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Health

Five Finger Toe Socks | Weird or Brilliant?

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Five-finger toe socks are often fobbed off as creepy or a gimmick, but they have a lot of benefits over conventional socks. We’re going to cover those pros and cons so that you can know whether your feet would be happier in funny-looking foot-shaped socks.

Toe socks have been around for a while now, often relegated as a gimmick harking back to the 1980’s rainbow, calf-length socks (like this), or isolated to use in specific communities such as long-distance ultra and trail runners for toe protection.

rainbow toe socks benefits

Should toe socks be normal socks?

Let’s explore the pros and cons:

Pros

  1. Blister protection
  2. Foot hygeine
  3. Optimised biomechanics

Blister protection

Most people that have gone hiking over multiple days or run 20km+ would have experienced blisters on their toes from the friction of their toes rubbing together. This issue is all but gone when toe socks are used. Having your toes in separate sleeves reduces friction and hot spots and leaves you in blister-free bliss.

Foot hygeine

Athletes’ foot, sweaty toes, and other bacterial or fungal issues are all too common with feet. This often occurs de ot the feet being in socks and shoes for long periods with foot breathability and ability to spread out. Toe socks do help with reducing this as with fabric surrounding each toe helps wick away extra moisture and also allows a small gap between your toes to reduce moisture further

Optimized biomechanics

Your big toe plays an important part in foot mechanics. Your foot is made to be mobile and rolls with the punches when in stance phase but then turns into a strong lever when your heel comes up and you go to push off in order to move economically and not lose any force. This is called the windlass mechanism and occurs via your plantar fascia, which runs from your heel to your big toe. As our heel comes off the ground, your big toe is pushed up, increasing tension on the plantar fascia, which raises and stabilizes your arch up.

With traditional sleeve-shaped socks, all the toes are pulled and held together, often causing the big toe to losing its straight alignment and reducing your windlass mechanism. With toe socks, good function is optimized as with your big toe separate, it can maintain good alignment and continue to function how it was intended.

You can learn more about that in other blogs HERE and HERE

Cons

  1. Thin material
  2. Price
  3. Lagre variation in quality
  4. They look a bit creepy!

Thin material

Due to the increased detail needed to manufacture toe socks, it’s difficult to make them very thick. As well as this, if the toe sleeve walls were too thick, they would become difficult to get on. This limited thickness means the socks won’t last forever and will eventually wear and get holes.

Price

The quality socks aren’t cheap and that is partly due to the increased cost of manufacturing toe socks

Variation in quality

Yes, there are huge variations in stitching quality of toe socks available and the best ones have seamless toe stitching where the seam is not inside the toe sleeve and so there is nothing to cause irritation.

They look a bit creepy

This is largely because they are different from what we are used to I think and fair enough too, toe socks aren’t to everyone’s liking.

Conclusion:

Toe socks are foot-shaped, rather than shoe-shaped and allow our toes to breath better and move better, as long as your shoes aren’t too narrow. They help reduce discomfort and irritation when on your feet for long periods and definitely help reduce blisters on long runs or hikes. So yes, they are functional, but not always easy on the eye for a lot of people.

Toe sock reccommendations

These are the best we have come across thus far:

Injinji: Most popular and well known

Creepers socks; Sustainably made Merino socks and high rating


Health

Piriformis Syndrome: What is it and how to self-treat it

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The Piriformis muscle can be a huge pain in the butt. Severe cases of Piriformis syndrome can even cause sciatic nerve issues down the leg. Fortunately, through proper piriformis release, stretching, and strengthening Piriformis Syndrome can be avoided [1].

Piriformis Muscle Anatomy

Piriformis is a deep glute muscle and the largest of the short hip rotator muscles. It connects from the sacrum (tailbone) to the top of the femur and lies underneath the Gluteus Maximus muscle.

These attachments allow the Piriformis muscle to rotate the leg outward – think rotating the knee 90 degrees to the side of the body.

Piriformis is particularly active in sports with lateral side-to-side movements like tennis and basketball. If untrained or unconditioned, Piriformis is susceptible to developing trigger points and tightness from lateral movement sports [1]. 

Piriformis Syndrome Pain Mechanism

The Piriformis muscle can cause a plethora of problems when tight. Piriformis can refer muscle-induced pain to nearby areas in the back of our hip, but it also can compress the large Sciatic nerve that runs from the base of the spine down the leg.

The latter – compressing the Sciatic nerve – is known as Piriformis Syndrome.

