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There is no such thing as one-size-fits-all exercises for tennis elbow. In this article, we demonstrate 10 of the most commonly used exercises for tennis elbow and discuss their benefits, common pitfalls, and how to decide whether they are right for you. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. This article contains affiliate links. We might earn a small commission on sales at no extra cost to you. In this article: Important! Exercises must match healing stage Should tennis elbow exercises cause pain? Types of exercise for tennis elbow Tennis elbow stretches Neural mobilization for tennis elbow Strength training exercises for tennis elbow Final thoughts on exercises for tennis elbow How we can help We've also made a video about this: Important! Exercises must match healing stage It’s natural to want to “do something” to heal more quickly when you get injured. But, depending on the stage of healing of your injury, “not doing anything” might actually be the correct treatment. Yes, we know – the Internet is swarming with people telling you to strengthen your elbow muscles and tendons to get it to heal. And yes, that is the correct advice … for the later stages of recovery. If you jump in and start doing strength exercises or strong stretches during the early stages of healing (the reactive stage), when the injury is still trying to settle down, you usually just irritate it further and delay your recovery. You can find a detailed explanation of the stages of healing for tennis elbow and how you can tell which you are in here. As a quick reference, you are likely in the: Reactive stage – if your elbow pain only started a few weeks ago. Tendon dysrepair stage – if your elbow pain has been going on for more than 6 weeks. Tendon degeneration stage – if your elbow pain has been dragging on for more than 6 months. 👉 I will refer to these stages when I discuss the exercises below. You can read more about what treatments other than exercise work best during each stage of tennis elbow here . Should tennis elbow exercises cause pain? When you have tennis elbow, you can expect to feel a certain amount of pain or discomfort during everyday activities. Research suggests that tennis elbow treatments are most effective when they don’t cause a significant increase in pain during and in the hours after the treatment. With this in mind, we tend to find best results when our patients: Experience only slight discomfort while doing their exercises (you’re aware of the injured area but it’s not really painful), and no or only slight discomfort after completing the exercises, and any increased discomfort caused by the exercises settles back to its previous level within 24 hours. 💡 If the exercises we prescribe cause a significant increase in the patient’s symptoms , it is usually a sign that they need to be adjusted (resistance reduced, done in a different position, or less force applied), swopped out for a different type of exercise, or that the patient is actually not ready yet for exercises. Types of exercise for tennis elbow You can divide the exercises used for tennis elbow into three categories: Stretches – For the muscles that attach to the outer elbow but also the shoulder girdle and neck. Neural mobilization – These exercises ensure that the nerves that run across your elbow are free to slide. Strengthening exercises – These exercises restore the strength in the tendon. Let’s look at each type of exercise and whom they benefit. Tennis elbow stretches When to use them You can usually start with gentle stretches while you’re in the reactive stage. Elbow-specific stretches With tennis elbow, your wrist extensor muscles can feel very tight and painful. Gentle stretches can help to relax these muscles and reduce your pain. ⚠️ You should feel a gentle stretch in your wrist extensor muscles – it should not cause a strong stretch in the painful area on the outside of the elbow. 1. Gentle wrist extensor stretch Instructions Sit with your elbow bent about 90 degrees and your palm facing down. Make a gentle fist (keep your palm facing down). Use your opposite hand to bend your wrist down into flexion and slightly out to the side (direction of little finger). You should be feeling a comfortable stretch in the top of your forearm. Hold the position for 10 to 30 seconds – it is often best to test shorter durations first. Relax for about 10 seconds. Repeat up to 3 times in one session. You can usually do this 2 to 3 times a day. If you don’t feel much of a stretch, try the stronger version below. 2. Stronger wrist extensor stretch Instructions Sit with your elbow bent to about 90 degrees and your palm facing down. Make a gentle fist (keep your palm facing down). Use your opposite hand to bend your wrist down into flexion and slightly out to the side (direction of little finger). Slowly straighten your elbow until you feel a gentle stretch in your wrist extensor muscles. Hold the position for 10 to 30 seconds – it is often best to test shorter durations first. Relax for about 10 seconds. Repeat up to 3 times in one session. You can usually do this 2 to 3 times a day.   👉 If these stretches make your pain worse: You may be pushing or pulling too hard or for too long – test whether adjusting your technique helps. Or your injury may simply not be ready for stretches – leave them for now. Stretches for the shoulder and neck Your radial nerve runs very close to the area in the wrist extensor tendons that typically gets injured when you have tennis elbow. This nerve originates in the neck, runs over the front of your chest, past the shoulder and then down your arm. The radial nerve is meant to slide freely as we move. Sometimes, stiffness or an injury in the neck or shoulder girdle can stop it from sliding freely, which then contributes to tennis elbow pain. Other times, the ongoing tennis elbow injury can irritate the nerve, causing your shoulder and neck to become stiff and uncomfortable. This is why stretches for the neck and shoulder can help for some cases of tennis elbow. ⚠️ These stretches are not appropriate if you have a serious injury in your neck or shoulder, e.g. a disc or joint injury. Ask your physiotherapist for tailored exercises. 1. Neck flexion stretch Relaxes the muscles at the back of your neck. Instructions Sit up straight Pull your chin into a “double chin”. Drop your head forward, moving your nose closer to your chest, until you feel a gentle stretch in the back of your neck. Hold the position for 10 to 30 seconds (shorter holds are often better for the neck). Then come back upright and rest for 10 seconds. Repeat 3 times. 2. Side flexion stretch Relaxes the muscles at the side of your neck. Instructions Drop your left ear towards your left shoulder. Place your left hand on your head and gently pull it to the left until you feel a gentle stretch in your right neck and upper traps. Check that your right shoulder stays down and doesn't pull up towards your ear. Hold the position for 10 to 30 seconds (shorter holds are often better for the neck). Repeat on the other side. Do 3 times each side. 3. “Double chin” stretch Brings the vertebrae (neck bones) into good alignment, increasing the space for the radial nerve to slide. Instructions Stand with your lower back against a wall and your feet about 40 cm away from the wall. Place the back of your head against the wall. Pull your chin in, as if you want to get the back of your neck to touch the wall. Take care not to tilt your head forwards as you do this – you’re aiming for the maximum “double chin” look. Do not push as hard as you can. Only pull your chin back to where you can feel a gentle stretch in the back of your neck. Hold the position for 10 seconds and relax. Repeat up to 10 times. 💡 Tip:  You may not be able to get the back of your head against the wall if your upper back is very stiff. If this is the case, place a small rolled-up towel between the back of your head and the wall. 4. Pec stretch Relaxes the muscles at the front of the shoulder girdle. Instructions Stand with your arm straight out to the side and hook your hand against a door frame or other solid object. Have your hand at shoulder height or slightly higher. Slowly turn your body away from your hand until you feel a gentle stretch over the front of your chest or shoulder. You may also feel a stretch in your biceps. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Top tip:  If your hand is lower than shoulder height, you will likely not feel a stretch. If your hand is in line with your shoulder, the stretch targets the pec minor more. If you hand is higher than shoulder height, it targets the pectoralis major more. 5. Triceps/lat dorsi stretch Relaxes the muscles at the back of the shoulder and upper arm. Instructions Place your right hand behind your head (it doesn't matter if you can't reach very far back). Use your left hand to gently pull our elbow back. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Neural mobilization for tennis elbow When to use them These exercises can usually be used in any stage of healing but may irritate your elbow if it is very sensitive to stretch. So, it can be useful to let your injury calm down a bit before trying them. 💡If your elbow tolerates the stretches we listed above that target the wrist extensor muscles, it is likely to also tolerate the neural glide discussed below. Radial nerve glides Neural mobilization exercises help your nerves to slide more freely. In this case, we want to target the radial nerve. ⚠️ For best results, loosen the muscles and joints in your neck and shoulder girdle by doing the stretches in the previous section BEFORE doing neural mobilization exercises. The radial nerve won’t be able to slide if the muscles are holding on to it. Instructions Stand with your feet shoulder width apart. Have your arm straight down by your side, palm facing forward, and open your hand so your fingers form a straight line with your arm. Rotate your hand inward and away from your body so your thumb faces backward. Bend your wrist so your palm faces up and flex your fingers as far as they can comfortably go (your hand won’t close all the way). Lift your arm out to the side until you feel a mild-to-moderate stretch in your forearm or rest of the arm. Hold that position. Now tilt your head to the hand-opposite-side and relax your wrist. Then bring your head back as you bend your wrist again. Alternate between these two head/wrist positions 10 times. Strength training exercises for tennis elbow When to use them It’s best to avoid strength training exercises during the reactive stage of tendinopathy, as these usually make the injury feel worse during this time – rest and techniques aimed at allowing the injury to settle are more effective during this stage. If you acted quickly and managed to calm your elbow pain down before it entered the dysrepair or degeneration stage, you might not have to bother with strength training exercises. However, if you’ve had your tendon pain for quite a few months , the injured part of the tendon and the wrist extensor muscles might have lost some strength, which can be part of the reason why even regular daily tasks make it hurt. Strength training exercises can help to restore your tendon and muscle strength and function. What type of strength training works best? Research shows that any of the following types of strength training can work: Eccentric exercises – these train only the lengthening (eccentric) muscle action, e.g. you slowly release a resistance band, moving your wrist from a fully extended position to a fully flexed position. Isotonic exercises – these train both the shortening (concentric) and lengthening (eccentric) muscle actions, e.g. you first bend your wrist back into extension against the resistance of the band (concentric) and then release it slowly so your wrist moves back into flexion (eccentric). Isometric – these strengthen the muscles without actually changing their length, e.g. you contract the muscles against resistance but without moving your wrist. In our experience, exercises that isolate the wrist extensor muscles often cause tennis elbow pain to flare up. We often get better results with exercises that work the wrist extensors isometrically (so, holding the wrist still against resistance) while performing functional movements with the arm. That’s not to say that we’ll never use isolated wrist extensor strengthening – patients are all different , and for some cases that is the best choice. 