push my tempo runs again so that I can continue to improve. 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 .

Neuromuscular electrical stimulation (NMES) units, which send currents through certain areas of your body depending on where you attach the electrodes, are quite useful for injury rehab and also for training. This article explains the ins and outs of using NMES for rehab and training. It also takes a look at whether marketing messages that NMES units are good for post-exercise recovery are supported by science. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We may earn a small commission on sales at no extra cost to you. In this article: What is neuromuscular electrical stimulation? What type of NMES unit do I need? Neuromuscular electrical stimulation for training Neuromuscular electrical stimulation for recovery Neuromuscular electrical stimulation for injury rehab How we can help We’ve also made a video about this: What is neuromuscular electrical stimulation? Your muscles contract in reaction to electrical pulses from your nerves. The number and type of muscle fibres that contract will vary, depending on what your brain thinks is required. Your brain tries to minimise muscle contractions, because it’s always trying to find ways to preserve energy. This is a remnant from a time in the history of our species when energy preservation was a matter of survival – when you couldn’t drive to a McDonald’s or order pizza delivery when you were feeling a bit peckish. In practice, this means that when you do a bicep curl, your brain will fire up just enough muscle fibres to get the job done and no more. If you want to work your muscles hard to make them stronger, you have to curl heavy weights to get as many fibres involved as possible. An NMES unit enables you to “override” your brain and decide how many muscle fibres you want to stimulate to contract. So, you can cause strong contractions in the biceps muscle without having to use those heavy weights in our bicep curl example. Depending on the frequency you select on the NMES unit, you can either recruit more of your slow-twitch muscle fibres, which are for endurance, at lower frequencies, or more of your fast-twitch fibres, which are more strength-based, at higher frequencies. What type of NMES unit do I need? The NMES unit ( a Compex ) we used at the sports injury clinic in which I used to work was state-of-the-art. But if you’re a recreational athlete and/or you’re looking for basic rehab functions, you can get away with an NMES home unit that’s much more basic and affordable . The number of pre-set programmes on the machine can make a substantial difference to the price. You get programmes such as one for disuse atrophy, e.g. if you haven’t been able to use your legs for quite some time (like when it’s been stuck in a plaster cast), or for neurological rehab. But if you’re willing to read up on the frequencies that are useful for stimulating various muscle fibres, you can get an NMES unit that is somewhat simpler and then do the necessary settings by hand. The basic settings you’re looking for are endurance, strength, and recovery. NMES units using cables are usually cheaper than wireless ones, but they can get in the way when you train. Another factor that influences the price of an NMES unit is whether the electrodes you stick on yourself are connected to the unit by cables or wirelessly. Obviously, with the wireless electrodes you are much freer to move about during your “workout”. Here's a selection of NMES units on Amazon. Or you can go to the Compex Store . Neuromuscular electrical stimulation for training So, does NMES actually work for training? The research is quite clear that it can make your muscles bigger and stronger and increase endurance, depending on how you use it. However, the research studies did not all use the same methodology, so it’s difficult to compare NMES units in this regard. For instance, you get better results if you don't just sit still and let the electrodes do all the work, but this is what some studies had their subjects do. So, if you want to exercise your leg muscles, you should also do gentle squats to activate the muscles and let the electrical current from the NMES unit augment the contraction. Interestingly, not all of the gains are down to your muscle fibres growing stronger. There's also research to show that NMES activates your spinal as well as the cortical nerves in the brain, so that it gets those neural pathways to your muscles firing better. If your nerves fire better, your muscles can contract better and are more coordinated, and more fibres can be recruited more easily. A few words of warning When you do “actual” exercise, your muscle fibres get micro-damage, which your body then repairs into a stronger state than before while you rest between exercise bouts, which is how we naturally grow stronger. NMES units create the same type of micro-damage. So don’t add NMES to your routine and keep on training like before; you might end up over-training. Give your muscles enough recovery time between NMES and training sessions. There have also been reports of people getting rhabdomyolysis, which is a potentially fatal condition where you get so much muscle damage from a single session that the resultant waste that your