Piriformis Syndrome occurs when the Piriformis muscle is so tight that it compresses on the Sciatic nerve that runs directly underneath it. In this case, the Piriformis muscle is undoubtedly tight and likely has trigger points that need attention.

Piriformis Syndrome Symptoms and Pain Pattern

Piriformis tightness is required for Piriformis Syndrome, but tightness does not always cause the nerve compression associated with Piriformis Syndrome.

If your Piriformis is tight and contains trigger points you will likely feel the following symptoms:

  • Pain at the tailbone or outer buttock, as shown in bright red below
  • Discomfort sitting too long
  • Difficulty crossing one leg over the other
  • Difficulty pointing the toes inward
Piriformis syndrome Symptoms and pain patterns

Now that we unpacked Piriformis tightness symptoms as the key symptoms, we can better understand Piriformis Syndrome symptoms.

The tightness and Syndrome go hand in hand, so if you are experiencing Piriformis Syndrome it is best to understand the tightness going on first.

Sciatic nerve compression is the key symptom of Piriformis Syndrome. This can feel like pain, numbness, and/or tinging felt running down the leg and potentially all the way to the foot.

In addition to nerve-induced symptoms down the leg, all symptoms of Piriformis tightness listed above are likely at play.

Note: sciatic pain down the back of your leg can be caused by other issues so make sure to see your GP for assessment as this post is not medical advice.

Piriformis Syndrome Treatment

Piriformis Syndrome relief should be treated in two steps: 1) Massage/Release and 2) Stretch.

1. Massage/Release: 

Piriformis Syndrome is the manifestation of a tight, knotted Piriformis muscle. The best way to break up any tightness and trigger points is by physically smashing and loosening up the muscle tissue.

Piriformis release can be done by a trained massage or physical therapist, or at home on yourself. Self-release is best done with a targeted deep tissue massage tool, but some have found success with a lacrosse or tennis ball.

Deep Tissue Massage Tool for Piriformis syndrome

2. Stretch: 

After breaking up any tightness, trigger points, and knots in the Piriformis it will be much more compliant to stretch. This is an important step because once the tightness is broken up, Piriformis will likely still be short.

To relieve the nerve pressure that is causing Piriformis Syndrome the muscle will have to be lengthened.

Upon effectively massaging and stretching the Piriformis muscle for a few days consecutively, pain relief should be felt. 

To improve Piriformis resilience after releasing the muscle, it would be beneficial to include glute and hip strength sessions into your week.

In addition, continued massage and stretching after exercise is a great long-term strategy to avoid Piriformis Syndrome in the future.

Sources:

[1] Davies, Clair, and Amber Davies. The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief. 3rd ed., New Harbinger Publications, Inc., 2013.

[2] Donnelly, Joseph M. Travell, Simons & Simons Myofascial Pain and Dysfunction: the Trigger Point Manual. 3rd ed., Wolters Kluwer Health, 2019.


Health

Stiff Ankle? Why it’s stiff and how to FIX it

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A stiff ankle is a huge issue after an ankle injury, but it’s not something you have to put up with. With the right stretches, self mobilizations and re-training, you can have your ankle mobile, functional and pain-free again.

Stiff ankle stretch mobilisation

Ankle stiffness and lingering ankle pain is common after injuries such as ankle sprain, Achilles tendon tear, ankle fracture and reconstruction. This is especially true for those that need to be immobilized in a moon boot or cast.

Immobilization is necessary for the injured structure to heal but it also means we get swelling bleeding and a soup of beneficial inflammatory messengers and no movement at all. it needs to be done but is the perfect recipe for tissue stiffness. A lot of people get some ankle stiffness after ankle sprains too and this isn’t down to ligament shortening but secondary soft tissue stiffness and loss of good joint motion.

The most common and limiting range of motion lost is dorsiflexion which is really important for walking and running. Dorsiflexion is where your foot comes up towards your shin, such as when your foot is planted and you step through. Without a reasonable amount of dorsiflexion, your stride is limited and you are constantly jamming up the front of your ankle.

A short term quick fix to help this is to wear shoes with a high-ish heel or put an 8mm heel wedge in your shoes. Medium to long term though, you need to get your ankle range and full function back – don’t put up with your ankle stiffness!

First, TEST your ankle range out, that way you can monitor improvements:

easy test to measure your ankle range

Our Ankle Mobility Testis easy – find out how far you can have your foot from the wall while still being able to keep your heel down and just touch your knee to the wall. This is called the knee-to-wall test for dorsiflexion range. It’s an easy way to gauge asymmetry and progress so test your non-injured leg also to get an idea of your “normal” as a goal. You can read more about this test in a past post HERE.

