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

You may think that osteoporosis or “brittle bones” is something that just “old” people have to worry about, but what you do when you’re young paves the road for when you’re older. We build most of our bone before the age of 25 and what we do in the years that follow can have a massive impact. In this article, I’ll focus specifically on what type/volume of exercise is needed to prevent and improve osteoporosis. Other things like diet and Vitamin D are also very important and you can read more about that here . 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: Impact activity Strength training Balance exercises Posture exercises Avoid sitting for long periods Final thoughts Here's the video of the livestream I did on this topic: Impact activity This type of exercise/activity is by far the most effective in stimulating bones to grow. Other benefits include heart health, blood sugar control, muscle strength, healthy joints, improved balance and pain management. Aim to do at least 20 minutes of moderate impact activity per day. This can be broken up into smaller portions throughout the day. If you’re doing a high impact activity like jumping or running, you only need 50 impacts per day for strong bones. You can read the full guidelines here . Examples include: Running, walking, stair climbing, jumping, marching on the spot, dancing and even gardening (depending on what you do in the garden). Strength training When you do strength training, your muscles pull on your bones and this acts as a stimulus for your bones to strengthen themselves. Besides helping with bone health, strength training also helps you to regulate your blood sugar levels, increases your muscle strength, improves your posture, protects your joints, improves your balance and helps to reduce pain. Aim to do at least 2 to 3 sessions per week. Include exercises for your arms, back and legs. Examples include: Bodyweight exercises, using weights or exercise bands , carrying shopping, gardening, house work, climbing stairs, Thai Chi, Yoga, Pilates etc. You should include exercises that strengthen your back muscles as this will also help with your posture. Balance exercises for osteoporosis The main benefit of having good balance is that you’re less likely to fall and break a bone. The good news is that having strong muscles and being fit already improves your balance, so all the exercises in the previous 2 sections will also benefit your balance. Aim to do some form of balance exercise every day. If your balance is poor, you would benefit from seeing a physiotherapist who can help you find a safe exercise to start with. Examples: Most people can benefit from doing exercise that specifically challenge their balance for example standing on one leg or doing exercises like Thai Chi, Yoga or Pilates. Posture exercises for osteoporosis Osteoporosis can lead to spontaneous fractures in your back and/or back pain. It’s very easy to stoop when you have pain in your back or your neck. The problem is that this can become a habit and that you can get stiff in that position. Having a stooped posture can actually put more strain on some of the muscles in your back and cause you more pain. It can also affect you balance. Examples : To improve and maintain good posture you need to do a combination of balance, flexibility and strength training exercises – with special focus on strengthening the back and neck muscles. Aim: These can easily be incorporated into your 2/3 strength training sessions per week. Avoid sitting for long periods Sitting for long periods in the day has a very negative effect on your muscles, joints and bones. It’s literally a case of “if you don’t use it, you lose it”. It decreases your bone density and muscle strength and stiffens up your joints. Joints don’t have arteries going in to them. They need movement to get fluid and nutrients in and out. If you don’t move them for long periods of the day, you’re “starving” them to some extent. It’s hardly surprising that a recent study found prolonged periods of sitting to be the most aggravating factor for back pain! Sitting for long periods of time has also been shown to increase your chances of diabetes and heart disease. Top tip: Take active breaks at regular intervals during the day. For example, if you do a flight of stairs during your quick break, you’ll feed your joints and add to your muscle strength and bone density! Final thoughts Exercise should be fun. If it’s not, find something else to do because you’ll likely lose interest. If you’re struggling to find activities that you can do without pain, consult a physiotherapist. Every person can do exercise – you just need to start at the right level and with the right type of exercises. Pain can be a big barrier to exercise. These days we know that medication is not always the most effective treatment for people with ongoing pain. If pain is a barrier for you, speak to someone who specialises in pain management about your options. Things like mindfulness, CBT, acupuncture, exercise, massage etc. can all help to bring pain down to a manageable level. Please let me know if you have any questions . You’re also welcome to consult me online via video call if you would like more help with a specific injury. Best wishes Maryke About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn , ResearchGate , Facebook , Twitter or Instagram . References Strong, Steady & Straight: NOS Exercise and Osteoporosis Consensus Statement Suri, Pradeep, et al. "Do Physical Activities Trigger Flare-ups During an Acute Low Back Pain Episode?." Spine 43.6 (2018): 427-433. Wilmot, Emma G., et al. "Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis." (2012): 2895-2905.

Biceps tendonitis pain is one of the more common types of shoulder pain. This article explains what causes biceps tendonitis, what biceps tendonitis feels like, and how to rehab it, including exercises to do and activities and exercises to avoid. It also discusses recovery times for biceps tendonitis. 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 earn a small commission on the sale of these products at no extra cost to you. In this article: Anatomy and function of the biceps muscle and tendons What causes biceps tendonitis? What does biceps tendonitis feel like? Treatment for biceps tendonitis Alternative treatments Biceps tendonitis recovery time How we can help We’ve also made a video about this: This article is about proximal biceps tendonitis, at the upper or shoulder end of the biceps muscle. We also have an article on distal biceps tendonitis , at the lower or elbow end of the muscle. Anatomy and function of the biceps muscle and tendons The bicep muscles are your “guns” that run from the font of your shoulder down to the crook of your elbow. Picture adapted from wikimedia The shoulder end of the muscle has two heads – the long head and the short head. The long head is attached directly to your shoulder joint via a tendon, and the short head is similarly attached to the coracoid process, which is a bit of bone sticking out from the top of your shoulder blade. Biceps tendonitis most commonly affects the long head's tendon but it can affect either or both of these tendons. The biceps muscle has three main functions 1. It bends the elbow When you stand with the palm of your hand facing forwards or up (forearm in supination) and bend your elbow (do a bicep curl), it’s the biceps doing most of the work; it doesn’t do much work when you do this movement with your palm facing inwards or down. The biceps muscle does most of the work when you bend your elbow with your palm facing up. The biceps muscle does not work as hard when you bend your elbow with your palm facing in or down. 2. It helps to flex the shoulder Its second function is to help your other shoulder muscles to lift your arm upwards (shoulder flexion), like when you’re lifting something above your head. 3. It turns the forearm out (supination) The third function is to help rotate the forearm outwards (supination) What causes biceps tendonitis? There are three types of causes of biceps tendonitis: overload, overstretch (especially if it’s combined with added weight), and poor biomechanics. Overload The most common cause of proximal biceps tendonitis is that the tendon has been worked too hard to an extent that it isn’t used to or not allowing enough recovery time between workouts. So, we’re talking about something like a pull-up challenge, massively ramping up the weight on your bicep curls, or a marathon session in front of a one-armed bandit. Even a sudden increase in household activities that requires you to either lift your arms above your head or carry heavy things can cause trouble, e.g. redecorating the house. Any sudden increase in activity that uses the biceps muscle can cause biceps tendonitis. Overstretching or excessive compression A second cause is overstretching, where the tendon is stretched too tight over the bones. This can cause excessive compression between the shoulder bone and tendon which then causes it to get injured. An example is when you go too far with certain yoga positions. And during the lockdowns of the COVID-19 pandemic, I had quite a few patients who got biceps tendonitis from doing triceps dips with their arms behind them – typically off the edge of a chair or coffee table. In that position, your upper bicep tendons are really stretched and compressed over the bone and can get irritated if you don’t have good strength and control in your shoulder girdle. Tricep dips stretch the biceps tendon while also loading it and can cause biceps tendonitis if you lack the strength to control the movement properly. Poor biomechanics Lastly – and this is especially the case with swimmers and people who do racket sports – biceps tendonitis can be caused when the muscles that stabilise the shoulder blade aren’t strong enough to do their job properly towards the end of a long session. When these muscles are tired, the shoulder blade tilts further forward than it should, and this leads to more compression and friction than the biceps tendons are used to. This is also the reason why you should avoid rounding your shoulder girdle while lifting weights. What does biceps tendonitis feel like? Tendons are sneaky things. Often, they won’t complain at the time when you’re overworking them, only to pipe up hours later or even the next day. So, it could be difficult to trace the cause of the pain. When the pain caused by proximal biceps tendonitis does arrive, it is over the front of the shoulder, and it is painful when you press directly on the biceps tendon in that area. If the tendon is very irritated, you may even feel the pain down your arm, in the biceps muscle itself. The muscle can also feel tight, and if your nerves are affected (they run close to the tendon), you can get a tingling feeling. There are other conditions that may cause similar symptoms. A tingling feeling might be due to nerve issues in the neck, and your pectoral and rotator cuff muscles are attached to your skeleton in the same area. In fact, upper biceps tendonitis is often misdiagnosed as a rotator cuff injury. An indication that it might indeed be your biceps tendon causing the trouble is if it hurts when, with the palm of your hand facing up, you curl up your forearm or lift your arm up towards the ceiling against resistance. However, other muscles also contract during these movements, so it’s not a 100% accurate test. Seeing a physio would be useful, because they will ask you some specific questions and make you do some movements to piece the puzzle together. Treatment for biceps tendonitis The treatment for biceps tendonitis comprises two aspects: Treatments that help the pain to calm down. These include using ice, relative rest, avoiding certain exercises and activities, and performing gentle exercises. See the sections below for more details on each of these. Exercises that restore the strength and endurance in your injured tendon. Here is the clip from our main video about the treatment of upper biceps tendonitis. At some of the exercises discussed below, we have provided a time stamp of where in the video you can see a demo. Treatments that reduce pain The early stage of rehab refers to when the tendon is still really painful, and any type of exercise or activity easily makes it worse. The right treatment here is to give it a bit of breathing space and to get the pain levels down to where you can start doing some strengthening exercises. Ice Ice is really useful for calming the irritation down. We have an article with more information on using ice for sports injuries . Relative rest Relative rest means that you don’t have to rest your tendon completely. Instead, you adapt your daily activities and training so that you cut out all the things that aggravate your pain but continue with the activities that don’t affect it. When done correctly, relative rest can help to preserve your strength and speed up your recovery. Remember to check the 24-hour pain response. Tendons will often feel absolutely fine during an activity only to flare up and hurt a lot more several hours later or even the next day. The guideline for relative rest to