muscles excrete affects your heart and/or kidneys. So, if you’re new to NMES, rather ease into it – as one should do with any new type of exercise – than dialling your NMES unit up to maximum from the start. Neuromuscular electrical stimulation for recovery One of the big selling points that the marketers of NMES units try to hammer home is that it works wonders for post-exercise or post-competition recovery. However, the evidence for this is not very strong. We have to distinguish here between active and passive recovery. Active recovery involves some gentle activity, while passive recovery is just resting as much as possible. Using an NMES unit for recovery would obviously simulate active recovery. A review of a group of research studies compared NMES recovery with passive and active recovery by looking at three issues: how quickly the recovery reduced blood lactate levels back to normal, post-recovery performance, and post-recovery pain and fatigue. Getting rid of blood lactate: NMES was better than passive recovery, but no better than active recovery. Performance: NMES wasn’t any better than passive or active recovery, and in one of the studies it fared worse. (You’re at risk of not recovering that well if you use an NMES unit on a setting that’s too high, or if you use it at all when you’re not very fit. In general, passive recovery works better for people who aren’t fit. So, make sure you choose your recovery according to your fitness level.) Pain (DOMS) and fatigue: NMES produced better results than passive recovery but wasn’t any better than active recovery. So, in a nutshell: if you’re doing active recovery anyway, you don’t need NMES on top of that. But NMES could be useful for recovery in a scenario where e.g. a football team has to get onto a bus for a long ride home right after a game, which would make active recovery impossible. Active recovery using NMES is a good option if you have to travel immediately after finishing a training session or match. Neuromuscular electrical stimulation for injury rehab I have found NMES really useful for people who have had a limb immobilised for a very long time or whose muscles are struggling to contract after certain types of surgery. For example, when you remove the plaster cast or orthopaedic boot after an ankle fracture (usually after 6 to 12 weeks), it’s amazing how “dead” the calf muscles are. And after knee surgery, the quad muscles sometimes just don’t want to fire. NMES can be a useful tool to enhance your rehab. Because NMES activates the nerve endings, it can really get the muscle working much quicker than if you tried to get them working properly again just with regular exercise. Another good rehab use of NMES is to exercise muscles when a joint injury, such as a meniscus tear, makes regular exercises impossible or very painful – especially in the initial stages of rehab. Like with regular rehab exercises, you have to start gently so that you don’t re-injure yourself. You can do this by going for the “disuse atrophy” setting on your NMES unit or, if this setting isn’t available, setting up your session so that the rest periods between contractions are quite long. If the machine doesn’t allow you to do that either, just use the endurance setting and go for shorter sessions to start with; the typical standard session duration on an NMES unit is 30 minutes, so maybe switch it off after just 10 minutes. As with normal rehab exercises, if a session hasn’t caused you pain during or in the 24 hours afterwards, you know you’ve used your NMES unit right. 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 Amaro-Gahete, F. J., et al. (2017). "Could superimposed electromyostimulation be an effective training to improve aerobic and anaerobic capacity? Methodological considerations for its development." European Journal of Applied Physiology 117(7): 1513-1515 . Amaro-Gahete, F. J., et al. (2018). "Functional exercise training and undulating periodization enhances the effect of whole-body electromyostimulation training on running performance." Frontiers in Physiology 9: 720. Amaro-Gahete, F. J., et al. (2018). "Whole-body electromyostimulation improves performance-related parameters in runners." Frontiers in Physiology 9: 1576 . Amaro-Gahete, F. J. (2019). "Changes in physical fitness after 12 weeks of structured concurrent exercise training, high intensity interval training, or whole-body electromyostimulation training in sedentary middle-aged adults: A randomized controlled trial." Frontiers in Physiology 10 . Filipovic, A., et al. (2012). "Electromyostimulation—a systematic review of the effects of different electromyostimulation methods on selected strength parameters in trained and elite athletes." The Journal of Strength & Conditioning Research 26(9): 2600-2614 . Filipovic, A., et al. (2011). "Electromyostimulation—a systematic review of the influence of training regimens and stimulation parameters on effectiveness in electromyostimulation training of selected strength parameters." The Journal of Strength & Conditioning Research 25(11): 3218-3238 . Filipovic, A., et al. (2016). "Effects of a whole-body electrostimulation program on strength, sprinting, jumping, and kicking capacity in elite soccer players." Journal of Sports Science & Medicine 15(4): 639 . Hortobágyi, T. and N. A. Maffiuletti (2011). "Neural adaptations to electrical stimulation strength training." European Journal of Applied Physiology 111(10): 2439-2449 . Jee, Y.