Great, now you know how stiff your ankle is, here’s how to work on Fixing it.

1. Self Mobilization for Stiff Ankles

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Using a power band ideally but you can also use a belt, tie-down, or anything about 2-3cm in diameter, you can really gain a lot of range from your ankle. As your ankle dorsiflexes, the bottom of your shin bone, which forms a bit like a socket, glides forward and the Talus (the dome) glides back so having the band around the front of your ankle, hugging under your ankle bones (malleoli), helps assist this natural joint movement and enhance the stretch.

Work on this daily and there is no perfect amount as everyone responds differently but aim for 3 sets of 20 repetitions for a start – but listen to your body.

2. Soleus stretch for a tight lower calf

calf stretch , soleus, gastroc - self treatment for shin splints

This is a very easy stretch to do but there is a key thing to make sure you are doing it well. First, have one foot flat on the step and just the balls of your other foot on the edge as shown. Hang your heel down until on stretch, keeping your calf relaxed, and then, here’s the key, bend your knee a little of the side you are stretching. this will give you a stretch lower down in your calf complex rather than high in your gastroc muscle.

Hold for at least 30seconds 1-2 times, each day.

3. Strengthen – Through the full range

There is little point in regaining some movement from your stiff ankle if you don’t re-train your body to use that range and regain good strength within the range. You likely haven’t had the full range for a while, and so also haven’t been using the muscle through the full range so it makes sense that they would be weaker than normal.

Stand on the edge of a step with one leg and bend your knee slightly (to 20-30degrees). Keep your knee fixed at that slight bend and raise your heel up and down. Doing calf raises with a bent knee loads up your soleus muscle, your deep calf muscle and importantly works it through the full range. if we did them with a straight knee, the long, superficial calf muscle (the Gastroc) would limit how low you could go.

Do 3 sets of 10 reps. if that is easy and you think you could do more – don’t – add some weight instead by holding onto some weights or a backpack etc. Do this every second day, adding weight as able to keep yourself tiring out at about 10 reps.

Too hard? If it is sore, or you aren’t strong enough for this, then start double legged with both feet doing it together.

SL calf raise

There it is, 3 simple exercises to improve ankle stiffness. Work at it for 6 weeks at least as you will likely get improved range well before this but strength gains don’t happen much before this and to get tasting changes 6+ weeks is crucial.

You may also like: The Ultimate Sprained Ankle Rehab


Health

Training for a half marathon? The secret to avoiding injury and nailing it!

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Over half of those training for a half marathon or marathon get injured every year. There is some very common lower limb running injuries that you can reduce your risk of, while increasing performance. You just need to know what is a myth (hint: don’t waste your time stretching) and what DOES lead to injury… and avoid that!

In this post, we “run” you through what does and doesn’t increase the risk of injury and then what you can do to reduce those risk factors and in the process, optimizing training and performance.(8)

The five most common injuries in long distance runners are:

  1. Patellofemoral Syndrome
  2. Achilles Tendinopathy
  3. Iliotibial Band Syndrome
  4. Plantar Fasciitis
  5. Tibial Stress Syndrome (a version of shin splints) (1)

The thing about these 5 most common injuries runners get when training for a half marathon is that they are all gradual onset injuries and they all can occur through training error.

You might think that that is a load of bull, and I totally understand. It’s actually been shown in research that the majority of runners are way off when asked what they think causes injury (2).

Here’s what the majority of runners think causes injury:

What runners think cause injury, right or wrong
  1. Not stretching – this was the most popular reason runners thought led to injury
  2. Excessive running
  3. Shoe type
  4. Foot type (over/under pronated)

Not many of those reasons are backed by the studies that have looked at it. Stretching has been shown to have no protective effect and even though it can benefit recovery, does not help prevent injury(3).

Excessive training when training for a half marathon is spot on though. Runners build up too fast or don’t have enough recovery to allow adaptation, overload certainly occurs, this is true.

Selecting shoes based on foot type has not been shown to be protective or beneficial either. There is no evidence that choosing shoes based on your arch height etc help reduce the risk of injury. There have been quite a few studies looking into this with thousands of participants – don’t get caught up in all the marketing you see! (4,5,6,7)

So, what can you do to legitimately reduce your risk of injury when training for a half marathon?