be effective is: You can do any activity as long as it doesn't cause an increase in pain during and within the 24 hours after completing the activity. Stretches for biceps tendonitis Avoid stretching your shoulder backwards - this includes doing pec and bicep stretches as well as movements that take the biceps into a stretch position. Avoid stretching your biceps tendon during the early stage of rehab. One of the symptoms of biceps tendonitis is a stiff feeling in the biceps muscles, so many people are naturally inclined to want to stretch. However, the stiffness is due to the irritation caused by the injured tendon and will only permanently go away once your tendon starts to recover. Injured tendons don’t like being stretched. When you stretch the biceps muscle, you also stretch the tendon and, whilst that can feel really good and satisfying in the moment, it often causes it to hurt more later, or it’s the reason why the pain does not want to settle down. A better solution to help relieve that tight feeling is to massage the muscle. Just be careful not to massage too hard over the biceps tendon itself, because that can further irritate it and also cause it to hurt a lot more several hours later. And if someone tells you that your tendonitis is due to a tight biceps muscle that needs to be stretched, don’t listen to them. Biceps tendonitis is not caused by overly tight muscles. Everyday activities to avoid When you lift your arm towards the ceiling, the space in the front of your shoulder joint reduces as the bones move closer together, and they press on your biceps tendon. This is normal, and for a healthy tendon this isn’t a problem; but when the tendon is injured and sensitive, this can really irritate it. This is why, during the early stages of recovery, it is best to avoid positions that lift your arm above 90 degrees shoulder flexion or where you have to keep it at that level for a prolonged period of time. You’ll be surprised how often we move our arms into that position. Be careful with seemingly innocuous activities that can cause compression or friction on the tendon. Obvious movements to avoid are things like washing windows and hanging the washing out to dry. But there are several less obvious activities that can cause trouble. For example, when you’re driving, it would be better to grip the steering wheel towards the bottom than at the top. If you sleep on your front with your arm up next to your head, try and change that position so your arm is next to your body. Sleeping with your arms up causes a low level of compression on your shoulder tendons and can increase your pain. If your job involves sitting at a desk and working on a computer, make sure that your chair is high enough and you sit close to the keyboard, so that your shoulders are not as flexed and your biceps muscles and tendons don’t have to work too hard to keep your arms stretched out. Keeping things moving – exercises that can reduce pain You have to rest your tendon, but not moving enough can also make an injured tendon ache more. (This is why relative rest is better than total rest.) Pendulum exercise A nice, gentle way to get some movement going is to lean slightly forwards while supporting yourself with the uninjured arm on a desk or table and to let your injured arm swing gently back and forth and from side-to-side – nothing more vigorous than the pendulum of a grandfather clock. The pendulum exercise can help reduce your pain when you have biceps tendonitis. See video for demo: 00:12:32 Place your uninjured side's hand on a table and bend over so your injured arm is hanging down relaxed. Gently swing your arm forwards and backwards, or side to side. You may find that it hurts if you swing to vigorously or into a specific direction, so keep the movements gentle and choose the direction that feels most comfortable. Avoid doing circles, because that can often irritate the tendon - stick to straight lines. Do this for 30 seconds. Come upright and rest for 30 seconds. Do 3 sets. Do this 2 to 3 times a day. Shoulder blade positioning A movement that will create some more space for your tendon is opening up the space in the front of your shoulder by gently rolling your shoulder blades back from time to time. This reduces the pressure over the tendon and can make it feel a lot more comfortable. Gently rolling your shoulder back can reduce the pressure on your injured biceps tendon. See video for demo: 00:13:48 Grow tall – by lengthening your spine up towards the ceiling, you will find that your shoulders naturally move into a more open position. Your natural inclination might be to pull your shoulder blades down and back as much as you can, but this isn’t that useful for the biceps tendon because it can often make the bones press down on it more. The better way is to pull your shoulders up slightly and then roll them back gently. It's a very small movement. Hold the position for 10 seconds. Rest for 10 seconds. Do 6 repetitions. Do this 2 to 3 times a day, and correct your position every time you become aware that your shoulders have hunched forward. Biceps tendonitis exercises that strengthen the tendon Once the pain has calmed down, you can gradually start to build the tendon’s strength back up. The key word here is “gradually”. If you were doing weights, forget about what you used to be able to do, and try out every exercise with super light weights first. It’s easier to increase the weight when you feel it's too easy and doesn't flare it up than to start out too heavy, irritate your tendon, and then having to go back to square one and wait for it to calm down again. Also, in the first few weeks, don't do strength training that involves lifting your upper arms higher than 90 degrees, because we still want to avoid compression of the tendon at this stage. Bicep curls Check the position of your elbow. If your elbow is going to be at your side or further behind your trunk, it will stretch the tendon more than when you have it out in front of you (supported). So, seated bicep curls with your upper arm resting on or over something in front of you are better. Start with a very light weight and only do a few repetitions to test what your tendon can tolerate. Supporting your arm so your shoulder is flexed between 10 and 45 degrees can be useful. Seated rows These are useful for strengthening the muscles around your shoulder blades, which will lessen the compression and friction on your biceps tendon. Only pull your elbows back as far as your torso; pulling them back further during the early stages may irritate the tendon. Initially, avoid pulling your elbows back too far when doing the seated row exercise. Overhead press It is usually best to do these only to shoulder height or even a bit lower (about 80 degrees shoulder flexion) initially to avoid compressing the tendon while it is still irritable. You may also find that it is more comfortable to have your elbows slightly forward rather than straight out to the side. Initially, it may be better to start the overhead press movement with your elbows slightly forward - find the position that feels most comfortable. Once the tendon has calmed down significantly and my patients are able to lift weights without discomfort to 90 degrees shoulder flexion, it is usually time to start going higher. For the first few sessions, I then start my patients with just the weight of their arm. Only when their shoulders are happy to do three sets of 15 through full range do we start adding some weights. I don't recommend exercise bands for these; the resistance of the band increases as your arm goes higher, but your shoulder is normally not as strong in the fully extended position. So, as you get to the weaker range, the band is now tighter. It's a much better option to use light weights , so that the load stays constant throughout the movement. Here's a selection of weights in different price and weight ranges: If you don't have weights, remember that one litre of water equals 1 kg or 2.2 lbs. So, you can use bottles or other containers filled with water. If you want to increase the weight eventually and you don’t have bottles that are big enough, put a number of smaller bottles in a bag. The endgame As you carefully progress your exercises to become more difficult without flaring your biceps tendon up again, you should eventually aim to replicate the movements of your arm that your sport will require you to do, whether it’s doing weights, swimming, or tennis. Exercises to avoid (during the early stages) Turning your arm in and out An exercise that often aggravates the biceps tendon when it is injured is where you have your elbow tucked into your side, forearm parallel to the floor, and you move your forearm in and out against resistance (lateral rotation). The exercise is typically prescribed for rotator cuff injury rehab, and I think clinicians sometimes just assume it should be good for the biceps tendon as well. The reason it can often cause trouble when you have biceps tendonitis is that the rotation movement causes increased rubbing or friction on your injured biceps tendon, and that can make it hurt more. A better way to train your shoulder rotators is to start with isometric holds, but even these may aggravate the biceps tendon if it is still very sensitive. Rotating your shoulder against resistance often irritates the biceps tendon. Doing isometric holds may be a better option. See video for demo: 00:16:04 Stand with your elbow tucked in your side and bent to 90 degrees, forearm pointing forwards. Hold an exercise band in your hand so it is pulling straight out to the side. Now gently step away (very small step) from the band so it pulls on your hand, but resist the movement so that your arm continues to point straight forward. It should be a very light pull, just requiring a gentle activation of your muscles. If you're too aggressive, it will likely make your pain worse. Hold the contraction for 10 seconds. Rest for 10 seconds. Do up to 10 repetitions. Train it into both directions to work the internal and external rotators. Push-ups Avoid these until you have progressed quite a bit with the other strength training exercises, because they create a huge compression force on the bicep tendon. Push-ups often irritate the biceps tendon when you have biceps tendonitis. Start with low-load positions and then gradually progress from there. For example, start off by doing push-ups against a wall, then gradually progress to doing them with your hands on the edge of a table, then on the floor but on your knees, and then finally in the classic hands-and-feet position. Test different hand placements to find the most comfortable one for your shoulder. Alternative treatments Medication I’m not a doctor who can prescribe medicine, so check with your GP before you follow any of the following advice. Anti-inflammatories are not usually prescribed for tendon injuries, because inflammation is not a big component of this type of injury. However, if your pain just doesn’t want to go away, it could be that you also have an inflamed bursa in your shoulder. A bursa is a fluid-filled sac that is meant to reduce the friction between various body parts, e.g. between tendons and bones. But if a bursa experiences excessive compression or friction, it can become inflamed and painful. In that case, it could be useful to speak to your doctor to ask whether it's okay to take a short course of anti-inflammatories to see whether it makes a difference. Only consider using a corticosteroid injection as the very last resort. It works well to calm down pain, but it will do nothing to heal your tendon. In fact, steroids are harmful to tendons, and may have detrimental effects on long-term healing. Shockwave Shockwave can be useful, but it has to be introduced at the right time. If your biceps tendon is still very irritated and painful, shockwave is not the way to go. Biceps tendonitis recovery time If you follow the advice in the pain management section of this article, resting the tendon from all activities (exercise and daily life) that make the pain worse, your pain should calm down within a few weeks. However, the rehab period that follows this can be quite long. Tendon injuries generally take longer to heal than muscle injuries. If you have flared it up very badly or ignored it for a long time and continued to train with it, expect anything from four to six months of doing rehab exercises before it’s back to its former strength. Biceps tendonitis recovery time also depends on what you want to be doing. If you just want to get on with life, you could be looking at three months. However, if you’re seriously into stretchy or strength things like yoga or weightlifting, it could take up to six months or even more. 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: Cools, A. M., et al. (2014). "Rehabilitation exercises for athletes with biceps disorders and SLAP lesions: a continuum of exercises with increasing loads on the biceps." The American Journal of Sports Medicine 42(6): 1315-1322. Brukner P, Clarsen B, Cook J, Cools A, Crossley K, Hutchinson M, McCrory P, Bahr R, Khan K. eds. Brukner & Khan’s Clinical Sports Medicine: Injuries, Volume 1, 5e . McGraw Hill; 2017.