💡Tips to avoid flare-ups Start with super light resistance and very few repetitions. Check how your elbow pain reacts in the 24 hours after the exercise session, then adapt the exercises accordingly. Leave at least one recovery day between training days – your body needs time to adapt and recover after strength training exercises. Examples of isometric strength training for tennis elbow 1. Shoulder external rotation This exercise mimics how the wrist extensor muscles work when we move our arm out to the side while holding something. Instructions Tie a light resistance band to something solid that won’t move if you pull on it. Position yourself so the the band is fastened on the opposite side to the side you want to exercise. Stand with your elbow bent 90 degrees and tucked into your side. Hold the loose end of the resistance band and make a first with your palm side facing the resistance band. The back of your fist should form a straight line with your forearm. Slowly turn your arm out to the side (about 60 degrees), keeping your elbow bent and tucked into your side. Your wrist must remain in line with your forearm,  not bending back or forward. Pause for a moment and then slowly rotate your arm back so your first is pointing straight forward again. Repeat this up to 10 times. Rest for 1 to 2 minutes. Do 3 sets. Your wrist must remain straight throughout this exercise. ⚠️ If this exercise causes pain , you may be gripping too hard, using too strong a resistance band, doing too many repetitions, or turning your arm too far out. See whether adjusting the exercise helps. If not, it might not be the right exercise for you. 2. Forward punch This exercise mimics how our wrist extensor muscles work when we lift an object or reach for something, e.g. lifting a kettle. Instructions Tie a light resistance band to something solid that won’t move if you pull on it. Position yourself so the the band is fastened directly behind you. Grip the loose end of the band and make a fist. Start with your elbow bent to 90 degrees next to your body and the palm side of your fist facing in (thumb is pointing up). Now slowly punch forward and upward, lifting your arm and extending your elbow, but keeping your thumb pointing up. Pause for a moment, then lower back down to the starting position. Repeat this up to 10 times. Rest for 1 to 2 minutes. Do 3 sets. 👉 As you get stronger , you can start to turn your fist as you punch out, so that the back of your first points to the ceiling. This will cause the wrist extensor muscles to work harder. Only do this once you can easily do the first version with heavier resistance bands. ⚠️ If this exercise causes pain , you may be gripping too hard, using a too strong resistance band, or doing too many repetitions. See whether adjusting the exercise helps. If not, it might not be the right exercise for you. Final thoughts on exercises for tennis elbow There are many stretches, mobilizations, and strength exercises you can use for tennis elbow. So, just because your physio has given you something different to what we demonstrated above does not necessarily mean that their plan is wrong. It is not always possible to accurately predict how an exercise will affect your elbow pain. Rehab plans often have to be adjusted and fine tuned. This is why it’s important to have your exercises reviewed by your physiotherapist, so they can listen to your feedback and adjust your programme accordingly. One of the most common causes of lateral elbow pain not calming down is patients overdoing their rehab. If you are able to lift heavy weights or do a lot of strength training (showing us your tendon and muscles are actually strong), but your pain persists, you might just need to give it a break and allow the sensitivity to calm down. My colleague Steph has written a brilliant article where she shares tips for tennis elbow that doesn’t want to stop hurting. 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 Bateman, M. et al. (2021) "Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique" BMJ Open 11(12): e053841. Landesa-Piñeiro, L. and R. Leirós-Rodríguez (2022) "Physiotherapy treatment of lateral epicondylitis: A systematic review" J Back Musculoskelet Rehabil 35(3): 463-477. Lapner, P. et al. (2022) "Position statement: nonoperative management of lateral epicondylitis in adults" Canadian Journal of Surgery 65(5): E625. Pavlova, A.V. et al. (2023) "Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis" British Journal of Sports Medicine 57(20): 1327-1334. Yoon, S.Y. et al. (2021) "The Beneficial Effects of Eccentric Exercise in the Management of Lateral Elbow Tendinopathy: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 10(17): 3968.

Your groin is a bit like King's Cross station in London, with several different structures crossing and attaching in that area. In this article, we’ll discuss the most common causes of groin pain in runners and running sports and give you some tips on how to get it better. Remember, if you need more help with an injury, you're welcome to consult our team of sports physios online via video call. Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We might earn a small commission on the sale of these products at no extra cost to you. In this article: What structures can cause groin pain? The 5 steps to treating groin injuries How we can help Here's a recorded video of a livestream that Maryke did on this topic: What structures can cause groin pain? The groin area is a very “busy” area, with lots of bones, ligaments, muscles, tendons, and nerves either attaching there or crossing over it, and any of them can be the cause of your pain. This article focuses on only the most common causes of groin pain that we see in runners/running sports. 1. Hip joint impingement (Femoroacetabular impingement) When we run and walk, our legs are meant to move in pretty much a straight line. In some people their hips may turn in too much when they run, causing the bones in the groin to press against each other. If this happens, often it can cause inflammation and pain deep in the groin. This type of injury usually causes a gradual build-up of pain over several days or weeks. The shape of your hip bone and socket may also predispose you to getting this injury, but don't worry about this too much. If you've been able to run pain free in the past, you should be able to get back to pain free running regardless of the shape of your bones as long as you follow the correct rehab plan. How to fix it: The main cause of this is usually a lack of good muscle strength and pelvic stability , which can easily be fixed by following a rehab programme that focuses on strength and control in progressively more challenging positions. 2. Muscle strains/tears A strain or tear in any of the muscles that attach around the groin area can cause pain there. The most common ones are the hip flexors (iliopsoas, rectus femoris), adductor muscles and abdominal muscles (rectus abdominus). You can usually tell that you’ve torn or strained something if the pain comes on very suddenly and is quite sharp. But ligament strains can feel very similar and there are specific tests that physios can help you perform to distinguish between muscle strains and ligament strains. How to fix this: Muscle strains recover relatively quickly, but they have a tendency to recur if you don't strengthen the injured area properly before you go back to running or sport. So make sure that you progress your strength training to include heavier loads before you ease back into activity. 3. Gilmore’s groin / Sportsman’s hernia Gilmore’s groin or Sportsman’s hernia causes pain deep in the groin area. It can start suddenly or develop slowly over time, and it usually affects people who play sports that involve a lot of twisting movements, e.g. football. It's not that common in runners. It’s not a true hernia, and you don’t get a bulge like you would with a normal hernia. They’re not really sure about what exactly causes the pain, but most athletes with this condition seem to have a tear in some of the ligaments and tendons deep inside the inguinal area. How to fix this: The first line of treatment for Gilmore’s groin is to follow a carefully graded strengthening programme for at least 12 to 24 weeks. If this isn’t successful, you may benefit from surgery to fix or trim the ligaments or tendons that are causing the problem. 4. Adductor tendinopathy Adductor tendinopathy, or tendonitis. as it’s sometimes called, is a very common cause of groin pain in runners. This condition affects the adductor tendons close to where they attach onto your pubic bone and can be very painful. Watch the video below if you would like a detailed explanation of the treatment for adductor tendinopathy. The pain can come on gradually over a period of days/weeks or during a run. Sometimes, you may only feel the pain the day after a hard training session. Initially, runners find that they may be able to “run it off”, but that it then hurts again after the run. As the injury gets worse, it may stop them from running altogether. You can develop adductor tendinopathy or tendinitis for several reasons, but the main ones we see in our online clinic include if your hip/pelvic stability is poor or if you push your training too much, not allowing enough recovery time or suddenly do a lot of downhill running. How to fix this: The best treatment for adductor tendinopathy is a combination of relative rest and strength training. We've shared some tips on exercises for adductor tendinopathy here . 5. Osteitis pubis Osteitis pubis is another type of over-use injury in the groin. It’s caused by a lack of stability in the core, pelvis, and hip muscles, which causes the tendons and even the pubic bone to take too much strain. This injury usually develops gradually over several weeks or months and typically in a runner who has been ignoring their groin pain and has been trying to train through it. MRI scans usually show bone oedema (swelling in the bone) over the pubic area, and the abdominal ( abdominal tendinopathy or tears) and adductor tendons (adductor tendinopathy or tears) are often also affected. How to fix this: Just like with adductor tendinopathy, it's a combination of relative rest and slow progressive strength training that will restore your strength and get you back to running. However, you have to be careful with which exercises you choose to start with. To allow the pubic symphysis (the front of your pelvis) to recover, it's usually best to initially avoid any movements that cause rotation forces through the front of the pelvis. The 5 steps to treating groin injuries Step 1: Identify the cause of your pain Getting your injury diagnosed and understanding what exactly caused the injury in the first place will stop you from wasting time on treatments and exercises that aren’t appropriate. Unfortunately you cannot get an accurate diagnosis from Google but it is possible to get one via video call ! A sports physio is a good person to consult about this, as they can: Determine what is wrong by listening to how your injury developed, analysing your training schedule and getting you to perform certain test movements, all of which can easily be done via video call. We get all of our online patients to perform a full battery of tests in front of the camera to check their muscle strength and movement patterns. We often also get them to film themselves running on a treadmill so that we can play it back in slow motion and identify factors that could have contributed