Here are your 3 BIG things to give yourself the BEST chance in staying injury free and performing well:

  1. Warm-up: This is not static stretching’s where you stand around stretching’s a few muscles. Warming up should increase body temperature and prepare your body. Think of it as a dynamic warm-up – this has been shown by high-level evidence to decrease injury rate (8).
  2. Avoid spikes in training load: Follow a set plan where weekly mileage goals are set out as well as adequate rest. The gradual build-up, following the 10% rule as well as factoring in rest days in order to give your body time to adapt is key in preventing overload injuries.
  3. Have variation: In distance, speed, footwear, and terrain. This means you load your tissues differently, avoiding repetition and ensuring you build resilience.

Takeaways:

  • The more consistently you can train, the better you will perform. The less pain and injury you have, the more consistently you can train.
  • Rest is not a loss of training. Rest is when your body adapts to your training!

You might also enjoy: Running Myths Busted


Health

Ankle Sprain – The Real Reason It Just Keeps Happening!

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As a Physiotherapist, I’ve lost count of the amount if times patients have claimed they have a “bad ankle”, that they have sustained an ankle sprain have on the same side numerous times before, or that they always sprain that ankle…. like it’s a normal thing.

Don’t Ignore that Sprain

An ankle sprain is one of the most common injuries, and not just on the sporting field, that’s for sure. They are so common that they almost get written off as a “normal” occurrence and they are brushed off as “oh, it’s just a sprain”. Almost half of those that sprain their ankle are back to their normal activity or sport within a week, even though we know ligament healing time is up to 12 weeks in a lot of cases

But do you know what? A sprain, in most cases, is a partial tear to the lateral ankle ligaments and just brushing them off and resting them for a short time can cause real long-term issues.

After spraining their ankle, over 50% of people still don’t have full recovery after a year and 25% of people re-sprain their ankle within a year(1). That isn’t just something to brush off and rest, it’s a serious injury.

Sprained ankle

Factors contributing to Ankle Sprain

To help figure out how to reduce the risk of long-term pain and instability, there is a lot of research looking into the factors that make you more at risk of pain and injury.

What’s one of the main risk factors? Past ankle injury. Now some of you may think that’s because the ankle ligaments were “damaged” and yes, in a small percentage of people there are high-grade tears that don’t heal well but in the majority of people, you ligaments do heal, just like the rest of our body – we have a great capacity for healing.

High Risk Factor – Prior Injury

So, what makes you almost 4 times more likely to sprain your ankle after you have done it once? One of the main causes is not your ligaments, it’s the secondary weakness and loss of control that occurred after the injury(2). The great thing is that you can improve these things, but only if you challenge them and force change.

Rather than blaming an injured ligament, you can do something about it. Doing exercise rehab after a sprain can massively reduce your risk of re-injury and actually will also reduce your risk of spraining your ankle even if you haven’t had a sprain before because it simply creates a stronger ankle with improved capacity.

A large systematic review, which included 3500 people found that the risk of ankle injury was decreased by 46% when balance and strength training was done! If you want to go the whole hog though, there is solid research that shows that using a good lace-up ankle brace, particularly in the 12 weeks when your ligament is healing, reduces the risk of a sprain by 64% (3).

how to prevent an ankle sprain

Live Pain Free – Manage Risk and Injury Pain

So remember, ankle sprains often don’t need to be a long term thing, particularly if you rehab them well and protect the ligaments while healing you can hugely decrease your risk of injury and ensure your ankle heals stronger, faster, with less pain and long term instability.

Do your ankle rehab, and follow through with it to help your ankle heal better, faster, and stronger after a sprain and get a good brace (if needed) for your ankle to give yourself the best shot at recovery.

If you need great rehab guidance, check out our post HERE for ideal early treatment or our Ankle Sprain rehab guide HERE for a full rehab plan.

If you haven’t injured your ankle but want to reduce the risk of injury, check out another past post HERE

Ankle sprain treatment


Health

Percussion Massage Gun | Fad or legitimate self-treatment tool?

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The Percussion Massage Gun, in various forms, has become wildly popular in the last couple of years and have a lot of claims to how much they can do! But are they really worth the money? Do they do all that is claimed?

Gaining Popularity

Massage Guns are widely available now and used by both therapists and the general public. They are easy to use, easy to get and people often need little encouragement to get something that makes recovery easier for us. It’s easier and takes less time than foam rolling or stretching? It’s cheaper than a massage therapist in the long run? Sign me up!