Mild knee sprains usually don’t need a brace, but some types of brace can be very useful in certain circumstances. We discuss two types of knee sprain brace and when they might aid your recovery from a knee sprain. 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: Let’s quickly define what I mean by a sprained knee When to wear a brace for a sprained knee What types of brace work best for mild knee sprains? How we can help We've also made a video about this: Let’s quickly define what I mean by a sprained knee   When you sprain your knee, you injure the joint surfaces and the ligaments, but you may also injure the menisci (cartilage discs inside the knee). The severity of a sprain can vary from mild (just bruising the knee inside or sustaining minor injuries to the ligaments) to severe (complete ligament ruptures or meniscus tears). What treatment will work best for your specific knee sprain will depend on which parts you’ve injured and also how badly they are injured. So, I would always advise that you get your knee assessed by a physiotherapist who can help guide your treatment.   Whether you need to wear a brace and the type of brace that you need, will depend on what you’ve injured when you sprained your knee.   The advice in this article is for people who have mild to moderate sprains without any serious injuries to any of the structures around the knee. So, your knee might be swollen and painful to move into certain positions, but it’s not severe.   If, however, you’ve been diagnosed with a significant ligament or meniscus injury, you can find detailed advice here: Guide to braces for meniscus tears Guide to braces for MCL tears Guide to braces for LCL tears When to wear a brace for a sprained knee   Braces aren’t essential for recovery from a mild knee sprain, but they can be useful for the following reasons: If your knee feels a bit insecure or unstable , they can make it feel more secure and give you confidence to move. They can make it easier to walk on uneven terrain. Braces make other people aware of your injury – useful in crowded areas where people can bump into you. They can also act as a reminder to you that you need to take things easy and prevent you from moving your knee into positions that hurt.   👉 My advice is:  Only wear a brace when you feel you need it – for example, if you’re going to walk on uneven terrain or do activities where you may not be concentrating on your knee.   I’ll provide more general treatment advice for sprained knees in a future article. What types of brace work best for knee sprains?   There are two types of brace that can be helpful for mild to moderate knee sprains, depending on the injury situation.    Braces that support your knee These braces are a good option if you have to walk on uneven terrain, do an activity that might place extra strain on your injured knee, or your knee feels quite unstable when you move.   Such a knee brace should have: Plastic or metal rods or spring stabilisers on the sides of the knee, which improve stability. A hinge if the rods don't bend, so you can easily bend and straighten your knee. A gap for the kneecap.   Examples of these braces:   Braces that also prevent your knee from straightening too far Sometimes, the pain and swelling in the joint can cause your hamstring muscles (at the back of your thigh) to not function as well as usual. The hamstrings are meant to control how far your knee straightens (extends) as you walk. If they aren’t working 100%, your knee might feel unstable and keep on hyperextending.   If that is the case, it might be useful to wear a brace with: Support rods on the inside and outside and a hinge that you can adjust to stop your knee from straightening past a certain point.   Examples of braces that can prevent knee hyperextension:   It’s important that your physio rules out any serious ligament injuries if you do experience hyperextension when you walk. 👍 The good news is , if the instability is due to the hamstrings not being fully awake, this is easy to fix by getting the swelling to reduce and doing some simple rehab exercises. I’ll discuss this in more detail in a future article. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate .

At SIP we are often consulted by runners who have pulled their calf muscles once and then find that they reinjure it every few weeks or months – usually just as they’re getting back into their natural training rhythm. In our experience this is usually either due to a lack of a proper rehab/strength training programme or they may have increased neural tension in their legs. Some of the links in this article are to buy products or brands discussed or mentioned here. If you buy anything, we may earn a small commission at no extra cost to you. In this article: Why you have to do a specific strength training programme when you’ve torn a muscle What a rehab programme for a torn calf muscle should include How increased neural tension can lead to calf muscle strains Here's a video of a livestream I did about this topic: Why you have to do a specific strength training programme when you’ve torn a muscle When you tear a calf muscle, you literally tear some of the muscle fibres or cells. In order for you to get back full function of that muscle, it has to go through a three-stage healing process. Stage 1: The body first has to get rid of the injured cells. It does this through inflammation – during which the torn muscle fibres are absorbed by the inflammatory cells. Inflammation is a very important part of the initial healing process and that’s why it’s not a good idea to take anti-inflammatory drugs (like ibuprofen) during the first five days of a muscle injury. Stage 2: You body now has to create new muscle cells to replace the damaged ones. This takes roughly 3 weeks BUT the new cells aren’t strong yet. You have to gradually strengthen them to the level they were before you pulled your calf muscle. Stage 3: During this stage, your body will strengthen the new muscles cells, but only if you do the right exercises to signal to it that they need to be stronger. Think about it: you can’t build strong muscles by just resting them – you have to exercise them. The same goes for when you’ve injured your muscles. How long this part of the process takes will depend on how badly you’ve injured your calf. As a rough guide, we find that: Mild calf strains take about 4 weeks to heal. Moderate tears take between 6 to 12 weeks before they are back to normal. Severe calf tears can take more than 12 weeks before you can do your regular training. What a rehab programme for a torn calf muscle should include We hope that, from the discussion above, it’s clear why you can’t just sit and wait for the pain in your calf to disappear and then think that it’s fully recovered! You have to use a carefully graded exercise programme that strains the muscle at the right level. None of the exercises should cause any pain while you’re doing them or after you’ve done them. There’s no one-size-fits-all and what exercises you start with will depend on your specific injury. The exercises that you choose to do should be at the right level for you, but you usually want to start with something that works the calf muscle in isolation. Going up and down on your toes is a good example of an exercise that isolates the calf muscles. You would normally start calf specific strength training with double leg heel raises and then progress to doing them on one leg and even adding extra weight to it . These exercises should also be done slightly differently depending on what part of the calf muscle you've strained. Doing the heel raises with your knees straight targets the Gastrocnemius (upper calf) more, while doing them with your knees bent works the Soleus (lower calf) harder. The important thing is that you should build up the strength to the level that you need for your specific sport. When you run, forces as high as 3 to 6 times your bodyweight can go through your calf muscles. So you can see why it won’t be enough to just do easy double leg heel raises and then expect your calf to be strong enough to cope with the forces from running. Some options on Amazon for adding extra weight to your exercises: Make sure that you also strengthen all the muscles in your legs and around your core as they all help to spread the load during sport. If your sport involves jumping, you’ll also have to include plyometric exercises, that trains the muscle to contract forcefully, during the later stages of your recovery. And lastly make sure that you do a slow return to running or sport. Start with slow short runs and gradually increase the distance and speed. In summary – Your calf muscle tear programme should include: exercises that work the calf muscle in isolation, starting light and increasing the weight over time, exercises that strengthen the muscles in the rest of your body, exercises that prepare your calf for your specific type of sport e.g. plyometrics if you play jumping sports like volleyball, and a slow return to running/sport programme. How increased neural tension can lead to calf muscle strains Your nervous system is continuous from your head to the tips of your fingers and toes. It has the brain at the top that is connected to the spinal cord and from there you’ve got loads of nerves that run into your arms and legs. As you move, the nerves are meant to slide freely. Sometimes something may prevent the nerves to slide, causing them to stretch and pull tight = increasing the tension in the nerve. When this happens to the sciatic nerve it can lead to hamstring and calf muscle injuries . If you have increased neural tension in your sciatic nerve , you may reinjure your calf muscles frequently despite following the correct rehab programme. This sounds quite sinister but in most cases it’s quite easy to improve. It’s something that we can easily test for via a video call consultation – check out the demo I did in the video above to understand how it works. Nine times out of ten we find that working on flexibility around the lower back and glutes as well as changing some daily habits are all that’s needed. Neural Tension Slump Test 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 Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. (5th ed.) Vol 1: Injuries. (2017) McGraw-Hill Education. Bryan Dixon J. Gastrocnemius vs. soleus strain: how to differentiate and deal with calf muscle injuries. Current Reviews in Musculoskeletal Medicine 2009;2(2):74-77. doi: 10.1007/s12178-009-9045-8 Orchard JW, Farhart P, Leopold C. Lumbar spine region pathology and hamstring and calf injuries in athletes: is there a connection? British Journal of Sports Medicine 2004;38(4):502-04. doi: 10.1136/bjsm.2003.011346

The two best types of ankle sprain exercise are those that restore the strength and the position sense in your ankle and foot. All the exercises in this article can be done at home. We start off with ankle sprain strengthening exercises for plantar flexion, and then move on to balance exercises, including how to achieve excellent balance with a balance board. 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: Ankle sprain strengthening exercises Balance exercises for ankle sprains – stable surface Ankle sprain exercises on a balance board How we can help We've also made a video about this: The exercises in this article are appropriate for inner (medial) ankle sprains and outer (lateral) ankle sprains. The treatment for high ankle sprains is somewhat different. Ankle sprain strengthening exercises What muscles should you strengthen? You must make sure that all the muscles in your foot and around your ankle are strong. These include: The small intrinsic muscles in your foot The muscles that turn your foot in (invertors); the main one being tibialis posterior The muscles that turn your foot out (evertors); the three peroneal muscles The muscles that bend your foot up (dorsiflexors); the main one being tibialis anterior The muscles pointing your foot down (plantar flexors); gastrocnemius and soleus (the calf muscles). We’ve previously demonstrated exercises for strengthening the foot muscles and tibialis posterior as well as the peroneal muscles . However, it is usually best to get guidance from a physiotherapist before starting with those, because they directly work the muscles you commonly injure when you sprain your ankle and can make things worse if done at the wrong time. In this article, we will focus only on the strengthening exercises for plantar flexion, because they are usually safe to start with for everyone with an inner or outer ankle sprain. Why are plantar flexion exercises so important for ankle sprain rehab? In short, they help you to: Regain your range of motion Strengthen the muscles you use to propel yourself forward when walking, running, and jumping Strengthen your foot muscles Improve your ankle stability. Wondering how they achieve all of this? Plantar flexion is when you point your toes down or stand on your tippy toes. To do this, your calf muscles contract and pull on your Achilles tendon, which, in turn, pulls your heel bone up. In practical terms, you use plantar flexion when you go up on your toes, when you push off when you walk and run, and when you jump. The same muscles and tendon come into play when you need to cushion yourself, e.g. when landing after a jump or if you land on your forefoot when running. All of these functions are reduced when you’ve sprained your ankle, so it needs to be strengthened back up. The plantar flexion movement also helps you to regain the range of motion in your ankle after you’ve sprained it – your ability to move your foot up and down freely. When you do plantar flexion in a controlled way (more about that below), you're also asking all the muscles around the