Ankle Sprain & Strain – Lateral Block Hops

Stand beside a 20 inch high block that is about 20 inches wide as well. With your inner core engaged, perform a lateral hop onto the block and then hop down onto the ground to the other side.

Then do a lateral hop back to the start position to complete the repetition. Do 3 sets of 10 reps 3 times x/week.

This will help you develop more progressive strengthening so you can more readily return to your functional sports or activities that require dynamic ankle strength.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your ankle injury or sprain, consult your local Physiotherapist before continuing. 

Low Back Pain – Adam Mann

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann, Insync Physio in Vancouver consistently, currently rated one of the top physiotherapists clinics in Vancouver as voted by their customers, the people who count the most. And we're going to talk about that low back pain. Adam's going to talk about a client of his, that injured themselves. How they injured themself?

Adam:  So came on kind of out of nowhere they were cycling, for about 50 kilometers on the weekend. And then they felt this sharp pain in their back the next morning. and it was pretty sharp, but the thing that was really bizarre about this pain is it actually caused a shooting pain down into the heel of her left side.

And so it was pretty short and it was different than other back pain that she's had in the past. And she's had back pain in the past, but this was something new where there was this kind of zinging, electrical feeling down into the foot. So, she was quite scared and she went to the doctor and the doctor referred her to physio.

Mark: So how did you go about assessing the injury? 

Adam: So, yeah, we started with a thorough assessment. We basically, again, did a nice history where we talked about, what caused this. And so again, it kinda came out of nowhere, but we found out that she did have back pain in the past, but usually it was just in the lower back and never shot down in the past.

I found out that actually she was born genetically with an extra vertebrae in her back, meaning an extra spinal segment and that's different, but it's normal. It's considered just a normal thing. Isn't something that would have caused that pain necessarily.

 What we found out is where the numbness and tingling, where that zinging pain in the leg was. That gives us a clue where that possible nerve could be compressed. So it gave us a bit of a homing signal where we should focus our assessment. Nerves if we think about them. So tingling and zinging pain is usually a sign of a nerve injury and so nerves perform three things. They do reflexes, muscle strength and they do sensation. 

So we tested all three of these components and we just basically compared, the reflexes sensation and the muscle strength to the other side, to find out what was normal for her. The thing that we did differently in the way I approach back pain is I actually really want the spine to move.

So I look at the range of motion pretty carefully. And this is a, this is a different style of assessment. It's called The Mackenzie Method or MDT. And we use it for diagnosis and treatment. And basically it's a very safe method where we get people to perform some repeated spinal movements. So we find out if their spine has a preference to go in the direction of backwards or forwards, or if that increases or decreases some of the numbness or tingling sensation.

We look at if sitting is aggravating or if I'm walking is aggravated. So basically we find different ways how their spine likes to move, and doesn't like to move. And so with these repeated movements, we found out that actually this person, liked a flex spine. So we found a certain type of motion that her spine responded to.

And how did we find that their spine responded that way? It was basically, the pain stays relatively constant at first, but the location of the shooting pain moved closer to the spine. So it wasn't necessarily in this case that the pain or the shooting sensation went away entirely, but it was closer to the area where there was a problem. If that makes any sense. 

Mark: So tell me some more about that. How does that work? 

Adam: So basically if we can get the pain closer to where the spine is, that's called centralization in this McKenzie Method. And basically at that point, we can really focus in on the joints that might be dysfunctional or the muscle tone or the pelvis position, some of these other components and deal with it.

If we find emotion, alternatively, that makes the pain in the foot stronger or more intense then we can sort of get a clue that that is emotion, that the spine doesn't like, but that further aggravates pain. And the reason why we do this is at the end of the day, back pain, although we can get people pain-free and get them moving much, much better, it tends to come back. So if someone is doing something that's pretty explosive or snowboarding, and if they haven't done it in a long time, they haven't been keeping up with their exercises. It tends to come back. I'm not sure if that's just why they call it the back, but, this is a good way for us to find how each spine likes to be moved and what exercises we can give them so that they can self manage some of these problems on their own. 

So basically when we found that this person liked to flex spine, we gave them some exercises that basically would get their spine into a more flexed position. And it would take away the pain. And so once the pain got under control and that shooting electrical pain was in the spine area, we actually could work on other things. Like joint mobilizations, how this position, like I just sort of talked about and of course, core strengthening. 