-S. (2018). "The efficacy and safety of whole-body electromyostimulation in applying to human body: based from graded exercise test." Journal of Exercise Rehabilitation 14(1): 49 . Kemmler, W., et al. (2016). "Effects of whole-body electromyostimulation versus high-intensity resistance exercise on body composition and strength: a randomized controlled study." Evidence-Based Complementary and Alternative Medicine 2016 . Kemmler, W., et al. (2016). "Whole-body Electromyostimulation–the need for common sense! Rationale and guideline for a safe and effective training." Dtsch Z Sportmed 67(9): 218-221 . Maffiuletti, N. A. (2010). "Physiological and methodological considerations for the use of neuromuscular electrical stimulation." European Journal of Applied Physiology 110(2): 223-234 . Malone, J. K., et al. (2014). "Neuromuscular electrical stimulation during recovery from exercise: A systematic review." The Journal of Strength & Conditioning Research 28(9): 2478-2506 . Rhibi, F., et al. (2016). "Effect of the electrostimulation during the tapering period compared to the exponential taper on anaerobic performances and rating of perceived exertion." Science & Sports 31(4): e93-e100 . Sillen, M. J., et al. (2013). "Metabolic and structural changes in lower-limb skeletal muscle following neuromuscular electrical stimulation: a systematic review." PLoS One 8(9): e69391 . Teschler, M., et al. (2016). "(Very) high creatine kinase (CK) levels after Whole-Body Electromyostimulation. Are there implications for health?" Int J Clin Exp Med 2016;9(11):22841-22850 Wirtz, N., et al. (2016). "Effects of loaded squat exercise with and without application of superimposed EMS on physical performance." Journal of Sports Science & Medicine 15(1): 26 .

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

What are the benefits of ice baths after workouts or exercise like running, if any? We take a look at the research into ice baths for recovery and also whether an ice bath benefits strength and endurance gains after exercise. 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: Ice baths for better post-exercise recovery Ice baths for better gains from exercise? How and when to take ice baths for recovery An ice bath is not the only show in town for post-exercise recovery How we can help We've also made a video about this: 🔎Scientists are studying the relationship between ice baths and exercise in two broad fields: Recovery – Do ice baths help an athlete to recover quicker after exercise or competition (e.g. to start the next training session sooner or to compete better in the type of event that allows for ice baths during the event)? Exercise gains – Can the strength and/or endurance gains brought about by exercise be increased by taking ice baths after exercise? Like with many research topics in sports science, there are no clear-cut answers. Much of the research is contradictory, inconclusive, and riddled with ifs and buts. However, when we look at the findings of reviews and meta-analyses (studies that number-crunch and summarise the results of many studies), some trends do emerge. Ice baths for better post-exercise recovery A comprehensive review of the research into the effect of ice baths on post-exercise recovery, published in 2022, looked at short-term recovery (up to 9.5 hours) and longer term recovery (24 to 72 hours) after endurance, sprint, and strength exercise. Recovery was measured by how well subjects performed exercises after taking an ice bath versus subjects who did not take an ice bath. These are the main findings: Recovery after endurance exercise Short term: Taking an ice bath for less than 30 minutes improved endurance performance, but only if the post-ice bath endurance exercise session was within one hour after the pre-ice bath session. Ice baths had no effect or maybe even a negative effect on jumping and strength performance directly after the bath. Long term (24 to 72 hrs after): Ice baths were found to have no effect on endurance recovery and neuromuscular function (how well your muscles “fire” during exercise). Recovery after sprint exercise Short term: Taking an ice bath had a negative effect on sprint performance for up to two hours after the bath. Ice baths did not influence jumping and strength performance. Long term (24 to 72 hrs after): Ice baths had some benefits for jumping and strength exercises. An ice bath may impede your sprint performance for up to two hours. Recovery after strength exercise (resistance training) Short term: Taking an ice bath could possibly lead to better strength recovery for up to 40 minutes after the initial strength exercise. It could also possibly lead to better fatigue resistance (so you don’t tire as quickly) in the 1 to 6 hours after the initial exercise. Long term (24 to 72 hrs after): An ice bath could have either no effect or a negative effect on strength recovery. To summarise: 👍It would make sense to take an ice bath for quicker recovery in competitive situations (races or matches) where you have to perform again (needing either endurance or strength) soon afterwards. 