ankle that are in charge of stability to co-contract. So, you're actually strengthening the muscles that stabilise your ankle at the same time. These exercises also strengthen the foot muscles, because as you lift up, your foot muscles have to work harder. Therefore, it's a lovely all-in-one type of exercise. An ankle brace can be useful Before we get stuck into the exercises, keep in mind that an ankle brace might be useful for providing some extra stability for your sprained ankle while you do these exercises, especially early in your rehab. The right type of brace will allow plantar flexion but prevent side-to-side movement of the ankle – the type of movement that most likely caused the sprain in the first place. Here’s our full article on braces for sprained ankles . An ankle brace is not appropriate for the balance exercises I will be discussing lower down. If you have to wear an ankle brace for those, you’re not ready for them yet. Exercise 1: Seated heel raises This is a nice and easy exercise for regaining range of motion, strength and control for plantar flexion in the early stages of rehab, when the ankle is still quite weak and painful. All you do is sit on a chair, feet on the floor, and slowly raise your heels up and down – both of them. Some tips to get the most out of this exercise: Don’t bounce your heels up and down. Research shows that you gain better control if you do these slowly. Ensure that you have an equal amount of pressure under the ball of your big toe and the ball of your little toe, so that you go over the middle of your foot; people tend to want to turn their feet out on the little toe. Some people get calf muscle cramps if they lift their heels up very high, so just go to where it’s still comfortable, and then come back down. If you have your feet really close underneath you, it’s going to stretch your ankle and ligaments, so that position can sometimes be uncomfortable. Simply move your feet out in front of you a bit until you find a comfortable position. Having your feet too far back when doing this exercise can cause the injured ankle ligaments to stretch and hurt. Work towards three sets of 20 heel raises with a minute’s rest between sets. But don’t go hell-for-leather right from the start. If your ankle is still painful, start with, say, three sets of five repetitions, and then add a few every day. Exercise 2: Plantar flexion with an exercise band The obvious benefit of an exercise band is that it strengthens the calf muscles as you push down. But also, when you control that movement slowly on the way back from plantar flexion and don't allow your ankle to swivel all over the place, you're working on the control of your ankle. So, you are strengthening all the muscles that are working to keep your ankle in a straight line, not just the plantar flexors. Another benefit of this exercise is that it's lovely for when your ankle is still painful and doesn't want to go all the way down or all the way up. So, you just stay in the range of motion that's comfortable for it. This is not a stretch exercise. Yes, you can use it to stretch your foot back, but if you're going to really pull on the band every time your foot comes back from plantar flexion, you're just going to make your pain worse. This exercise is usually introduced when the ankle is still painful and the ligaments are still sensitive. The bands come in different strengths. Below are some examples of sets of exercise bands, each with a different strength, that you can find on Amazon. Yellow and red are usually on the easier side, while dark blue and black have usually much more resistance. How to do the exercise: Sit on the floor with the injured leg straight out in front of you. Place a foam roller or something similar under the lower part of your calf muscle so that your heel and ankle can move freely. Hook the exercise band under the ball of your foot and hold the two ends with your hands. Don’t pull it too taut – just so there’s no slack in the exercise band for starters. Start with your foot in the neutral position, not bent upwards towards you. Slowly point your toes down into plantar flexion, pause for a moment, and then slowly bring your foot back in a controlled manner to the point where you feel you can control it and it's comfortable. Start with about three sets of 10 repetitions, with a minute’s rest between sets. If you find it too hard, you can start with three sets of five or six, or even four or five sets of five or six. And remember, the rest between sets is important, because the muscles need to recover so that they can work again. Start with an easy resistance. When you can do about three sets of 10 to 15 repetitions with that exercise band, you can consider switching to a harder band. But to be honest, if you can do three sets of 15 with a red band, you are probably ready to move on to the next exercise in this list. Exercise 3: Standing double-leg heel raises This is the same ankle movement as in the seated heel raises above, but this time you’re standing, so you’re lifting your whole bodyweight. Some tips: This is not a balance exercise, so hold on to something. A chair is not ideal because it can tip over if you really go wobbly; something like a dining room table or a kitchen counter is better. Have your feet about hip distance apart and, again, there should be equal pressure under the ball of your big toe and the ball of your little toe. Same as for the seated heel raises, don’t bounce up and down. Especially on the down movement, it is important not to let gravity do the work for you. You're going to get much more benefit from this if you go down nice and slow and controlled. Avoid doing this exercise in bare feet on a hard surface – it can injure the ball of your foot and cause metatarsalgia . If you can’t find a soft surface, rather wear something like running shoes for a bit of cushioning. If it hurts to lift all the way up, just go to what you can do without pain. It will improve over time so that you can eventually go all the way up. You’re aiming for three sets of 20 repetitions, but start with fewer – maybe three sets of five – and gradually add a few every day. Rest at least one minute between sets; two minutes is also fine. Once you can do three sets of 20 double-leg heel raises, it’s time to move on to single-leg heel raises, using the same approach as for the double-leg ones. Sport-specific exercises If you think about the forces that go through your ankle when you run – much greater than just your bodyweight – it makes sense for runners and people who do sports that involve running to add some extra weight to their single-leg heel raises at some stage. And to get back to sports that involve jumping, you would have to progress to plyometric exercises. Balance exercises for ankle sprains - stable surface Why do balance exercises for an ankle sprain? The research shows that people who have sprained an ankle are more likely to sprain it again in the year after than people who have not sprained an ankle. This is thought to be due to the injury causing reduced strength and position sense in the ankle. You're at increased risk of spraining an ankle for up to a year after an ankle sprain. You can reduce the risk of recurring ankle sprains if you improve the strength, control, and position sense in your ankle. ( Wearing an ankle brace also helps, but this is not an attractive long-term solution.) We’ve already taken the muscles in your ankle that stabilise and control it into account in the strength exercises above. The balance exercises now go further to target these muscles specifically and to improve your position sense (proprioception). Balance and position sense Position sense refers to your brain’s ability to know exactly where various parts of your body are and how they are moving without you having to look at them. Test it. Close your eyes. Do you notice how you still know where body parts like your feet, your hands, and your fingers are? This is because there are little sensors in your tendons as well as your ligaments and your joints that tell your brain where everything is and how you're controlling it. That's why you don't have to look at the stairs when you run up them, for example. Position sense refers to the ability of your brain to know where your body parts are and how they are moving without having to look at them. When you sprain an ankle, you injure some of the ligaments and some of the tendons, and the signals to your brain get a bit muddled, which affects your position sense. Your ability to balance is linked to how good your position sense is, and that’s why it can be so difficult to balance on a sprained ankle. Research has shown that position sense can be restored by doing strength training exercises, like the ones above, very slowly and focusing on good control, and the type of balance exercises below. Again, we’ll start with the easy ones before moving on to the more challenging ones. Exercise 1: Balancing with head still If your sprained ankle is still painful, we want to limit how much it wobbles from side-to-side when you try to maintain your balance, so it’s quite OK to hold on to something when you start with these exercises, just for a bit more stability. If your ankle is still quite painful, start by wearing shoes and holding on to help you balance. Stand on both feet, barefoot, and then slowly transfer your weight onto your injured side. You can now start to reduce how much you’re holding on with your hand. If your ankle is quite steady, it’s fine to reduce holding on and eventually let go. But if you’re still a bit wobbly while holding on, keep holding on, even if it’s with only one finger – it will get better with time and practice. Aim to balance without support and preferably barefoot. Tips to get the most out of this exercise: Hold on with the opposite hand; so, if you’ve sprained your right ankle, hold on for stability with your left hand. Bend your knee slightly; it’s easier to balance this way than with a leg that’s locked straight. Don’t hunch forwards; stand tall and tighten up your stomach muscles. It may help to look at your foot initially, but ideally you should look straight ahead. Don’t lift the healthy leg up too high – just above the floor is fine – so that you can quickly catch yourself if you start to keel over. For me, it helps to push my big toe gently into the floor, because it activates the muscles in the foot better. But don't overdo it, because that can cause irritation in the foot. Doing it on a very soft surface is much harder than doing it on a firm surface. Doing it with supportive shoes on is cheating a little bit, but if you've got a really painful and swollen ankle, that's a really good way to start. You're looking to start with three sets of really short holds; maybe 10 seconds per hold. Rest for a minute between sets. That’s it for the day. You want to gradually build this up to three sets of 30 seconds where you can stand nice and solid without having to hold on before moving on to the next exercise. Exercise 2: Balancing with head moving Now we're going to start moving our heads. Why does this make things more difficult? To balance, your brain uses input from your ears, your eyes, and those little position sensors in your body tissues. If you’re focusing on a single point, the brain can use all three these systems. As soon as you start moving your head, there’s more input. Now your ears and eyes are moving, so your brain has to rely more on the signals from the position sensors. Start off with going into the head-still balancing position as described above. Once you’re nice and stable, slowly turn your head to one side, pause for a second, and then turn it to the other side. Some tips: Move slowly, so your brain has time to adjust to the new positions. If you lose your balance, pause where you lost it, see whether you can regain it, and then slowly bring your head back to face forwards. At the start, you can have your fingers against a wall to make things a bit easier and then remove it as you get better at it. Like before, try to start with three sets of 10 seconds at a time and work your way up to 30 seconds at a time, with rest between sets. Exercise 3: Balancing with eyes closed When your eyes are closed, your brain has to rely fully on the signals being sent from your limbs and ears. This one is quite difficult, so make sure that you’ve got the previous balancing exercises down pat before you attempt it. Some tips: Make sure there's something to hold on to and use it if necessary. Open your eyes immediately if you lose your balance; don't keep them closed and try to balance or catch your balance. You may start to feel dizzy. Open your eyes if that happens and reset. I find that the first attempt is often the hardest. And then, as you go on, your brain kind of wakes up and goes, “Ah! You want me to actually listen to the foot?” And then it gets easier. If you totally suck the first time round (on any given day that you start this exercise), do a few of the open-eye ones first and then try again with eyes closed. Same drill as before: Work your way up to three sets of 30 seconds with eyes closed and good, stable balance without holding on. Ankle sprain exercises on a balance board An excellent way of progressing balancing exercises even further and really working on that control is using an unstable surface, such as a balance board. Choosing the right balance board If you go on Amazon, you'll see that there are many types of balance board. A few things to consider and look out for: It should be big enough to support both your feet, hip distance apart. The dome at the bottom should allow movement in all directions. Some balance boards just tilt backwards-and-forwards or side-to-side. Our ankles need to be able to move