Mark: That sounds really good. So any final points you want to make? How did this end up for the client? 

Adam: So basically this person is back to full activity and we talked a little bit about return to full activity looked like, cause they really like cycling. So, if they're going to go for a longer cycle, they have a routine of exercises that they do basically right before it. They keep up with some strengthening components that we give them, you know, that they have to do at least once a week, maybe twice a week.

And if they do those things, their back pain is pretty well under control. They don't have any of that shooting, electrical sensation anymore. And they're able to return to full activity, which is snowboarding, cycling, and climbing. And they live a very active, happy life. So basically, the idea is that this Mackenzie Method is a fantastic way for addressing back pain because it gives the clients some self management tips. Like I mentioned before, and then they also have a bit of self awareness.

They know if they're going to do something in particular, like walk for a long distance or get their spine in a position where their spine doesn't like it, they can avoid it or they can prepare for it. 

Mark: There you go. If you're looking for some relief for your back pain and especially, if you're willing to take some responsibility and maintain it, the guys who can really help you with a course that not only takes the pain away, but helps keep you pain free as much as is practically possible. Back pain is the number one problem that people have in terms of pain in their bodies.

Adam: It is Mark. 

Mark: So this is really important and I'm sure lots of people who are watching this have encountered this in the past. I certainly have. Adam Mann, at Insync Physio, you can check him out at their website, Give him a call in Vancouver, (604) 566-9716 to book or in Burnaby (604) 298-4878 to book. You can also book online right on their website. Thanks Adam. 

Adam: Hey, have a good one.

Ankle Sprain Treatment and Recovery

Mark: Hi, it's Mark from Top Local. I'm here with Adam Mann of Insync Physio in Vancouver, and we're talking physiotherapy, how are you doing today? 

Adam: Hey, Mark. Good to see you. I'm doing quite well. 

Mark: So you're going to tell me about an ankle injury today. What was going on with this person's ankle? 

Adam: Yeah, so this was a young professional, like a 20 year old and he just was getting into CrossFit. And his trainer was trying to get him to do some lateral hopping drills, basically a lateral lunge. So he was jumping pretty far off to the side and he tipped over and he kind of rolled his ankle sort of like this. And he heard a snap. And he could walk on it afterwards, but it got really swollen and it got pretty painful.

And so the next day he went down to the hospital and actually got an x-ray. He was pretty worried about it. They couldn't find a fracture. They told him it was a pretty bad ankle sprain and they referred him to physiotherapy. So he sort of waited a week thinking it might get better, but it really wasn't getting too much better.

Mark: So what did you do? He came in to see you, obviously, what did you do to assess it?

Adam:  So, basically we took a detailed history. I wanted to find out there's a lot of different ligaments in the foot and in the ankle. Some are more serious than others. So we took a history. We basically found out if this was the first time this has happened, if it's happened again. We looked at his walking pattern or his gate. We basically went in and we tested all the different ligaments. This sounds painful, but it actually, wasn't really painful at all. We found out which ligament was at fault and it was actually a ligament called the anterior talofibular ligament.

It's just an ankle on the side of the, the foot and it basically prevents your foot from moving too far forwards versus your shin bone. So it's quite a common injury. But because he heard a snap, he was pretty worried about it. So we also looked at the muscles around his hip and his knees to make sure that there weren't any contributing factors to the fall.

But basically the idea was that we figured out what the injury was and how we should treat it. So on assessment day, Really, what we tried to do is just figure out exactly what's going on, give a prognosis on how we can recover from it and give them some good exercises so that they can start the healing process.

The other thing we did as I taped his ankle, so I basically went in and helped just prevent any provocative motions on that ankle. And that was basically our assessment. 

Mark: So what was the course of treatment?

Adam: Ligaments can take a while they don't have a lot of blood supply. And the main thing is that this type of injury tends to get quite swollen. So a lot of the stuff we know, but we don't entirely know how it works. So basically swelling means that we have to elevate and we really want to make sure that there's more space inside the joint for the joint to move freely.