to their injury. Provide you with a treatment plan that addresses all the aspects, including how you should adjust your training and what you need to do to strengthen your body and allow your injury to recover. Step 2: Relative rest Yes, your injury will likely require a bit of rest to recover BUT you don’t always have to use complete rest. We're firm believers in relative rest, which means that a person continues all exercise that does not trigger their pain. For instance, if you can run 3 miles slowly without an increase in pain during or in the 24 hours after the run, then that is fine to do. But if it does cause your pain to increase, it may be a better option to run shorter distances or stick to cycling or swimming for a while. There’s really no recipe for this. We tend to have a thorough discussion with our patients about when they feel pain and what happens with every type of exercise they do and then come up with a plan. This plan is also not cast in stone – we try and teach our patients how to decide for themselves what is good vs. what should be avoided. Relative rest can be a very effective way to maintain your fitness and sanity while actually strengthening your injury! Step 3: Build strength and flexibility Some injuries, e.g. hip flexor strains, can be caused by not being flexible enough while others, e.g. adductor tendinopathy and osteitis pubis, are usually caused by a lack of muscle strength/control around the pelvis and trunk. You can see how understanding your injury and its causes plays a key part in deciding what exercises you should do. That said, most groin injuries can usually benefit from improving core and glute strength. The level of strength training that you start with is also important. Some injuries will allow you to immediately do heavy or strong core workouts while others will flare up if you’re not careful. The exercises that you choose to do should not cause any increase in your symptoms during or after doing them. Step 4: Your exercises should be progressed over time Your injury won’t get back to its full strength if you just do the same exercises all the time. Your strength training programme should be progressed over time as you recover and grow stronger. We usually set our patients clear targets to hit so that they know when they’re ready to move on to the next step. For instance, if you can do single leg squats with extra weight and hop 20 times with good form and no pain, you may be ready to trial a short run/walk session. Some options on Amazon for adding extra weight to your squats: Step 5: Slow return to running This is where most people get it wrong, so please be careful when you go back to running. Your first few runs should be run/walks where you alternate short periods of running and walking. A run/walk session has two benefits: If you do aggravate your injury, you usually just annoy it rather than properly making it angry, which means that it settles down again within a few days. If, on the other hand, you’ve gone and done a full-on run, you may end up flaring it up for a week or more. A run/walk session is a great way to strengthen your legs, and most of our patients find that they can progress to a continuous 20 minute run within 2 or 3 weeks of starting to run/walk. Of course, you have to make sure that you've built up to it by doing strength training and building your walking endurance. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon) McAleer, S. S., et al. (2015). "Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy." Physical Therapy in Sport 16(3): 285-299. Nakano, N., et al. (2017). "Current concepts in the diagnosis and management of extra-articular hip impingement syndromes." International Orthopaedics 41(7): 1321-1328. Yousefzadeh, A., et al. (2018). "The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol." Rehabilitation research and practice 2018.

Static stretching has become a controversial subject in recent years. You may have seen headlines such as "Stretching does not prevent injury" or you may even have been told by a well-meaning trainer that static stretches are bad and should never be done before a workout. There is some truth in this, but it's an extreme oversimplification of the research and applies only to very specific circumstances. In this article, we discuss the most recent research and explains how to do static stretches safely before your workouts. 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 static stretching? Is static stretching bad for you? Benefits of static stretching What it doesn't do Static stretches for legs Static stretches for arms Summary and recommendations How we can help We'e also made a video about this: What is static stretching? Static stretching is characterised by long, sustained holds - it is when you passively stretch a muscle as far as it will allow you to and hold it still at that point. The woman in the picture above is doing a static stretch of her hamstrings. The main difference between static and dynamic stretching is how long you hold the position for. With dynamic stretching, you move repetitively into and out of the stretch position, perhaps pausing for a few seconds, whereas with static stretching, you maintain the stretch for ten seconds or longer (most commonly for 30 seconds). Is static stretching bad for you? No, static stretching isn’t bad; it depends on how you do it. The two common mistakes that can produce bad outcomes are holding a stretch for too long and being too forceful . So, lets look at how to avoid this. Static stretching before workouts The reason people often tell you not to do static stretches before workouts is because there is some research that showed that static stretches can temporarily reduce your muscle strength and power. However, this only happens in very specific circumstances. According to the research: Holding static stretches for longer than 60 seconds may reduce muscle strength and power for a few minutes, but this is not permanent and does not reduce strength gains from workouts. Holding a static stretch for less than 60 seconds does not affect your muscle function, especially if you do it at the start of a well-rounded warm-up session that includes sport specific movements. (The research: Reference 1 , Reference 2 , Reference 3 , Reference 4 .) The verdict: Static stretching is not bad for your performance if you use shorter static stretches (30 seconds work well) and follow them up with sport specific activities (drills like butt kicks, high knees, jumps, and sprints). Over-stretching injuries You can injure yourself by doing very strong stretches and holding them for extended periods of time or just repeating them too often. Two examples of injuries that can be caused by excessive stretching are high hamstring tendinopathy (overdoing hamstring stretches) and insertional Achilles tendinopathy (overdoing calf stretches). The verdict: Static stretches are safe as long as you only take them to the point where you feel a comfortable, gentle stretch, hold them for less than 60 seconds, and don't do them too often. Remember, you should not pull or push as hard as you can. Just take the movement to the point where you feel a gentle stretch and hold it there. Benefits of static stretching It effectively increases your flexibility and range of motion (how far a joint or muscle can move). Static stretching has been shown to be more effective than dynamic stretching in improving your flexibility. Static stretching has also been shown to prevent acute muscle strains and tears in running and sprinting sports. Increased flexibility may help athletes, e.g. gymnasts or even tennis players, perform better (think how far Novak Djokovic can stretch), but only if you also work on strengthening your muscles to control your movement through that range of movement. You may think, “I’m just an office worker who wants to go for a jog or do a step class after work, so this is not very important for me.” But if you sit for long periods, the muscles at the front of your hips (hip flexors) shorten. If you then go for a run or try and do an exercise class without stretching them out first, your legs can’t move back as far as they should. This can predispose you to muscle strains, but it also means that you can’t use your glutes (muscles in your bum) effectively. As we get older, our bodies naturally lose some of the flexibility in their muscles, tendons, and ligaments. Static stretching becomes more important for older athletes who want to stay injury free and maintain their flexibility. What it doesn’t do Stretching does not help to reduce soreness in the days after exercise (DOMS). The research has also shown that routine stretching does not prevent repetitive strain injuries, but that it does play a role in preventing acute muscle strains and tears. Don't do static stretches if you have an injury. Stretching sensitive or injured muscles and tendons often just makes things worse . Speak to your physio to find out what exercises are right for your injury and when you can safely start adding in static stretches. Static stretches for legs Glute stretch Instructions Lie on your back with your knees bent up. Place your right leg (just above the ankle) on your left thigh. Grab hold of your left thigh and pull it to your chest until you feel a gentle stretch in your right buttock. Hold the position for up to 30 seconds. Switch legs and repeat. Do 3 times on each side. Top tip: Place a pillow under your head if your upper back is stiff and you struggle to keep your head on the floor. Place a towel around your leg and grab that instead if you’re very tight and struggle to bring your leg up. Hip flexor stretch Instructions Kneel on a soft cushion on your right knee and with your left leg out in front of you. Tighten your stomach muscles and tilt your pelvis back. Now slowly lean forward until you feel a gentle stretch over the front of your right hip and thigh. You may also feel a stretch in the back of your left thigh and buttock if your hamstrings are tight on that side. Hold the position for up to 30 seconds. Switch legs and repeat. Do 3 times on each side. Quad stretch Instructions Stand on your right leg - hold on to something stable if you struggle to balance. Grab hold of your left ankle. Bring your left knee in line with your right knee. You may already be feeling a stretch over the front of your left thigh. If the stretch feeling is not too strong, you can also pull your foot up to your buttock. Hold the position for up to 30 seconds. Switch legs and repeat. Do 3 times on each side. Top tip: Make sure your knees remain aligned. If you allow your knee to move further forward than your supporting leg, you will lose some of the stretch. Hamstring stretch Instructions Lie on your back. Bend your left knee up and hook a band around your foot - a non-stretchy band works best. With your hip in a 90 degree angle, slowly start to straighten you knee out. You leg might not move as far as in the picture - that is absolutely fine. Only straighten it until you feel a gentle stretch behind your thigh. Hold the position for up to 30 seconds. Switch legs and repeat. Do 3 times on each side. Top tip: If you strongly pull your foot back while your leg is straight, it will also stretch your sciatic nerve, which can make the stretch very uncomfortable. So, focus on straightening the knee rather than pulling hard on your foot. Calf stretch Instructions Take a step forward so your right foot is about a stride’s length in front of the left. Keep the left knee (leg at the back) straight and that heel on the floor throughout the exercise. Slowly bend your right knee (leg at the front) until you feel a gentle stretch in your left calf. Hold the position for up to 30 seconds. Switch legs and repeat. Do 3 times on each side. Top tip: If you don’t feel much of a stretch, you can take a larger step. If you find the stretch uncomfortable, take a smaller step and only bend your front knee a little bit. If, with any of these exercises, you don't really feel a stretch, then it may be that you are not tight in that area and don't need to stretch it. Static stretches for arms Posterior deltoid and rotator cuff stretch Instructions Cross your left arm over your chest at a slight downward angle. Use your right arm to gently press your left into your chest until you feel a gentle stretch in the back of your shoulder. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Top tip: Remember to angle your arm down a bit. If you reach straight over at shoulder height or higher, you will often not feel a stretch. Pec stretch (plus a bit of biceps) Instructions Stand with your arm straight out to the side and hook your hand behind a door frame or other solid object. Have your hand at shoulder height or slightly higher. Slowly turn your body away from your hand until you feel a gentle stretch over the front of your chest or shoulder. You may also feel a stretch in your biceps. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Top tip: If your hand is lower than shoulder height, you will likely not feel a stretch. If your hand is in line with your shoulder, the stretch targets the pec minor more. If you hand is higher than shoulder height, it targets the pectoralis major more. Biceps stretch Instructions Interlink your fingers behind your back. Lift your hands up behind you. You can also bend forward to increase the stretch. Hold the position for up to 30 seconds. Rest for 20 seconds while swinging your arms. Do 3 repetitions. Triceps and latissimus dorsi stretch Instructions Place your right hand behind your head (it doesn't matter if you can't reach very far back). Use your left hand to gently pull our elbow back. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Upper traps stretch Instructions Let your left ear drop towards your left shoulder. Place your left hand on your head and gently pull it to the left until you feel a gentle stretch in your right neck and upper traps. Check that your right shoulder stays down and don't pull up to your ear. Hold the position for up to 30 seconds (shorter holds are often better for the neck). Repeat on the other side. Do 3 times each side. Wrist flexor stretch Instructions Hold your left arm out straight in front of you - your palm can face up or down. Use your right hand to gently pull your fingers and palm back until you feel a gentle stretch in your palm and/or forearm. Hold the position for up to 30 seconds. Switch arms and repeat. Do 3 times on each side. Top tip: You may feel a better stretch if you start with your palm facing up so that your fingers move towards the floor when you pull the wrist back (so, opposite to the picture above). Try not to bend you fingers back too severely - the person in the picture is likely to sprain his fingers over time by placing so much force on them. Instead, place half of the pressure on your palm. Summary and recommendations Static stretches are better than dynamic stretches in producing flexibility and improving range of motion. We all require a certain level of flexibility to perform our chosen sport/activity. Be careful not to over-stretch. As part of your warm-up: Don’t hold static stretches for more than 60 seconds and do a set of dynamic or sport specific movements immediately after the static stretches to ensure that you wake your muscles up. As part of your cool-down: You can hold static stretches for longer than 60 seconds, but be careful not to overstretch. Shorter holds may still be better and it should feel like a gentle, comfortable stretch. Most injuries don't tolerate static stretching during the early stage of recovery, so speak to your physio to understand what exercises are appropriate for you. How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. 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 Medeiros, Diulian Muniz, and Tamara Fenner Martini. "Chronic effect of different types of stretching on ankle dorsiflexion range of motion: Systematic review and meta-analysis." The Foot 34 (2018): 28-35 . Medeiros, Diulian Muniz, and C. S. Lima. "Influence of chronic stretching on muscle performance: Systematic review." Human Movement Science 54 (2017): 220-229 . Behm, David G., et al. "Non-local acute passive stretching effects on range of motion in healthy adults: a systematic review with meta-analysis." Sports Medicine 51 (2021): 945-959 . Arntz, Fabian, et al. "Chronic Effects of Static Stretching Exercises on Muscle Strength and Power in Healthy Individuals Across the Lifespan: A Systematic Review with Multi-level Meta-analysis." Sports Medicine (2023): 1-23 . Bengtsson, Victor, Ji-Guo Yu, and Kajsa Gilenstam. "Could the negative effects of static stretching in warm-up be balanced out by sport-specific exercise?." The Journal of Sports Medicine and Physical Fitness 58.9 (2017): 1185-1189 . Blazevich, Anthony J., et al. "No effect of muscle stretching within a full, dynamic warm-up on athletic performance." Medicine & Science in Sports & Exercise 50.6 (2018): 1258-1266 . Reid, Jonathan C., et al. "The effects of different durations of static stretching within a comprehensive warm-up on voluntary and evoked contractile properties." European Journal of Applied Physiology 118 (2018): 1427-1445 . Konrad, Andreas, et al. "The influence of stretching the hip flexor muscles on performance parameters. A systematic review with meta-analysis." International Journal of Environmental Research and Public Health 18.4 (2021): 1936 . Behm, David G., et al. “Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.” Applied Physiology, Nutrition, and Metabolism 41.1 (2015): 1-11. Chatzopoulos, Dimitris, et al. “Acute effects of static and dynamic stretching on balance, agility, reaction time and movement time.” Journal of Sports Science & Medicine 13.2 (2014): 403. Herbert, Robert D., Marcos de Noronha, and Steven J. Kamper. “Stretching to prevent or reduce muscle soreness after exercise.” The Cochrane Library (2011). Kay, Anthony D., and Anthony J. Blazevich. “Effect of acute static stretch on maximal muscle performance: a systematic review.” Medicine & Science in Sports & Exercise 44.1 (2012): 154-164. 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. Murphy, Justin R., et al. “Aerobic activity before and following short-duration static stretching improves range of motion and performance vs. a traditional warm-up.” Applied Physiology, Nutrition, and Metabolism 35.5 (2010): 679-690. Samson, Michael, et al. “Effects of dynamic and static stretching within general and activity specific warm-up protocols.” Journal of Sports Science & Medicine 11.2 (2012): 279. Simic, L., N. Sarabon, and Goran Markovic. “Does pre‐exercise static stretching inhibit maximal muscular performance? A meta‐analytical review.” Scandinavian Journal of Medicine & Science in Sports 23.2 (2013): 131-148. Yamaguchi, Taichi, and Kojiro Ishii. “An optimal protocol for dynamic stretching to improve explosive performance.” The Journal of Physical Fitness and Sports Medicine 3.1 (2014): 121-129.

Sinus tarsi syndrome can cause pain and swelling (not always present) over the outside of the ankle, about in the same area as when you’ve sprained your ankle . It can cause your foot or ankle to feel unstable when you walk, and the symptoms often increase after sport or walking on uneven ground. In this article, I discuss what causes it and how it can be treated. In this article: Anatomy of the foot/ankle What happens when you get sinus tarsi syndrome? Treatment for sinus tarsi syndrome I've discussed this in a lot more detail in this video: Anatomy of the foot/ankle Your ankle joint is formed by the bones in your lower leg (the fibula and tibia) resting on the talus bone in your foot. The movements of pointing your foot down into plantar flexion and pulling it up into dorsiflexion happen mostly at this joint. The talus rests on the calcaneus (your heel bone) and between these two bones they form the subtalar joint. When you turn your foot in and out (supination and pronation) a large part of the movement happens in this joint. The sinus tarsi is a tunnel between the talus and calcaneus. What happens when you get sinus tarsi syndrome? Sinus tarsi syndrome can be caused by trauma, like after you sprain your ankle. In fact, it most often occurs in people who have an ongoing instability in their ankles after spraining it several times. An ongoing instability can have two causes: It can be a functional instability which means that your ligaments are actually all intact, but your muscles aren’t controlling your ankle and foot properly which is causing it to sprain repeatedly when you walk or run. This type of instability reacts really well to rehab exercises . It can be a structural instability which means that you’ve fully torn several ligaments and they’ve not grown back together or they are more lax than before and not providing your joint with enough stability. This type of instability can sometimes be helped through rehab exercises, but often requires surgery – it depends on the person, what activities they want to be doing and how bad the instability is. This trauma (either sudden or repetitive) can cause inflammation and irritation of the lining of the capsule that surrounds the subtalar joint and the sinus tarsi. We call this synovitis. Over time the synovitis can cause the joint lining to thicken and catch in the joint when you move, cause quite sharp pain. If the ligaments haven’t healed properly, some of the loose ends can also get caught in the joint and contribute to the pain. Something else that can cause irritation and synovitis in the sinus tarsi is when your foot hyper-pronates as this causes more compression over the outside of the ankle and foot joints. Treatment for sinus tarsi syndrome You should always try up to 6 months of conservative treatment first before considering surgery. In my experience, combining several things from the list of conservative treatments work best. It is for instance not really useful to take anti-inflammatory medication if you’re going to continue irritating the joint by walking with your foot in a hyper-pronated position. Combining the use of anti-inflammatory drugs with orthotics may give you better results. Conservative treatment could include: A short course of anti-inflammatory medication to calm the synovitis down. Make sure you check with your doctor before taking any medication. Semi-rigid orthotics to ensure that your foot does not go into hyper-pronation so that it can stop irritating the joint. These orthotics may just be a temporary thing if your over-pronation is caused by muscle weakness, but it may have to be permanent if you have a structural cause for it. Buy them here . Rehab exercises consisting of strengthening the muscles that bend your ankle up and down, the ones that turn it in and out as well as the ones that support your foot. Your exercise programme should also include exercises for correcting foot posture and balance (static and dynamic). Strengthening your glutes may also help – I explain why this is in the video. Avoid stretching your ankle into deep dorsiflexion! It causes the sinus tarsi to compress and will make it feel worse. Corticosteroid injections can also be very useful in cases where the pain doesn’t want to subside. They are best done under ultrasound guidance so that you can be sure that the steroid is injected into the sinus tarsi. If you’ve followed all the conservative treatment for at least 6 months and is still struggling, you may have to think about surgery. Surgery for sinus tarsi syndrome usually involves: That they just go in with a small camera and trim away all the swollen and loose bits that are getting caught in the joint or; If they think that the reason for your pain is due to a structural instability of the subtalar joint, they may perform surgery where they actually stabilise the joint for you or; They can also combine both procedures in step 1 and 2. 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 , ResearchGate . References 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.