into all directions, e.g. when you’re walking or running on uneven terrain. Look at how “pointy” the dome is; very pointy means it’s going to be harder to balance on. If you already have one and it’s too pointy, you can fix this by placing it on something soft, like a folded towel, a cushion, or a soft carpet that allows it to sink in a bit. Examples of the type of balance board that will be useful for the exercises below: Common balance board mistakes These are some mistakes I’ve seen people make when they do balance board exercises for an ankle sprain: They get onto a balance board before being able to balance on one leg on the floor. If you're not able to maintain your balance on your one leg on a stable surface like the floor, it's not the time yet to get onto an unstable surface like a balance board. People start these exercises when their ankle joint is still very painful and doesn't have enough range of motion yet. You need to be able to tilt your foot up-and-down and side-to-side with relative comfort and have nearly full range before you start on balance board exercises. And the reason for that is – you'll see when I demonstrate the exercises – it takes your foot through the full range of motion. Some people focus solely on balance and don’t incorporate all the other types of exercise you need to rehab a sprained ankle, like range of motion exercises and strength training exercises. Five balance board exercises (demo video) Show-and-tell is a more useful way of demonstrating these exercises than writing about them, so here’s the part of my video about balance boards where I wobble about on one. They are arranged from easy to difficult, so please master the first one before moving on to the second, and so on. Also, please check with the physiotherapist in charge of your ankle rehab before you start with them, because it may be that they're not appropriate for you at this stage. How to make your balance board exercises more challenging So, the video shows the basic way of doing these exercises. Once you have mastered them, there are several ways in which you can make them more challenging, and some of these mimic the progression of the floor balancing exercises above: Move your head from side-to-side. You can also try looking up-and-down. Move your arms around or twist your body from side-to-side. When balancing on one leg, move the other leg into various directions. Do sport-specific things. For instance, if you play netball, get someone to throw a ball at you to catch and then throw back at them. This can be done while balancing on two legs or one. You should aim to make your balance exercises sport-specific eventually, so that they properly prepare your sprained ankle for the movements used in your sport. However, if you’ve sprained your ankle and you just want to get back to walking the dog again, this last batch of exercises is not necessary. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate . References Vuurberg, G., Hoorntje, A., Wink, L. M., Van Der Doelen, B. F., Van Den Bekerom, M. P., Dekker, R., ... & Kerkhoffs, G. M. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine, 52(15), 956-956 . Fuerst, P., Gollhofer, A., Wenning, M., & Gehring, D. (2021). People with chronic ankle instability benefit from brace application in highly dynamic change of direction movements. Journal of Foot and Ankle Research, 14(1), 1-11 . Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610 . Moore, M. L., Haglin, J. M., Hassebrock, J. D., Anastasi, M. B., & Chhabra, A. (2021). Management of ankle injuries in professional basketball players: Prevalence and rehabilitation. Orthopedic Reviews, 13(1) .

In this article I discuss what compression socks are and how they work. I also take a closer look at the current research to find out if, like the manufacturers claim, they can truly help you perform and recover better. In this article: How compression socks work Can compression socks improve your performance? Do compression socks help you recover quicker? Are compression socks able to prevent injuries? Some important things to consider How compression socks work Compression socks are thought to work in three ways: It improves your circulation As you know, your heart is the main pump that circulates your blood through your body. It pumps freshly oxygenated blood into your arteries, circulating it all the way to the tips of your fingers and toes. Thanks to the forceful action of the heart, it’s relatively easy for the blood to reach your limbs where your muscles and cells use the oxygen and nutrients in the blood. But it’s a lot harder work for the blood to find its way back to the heart again – especially if it has to flow up your leg against gravity. The further the blood is away from the heart, the weaker the pump-effect. That’s why the blood flows back to the heart through veins that have one way valves that stops the blood from running back down (it’s a bit like a canal system with locks). Your muscles (especially your calf muscles) can also act as pumps when they contract during exercise, helping to pump the blood back to the heart. Have you ever noticed how your ankles swell if you sit for a very long time e.g. on a bus or aeroplane? That’s because the lack of movement (muscles pumping) allows your blood and fluid to pool in your ankles and feet. Research have shown that graduated compression socks (that are tighter at the bottom and looser at the top) can increase your venous blood flow and stop the blood from pooling in your limbs. For athletes this may mean that they can recover faster as they would get rid of the waste products from exercise more quickly, their muscles would get more oxygen and that they would have less swelling in their muscles (exercise always cause a bit of swelling due to micro-trauma). It improves lymph drainage Compression garments also improve lymph drainage. Your lymph vessels transports waste products away from the cells and dumps it back into the blood so that it can be excreted in your urine. If you can improve your lymph drainage you can usually also improve recovery and healing. It protects your muscles It has also been suggested that compression garments may help to protect muscles during exercise by reducing the impact forces on the muscles which in turn helps to reduce exercise induced inflammation, swelling and muscle damage. So in theory, compression socks seem to potentially hold a lot of benefit for athletes but what does the research say? Do they provide any clear performance and recovery benefits when tested on athletes? Can compression socks improve your performance? The research is not very clear on whether compression garments can improve performance. It appears that different athletes may benefit in different ways from compression socks. Here are some of the findings: Slower athletes may benefit more from a circulatory effect In studies where they looked at blood flow, it was shown that compression socks improved the blood flow in the calf but only when participants exercised at a very low level e.g. walked slower than 6km/hour or cycled at less than 120W. Their circulator systems did not seem to gain anything from wearing compression socks when they exercised at higher intensities. Remember that I mentioned above that the calf muscles, when they contract, can act as a pump to pump blood back to the heart? The researchers think that this calf-pump effect becomes so efficient when you exercise at higher intensities that compression socks don’t really offer any additional benefits to the circulatory system. Runners A group of researchers recently collected all the studies performed on runners to see if wearing compression stockings while running held any benefits for them. They found that it did not seem to influence running performance (times for a half marathon, 15-km trail running, 5- and 10-km runs and 400-m sprint), oxygen uptake, blood lactate concentrations or heart function. They did, however, find some positive effects. Time to exhaustion (how quickly the runners got tired) and running economy were improved in the group of runners that wore the compression socks while their blood markers also showed that they had less muscle damage and inflammation after exercise. Football players Full length compression tights (compared to shorts or socks) were found to work best to reduce the amount of muscles damage and inflammation that players sustained during a match.  So if your aim is to reduce muscle damage during exercise, you may want to consider wearing more comprehensive compression garments than just socks. The compression tights below looked like good value for money when I searched on Amazon. But I must admit that I prefer to just wear compression calf sleeves in the summer. Do compression socks help you recover quicker? Yes, the research is a lot clearer on the benefits that compression garments hold for recovery. DOMS Multiple studies have shown that compression socks can reduce the pain you feel after exercise (DOMS). This is most likely due to it allowing you to get rid of waste products more quickly. There is strong evidence that shows that compression socks improves your circulation to your muscles if you wear them after exercise or at rest. Fatigue Athletes who use compression garments consistently report feeling less tired during recovery. Strength, power, endurance A common way to test how long an athlete takes to recover is to see how long it takes them to regain their full strength, power and endurance that they had before the training session or competition. Athletes who use compression garments appear to show a quicker recovery for strength and power and to a lesser extent endurance when compared to athletes who don’t wear them. Type of exercise It seems that the more damaging the exercise is, the greater the recovery benefits are that you’ll get from wearing compression socks or tights. For instance, a much greater recovery effect has been found after strength training versus running or cycling. The products below had good reviews on Amazon. Again, I prefer the calf sleeves because I like to wear my own socks. Are compression socks able to prevent injuries? We don’t know yet. I could only find one study that tried to investigate this, but it was unfortunately not a very good study. The researchers sent out a questionnaire to 203 trail runners and asked them about their training, if they used compression socks when training and how many injuries they accumulated during the season. They found that the group of trail runners who wore the compression socks while training reported significantly fewer injuries. The problem with this research is that we can’t really tell if this difference was purely down to the compression garments as it could just as easily have been down to training, fitness or experience. Some important things to consider More is not always better. Compression socks that are too tight can actually cut off your circulation and have the opposite effect. Researchers have found that compression socks don’t always produce the amount of compression that they claim to provide even if you select them according to the manufacturer’s guidelines. Differences of between 3% and 20% from the target pressure has been reported. I would suggest that you don’t worry too much about it. Select the size according to the manufacturer’s guidelines and make sure that they feel firm but not uncomfortable when you wear them. They’re too tight if they cause your muscles to cramp or hurt. If you spend a lot of time standing during the day, you may benefit more from compression socks than other athletes. Gravity will make it much harder for your blood to flow back to your heart and compression can help you overcome this and recover better. Varicose veins affects your circulation and tends to allow your blood to pool more in your limbs. This means that athletes with varicose veins will likely benefit more from compression socks than others. 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: Brown F, Gissane C, Howatson G, et al. Compression garments and recovery from exercise: a meta-analysis. Sports Med 2017;47(11):2245-67. Dupuy O, Douzi W, Theurot D, et al. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue and inflammation: a systematic review with meta-analysis. Frontiers in physiology 2018;9:403. Engel FA, Holmberg H-C, Sperlich B. Is there evidence that runners can benefit from wearing compression clothing? Sports Med 2016;46(12):1939-52. Hill J, Howatson G, van Someren K, et al. Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine 2014;48(18):1340-46. doi: 10.1136/bjsports-2013-092456 Hill J, Howatson G, van Someren K, et al. PRESSURES EXERTED BY COMMERCIALLY AVAILABLE LOWER LIMB COMPRESSION GARMENTS. British Journal of Sports Medicine 2014;48(7):608-08. doi: 10.1136/bjsports-2014-093494.131 Lee DC, Lee SW, Khaw K, et al. Haemodynamic responses of wearing low-pressure sports compression tights during an orthostatic challenge in healthy individuals. Journal of Science and Medicine in Sport 2017 Marqués-Jiménez D, Calleja-González J, Arratibel-Imaz I, et al. Influence of different types of compression garments on exercise-induced muscle damage markers after a soccer match. Research in Sports Medicine 2018;26(1):27-42. Ménétrier A. THE USE OF THE ELASTIC COMPRESSION TO DECREASE THE RISK OF INJURY. British Journal of Sports Medicine 2014;48(7):638-38. doi: 10.1136/bjsports-2014-093494.211 Peseux M, Muzic J, Bouhaddi M, et al. Changes in Tissue Oxygen Saturation with Well-and Tight-Fitted Compression Sleeves During an Incremental Exercise on Treadmill. Asian Journal of Sports Medicine 2017;8(4) Stanek JM. The effectiveness of compression socks for athletic performance and recovery. Journal of sport rehabilitation 2017;26(1):109-14.