So the other thing, with treatment is we really want to limit the provocative motion. So if he rolled his ankle kind of like this, you want to avoid this motion initially. Once you get that under control, we are trying to actually strengthen the muscles on the outside and the inside of the ankle. And it's really hard to actually do this. We use the band and we use some pretty specific exercises to really work on that. The other thing I tell people is just elevation, elevation, elevation. So really making sure that that fluid has a place to drain to, so it can get out of the area. 

We do some soft tissue work. So we really get the muscles around the area to relax. We do some lymphatic massage, that sort of thing. And eventually we definitely start to add load onto it. So we start to strengthen the muscles all around the ankle. The other component I like to tell people is that we like to work on balance or joint sensors. So basically ligaments have really specific, processes where it tells your joint position. And that's really important for when you are jumping or running or doing anything like that. And these get injured when you have a ligament sprain. 

So what we do is we really do try to work on balance and proprioception, which is just basically another one word for body awareness. So we added in a couple of hopping drills once the pain levels were down and we worked on basically balance as well.

Mark: And how did it all work out for your patient? 

Adam: Well, he's running a half marathon in about a month from now. So he's doing quite well. Got him back to what he was doing. 

Mark: Another happy customer at Insync Physio. If you've got any kind of ankle problems, I've had this, I had this in basketball. This exact injury actually, and it was not treated very well and it's still pains me to this day. But if you want it looked after properly so that you never have this happening or reduce the odds of it happening substantially you want to use a physiotherapist who really understands how the body functions. And will take you through a course of treatment that's going to make you feel better and strengthen your body so that it can heal properly. Insync Physio. You can reach them at the website You can book right from there, or you can give them a call in Vancouver, (604) 566-9716 or in North Burnaby, (604) 298-4878. And ask for Adam, he'll help you out. Thanks, Adam. 

Adam: Alright. Thanks Mark. Have a good one.

Knee Ligament Injuries – 2 Leg Lateral Block Hops

Stand beside a 20 inch high block that is about 20 inches wide as well. With your inner core engaged, perform a lateral hop onto the block and then hop down onto the ground to the other side. Then do a lateral hop back to the start position to complete the repetition.

Do 3 sets of 10 reps 3 times x/week.

This will help you develop more progressive strengthening so you can more readily return to your functional sports or activities that require dynamic knee strength.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your knee injury, consult your local Physiotherapist before continuing. 

Shoulder Strain Injuries – Biceps Strain Rehabilitation

Hi everyone!!! It’s Wil Seto here from INSYNC PHYSIO Sports and Orthopaedic Rehab clinics, with two locations, one in Central Vancouver and one in North Burnaby BC. I’m going to talk about a type of shoulder strain and shoulder injury that involves the biceps today.

What usually goes on with a biceps injury? Your biceps muscle is made up of 2 muscles… hence “biceps”. A few things can occur.

Number 1, you can strain or pull the tendon of the long head of your biceps at the shoulder or the biceps tendon down by your elbow. You can also have what’s called Tendinopathy of the long head of the tendon at the shoulder or elbow. If it’s a minor strain or a Tendinopathy, strengthening the tendon is one of the best things you can do for it.

Here’s an exercise you can start off with. This focuses on the strengthening and rehabilitation of the tendon by performing eccentric contractions. If the left is the affected side, assist shoulder flexion with the elbow flexed all the way up with a resistance band for your non affected arm.

Then using only your affected side, slowly lower the arm and straighten the elbow with constant resistance throughout until you reach the start position again. Repeat this for 10 repetitions doing 3 sets 2x daily.

If you’re unsure about the exercise or have any uncertainty about what you’re doing, consult your local Physiotherapist before continuing.

Ami Sanyal Testimonial

Before seeing Insync Physio I had some pain in my leg and for years I ignored it. Eventually it got painful enough that I went to a doctor. And he said it was nothing probably just needed to do some stretching or maybe exercising. When it didn't get better, I decided to see Insync and the physiotherapist there actually listened to my story.

And the first thing he said is that he thought I should get an x-ray. I got the x-ray and it turned out that there was a benign tumor in my femur that was threatening to break my femur. It was responsible for all the pain it needed to come out. I ended up going back to Insync several times just to get the exercises and treatment that I needed.

 At this point post-surgery I am much more able to walk and run and play with my kids. And, really that one appointment was pretty life changing for me. So thank you Insync.