The majority of running injuries that I see in practice fall into two groups. The first is caused by a weakness somewhere and could have been avoided by a basic strength training programme. The second is through training errors. In this article, I’ll give you some simple tips that you can apply to your training schedule to help avoid injury. In this article: First things first: What happens to your body when you train How much rest do you need? How to safely increase your mileage or speed Don’t push all year round Mental fatigue plays a big role How we can help First things first: What happens to your body when you train When you do a workout, the body first responds by breaking down before it slowly recovers and rebuilds itself to a point where it is actually stronger than before. If you train that same muscle group again before it has fully recovered, you’ll accumulate the damage and if you do this often enough it may lead to injury. How much rest do you need? It depends on several factors e.g. what type of training you’ve done, your fitness levels, for how many years you’ve done that specific activity, genetics and mental fatigue to name but a few. But here are some basic guidelines that you can apply: Allow 24 hours recovery after a moderate or easy workout. So if you did an easy run this morning, don’t run again until tomorrow. If you’re fit enough, you may be OK to swim or do an arm workout 8 hours later as it will work different muscles groups and your cardiovascular system should have recovered by then. Allow 48 hours recovery after a hard workout, before you train the same muscles. A hard workout can include sprint work, hill work, strength training or even a very long run. Again, if your cardiovascular system is fit enough you may be able to do an easy workout the next day e.g. swim or easy bike ride if you did a hard legs session the previous day. Plan a rest week every 3rd or 4th week. If you're serious about training, you should make sure that you plan your recovery periods just as meticulously as the rest of it. Cut the volume and intensity of your training dramatically during that week and make sure that you eat a good diet and get enough sleep. That will ensure that you’re physically and mentally ready for your next block of training. Listen to your body! If you're feeling tired and sore, it’s not the time to try and smash out a hard session. You can use the grid below to help you decide if you should train or rather rest and recover. How to safely increase your mileage or speed The 10% rule seems to hold true across several different sports. It basically states that you should not increase your training by more than 10% per week or else, the research in cricket, running, rugby, etc. has shown, you may be heading for injury. Of course you may be able to do it safely if you’re working alongside an experienced coach who closely monitors your mental and physical well-being, but I would advise not to push the boundaries too often. What does this mean in practice? For runners, you can measure it in a few different ways. Speed work may be best measured in total time spent working at a certain heart rate while endurance training is usually measured as total distance that week. E.g. if I ran 20 km this week, I should not increase my total mileage by more than 2 km next week. A GPS enabled sports watch, such as those made by Garmin, can help you to log your mileage and effort accurately. For more options, visit the Garmin Store on Amazon . Don’t push all year round Have you ever noticed that most sports seems to have an on and off season. Yes, climate does influence this to some extent, but one of the main reasons is that the human body can’t consistently perform at a high intensity all year round. Top athletes usually divide their year into 3 phases. During phase one they build up their base level strength and fitness to gradually reach peak performance. Then they enter competition phase where their aim is usually to just maintain that peak level of fitness. Once the competition phase is over they enter a 3 to 6 week rest phase where they take time off to rest and recover physically and mentally. One sport where players seem to ignore this cycle is tennis. The players tend to follow the sun and continuously play tournaments all year round. This may be one of the reasons for the high injury rate amongst the top players. Mental fatigue plays a big role It is important to understand the mental fatigue also has a physical effect on your body and it has been shown to slow down your healing process and recovery from training, reduce your response to training and affect your performance. The image below summarises it nicely. As a result, you may be predisposing yourself to injury if you continue to try and train hard without taking time out for self-care. Picture with thanks from the RunningPhysio Mental fatigue is an interesting subject because exercise can either help it or make it worse. If hard training is the main reason why you’re feeling drained, then the obvious thing would be to reduce training. If, however, stress from work is the main cause and you find that exercise relieves it, you may be better off continuing to train but just adjusting the volume and intensity so that you enjoy it rather than feel overwhelmed by the thought of it. And lastly, make enough time for self-care. This can take many forms, but the basics include eating healthy meals, enough sleep and time to relax. How we can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. 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 Gabbett TJ, Nassis GP, Oetter E, et al. The athlete monitoring cycle: a practical guide to interpreting and applying training monitoring data. Br J Sports Med 2017;51:1451-1452. Murray NB, Gabbett TJ, Townshend AD, et al. Calculating acute:chronic workload ratios using exponentially weighted moving averages provides a more sensitive indicator of injury likelihood than rolling averages. Br J Sports Med 2017;51:749-754 . Gabbett TJ. The training—injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 2016;50:273-280. Windt J, Gabbett TJ. How do training and competition workloads relate to injury? The workload—injury aetiology model. Br J Sports Med 2017;51:428-435.

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 .

Pain over the outside of your hip or in the gluteal area was traditionally blamed on trochanteric bursitis – a condition where the bursa (a fluid filled sac) that lies between the hip bone and gluteal tendons become inflamed and painful. But thanks to advances in imaging technology and research we now know that lateral hip pain is actually often caused by a combination of gluteal tendinopathy and bursitis and researchers have therefore proposed that a better name for pain in this area may be Greater Trochanteric Pain Syndrome. With this in mind, Alison has made a series of videos to explain what causes lateral hip pain, how it's diagnosed, what exercises should be avoided and what types of exercise are the most useful. Some of the links in this article are to pages where you can buy products or brands mentioned here. We might earn a small sales commission at no cost to you. In this video Alison explains what structures may be causing the pain that you feel over the outside of your hip: There are of course other conditions that can cause very similar symptoms and in this video Alison discusses the most typical signs and symptoms that may suggest that your pain is indeed linked to Greater Trochanteric Pain Syndrome. In Episode 8 she also discusses what other conditions may also refer pain over the side of the hip and how to diagnose or identify them. Sitting can often be very uncomfortable when you have a gluteal tendinopathy or hip bursitis and here Alison shares some tips on how to adjust your sitting position: One of the most annoying aspect of Greater Trochanteric Pain Syndrome is that it often won't allow you to sleep on either side and few people are truly comfortable with lying on their backs all night long. In this video Alison demonstrates how you can use pillows to improve your sleep: You might find this ergonomic side sleeping knee pillow useful. An alarming number of clinicians are still telling people to stretch their glutes when they have lateral hip pain. In this video Alison explains why stretching may be a very bad idea when you have either a gluteal tendinopathy or a hip bursitis: In Episode 6, Alison explains how and why the menopause may predispose you to developing outside hip pain and how you can adapt your training to mitigate this. In Episode 7 she discusses what exercises you should be doing if you have lateral hip pain and also what other factors should be taken into account when someone designs your rehab programme for you. In Episode 8 Alison explains what other conditions or structures can cause symptoms that can feel very similar to Greater Trochanteric Pain Syndrome and how we can distinguish between them. While this video is not specifically about lateral hip pain, the method that Ali shares for using pain as your guide during rehab, works really well for this condition. You may also find the following articles useful: 3 Interesting facts about Hip/Trochanteric Bursitis Top tips for runners with Gluteal Tendinopathy Running style tips for Gluteal Tendinopathy treatment 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 Alison: Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn , Facebook , Instagram , and Twitter . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. (Links to Amazon) Grimaldi, A. and A. Fearon (2015). "Gluteal tendinopathy: integrating pathomechanics and clinical features in its management." Journal of Orthopaedic & Sports Physical Therapy 45(11): 910-922. Grimaldi, A., et al. (2015). "Gluteal tendinopathy: a review of mechanisms, assessment and management." Sports Medicine 45(8): 1107-1119. Leblanc D, Schneider M, Angele P, et al. The effect of estrogen on tendon and ligament metabolism and function. The Journal of steroid biochemistry and molecular biology 2017;172:106-16. Mellor, R., et al. (2018). "Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial." British Journal of Sports Medicine 52(22): 1464-1472. Oliva F, Piccirilli E, Berardi AC, et al. Hormones and tendinopathies: the current evidence. British medical bulletin 2016;117(1):39-58.