BPC-157 is often marketed as a game-changing peptide for muscle repair, injury recovery, and athletic performance. But does the science back up these claims? And is it even safe or legal to use? In this article, we take a closer look at what BPC-157 is, why athletes are interested in it, and what the risks are. Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call. In this article: What is BPC-157? Why do people use BPC-157? Does BPC-157 enhance athletic performance? Is BPC-157 safe and legal? My recommendation How we can help 👉 We don't have total control over what ads are being shown on this page. If you see ads selling BPC-157 here,  follow the advice in this article and ignore them. What is BPC-157? BPC stands for “body protection compound”. It is a substance that occurs naturally in our gastric juices. It protects the stomach lining from stuff like alcohol, acid, and nonsteroidal anti-inflammatory drugs and helps to heal ulcers caused by these substances. BPC-157 is a peptide that scientists have derived from human gastric juices. In experiments  on various animal species (mostly rats), its healing properties have been shown to extend to various other tissue types, including muscles, tendons, and ligaments. It also acts as an anti-inflammatory in some of the animals on which it has been tested. Why do people use BPC-157? The healing and anti-inflammatory properties of BPC-157 in lab animals are thought to work in the same way in humans. So, it might enable athletes to recover faster from hard training sessions, which would enhance their performance in the long run. It might also help athletes to recover faster from injuries. BPC-157 has been dubbed “the Wolverine peptide” among some weightlifters due to their belief in its ability to speed up healing. Some medical professionals tout and prescribe BPC-157 as a treatment for various conditions and injuries, including gastric ulcers, irritable bowel syndrome (this sounds plausible, given the role of natural BPC in our stomachs), ligament, tendon, and joint injuries, and erectile dysfunction. ❓ But is there any evidence that BPC-157 actually works as expected in humans? Just because something works a certain way when tested on a rat does not mean it will work the same way in humans. Does BPC-157 enhance athletic performance? 💡 The answer is short and simple: We don’t know. No credible, published research has been done on whether BPC-157 helps athletes to perform better. Is BPC-157 safe and legal? Safety 💡 We don’t know yet whether BPC-157 is safe for humans. Only two small pilot studies  have been done on humans thus far. One looked at the effect of BPC-157 on bladder pain (12 people) and the other looked at knee pain (16 people). In both studies, BPC-157 seemed to provide pain relief, and no adverse effects were reported. However, we can draw no definitive conclusions from such small studies. The U.S. Anti-Doping Agency  warns that “there is a concerning lack of published clinical trial data because studies appear to have been cancelled or stopped without any published conclusions”. Legality 💡 The use of BPC-157, either for sport or for medical treatment, is not legal in most countries. The World Anti-Doping Agency  (WADA) has declared it a prohibited substance as of 2022. In 2024, a 19-year-old American speed skater, Kamryn Lute, received a one-year ban  after using a supplement containing BPC-157 that was recommended by a medical provider. WADA does not state why it has banned BPC-157, but presumably there are concerns about the lack of research into its safety and the (also unresearched) possibility that it does indeed enhance athletic performance. As for medical use, BPC-157 may only be used for research purposes with special permission (as in the two pilot studies mentioned above) and may not be sold to the public or even prescribed by medical doctors, according to the U.S. Food & Drug Administration . It also has not been approved by the European Medicines Agency or any other major health regulator in other countries. However, it is freely available online, and sellers mostly target athletes and weightlifters. Certain medical practitioners are also quite open online about the fact that they prescribe it. My recommendation The mere lack of research into the safety of BPC-157 means that I won’t take it for either sport or medical reasons – the difference between useful and harmful often lies in getting the dosage right, and at this stage we’re flying blind. BPC-157 is so widely available that I doubt any pharmaceutical company would invest in the necessary research to prove or disprove its efficacy and safety, since they are unlikely to gain from it financially. The only way it might be done is if a group of researchers could convince a non-profit organisation to provide a grant. From an athlete’s perspective, I also won’t consider using it until it has been approved by anti-doping authorities. But I’m not holding my breath. How we can help Need 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 DeFoor, M.T. and Dekker, T.J. (2025) “Injectable Therapeutic Peptides—An Adjunct to Regenerative Medicine and Sports Performance?” Arthroscopy: The Journal of Arthroscopic & Related Surgery 41(2): 150-152. Matek, D. et al. (2025) “Stable Gastric Pentadecapeptide BPC 157 as Therapy After Surgical Detachment of the Quadriceps Muscle from Its Attachments for Muscle-to-Bone Reattachment in Rats” Pharmaceutics 17(1): 119. Gwyer, D. et al. (2019) “Gastric pentadecapeptide body protection compound BPC 157 and its role in accelerating musculoskeletal soft tissue healing” Cell Tissue Res 377: 153-159. World Anti-Doping Agency (2021) “World Anti-Doping Code International Standard Prohibited List 2022” U.S. Food & Drug Administration (2023) “Certain Bulk Drug Substances for Use in Compounding that May Present Significant Safety Risks” Chuanyang Xu et al. (2020) “Preclinical safety evaluation of body protective compound-157, a potential drug for treating various wounds” Regulatory Toxicology and Pharmacology 114: 104665. Lee, E. et al. (2024) “Effect of BPC-157 on Symptoms in Patients with Interstitial Cystitis: A Pilot Study” Altern Ther Health Med 30(10): 12-17. U.S. Anti-Doping Agency (2020) “BPC-157: Experimental Peptide Prohibited”

I've been wanting a smart ring for ages, but I've been too stingy to buy one. So of course I said yes when Ultrahuman asked me if they could send me one to test. Now, I wanted one to help me track my running and other activities better, and it actually disappointed me in that area. But it gave me something else that surprised me, and now I'm hooked on it. In this article: First impressions A pleasant surprise - Recovery tracking - Actionable stats for better sleep - Is it too late for another coffee? Clever smart ring stuff that I don’t even use A smart ring to track my running? Not this one What about step counting? My verdict on the Ultrahuman ring Injured? We can help I’ve also made a video about this: 👉  Disclosure:  I'm not getting paid for this article or the video. I only agreed to test the smart ring after the folks at Ultrahuman confirmed that a good review wasn’t a requirement. So, this is my honest assessment of its pros and cons for me as a runner after having used it for a couple of months. If you use the link and discount code below to buy a ring (maybe as a Christmas present or to firm up your New Year’s resolutions?) I will get a commission. First impressions The process to get the right size ring on my finger was sleek and professional. Before sending you your ring, they send you a set of “fake” rings of various sizes to try on so that you can be sure that the real McCoy fits properly when it arrives.   I was spending some time on a remote island in the Philippines when the ring was getting shipped, and I wondered whether it would reach me OK. It did. And it came in a beautiful, sturdy box that matched the experience when you open a box with an Apple product inside. A pleasant surprise I never saw the point of tracking my sleep. I woke up in the morning, and I "knew" whether I've slept well or not. But what I didn't know was just how valuable knowing the details of a night's sleep can be. The main reason I wanted to test the Ultrahuman Ring AIR was to see how it compares with my Garmin watch (a Forerunner 255) for tracking my runs. To my surprise, the most useful feature of the ring was that it helped me to improve my sleep and recovery between running sessions . Recovery tracking There are certain aspects of recovery, like your resting heart rate and heart rate variability, that can only be measured properly at night, while you sleep. And these metrics also tell you a lot about your long-term stress levels as well as your general health. My Garmin can measure all of that, and I've tried sleeping with it, but it's just too uncomfortable and bulky and sweaty at night. So I gave up, because it was actually interfering with my sleep. Of course, I was curious to see what the smart ring would measure while I sleep, and I was pleasantly surprised with how comfortable it is to wear in bed . I also noticed that the ring is a lot more accurate with certain measurements than my Garmin watch. For instance, the watch (when I did wear it to bed) gave me SATS readings (the percentage oxygen in your blood) of as low as 92%. I worked in a hospital years ago, and if a patient has a SATS reading of 92%, you would immediately stick an oxygen mask on their face. So, the watch’s readings could not have been very accurate. The ring, on the other hand, gives me SATS readings of 98% to 99%, which is normal for people without lung conditions. So now, for the first time, I was able to properly measure all aspects of my recovery between running sessions. And I realised that the metrics it measures are also useful for general work-life balance. Actionable stats for better sleep The smart ring actually improved my sleep. I hate to admit it 🙈, but the sleep tracking that I had been dissing for a long time is actually very useful. It shows you how much time you spent in deep sleep, REM sleep, as well as light sleep. You know how you sometimes wake up and think, “Why am I so tired? I got my full eight hours of sleep!” And then you look in the Ultrahuman app at the stats that the ring kicked out, and it shows that, actually, you were in light sleep all night long, and you woke up quite a few times. And the nice thing about that was, because I looked at it every morning as I uploaded the data, it allowed me to immediately reflect about what I did the day or the evening before that could have influenced my sleep. So, it was easy to figure out things like, “Ah! You know what? It's because I worked until 8 p.m. on my laptop.” Or I had a big meal, or maybe alcohol, or caffeine too late in the day. Because I was reflecting on these things every morning, it brought about habit changes for me. And now I sleep better. Is it too late for another coffee? The second way in which the ring helps me to sleep better is its use of my sleep pattern – i.e. when I typically go to bed and when I typically wake up – to create a “caffeine window” . So, it shows you when the best time of day is to take caffeine to help your performance, but it also shows you throughout the day on the app what beverages you can still have that your body will get rid of in time for getting a good night's sleep. Clever smart ring stuff that I don’t even use Rummaging around the Ultrahuman app, I found quite a few useful features that I haven’t tried yet. The ones I found most interesting are: It tells you the best time window for light exposure to manage your circadian rhythm. Connect it to a special patch, and it tells you how your glucose levels are changing due to things like having meals or doing exercise. Cycling tracking. Pregnancy tracking. Managing jet lag (in development at the time of writing). Tracking weight loss (in development at the time of writing). A smart ring to track my running? Not this one Where the smart ring disappointed me was in tracking my runs, which was my original reason for wanting to test it. It cannot directly connect to a GPS. So, you have to take your phone with you on your runs if you want GPS tracking. I don't like taking my phone with me when I do exercise. If you've been out and about and you’ve done some exercise, the ring does pick up that you've done an activity, and then the app will ask you if you want to add it. But I found that the activity stats it reports do not really correlate well with my Garmin stats, so I don't tend to use that. The ring’s heart rate readings during running are definitely not accurate – I know that from years of tracking my heart rate during runs. This is a beta function at the moment, so it should improve. 