Golfer’s Elbow

Mark: Hi, it's Mark from Top Local. We're here with Wil Seto of Insync Physio. He's the owner. He's the boss. He's the man. He's one of the top rated physiotherapists in Vancouver. One of the top three. How are you doing today, Wil?

Wil: Yeah, I'm doing great. Thanks. Yeah. Thank you. 

Mark: Golfer's elbow is what we're going to talk about. So this is similar to tennis elbow, isn't it? 

Wil: Yeah, very similar, except just on the other side. A really good way to describe and explain what it is exactly is, we had a client that came in earlier this week, who was presenting with some pain on the inside of his elbow.

So he was a 27 year old, a rock climber, doesn't even play golf, slash computer programmer. So he's on the keyboard, like pretty much nine to five, five days a week kind of thing. Right. It's a lot of repetitive strain, and then, you add him being an avid rock climber to the mix of that. 

So he was complaining about the pain that he was getting and it started just as he started doing more climbing again and training and training was involving like three to four days a week. He's a pretty avid climber.

As we looked at it, he was getting some overuse and issues going on in his medial aspect of his tendons. It's an overuse syndrome involving the tendons, where it becomes weaker and there's different degrees of severity that you can get with golfer's elbow from mild, moderate to severe, where, when you get really bad swelling it's a pretty severe tendinopathies developing into there.

That's essentially what it is, is an overuse syndrome. And you can get a lot of overdeveloped strength in the forearm muscles that basically ended up causing a lot of pulling onto those tendons. When you have sort of this imbalance where the muscles are stronger, it can actually pull on those tendons a little bit more.

So what happens with his situation? Because he's also a computer programmer, he's not actually resting his arms, he's always using them, he's overusing them. And one of the other components of this that came out in his history and what he was telling me was that he wasn't stretching enough, he wasn't actually recovering. That's actually really important, too, because part of that recovery allows those muscles to relax. So when those muscles in the forearms, if your muscles are really super tight, then what happens is that things shorten and then it ends up causing a lot of stress and strain into the tendons.

If you start to do things really quickly, too fast, and you get strong too quickly, too fast, then your weakest points is usually when you get these kinds of injuries, are your tendons. Because your muscles will get strong, faster than your tendons, and then you ended up injuring them and then they become strained. So that's basically what it is. 

So the other interesting thing, is that if you have a preexisting injury in that arm and he had an issue with his finger before, cause he's an avid climber, so he was already prone to having that. That's the other thing to look out for. 

So if you've had stuff happen in your arm before and you are an avid golfer or a climber or a racket player, then you gotta be really careful in doing those recovery things for it. Right. That's good to keep up with. 

Mark: What was the treatment protocol?

Wil: When we actually looked at what was going on, the other interesting thing, was he didn't have any neck issues, but he had some neck stiffness too. That wasn't the main issue, it was just causing things to creep up in the neck. So we had to treat a little bit of that as well. 

We looked at three main things. Loosening up that area of the muscle in the forearm.  I'll spare the details there, the names and the terminology, but in the forearm muscles, we needed to actually relax them. They were always like this, so we needed to find a way to help them to be able have them in a state of relaxation. He was always like this with his forearms, always, even when he was relaxed. So that was the first thing. 

The second thing was helping settle down that actual irritation.  Referring him to the doctor, cause it was actually quite inflamed and getting something to settle down the inflammation or icing it. Having some kind of a brace... He really wanted to keep climbing, that was the problem. I'm not gonna say no, you know, I did say that it's a good idea not to, so we gotta give him more brace to absorb the excess forces and the tension that he's going to actually be using on his arms. 

The third thing too, is like, so how I was saying, that he has all this stuff going on higher up. His nervous system was all triggered, all tight, and tense.

So we needed to start to mobilize all of that, and we needed to make sure that the mobility component was really big. Really looking at increasing the mobility and that whole, not just the arm, but the neck area and the nervous system, and just really making sure that everything is moving well and the muscles, and then also the strength component, making sure that now we have other aspects of the antagonizing strength or the opposite muscles that he never uses get stronger.

Finally, the main thing here too, is educating him again. You know your job, this is what you do. You gotta work on stretching and you gotta work on doing certain things to recover in that forearm, not just after you climb, but after you work or even after you do something simple as gardening, and you're doing stuff with that arm.

So some simple stuff to really help them look at keeping that arm in a good state, because he likes to push himself. 