When discussing what exercises you should do for iliotibial band syndrome (IT band syndrome), a good place to start is to look at what other factors you should keep in mind before you do a specific exercise. In this article, we’ll explain what factors you should keep in mind when structuring your IT band rehab programme and what exercises you should include, depending on your goals and your IT band’s stage of recovery. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We might earn a small commission sales at no extra cost to you. In this article: Factors that influence the choice of exercises for IT band rehab Stretches for IT band syndrome Glute exercises for IT band syndrome Foot and ankle exercises Exercises that retrain movement patterns Running technique drills How we can help We've also made a video about this: Factors that influence the choice of exercises for IT band rehab 1. What caused your IT band syndrome? We’ve previously explained that IT band syndrome develops when the IT band experiences excessive compression forces where it crosses over the outer knee. The excessive compression can be caused by one or more of several factors (tight muscles, weak gluteal muscles, fatigue, overpronation, running terrain, etc.) For an IT band rehab plan to be successful, it has to address the cause of your injury. For instance, if your specific case was caused by overpronation, you can do glute exercises until the cows come home and may see no effect. But if you add in exercises that specifically improve the strength and stability around the ankle, you may notice some progress. Or it may be that your case was cause purely by training error and that muscle weakness or control had nothing to do with it. In that case, you really need advice about restructuring and planning your training better. This is why it’s useful to consult a physio so that they can help you identify your specific cause and compile a rehab plan that takes all the relevant factors into account. 2. How irritable your injury is A newly injured IT band can be quite short tempered and easy to aggravate. The exercises you do (movement patters, weight, volume) should change depending on how sensitive or irritated your injury is. If not, you may end up irritating it further or, if you’re too conservative, you may not see any progress. We explain this in more detail in the specific exercise sections below. 3. Your exercise goals IT band rehab can look very similar for everyone during the early stages. However, as their injuries heal and they progress to more intense and complex exercises, the choice of exercises should be influenced by what sports they want to get back to as well as at what level they want to do it. For example, if you’re a runner or do a jumping sport, your legs will have to deal with much stronger forces than those of someone who just wants to go for walks. Also, your programme should definitely include exercises that develop landing mechanics (plyometrics), whilst this is not really needed for a walker. If you’re a footballer, you will also have to retrain your control when changing directions quickly, whereas a regular runner doesn’t really have to worry about that. Stretches for IT band syndrome This is a topic that warrants a blog post and video of its own. You can read all about what muscles to stretch and what stretching pitfalls to look out for when you do stretches for IT band syndrome in this article . Glute exercises for IT band syndrome Your glutes (glute max, glute med, glute min) all work together to help stabilise your pelvis. They stop it from dropping to one side when you walk, run, or jump. The IT band is also attached to the pelvis. If your glute muscles are weak and allow your pelvis to drop excessively, this then pulls on the IT band and can cause increased compression at the side of the knee. What glute exercises are best for IT band syndrome? It will depend on how irritable your knee currently is. If your IT band is still very sensitive or newly flared up, then it is usually best to avoid : Exercises that require repetitive bending and straightening of the knee (like squats); Exercises that require a lot of control (like lunges or balancing on unstable surfaces); High load exercises (single leg standing). Glute exercises that can work well for the early stage of rehab include: Clams, side leg lifts, and isometric bridges (double support). We've includes instructions for these lower down. As your IT band settles down and recovers, you can add in more high load exercises like single leg bridges, squats, and deadlifts. Squats are brilliant because not only do they build good glute and general leg strength, they also help you retrain good movement patterns. But they should only be added once you can do them pain free. Clams Start without a band. You can add the exercise band later as a progression. If it hurts to place the band above the knee, you can move it to just below the knee. Instructions: Lie on your side with your hips bent to about 60 degrees and your knees at a 90-degree angle. Tighten your stomach muscles to help stabilise your trunk during the movement. Keep your feet touching each other while you rotate your top knee up and back down, so that your legs open and close like a clam. Check that your pelvis or hips don't roll back as you lift your leg. Hold the open position for 2 seconds and then SLOWLY lower your leg back down. Your aim is to do 15 repetitions, but don't force it. If you find it hard, do what you can and just add a few repetitions the next time as you get stronger. Rest 60 seconds. Do 3 sets. Side leg lift Instructions: Lie on your side with your head supported and lower leg bent. Contract your core and slowly lift your top leg up. Make sure that your leg does not drift forward during the exercise - you should only be able to see the tips of your toes if you look down at your foot. Also make sure that you don't roll back - your hips must stay vertical. You may not be able to lift your leg very high, and that's OK. Slowly lower it back down. Do 15 slow lifts and lowers. Then rest for 60 seconds. Do 3 sets. Isometric bridge Instructions: Lie on your back with your knees bent 90 degrees and your feet flat on the floor. Lift your bottom off the floor until your hips form a straight line with your trunk. Concentrate on squeezing your buttocks to get you up there. At the same time, tighten up your lower stomach muscles and avoid arching your back too high. Hold the position for 20 seconds. Then lower back down and rest for 20 seconds. Repeat 5 times. Foot and ankle exercises Overpronation (when your foot rolls in excessively) can cause your lower leg to turn in excessively. Because the IT band attaches onto the shin bone, this can also cause the IT band to pull tight and compress more than normal against the outer knee. By strengthening the muscles that control and support your foot and ankle, you may help reduce the overpronation or the force with which your foot moves into pronation. What foot exercises work best for IT band syndrome? The same principles apply as for the glute exercises. If your knee is very irritable, you want to start with exercises that don’t place a high load through your leg and also don’t require a lot of repetitive bending of your knee. Examples of good starter exercises are towel grabs and inversion (turning foot in) against a resistance band. The towel grabs strengthen the small muscles inside your foot that support your arch. The resisted inversion exercise strengthens your tibialis posterior muscle, which is one of the main ones that control pronation at the foot and ankle. Towel grabs Instructions: Sit on a chair - it works best if the floor is slippery or smooth. Place your foot on a towel and use your toes to gather in the towel. Do 20 "towel grabs". Then rest 30 seconds. Do 5 sets. Resisted inversion Instructions: Sit on a chair with one end of an exercise band attached to the leg of the chair and the other to the front of your foot (same side foot and chair leg). Cross your legs over to increase the resistance on the band. Now slowly turn your foot in against the resistance. Pause for 1 second. Then slowly turn it back out, controlling the movement so that your foot doesn't jerk back out. Repeat 10 times. Rest 1 minute. Do 3 sets. As your knee pain settles, you should then include exercises that develop your ankle control in positions that resemble the walking, running, and jumping movement patterns. The good news is that most of these exercises also strengthen your glutes, so you can get lots of benefit from doing just one exercise. Balancing on one leg is a good example of an exercise that requires your glutes to work in order to keep your pelvis level, and also your ankle and foot muscles to work to control your ankle and foot. A single leg squat is another great all-in-one exercise, but these should only be used much later in rehab, once your symptoms have fully settled. Exercises that retrain movement patterns Sometimes you may have pretty strong glutes and ankle muscles, but your legs still turn in excessively when you walk, run, or jump. If this is the case, you may benefit from retraining your movement patterns (biomechanics). The research has also shown that, even in cases where muscles are found to be weak, strengthening the key muscle groups (like the glutes) doesn’t automatically translate into better movement patterns; you still have to retrain the movement itself. What is a ‘good’ movement pattern? First, it’s important to understand that there’s not such thing as a perfect movement pattern, and that various patterns are acceptable. When we look at movement, the elements that have been indicated that might be important for IT band syndrome are to avoid: Excessive pelvis drop; Excessive leg internal rotation (the thigh and lower leg turn in too much when you step or land); Excessive adduction (the thigh moves too far over to the mid-line) You’ll notice the word “excessive” in all three bullet points above. The reason for this is that it is absolutely normal to see some drop in the pelvis and you should get some internal rotation and adduction of the leg as you move. It is only when these elements are deemed to be excessive that they should be corrected. How do you retrain movement patterns? You start by practicing them in very stable, easy positions. For example, by controlling your legs properly while you do a double leg squat, keeping the knees in line with the middle of your feet. Once you master the easy ones, you can go more dynamic, e.g. lunges. You should control all three elements (pelvis, leg, foot) while moving in and out of the lunge position. If you’re a runner or jumper, you should also include exercises that challenge your control and movement patterns under fast and explosive conditions, e.g. during hopping or jumping. But please make sure that you build up to these exercises by following a comprehensive strength training plan first and only add them into the final stages of your rehab. If you add them early on, you can really make your IT band flare up. Box jumps These should only be added into the final stage of rehab. Start with a low box and progress to higher ones. Instructions: Stand in front of a low box. Hop onto the box with both feet simultaneously. Make sure that when you land, your knees stay in line with the middle of your feet. Then jump back down, again checking your landing mechanics. Do 10 times (up and down). Rest 3 minutes. Do 2 sets in total. Running technique drills The last piece in the rehab puzzle is to ensure that all the good work you’ve done with your exercises is actually transferred into your running form. The best way to do this is through specific running drills or cues. We’ve dedicated a whole blog post to running tips and drills for coming back from IT band syndrome . How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskeletal Disorders 2015;16(1):356. Allen DJ. Treatment of distal iliotibial band syndrome in a long distance runner with gait re‐training emphasizing step rate manipulation. International Journal of Sports Physical Therapy 2014;9(2):222. Balachandar, V., et al. (2019). "Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment." Muscles, Ligaments & Tendons Journal (MLTJ) 9(2). Barton, C. J., et al. (2016). "Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion." British Journal of Sports Medicine 50(9): 513-526. Dodelin D, Tourny C, Menez C, et al. Reduction of Foot Overpronation to Improve Iliotibial Band Syndrome in Runners: A Case Series. Clin Res Foot Ankle 2018;6(272):2. Friede, M. C., et al. (2021). "Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?" Physical Therapy in Sport. McKay, J., et al. (2020). "Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study." Journal of Orthopaedic Surgery and Research 15(1): 188. Louw, Maryke, and Clare Deary. "The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners–A systematic review of the literature." Physical Therapy in Sport 15.1 (2014): 64-75. Phinyomark A, Osis S, Hettinga B, et al. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scandinavian Journal of Medicine & Science in Sports 2015;25(6):744-53. Van der Worp MP, van der Horst N, de Wijer A, et al. Iliotibial band syndrome in runners. Sports Med 2012;42(11):969-92.