Make an Informed Decision

There often isn’t much thought put into the claims that the percussion massage gun companies make or the risks of using them. We aren’t against massage guns and always encourage people to do more to look after their bodies, but we are also all about being fully informed. With a quick search, the first massage gun we selected had the below claims:

  • Accelerates warmup of muscles before exercise.
  • Regular use improves an athlete’s overall mobility and range of movement.
  • Helps to release trigger points and assists the breakup of scar tissue.
  • May help reduce common muscle and joint pain

Let’s break those down and help you figure out what is believable and what’s not (skip down below if you want to read the summary):

percussion massage gun

Accelerates warmup of muscles before exercise

Before exercise, it is definitely beneficial to do a warm-up BUT the idea behind a warm-up up is to increase muscle activation and readiness for exercise in order to improve performance and decrease injury risk.

When the mechanoreceptors in your tissue sense a quick stretch or vibration force, the muscle contracts for a short time (a bit like reflex testing). This doesn’t last long though because other receptors called the Golgi tendon organs to sense the stretch and cause the contracted muscle to relax. This reflexive inhibition means your muscles are lengthened and more relaxed – not the goal of a warm-up at all.

Regular use improves an athlete’s overall mobility and range of movement

There is no research that has looked into the long term benefit. There are short term benefits to range of motion due to muscle relaxation but once you stop using the percussion massage gun, how long do these last?

Helps to release trigger points and assists the break up of scar tissue

Using a massage gun can cause reflexive muscle inhibition and relaxation as well as increased blood flow, helping to decrease areas of muscle tension. BUT, claiming scar tissue or fascia can be broken up is very misleading.

There isn’t any research into the specific use of massage guns but in terms of massage, the research and evidence on massage breaking up scar tissue is very weak(1). That makes sense as scar tissue and connective tissue is very strong tissue made to withstand very high force.

May help reduce common muscle and joint pain

A lot of muscle pain can certainly be helped by massage and so massage guns, as long as there isn’t a recent acute muscle injury. Vibration therapy has been shown to decrease delayed onset muscle soreness (DOMS), similar to massage, and also eases pain AND also leads to a decrease in lactic acid in the blood(2). It isn’t the be-all and end-all but can play a part in improving performance, particularly when fast turnaround between performances is needed(3)

Summary

  • Accelerates warmup of muscles before exercise. No, it increases blood flow but likely decreases muscle activity
  • Regular use improves an athlete’s overall mobility and range of movement. Only if you keep doing it – it’s likely that the improvements you make using the percussion massage gun don’t last long when you stop using it
  • Helps to release trigger points and assists the breakup of scar tissue. It can help ease tight bits of muscles, what some people call trigger points. It won’t break up scar tissue – they simply cannot
  • May help reduce common muscle and joint pain. Yes, it can certainly help reduce muscle pain AND percussion massage guns can help speed up recovery time

Health

3 Best Lower Back Stretches | Beat Persistent Back pain

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Lower back pain is very common and all too often becomes a frequent occurrence, leading to people suffering prolonged pain or repeated bouts of back pain. This doesn’t need to be the case. A huge proportion of back pain resolves within 6-12 weeks, you just need to give yourself the best conditions to recover and the best lower back stretches do just that!

Back Pain is Pretty Common

Nearly 80% of the population get back pain in their lifetimes with 30% of us getting lower back pain each year! That is a really high rate and indicates a high rate of re-injury (regular flare-ups).

The good news though, is that 60% of people recover from a bout of back pain within 6 weeks and 80-90% recover within 12 weeks(1). BUT, the issue is that if a lot back pain of recovers well within 6-12 weeks – why does it regularly come back?

Passive Approach – Not Helping You

There are a few reasons for recurring back pain but it is partly because people are often passive or fearful of back pain.

People tend to take a passive approach when they have a sore back. They take the passive approach by taking it easy until the pain has settled or even actively avoid things that they think may make it worse or “harm their back” such as lifting things.

The issue with the passive, “rest” approach?

While waiting for the back pain to ease, you get stiff, you get weaker and often you learn to avoid things that load your back. Not ideal and here is why:

As with a lot of injuries or pain, with rest and reducing load, pain can settle with time but by doing less, our body adapts to that – not ideal.

  1. Weaker Muscles: Your muscles get weaker due to pain inhibition and low use and if you don’t make this come back, it often won’t. It’s the “use it or lose it” saying, so not only should you really work to regain strength once the pain has settled, it is actually best to keep moving and active as able when sore, to limit loss.
  2. Tightening of Muscles: Your muscles get tighter, to protect you. Whenever you have pain, your tissue responds by muscle guarding around the area of pain in order to limit movement and brace the area. This can be useful for a short time as it allows you to keep moving but after a few days, we need to start reducing this spasm to avoid losing too much range

Lower Back Pain – Anatomy Lesson

With lower back pain, we often get spasm through 4 main areas:

  • The quadratus lumborum, which tends to brace down the side of your spine
  • The gluteals, which tighten and causes loss of hip flexion, inability to bend down well and sit comfortably
  • The Hip flexors. These are like guy ropes form your hip right to your spine and when they brace up, we lose extension and can’t always straighten up well, particularly after sitting.
  • Hamstrings, causing further loss of flexion and cramping in the legs

Lower Back Stretches to the Rescue

Lower back pain often feels far worse than it is because of this secondary spasm. Fortunately, our 3 best lower back stretches combine to address all four areas of concern mentioned above.