💡There’s a workaround where you can automatically import your runs from Garmin into the smart ring’s app, so you can see everything in one place. But if you wanted to track your runs properly with this ring, that's not going to happen for now. What about step counting? However, the ring is quite useful if the only exercise you’re into is walking. In fact, it is better at step counting than my Garmin watch. Sometimes, when I drive along a bumpy road or ride a motorbike, the Garmin counts steps that I know for sure I’m not taking! The smart ring isn’t fooled that easily. My verdict on the Ultrahuman ring ✅ I would 100% recommend the ring if you're interested in health tracking as well as exercise recovery tracking and want to improve your sleep, your stress levels, and just your general health. It helped me to do all of these. Activity tracking: 👎 If you want to track your runs , it's not the best option out there. My trusty Garmin still does that better for me. 👍 If you're interested in walking only ; the Ultrahuman ring can be very useful. Lastly, one more thing that I like about the Ultrahuman ring is that they don't have a subscription fee like some other smart ring companies. So, you buy the ring, and that's it – the tech that comes with it is free. 👉 Use this link to claim a discount on the Ultrahuman ring. Injured? We can help Need more help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate .

Can you boost running performance with ketones? We explore the research on ketogenic diets and ketone supplements. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: What are ketones? How are ketones thought to help runners? Endurance running on ketones – Does it improve performance? Ketone supplements for post-exercise recovery? Is it safe to increase your ketone levels? My conclusion Injured? We can help What are ketones? Ketones occur naturally in our bodies and are produced by the liver and the kidneys. They help in the process of turning stored fat into energy. When the body is starved of carbohydrates, resulting in less glycogen – the body’s first port of call when looking for a source of energy – the liver increases the production of ketones so that more energy can be produced from fat. This metabolic state is known as ketosis . This has resulted in the rise of ketogenic diets , where people restrict their carbohydrate intake (and sometimes counter the reduction in carbohydrate calories with fat calories) to induce ketosis in an attempt to lose weight and/or perform better in endurance sports. How long it takes for ketosis to kick in depends on many factors, but consuming less than 50 grams of carbs per day for three consecutive days usually does it. Nowadays there are also artificially produced ketone supplements to increase the ketone levels in the blood without the need to restrict one’s carbohydrate intake. How are ketones thought to help runners? In theory, being in a state of ketosis means that our muscles have better access to fat in their mix of energy sources, which increases the total amount of fuel that is readily available during exercise. This would be especially handy during endurance activities, since most people have much more fat available than glycogen, and glycogen stores are typically depleted after about 90 minutes of aerobic exercise such as long-distance running. The thinking is that if you regularly train in a state of ketosis, your body will get better at using fat as energy source and you won't “hit the wall” (that moment in an endurance race where your glycogen stores are depleted) that easily. Endurance running on ketones – Does it improve performance? In 2023, a team of seven scientists did a comprehensive review  of the body of high-quality research that attempts to answer this question. They reviewed five studies that investigated the effect of ketogenic diets and seven studies that looked into the effect of ketone supplements, together involving a total of 132 professional and recreational endurance runners. Each of the twelve studies used one or more of the following measures of aerobic performance: VO2max, time trials (of up to 100km!), running-time-to-exhaustion, and runners’ perceived exertion. 👉 None of the twelve studies found improved performance due to ketones. The runners on a ketogenic diet did not do any better than the runners on a high carb, low fat diet. In one of these studies, the runners on the ketogenic diet fared worse in a time trial 4 days after having started the diet, but there was no difference in performance in subsequent time trials at 14, 28, and 42 days. And the runners who took ketone supplements did not fare any better than those who took a placebo. In one of these studies, the runners who took a ketone supplement had a quicker time-to-exhaustion than those who took cooking oil. The authors of the review conclude that they “did not identify any significant advantages or disadvantages of ketogenic diets or ketone supplements for the aerobic performance of endurance runners.” They acknowledge, however, that there is further research to be done before the influence (if any) of ketones on endurance running can be described definitively. They mention the following limitations of the research they reviewed: small sample sizes; of the 132 endurance runners, only one is a woman – it is known that female endurance athletes rely less on carbohydrates as a fuel than males do; the wide variety of methods that the studies used; external factors such as temperature and humidity as well as internal factors such as differences in metabolism might have played a role; most of the ketogenic diets lasted between three and six weeks, and it is not known how runners’ bodies might react to diets that last longer. Ketone supplements for post-exercise recovery? A similar review  of the available research into the effect of ketones on post-exercise recovery by two scientists in Belgium in 2023 found the following. There is evidence to suggest that ketones help to increase muscle mass after exercise and that they play a role in countering muscles getting weaker due to inactivity, e.g. when someone is injured. There is evidence that ketones increase the body’s production of natural erythropoietin (EPO, a banned supplement in sport), which helps with improving endurance exercise performance as well as the body’s adaptation to training. Ketone supplementation post-exercise increased the growth of capillaries (tiny blood vessels) in muscles, which improves blood and oxygen supply. Evidence indicates that ketosis counteracts poor sleep due to hard training. (However, it doesn’t seem to improve sleep for people who don’t have sleep problems.) Note the cautious wording, e.g. “evidence indicates”. And indeed, the authors of the review article note that the longest study thus far into the effects of ketone supplements post-exercise was three weeks, and this was for athletes who had been overtraining. So, it is not clear whether ketone supplements have the same advantages during normal training that maintains a balance between exercise and recovery, nor do we know the long-term impact. Is it safe to increase your ketone levels? Ketogenic diet Following a ketogenic diet is prescribed for some medical conditions as well as to counter obesity, and in this context its potential short- and medium-term adverse effects  are quite well-researched. However, there is no reliable research on the safety of a ketogenic diet that lasts longer than two years. Some people on a ketogenic diet suffer from “keto flu” during the first few weeks. Symptoms include nausea, vomiting, headache, fatigue, dizziness, insomnia, reduced tolerance for exercise, and constipation. Some of these symptoms can be countered by drinking enough water and getting enough electrolytes. Longer-lasting adverse effects include: not getting enough essential vitamins and minerals; digestive problems such as bloating, constipation, and diarrhoea; an increased risk of heart disease; an increased risk of getting kidney stones; rapid weight loss can include loss of muscle mass (not good for runners!); potential cognitive decline due to the effect of the low-carb diet on the metabolism of the brain; the risk of an inaccurate breathalyser reading, indicating more blood alcohol than is actually the case. Ketone supplements A 2020 review  of t he available research into whether ketone supplements enhances physical performance mentions that some participants in some of the studies reported various forms of gastrointestinal distress, including: nausea; diarrhoea; flatulence; constipation; vomiting; abdominal pain. My conclusion Currently, it is not clear whether a ketogenic diet is useful for endurance performance. From the available evidence, it seems unlikely that it will benefit you if you follow the diet for fewer than six weeks. And there is currently no evidence either which way for diets longer than six weeks. This contradicts many endurance athletes who swear by a ketogenic diet. One explanation for this might be that some people might react differently to it than others, because our bodies and our metabolisms are not the same. As far as side effects go, there are some worrying ones. However, we don’t actually know whether those side effects also apply to an active population, since those studies weren’t conducted on runners. Still, I would be cautious if you have a family history of heart disease or kidney stones. 👉 We definitely need more extensive research before we can draw concrete conclusions. Injured? 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 Sun, K. et al. (2024) “The Effects of Ketogenic Diets and Ketone Supplements on the Aerobic Performance of Endurance Runners: A Systematic Review” Sports Health 0(0). Robberechts, R. and Poffé, C. (2024) “Defining ketone supplementation: the evolving evidence for postexercise ketone supplementation to improve recovery and adaptation to exercise” American Journal of Physiology-Cell Physiology 326:1: C143-C160. Khouri, H. et al. (2023) “Exogenous Ketone Supplementation and Ketogenic Diets for Exercise: Considering the Effect on Skeletal Muscle Metabolism” Nutrients 15(19): 4228. Martyka, A. et al. (2023) “The power of ketogenic diet in physical performance – review of the latest research” Med Srod 26(3-4): 99-102. Masood, W. et al. (2023) “Ketogenic Diet”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Margolis, L.M. and O'Fallon, K.S. (2020) “Utility of Ketone Supplementation to Enhance Physical Performance: A Systematic Review” Advances in Nutrition 11(2): 412-419.