The Gluteus Medius muscle is one of the key muscles when it comes to injury prevention and plays an important role in core stability . Weakness in the glute med has been shown to contribute to lower back strains as well as hip, knee, and ankle injuries. This article is a summary of the livestream that I did as part of the Injury Prevention series. Other topics that I covered in this series include: Position Sense , Core Stability , Glute Max , Hamstrings , Quadriceps , and Calves . Some of the links in this article are to pages where you can buy products or brands discussed or mentioned here. We might earn a small commission on sales at no extra cost to you. In this article: What does the Glute Med do? How to strengthen the Glute Med Glute Med Training: Level 1 Glute Med Training: Level 2 Glute Med Training: Level 3 Download exercises as a PDF What does the Glute Med do? The Glute Med muscle is located over the side of the hip. It is one of the main muscles that allows you to move your leg out to the side (abduction) and also to turn your leg out (external rotation). But its injury prevention powers lies in its ability to keep your pelvis level and stop your leg from turning in when you walk, run or jump. Why is this important? Because it puts extra strain on your muscles, ligaments and joints if your pelvis drops or your leg turns in excessively when you move. I’ve highlighted some of the injuries that are associated with poor hip and pelvis stability in the picture below. You can learn how to test your own hip stability in this article . How to strengthen the Glute Med You should always master the low load exercises first and then move on to the more challenging ones. You may find that one leg is stronger than the other when you do these exercises and you should train it according to what the weakest leg can do. That way it will maintain the strength in the strong one while the other leg is allowed to catch up. You will notice that I tend to prefer single leg exercises. This is to ensure that both your legs get worked properly. I have chosen the exercises below, because they have all been shown to strongly activate the gluteus medius muscle and the level 3 exercises also work the muscle in its functional position (as you would use it when walking, running, jumping). NB: These exercises may not be right for you at this specific time. You should consult your healthcare provider before starting any of these. Remember, we also provide consultations via video call and can provide you with a custom training programme specific to your needs. Glute Med Training: Level 1 Clam Purpose: This exercise serves 2 purposes: 1. To teach you how to effectively turn your hip out – you’ll need this for the next level exercises. 2. Besides strengthening the glute med, it also strengthens the other muscles, e.g. piriformis and glute max, which are important for hip stability. Starting position: Lie on your side with your hips bent to about 60 degrees and your knees at a 90 degree angle. Movement: Tighten your stomach muscles to help stabilise your trunk during the movement. Keep your feet touching but lift your top knee up and back, so that your legs separate and open like a clam. Hold the position for 2 seconds and then SLOWLY take your leg back down. Check that: Your pelvis or hips does not roll back as you lift your leg. Aim: Build up to doing 3 sets of 15 repetitions. Rest 1 minute between sets. Side leg lift Purpose: To activate and strengthen the glute med muscle. Starting position: Lie on your side with the leg at the bottom bent up and the leg at the top straight. It works really well if you can lie with your back against a wall so that you keep your heel in contract with the wall as you lift it up and down. That way you ensure that you don’t roll backward and that your leg does not drift forward. Movement: Tighten up your pelvic floor and lower stomach muscles. Turn your foot so that the toes point to the ceiling and slowly lift your leg up and out to the side as far as you can BUT make sure that your leg does not drift forward. It has to stay against the wall or in a straight line. Check that: Your pelvis or hips does not roll back as you lift your leg. Your head, back and heel should stay in contact with the wall behind you. If you’re not using a wall and can see your whole foot as you do the movement, you’ve likely allowed your leg to drift forward – correct it by taking the leg back. Aim: Build up to doing 3 sets of 15 repetitions. Rest 1 minute between sets. Glute Med Training: Level 2 Side walk with band Purpose: To teach you how to position your knee over your foot in a more functional position while you strengthen the glute med. Starting position: Tie an elastic band around your legs – I prefer it just above my knees. Now place your feet hip distance apart and separate your knees against the band’s resistance so that your knees are aligned with the middle of your foot. Then squat down to about 45 degrees knee flexion. Movement: Walk sideways but make sure that your knees always stay aligned with the middle of your feet. Check that: Your knees should never turn in and always be pointing in line with the middle of your feet. Aim: Build up to giving a total of 45 steps into each direction. How many you do in one go will depend on the space you have available. Side plank Purpose: To strengthen the glute med. This is not a functional exercise but is much harder than the side leg lift and will give you better strength gains. Starting position: Lie on your side with your knees bent back so that your shoulders, hips and knees are in a straight line. (You can do this with the legs straight if you are strong enough) Support yourself on your forearm. Movement: First contract your pelvic floor and lower abdominal muscles. Then lift your hip off the floor so that your body forms a straight line. Hold the position Check that: You do not rotate your body forwards or backwards. Aim: Build up to being able to hold the position for 40 sec and do 3 repetitions. Rest 1 minute between reps. Doing the side plank with your legs straight is harder than with your knees bent. Glute Med Training: Level 3 Single leg squat with support Purpose: I love this exercise as it not only teaches you how to control your body in a functional position (improves position sense ), but also strengthens your glute med, glute max, quads and hamstrings. Starting position: Balance on one leg and have the other leg resting on a chair behind you. It’s best to do this in front of a mirror at first so that you can make sure that you are doing it right. Your pelvis should be level and your knee should be pointing in line with the middle of your foot. Movement: SLOWLY push your bottom out to the back and bend your knee so that you squat down. Your pelvis must remain level throughout the movement and your knee must stay in line with the middle of your foot. Stop at the bottom and check your alignment. If you find that your knee has turned in or pelvis has dropped, correct it first before you come back up. Check that: Your pelvis stays level. Your knee does not move in but stays over the middle of your foot. You knee does not cross over the front of your toes. If this happens, it’s a sign that you are not pushing your bottom out far enough to the back. Aim: Build up to 3 sets of 15 slow repetitions. Rest 1 minute between sets. Aim to squat to at least 60 degrees or more knee flexion. You may have to spend a lot of time on this exercise before you move onto the next one. Single leg sit-stand-sit Purpose: This exercise is a step up from the one above and the unstable position makes all your muscles and control systems work a lot harder. It’s a great exercise to strengthen your glute med, glute max, quads and position sense. Starting position: Choose a chair that you can manage to get up from using only one leg. Your aim should be to use a chair that places your knee in 90 degrees flexion, but if this is too hard use a higher surface. I usually place some pillows on the chair to make it easier. Sit on the edge of the chair with your one leg on the floor and the other one in the air. Your hands can either be in your sides or out in front of you. Movement: Slowly stand up from sitting, using only one leg. Make sure that your pelvis stays level and your knee moves in line with the middle of your foot. Then slowly sit down again. Check that: Your pelvis and knee stays aligned. If you find that you “plonk” down instead of slowly lowering yourself down, you may have to use a higher chair to start with. Aim: Test how many your can do with good form from 90 degrees knee flexion. Your aim should be to get to 22 with no wobbling and keeping your pelvis and knee aligned. I can only manage 8 and with rather poor form, so I should work on the Single Leg Squat With Support exercise BEFORE doing these. Retest this every 4 weeks to check on your progress. Start strengthening it by doing sets of 8 reps until fatigue. Rest at least 1 to 2 minutes between sets. Download exercises as PDF Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate . References Ebert JR, Edwards PK, Fick DP, et al. A Systematic Review of Rehabilitation Exercises to Progressively Load the Gluteus Medius. Journal of sport rehabilitation 2017;26(5):418-36. Penna G, Russo L, Bartolucci P. EFFECTS OF TWO TRAINING PROTOCOLS ON THE STRENGTH OF THE MEDIUS AND MAXIMUS GLUTEUS IN ADULT WOMEN. ACTA KINESIOLOGICA 2017;11(2):50-54. Reiman MP, Bolgla LA, Loudon JK. A literature review of studies evaluating gluteus maximus and gluteus medius activation during rehabilitation exercises. Physiotherapy theory and practice 2012;28(4):257-68. Stastny P, Tufano JJ, Golas A, et al. Strengthening the gluteus medius using various bodyweight and resistance exercises. Strength and conditioning journal 2016;38(3):91.