You can follow the best lower back stretches we show below to:

  • Help regain range of motion
  • Increase flexibility
  • De-load your lower back to allow it to get better, faster.
  • Help reduce asymmetry and mal-alignment remaining once you are better, meaning less risk of re-injury!

Through the best lower back stretches you can help reduce risk of re-injury. You can get rid of asymmetry and you can help your back pain get better, faster, ideally for good!

It’s up to you how you approach your back pain. You can:

  1. Rest it, avoid aggravating activities, and wait for it to settle.
  2. Keep moving and proactively stretch and strengthen for a faster, longer-lasting recovery

1. The absolute Best Glute stretch for lower back pain

We want you to be able to move and bend well still and we can do this through the hips, IF the glutes are guarding and limiting your movement.

Stretch your glutes to improve hip range and de-load your lower back.

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We’ve written a previous post on this stretch HERE.

2. Hip Flexor stretch for lower back pain

Hip flexor stretch lower back pain

Your hip flexor muscles come from your hip and run up and attach onto the inside of your pelvis and along the sides of your lower spine. Their job is to not just flex the hip but also to tilt the pelvis forward and extend the low back.

When you get back pain the hip flexors can go into protective mode and brace up to act like guy ropes, increasing the tension on your lumbar spine and causing an achy lower back.

hip flexor stretch for lower back pain

Instructions:

  • Get set up as shown above and lunge forward slowly, keeping your back straight, thrusting forward from the pelvis.
  • If it helps, contract your glutes to help ensure you are extending at the hip to stretch the hip flexors rather than arching your back.
  • You should feel a good stretch in your hip and/or thigh and minimal or no lower back pain.
  • Hold for 30 seconds each side and if you have a sore knee, place a cushion or folded up towel under your knee for comfort.

3. The McKenzie extension stretch (Cobra)

This is a great stretch for regaining lumbar spine mobility and very commonly used by health professionals.

McKenzie extension stretch for lower back pain

Instructions:

  • Start lying on your stomach with your hands under your shoulders.
  • Breath in slowly and using your arms, push your upper body upwards.
  • If you cannot straighten your arms right out, that is OK, just push up to the point of discomfort.
  • Hold there and breath out slowly and then return back down.
  • Repeat this TEN times and if you cannot do this then start just lying propped up on your elbows for 1 minute.

In Conclusion

That is our 3 most effective, easy and best lower back stretches – give them a go, do them 1-2 times per day and notice the difference and as usual if unsure, no improvement or worsening pain, see a health professional.

Quadratus lumborum pain

Note: You may also benefit from a muscle release of your Quadratus Lumborum muscle which tends to go into spasm and is hard to effectively stretch. Check out our earlier post HERE that shows how to do that at home.


Ankle, Health

The Ultimate Sprained Ankle Rehab: Heal Fast and Strong

• By

Treating a sprained ankle the RIGHT way early on, means a stronger ankle, faster recovery and less chance of re-injury. In this series, I will tell you what a sprained ankle involves, the most effective self-treatment and the best rehab exercises to get you back out there!

This post will take you through early, middle and late stage rehab exercises as well as self treatment advice for a lateral ankle sprain so that you can get on with life. Alternatively, you can skip the hassle and get all the extras in one document by downloading our comprehensive Sprained Ankle Recovery Guide


Stage 1: Acute Ankle Sprain, the First 72 Hours

First of all, a little information about what a sprained ankle involves, but if you are in the know about Sprains already, skip the info and scroll down to Self-Treatment.

Sprained ankles are known by a few different names:

  • Twisted ankle
  • Rolled ankle
  • Lateral ankle sprain
  • Inversion ankle sprain
  • Torn lateral ankle ligament

The most common type of sprained ankle is the lateral ankle sprain (85%), and that is what we are going to discuss and sort out today. The other 15% is made up of high ankle sprains and medial ankle sprains and the advice below is quite effective for those injuries also.

As with everything on this website, the rehab regimen does not claim to replace or be better than the best practice of going and seeing a doctor or physical therapist.