👎But it doesn't actually hold any benefit for longer term recovery and, as you will see in the next section, if done too often it may reduce your gains. Here's a selection of ice tubs available on Amazon: Ice baths for better gains from exercise? What about using ice baths to improve the endurance and strength gains you make after exercise? The study discussed above also reviewed research on the effect of regular post-exercise ice baths over periods ranging from 4 weeks to 12 weeks. Gains after endurance exercise The review study found that ice baths have “no clear effect” on the improvement of endurance performance. Two other review studies ( 2020  and 2021 ) agree that taking regular ice baths after endurance training does not have a significant effect on improving endurance gains. Gains after sprint exercise The 2022 review study similarly found that taking regular ice baths after sprint training does not enhance the gains made due to the training. Gains after strength exercise The three review studies (2020, 2021, and 2022) agree that regular ice baths after strength training sessions actually reduce the gains made from those sessions. To summarise: 👎You are shivering in vain if you take ice baths after exercise in the hope that it will make you fitter or stronger in the long run. And it may even interfere with your training gains if the goal of the sessions are to improve strength. How to take ice baths for recovery How long and how cold to ice bath Most of the studies covered by the reviews used water temperatures ranging from 5 to 15 degrees Celsius (41 to 59 degrees Fahrenheit). The subjects were in the water from 10 minutes up to 20 minutes. A 2022 review of the science  that looked at how temperature and time in the water influenced the outcomes concluded that a shorter, colder stint in the ice bath worked better for muscle damage recovery after high-intensity exercise than a longer, less cold bath. The same study also found that a shorter time in the ice bath had a marginally better effect for endurance recovery than a longer time. Ice bath thermometers on Amazon - all do Celsius and Fahrenheit: How deep? The various research studies had their subjects immersed at various depths – from waist deep to all the way up to their necks. A 2017 study published in the Journal of Applied Physiology  has some good news for those who balk at immersing everything but their heads in an ice bath. The researchers made their subjects stand in an ice bath with only one leg after exercise. They found that there was an increase in the protein that aids muscle recovery (PGC-1α) in both  legs. They therefore speculated that an ice bath affects the whole body and not just the parts that are immersed in the cold water. So, if you are a runner or a cyclist or play a sport using mostly your legs, you likely don’t have to go deeper than waist deep. And if you need to recover from exercise involving your upper body, the research suggests that your upper body will get at least some benefit from having only your lower body immersed. An ice bath is not the only show in town for post-exercise recovery Remember that there are many other ways to help you recover after exercise, including active recovery, massage , and compression garments . For example, a 2018 study  that did a meta-analysis of studies looking into post-exercise recovery methods found that massage was the most effective method for reducing delayed onset muscle soreness (DOMS)  – those muscle pains that kick in only a day or two after hard exercise) and feeling tired in general. None of these methods are mutually exclusive, so use whatever works for you, and remember that good nutrition and ample sleep are also necessary for good post-exercise recovery. You can read our round-up of useful post-exercise recovery techniques here . 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 Chaillou, T., Treigyte, V., Mosely, S. et al. "Functional Impact of Post-exercise Cooling and Heating on Recovery and Training Adaptations: Application to Resistance, Endurance, and Sprint Exercise" Sports Med - Open 8(37) (2022). Dupuy Olivier , Douzi Wafa , Theurot Dimitri , Bosquet Laurent , Dugué Benoit. "An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis" Frontiers in Physiology 9 (2018). Xiao Feiyan , Kabachkova Anastasiia V. , Jiao Lu , Zhao Huan , Kapilevich Leonid V. "Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis" Frontiers in Physiology 14 (2023). Jonathan M Peake. "Recovery after exercise: what is the current state of play?" Current Opinion in Physiology 10, 17-26 (2019). Moore, E., Fuller, J.T., Buckley, J.D. et al. "Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Performance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression" Sports Med 52, 1667–1688, (2022). Choo,Hui Cheng, Lee, Marcus, Yeo, Vincent, Poon, Wayne, Ihsan, Mohammed. "The effect of cold water immersion on the recovery of physical performance revisited: A systematic review with meta-analysis" Journal of Sports Sciences 40(23) 2608-2638, (2022). Ihsan Mohammed, Abbiss Chris R., Allan Robert. "Adaptations to Post-exercise Cold Water Immersion: Friend, Foe, or Futile?" Frontiers in Sports and Active Living 3 (2021). Malta, E.S., Dutra, Y.M., Broatch, J.R. et al. "The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis" Sports Med 51, 161–174, (2021).