The answer to this question leans heavily towards no, but there may be some exceptions. Let me explain why cortisone shots should not be a first line treatment for tennis elbow and what to do if you do decide to have one. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call. In this article: Why are steroid injections used for tennis elbow? Short term gain vs. long term harm What if I combine a steroid injection with physiotherapy? When could steroid injections be useful? Is a cortisone injection for tennis elbow painful? What should I do after I have a steroid shot? How we can help We discuss all the research-backed treatment options for tennis elbow in this video: Why are steroid injections used for tennis elbow? They are really good at relieving pain. Clinicians therefore often use them because they know they will likely have a happy patient … in the short term. Short term gain vs. long term harm The research  shows that steroid injections provide better pain relief than other treatments for the first six weeks. The problem is, when researchers  looked at the same patients 3, 6, and 12 months later, the ones who’ve had steroid injections are actually not doing as well as the ones who’ve not had steroid injections. So, steroid injections decrease your initial tennis elbow pain quicker, but after six weeks it then seems to slow your recovery down. Image from Smidt et al. (2002) showing short- and long term effect of steroid injections for tennis elbow. Other treatments like load management, physiotherapy exercises, shockwave, and injections such as PRP may not reduce your pain as quickly, but they seem to allow your injury to heal better in the long run. There is also evidence to suggest that people who have had more than one corticosteroid injection for their tennis elbow are more likely to have surgery later on. And steroid injections may also increase your chances of tearing your wrist extensor tendons; this is a small risk and it can be reduced by following a sensible rehab plan after your injection. What if I combine a steroid injection with physiotherapy? This has been tried, and it seems that the negative long term effect of the steroid injection still persists  despite following it up with physiotherapy. When could steroid injections be useful? If the benefits of short term pain relief outweighs the negative effect of slower healing. For instance, if someone has to complete an important test or exam that can significantly impact their life. Also if the pain is totally unbearable and not reacting to any other treatments, one could argue that a steroid injection may be an option. It is also something I would try before heading for surgery. Icing your elbow can help calm pain after the steroid injection. Is a cortisone injection for tennis elbow painful? Doctors often add a small amount of local anaesthetic to the injection, which means that you may experience immediate pain relief. However, it is not uncommon for a steroid injection to cause a significant pain flare-up the next day. The person injecting you will usually warn you about this and provide advice on what to do if it aggravates your pain. Icing the area for 10 minutes at a time can often help to relieve the pain. What should I do after I have a steroid shot? Do NOT jump into strenuous activity as soon as your pain subsides! The injection only took your pain away, it hasn’t strengthened your tendon. If you’ve had your elbow pain for quite a while, your muscles and tendons would have lost quite a bit of strength. So, it will be very easy to overload them and cause your pain to flare back up or worse, cause a tear. Instead, slowly ease back into activity and rehab exercises and slowly and progressively strengthen your arm to the level you need for your sport or daily tasks. We’ll discuss how to do this in a future article. How we can help Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call  for an assessment of your injury and a tailored treatment plan. We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here . About the Author Maryke Louw  is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn  and ResearchGate . References Brukner, P, et al. Brukner & Khan's Clinical Sports Medicine. Vol 1: Injuries. (2017) McGraw-Hill Education. Coombes BK, Bisset L, Vicenzino B. Management of lateral elbow tendinopathy: one size does not fit all. Journal of Orthopaedic & Sports Physical Therapy 2015;45(11):938-49. Kemp, J. A., et al. (2021). "Platelet-rich plasma versus corticosteroid injection for the treatment of lateral epicondylitis: a systematic review of systematic reviews." International Journal of Sports Physical Therapy 16(3): 597. Orchard JW, Saw R, Masci L. The use of ultrasound-guided injections for tendinopathies. Current Radiology Reports 2018;6(10):38.

Have you tried exercises for your neck pain in the past and not found them useful? It may be that they were the wrong exercises. Research has shown that most people can reduce their neck pain by at least 50% as long as the exercise programme follows certain principles. In this article: How the neck is put together The neck also has “core” muscles I have an injury in my neck – how can exercise help? 10 Features of a successful exercise programme for neck pain If your neck pain is from working on a laptop, this video might also be of use: How the neck is put together Your neck is formed by 7 bones (vertebrae) stacked on top of each other. These bones are separated by discs that are made of cartilage. Each bone in your neck also has two little joints (facet joints) at the top and the bottom that they use to slot into the bone above or below them. Image adapted from original by Anatomography found at https://commons.wikimedia.org/wiki/File:Cervical_vertebrae_lateral2.png Your spinal cord runs from your brain down the middle of your neck bones. There are little openings to the sides of where 2 neck bones meet where the nerves that run to your arms exit from. Several thick ligaments connect the neck bones together. As you know, your head is attached to the top of the neck and the neck itself is attached to your thoracic spine (where the neck meets the shoulder girdle). Your neck has a whole load of muscles that connect the vertebrae to each other, to the head and to the shoulder girdle. I stopped counting at 27 (and that’s just on one side) but I’m sure I missed out a few. The neck also has “core” muscles The muscles in the neck can roughly be divided into deep and superficial layers. The deep layer consists of smaller muscles that usually only run between 2 bones e.g. they connect 2 vertebrae together or connect the first bone in your neck to your skull. These deep neck muscles are thought to provide most of your stability in your neck and are seen as the “core” muscles. These are also the muscles that most often become weak when you have neck pain. The superficial layer includes larger muscles like your Upper Traps and Scalene. They cross over several joints and their main function is to create movement. They often become painful and over-active when you have neck pain. These larger muscles all run from somewhere in the neck and attaches around the shoulder and shoulder blade. They tense when you use your arms e.g. push or pull or lifts stuff. Your smaller "core" muscles' job is to keep your neck in a good posture - working against the pull of the big muscles e.g. your upper traps. If the stability muscles aren't strong enough, you may end up spraining your neck when you do things with your arms. That's why it's important to not push heavy weights in the gym if you can't keep your neck in the right posture. I have an injury in my neck – how can exercise help? By strengthening the muscles in your neck, you provide stability and support that helps to take the strain off the injury. The research has shown that exercise programmes that are specifically developed to help neck pain works for all sorts of neck pain, including whiplash and nerve pain. It may not always take all the pain away, but it can reduce the intensity of the pain, how often you get neck pain and headaches and help you to be more active and function better without getting the same level of pain. 10 Features of a successful exercise programme for neck pain Looking at the current research, a successful neck exercise programme for neck pain should include the following: The exercises has to be at the right level for you. If it is too hard it will likely aggravate your pain. There are a hundred different ways to strengthen the neck muscles and I’ve always managed to find one that works for my patients. It must include specific exercises for the “core” muscles of the neck . These muscles are the ones that run between your neck bones and that should be supporting your injury. “Core” exercises for your trunk and lower back should be included . Your neck sits on your torso. If your torso is jelly, the neck will have a hard time stabilising itself. The exercises should teach you the correct way to move your neck. When we’re in pain we often develop funny ways to move as we try to avoid the pain, but these can often add to the problem. The programme should help make you more aware of your posture and how to correct it. There is no such thing as perfect posture, but there are definitely positions and postures that put less strain on your neck and joints . It should start with easy low load exercises that are done on most days The programme should move on to include specific resistance training exercises for the neck. Resistance training should be done 2 to 3 times a week. The exercise level or intensity must be progressed over time. How quickly you move on to more difficult exercises all depends on your specific situation. It should not be rushed and must be at the right level for you. But staying at the same level for ever is also not useful. I don’t tend to follow any recipes with my patients. I monitor my patient’s symptoms closely and use their feedback to decide when we should make things a bit more difficult. You should not experience increased pain as a result of the exercises . Monitor your symptoms. It's not OK if you experience increased pain after doing the exercises. If this happens, your training programme is not right for you and should be adjusted. You won’t always see instant results. Most of the research studies found that patients only started noticing positive changes in pain and how they functioned after 6 to 12 weeks. Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan. About the Author Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn or ReasearchGate . References Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy 2008;38(9):A1-A34. Halvorsen M, Falla D, Gizzi L, et al. Short-and long-term effects of exercise on neck muscle function in cervical radiculopathy: A randomized clinical trial. Journal of rehabilitation medicine 2016;48(8):696-704. Lauche R, Wayne PM, Fehr J, et al. Does Postural Awareness Contribute to Exercise-Induced Improvements in Neck Pain Intensity? A Secondary Analysis of a Randomized Controlled Trial Evaluating Tai Chi and Neck Exercises. Spine 2017;42(16):1195-200. doi: 10.1097/brs.0000000000002078 Ludvigsson ML, Peterson G, Dedering Å, et al. One-and two-year follow-up of a randomized trial of neck-specific exercise with or without a behavioural approach compared with prescription of physical activity in chronic whiplash disorder. Journal of rehabilitation medicine 2016;48(1):56-64. Ludvigsson ML, Peterson G, Peolsson A. Neck-specific exercise may reduce radiating pain and signs of neurological deficits in chronic whiplash-Analyses of a randomized clinical trial. Scientific reports 2018;8(1):12409.