Mechanism of injury:

The plain and simple is that a sprained ankle is typically when your foot is forced inwards (inversion) and down at the same time.

This often happens when changing direction, turning and/or on uneven surfaces). This puts the ligaments under too much stress too fast which causes a tear of one or more of your ankle ligaments.

sprained ankle - lateral ligaments

Quick anatomy:

The lateral (outer) ankle has 3 ligaments supporting, with the weakest of these (and so most often injured) being the Anterior Talofibular Ligament (ATFL).

The ATFL is the Ligament at the front of the ankle shown here and in most simple sprains, this is the one torn with or without the ligament below it.

Sprained ankle recovery time:

The general recovery time is 2-6 weeks (if looked after properly). Keep in mind, even if it feels bad now if you do all the right things you will be one of the 95% who returns to sport and activity within 6 weeks.

Not taking ankle rehab seriously often leads to far too many chronic ankles, long-term disability and other injuries so YOU NEED TO TAKE THIS SERIOUSLY!

Note: it is important to rule out fractures early on. An accurate way of doing this is using the Ottawa ankle rules, or going to see your local Physio for a quick assessment – These rules are great for minimizing unnecessary X-rays. If clear of fracture, conservative rehab is typically the way to go – surgery is rarely needed or the first port of call (1).

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Sprained Ankle Self-Treatment

Initial management: In the first 72 hours it is very important to follow the RICE and HARM principles – This will take weeks off your recovery.

Summary:

  • Do POLICE
  • Don’t HARM
  • Protect
  • Keep Moving
  • Foot Paddling
  • Footwear

1. Do: POLICE

This has changed from the previous RICE recommendation, see more on this HERE.

POLICE acute ankle sprain treatment heal fast

Note: Don’t wear compression at night time

2. Don’t: HARM

  • Heat
  • Alcohol
  • Running
  • Massage

HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time.

3. Protect:

Braces have been proven to reduce re-injury rate and improve recovery so check out your options here. Using a functional ankle brace at all times during the day is now a go-to treatment for sprained ankles for the first 6 weeks and then up to a year after injury as needed.

You can see an update on the Clinical Best Practice Guidelines from the British Journal of Sports Medicine HERE if you want more detail on that. Basically, Lace-up ankle braces are a brilliant way to protect the ligaments and reduce re-injury rate and preferred over moon boots or nothing.

4. Keep moving (within reason of course)

It is important not to baby sprained ankles and start weight-bearing through them as soon as possible. This helps to normalize movement and decrease the loss of muscle activity.

If necessary you may need to be on crutches for the first 24-72 hours then move to partial weight-bearing and then full weight-bearing.

5. Foot paddling

This is a great exercise to do in these early days – In sitting or lying, simply point your toes up then down repeatedly in a pain-free range.

You can try doing small circles with your foot also, remember not to push into pain. Do this every 1-2 hours (little and often)

6. Footwear:

Wearing good supportive footwear with heel and arch support(such as your runners) is great as this takes the pressure off the injured ligaments and lets them heal well.

DO NOT WEAR HIGH HEELS (Please!).

Now that you have taken care of your sprained ankle in the first 48-72 hours by doing everything mentioned above. Let’s start on the next stage below.

You can download our comprehensive Sprained Ankle Recovery Guide, with all of this great information.


Stage 2: Early Rehab and Sprained Ankle Treatment

sprain strain self treatment ice rest compress

How to get a sprained ankle stronger, recover quicker and get back out there faster and better than ever!

Note: You still use ice after the first few days whenever it is sore or swollen.

Following on from the stage 1 rehab (above) about what to do in the first 72 hours, here we will cover a comprehensive rehab regime that will help the majority of you recover from an ankle sprain in weeks, not months.

Your body adapts to the forces that go through it. Progressively load your ankle, it will adapt and be better for it!

Sprained ankle treatment needs to include:

  • Proprioception exercises
  • Range of motion exercises
  • Strengthening exercises

1. Proprioception Exercises: Retraining for a sprained ankle

Proprioception is the ability for you brain to know where you body is in space.

If this is decreased, you have poor balance and increased chance of re-injury. Sprained ankles are the worst injury in the body for impaired proprioception and needs to be addressed.

Note: If you aren’t sure what proprioception is – extend one arm out to the side, close your eyes and mirror it exactly with the other arm – you could do this with your eyes closed because of your proprioception.

sprained ankle rehab exercises

Single leg standing (SLS):

Begin by standing on one leg on a solid surface (you can put one finger on the wall for balance if you need to start with) and aim for 1 minute.

When you can do this comfortably for 60 seconds, step it up by performing SLS on a folded up towel.