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.

Quad tears are quite common in any sport that involves fast running or sprinting, e.g. football and rugby. In this article, I’ll highlight the three components that you have to think about when you rehabilitate a torn quad muscle, and the video I’ve included will walk you through the full rehab process in a lot more detail. 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. Watch the video if you would like a more comprehensive explanation of the rehab process: Anatomy of the quadriceps The quadriceps actually consists of four muscles that work together and they function in three (main) ways: Part of it (the Rectus Femoris) helps to flex your hip; When your foot is free to move, the quadriceps muscles extend your knee e.g. when you kick a ball or stride forward; During the squat or lunge movement it helps to extend the knee and push you up, but it also controls the downward motion and helps to lower you down to the floor slowly – basically stops you from just dropping. Think about the running motion – you basically perform a single leg squat as you take your weight and land on one leg and then push yourself back up to move forward. Quad tears – the three functions that need to be restored When you design a rehab programme for a strained or torn quad, you have to include exercises that work the muscles in ways that are similar to all three these functions. I discuss this in much more detail in the video above, but example exercises include: For hip flexion: While standing on your uninjured leg, tie a resistance band around your ankle and slowly flex your hip up and then release it back down. For knee extension: The leg extension machine in the gym works well for this or you could tie a band around your ankle in sitting and extend your knee against its resistance. For squat control: Yip, it’s quite easy to guess – squats and lunges and step-ups are all examples that can be used for this. Here are some more resistance bands options from TheraBand . During the early stages of treatment everyone’s rehab programme may look quite similar, but it’s important to make the exercises sport specific during the later stages. A soccer player or rugby player, for example, has to be able to forcefully kick a ball and you have to prepare and train the quad to a high enough level to be able to do that. So working on explosive open chain knee extension is super important for them. For someone who does jumping sports, you would want to pay special attention on force production and landing in squat type movements as well as plyometrics that mirror movement that they would have to use in their sport. You may also be interested in reading this article where I give some tips with regards to your quads and injury prevention . Let me know if you have any questions . Need more help with your injury? You’re welcome to consult me online via video call for an assessment of your injury and a tailored treatment plan. Best wishes Maryke About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate , Facebook , Twitter , and Instagram .

Sports physio Maryke Louw demonstrates glute bridge exercises, including the following glute bridge variations: double-leg glute bridge, offset glute bridge, marching glute bridge, and single-leg glute bridge. She also explains the benefits of glute bridges as well as glute bridge progressions once you have mastered the basic stuff. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. Some of the links in this article are to pages where you can buy products mentioned here. We might earn a small commission on sales at no extra cost to you. In this article: Glute bridge benefits Glute bridge mistakes How many bridges should I do? Glute bridge progressions (how to make them harder) Glute bridge variations demonstrated How we can help We've also made a video about this: Glute bridge benefits   The glute bridge is a compound exercise that strengthens your : Back muscles (erector spinae and multifidus) Stomach muscles (rectus abdominus and obliques) Gluteal or buttock muscles (gluteus maximus, gluteus medius, gluteus minimus) Hamstrings (back of thigh muscles).   It can also help to actively stretch your hip flexor muscles  (over the front of your hips): Iliopsoas Rectus femoris (one of the quadricep muscles). Glute bridge mistakes   ❌  Lifting too high (over-arching your back): Overworks your back muscles and reduces your glute activation Can cause back pain Can strain your neck 👍How to fix it: Focus on driving the movement by squeezing your buttock muscles  rather than using your back. Contracting your stomach muscles at the same time also helps – it’s impossible to over-arch your back with your stomach muscles contracted.  ❌ Letting your hip drop  when you lift a leg or do single-leg bridge exercises: Can cause your back to strain Means that you’re not strong enough to control the rotational force when supported on one leg 👍How to fix it: Choose a slightly easier version  of the bridge to work on first Or concentrate on really tightening your glutes and core  before lifting the leg and on keeping them contracted as you lift Pressing your elbows and upper arms into the floor  while doing the exercise activates your posterior chain (latissimus dorsi and glutes), which can increase your control How many bridges should I do?   This will depend on whether you’re doing them as isometric bridges (where you hold the position for several seconds before resting)  or simply lift up and down several times before resting (isotonic bridges) .   Isometric bridges: Start with short holds and more repetitions, e.g. 10-second holds x 10 repetitions. Build up to longer holds and fewer repetitions, e.g. 30-second holds x 4 repetitions. Rest between the repetitions for at least as long as you hold each contraction.   Isotonic bridges: Do sets of 10 to 15 repetitions. Do 3 sets. Rest 1 to 2 minutes between sets.   When you can easily perform the suggested dose with good form, it’s time to progress and make them a bit harder. Glute bridge progressions (how to make them harder)   You can make each type of bridge harder by: Placing a weight across your pelvis (works all the muscles harder) Pulling an exercise band  apart with your thighs while bridging (works glute med harder) Holding the position for longer when doing isometric bridges Doing more repetitions or sets Or moving on to the next type of bridge in the list below.   Glute bridge variations   You can easily make the exercise harder or easier without the need for fancy equipment by adapting your glute bridge position. I've listed the progressions in order of increasing difficulty.   Make sure you master each type properly before moving on to the next.   1. Double-leg glute bridge This is a good one to start with to learn proper bridging technique. 📽️ Play video demo Instructions: Lie on your back with your knees bent 90 degrees. Tighten your tummy muscles. Squeeze with your glutes (not your back muscles) to lift up your hips – just to where they naturally stop. Come back down slowly. Top tips: Place your feet on a low step to work your glutes through a larger range of motion and/or if your hips don't want to go up very far. If your hamstrings cramp , place your feet closer to your bum.   2. Offset glute bridge This type of bridge allows you to work one leg slightly harder than the other . It helps to build the strength needed for single-leg bridges. 📽️ Play video demo Instructions: Lie with both knees bent to about 90 degrees. Then slide one foot slightly further away from your bum so that leg is a bit straighter. Tighten your stomach muscles and then squeeze your glutes to lift up into the bridge position. The leg that is more bent (foot closer to your bum) should be doing most of the work. Your hips must stay level. Pause for a moment at the top. Come back down slowly. Complete a full set with one leg closer to your bum. Rest for 60 seconds. Then repeat with the other foot closer to your bum. Do 3 sets on each leg (6 in total). Top tip: If you find that your hips do dip to one side, don't come down right away; correct the position before you come down.   3. Marching glute bridge Marching bridges help you to develop control , so you’re able to keep you back and pelvis stable when switching from double to single-leg support. 📽️ Play video demo Instructions: Go into the elevated double-leg glute bridge position (see instructions above). Check that you're squeezing your core and glutes. Lift one leg up, ensuring that your hips stay level and don't dip lower. Pause for a moment. Bring the leg down slowly. Repeat with the other leg. Do 10 to 16 repetitions (alternating legs). Rest 1 minute. Do 3 sets. Top tips: Press with your elbows into the floor for better stability. Again, if your hips tilt or dip while a leg is lifted up, correct your form before bringing the leg down. Take a brief rest between reps if you find that you're losing your form towards the end of a set. 4. Single-leg glute bridge Doing glute bridges on one leg at a time ensures that you work each leg equally hard . It also requires good strength and control in your core muscles. 📽️ Play video demo Instructions: Lie with your knees bent to 90 degrees and feet flat on the mat. Lift one leg towards you so that the thigh is tucked against your stomach. Tighten your stomach muscles and squeeze your glutes to lift you up. Keep your hips level, correcting your position if necessary before coming down. Complete a full set on one leg before switching legs. Rest 30 to 60 seconds between sets. Top tips: Press with your elbows into the floor for better stability. If your hamstrings cramp , stretch them for a bit before continuing. It can also help to move your feet closer to your bum. How we can help Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine 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 Bourne, M. N., Williams, M. D., Opar, D. A., Al Najjar, A., Kerr, G. K., & Shield, A. J. (2016). "Impact of exercise selection on hamstring muscle activation"  British Journal of Sports Medicine . Ebert, J. R., et al. (2017). "A Systematic Review of Rehabilitation Exercises to Progressively Load the Gluteus Medius" Journal of Sport Rehabilitation 26(5): 418-436. Yoon, J. O., Kang, M. H., Kim, J. S., & Oh, J. S. (2018). "Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study"  Brazilian Journal of Physical Therapy ,  22 (2), 161-167. Kim, C. M., Kong, Y. S., Hwang, Y. T., & Park, J. W. (2018). "The effect of the trunk and gluteus maximus muscle activities according to support surface and hip joint rotation during bridge exercise"  Journal of Physical Therapy Science ,  30 (7), 943-947.