A Folded towel is great to use as you can easy progress this by doubling it up again and again and then finally rolling it up to make it much harder.

Progressing each time when you can easily do it for 60 seconds.

NOTE: Have a bench in front or to the side to grab onto if need be – but only if you have to!

You can also use Wobble boards, Bosu balls and balance boards when towels become too easy (or boring!)

2. Range of motion Exercises

calf stretch , soleus, gastroc - self treatment for shin splints

Calf Stretch

The best way to do this is by dropping your heel of a step and holding for 1 minute as shown in the picture to the right. Make sure this stretch is within the pain-free range.

Lunge Stretches and accessory glides

See this video for great mobilization techniques. Remember not to push into too much pain!

3. Strengthening Exercises

Heel Raises

Begin using both feet and progress to one foot as pain and strength allows. Perform 30 with one finger against a wall for balance. Also known as Calf Raises.

Single leg Squat, hip stability and strength

Single Leg Squat/Pistol Squats

As soon as you can, begin doing these to maintain and increase the strength in your entire lower limb! do 2 x 12 on each side and begin by only bending a small distance – Give it a go!

Ankle Eversion Training

See this video on how to do this important exercise with a Theraband or similar elastic band.

Stick to this Rehab program for the full 6 weeks for best results and make sure to keep challenging and progressing yourself!


Stage 3: End Stage rehab – “Bulletproofing” after an Ankle Sprain

Research-based and very easy, with great results

You can also head over to our rehab guides page to get all three levels and much, much more in an eBook!

Anmle excursion exercise, balance rehab

These are the rehab exercises that you need to get your ankle 100% and to minimize chance of re-injury which is far too common.

This ankle sprain rehab is aimed at improving range, balance and strength with simple, effective home exercises.

Too many people simply sprain re-injure their ankle is the full rehab isn’t followed through with and actually 33% still have pain remaining after one year!.

On top of this, a history of ankle sprain ( you have injured it before) is the single most predisposing factor for ankle injury.(2,4)

Our bodies are great at healing by themselves but if you don’t push your ankle to regain strength and range – you leave yourself at high risk of re-injury

This means after you have an ankle sprain it is very important to rehab it right as you have a high chance of ongoing symptoms and re-injury. Remember, the research shows that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery – so get started as soon as possible for best results.(3)

First, Some Quick Tests:

Here is a great little test to see if your ankle range is back to it’s best. The other easy test to see if you need to do the level three exercises is to balance on the balls of your foot, one leg at a time – you should be able to do this for at least 30 seconds and you should be even between legs.

Stage 3 ankle sprain rehab has 3 main goals:

  • Achieve full range of motion
  • Have good ankle  and leg control through this range
  • Full strength of the ankle stabilizers

To get there, here are the exercises that you need to do:

Toe balance

ankle sprain balance exercise

This is a great balance exercise to strengthen your ankle in this vulnerable position and better yet, it is simple and you can do it anywhere.

Stand on the ball of your foot. You will most likely need to start with one finger on the wall for balance.

Goal: 1 minute each side

Make it harder: Do some one leg standing and toe balance on one of my favorite rehab equipment: a BOSU Ball

X excursion exercise – Balance re-training

This exercise has come about from a well-used test within the health industry – the Star Excursion Balance Test. The great thing about the tests we use as physiotherapists is that they really do challenge you, which make them great as exercises also as if your body is challenged, it is going to adapt to improve.

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Ankle stretch

Ankle stretch exercise

Along with the classic calf stretch, this one is great for getting full range in your ankle and making sure you are even. This only needs to be done if you can’t point your foot down evenly after 6 weeks – you don’t need to do it earlier.

Hold for one minute.

Ankle self-mobilization

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In Conclusion

Putting in the time to rehab your ankle fully is so important, not only will it decrease or get rid of any pain but it will improve your mobility and performance. Even just working on retraining your balance decreases your chance of re-injury by 22-33% – nothing to scoff at right!(5)

So write the exercises down, favorite this post and make it a routine.

Return to Sport:

As a simple rule, once both sides are even, you can get back to training and playing. So to test yourself out, see how far you can single leg jump and make sure both legs are within 5cm of each other and then do the X-excursion exercise as above and again, make sure both sides are within 5cm of each other. If they aren’t even, keep working at it.

Also if you are returning to sports such as basketball or volleyball etc that require a lot of jumping, twisting and hopping, or if you have sprained your ankle more than once, it is definitely worth your while looking into getting a good lace-up Ankle Brace.

Yours in health,

Shaun


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