Mark: Right. And so it's really indicative when you get a strain in one area of your body, it will magnify across other places as you try and compensate, basically.

Wil: Yeah, you can. For sure. The other interesting thing is that we got, as we get him the rehab and doing a lot of home exercises to reinforce other mobility and especially strength on this right side. You need to do it on the opposite side. And then also working on sort of this, like, you're saying this core strength for the upper extremity.

Mark: There you go. If you want expert help, if you've got pain in your elbows and you don't know what's going on, and you want somebody who can really diagnose it and get you going well, Insync Physio are the guys to get, having a look at what's going on with your body and get you feeling right again. You can check out the website at You can book online. They have two offices, one in North Burnaby, and one on Cambie street in Vancouver. Or you can call them and just book. 

In Vancouver, (604) 566-9716 to book your appointment or in North Burnaby, (604) 298-4878. They'll look after you and you will be feeling better really quickly.

Wil: Thanks, thanks Mark. I hope that helps.

Neck Injuries, Neuropathies

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. Repeatedly voted one of the best physiotherapy offices in Vancouver and Wil has just been voted one of the top three physiotherapists in Vancouver. Congratulations Wil. How you doing? 

Will: Yeah, I'm doing great, Mark. Thanks, and that was a total surprise. It's always great to be recognized. And I really obviously appreciate that. Things are definitely going great on my end. Can't complain. 

Mark: Let's talk about neck injuries, that's what we have on the agenda today. Neuropathies, what's a neuropathy?

Will: So first of all, I think the easiest way to kind of get into it is, looking at a client that came in, that that actually presents with that. So, we had this 57 year old woman, who's a golfer, that walked into our clinic and she presented with some interesting symptoms. The first thing she said to me, "Hey, I've got this pain going down my arm in my hand and my wrist, and it's been going on since April. So, the last four months, four and a half months, and it's just not going away. I've been seeing a chiropractor and massage makes it worse." 

And she actually saw her family doctor and her family doctor diagnosed her with carpal tunnel syndrome. It was interesting in that I was you know, taking her history, kind of dived into the questioning of what was going on, you know. 

She's, like I said, she's a golfer, she's retired, but she ran a successful business where she  was on the computer lots. And so there's a lot of sedentary stuff involved. And so it turns out she has this thing called the neuropathy going on in her whole upper extremity and relating to her neck.

What it is essentially is basically a malfunction or dysfunction of the nerve, that causes a lot of hypersensitivity. The word hypersensitivity is the medical term that they used for when a nerve is not functioning properly. It's just basically over firing for whatever reason and it's usually due to a minor injury, right. 

A minor irritation and that irritation, it turned out that it was coming from the woman's neck because she definitely didn't have the range. And her specific joints in the neck were fixated and a lot of the muscles in her neck and leading down to sort of the shoulder area, which is all related, were shortening to the extent where they were basically causing a lot of alignment issues.

 There's specific tests that we do that are able to help us diagnose, is this a neuropathy? And so with the hypersensitivity, there really isn't a major injury going on and you do scans on it and you do whatever x-rays, and stuff like that, and it won't necessarily show much going on.

You do these other different tests and adds up to what we would call neuropathy in terms of the hypersensitivity of these nerves. And that's basically what it is. 

Mark: So what kind of treatment protocol did you initiate with her?  

Will: Looking at what her impairments were. There were three major things going on, right? So with her neck, she had limited mobility because of the neck joints, and that was causing a lot of other mobility issues. This is chronic, too. So other thing that as you're ascertaining this, and we're assessing this, that this isn't something that just happens overnight or the span of two weeks. She's been having symptoms since April, it's been going on way longer than April.

Because of that and her neck issue, it's causing a lot of this type of immobility or lack of mobility, not just in the joints, in the range of motion of her neck itself, but also the nervous system and the nerves related dermatomal myotomal spread of what was giving her symptoms down into her hand and her wrist.

So we did three major things. We helped to restore her mobility and her neck, a combination of manual therapy and then some exercises to reinforce that mobility. And then number two, we assessed her neurodynamic system. So that's a bit of a mouthful there. So what that means is we assessed how her nervous system and her nerves are moving and functioning and we mobilized it. We used some hands on therapy to increase the mobility of that. So it was very specific techniques. And then we gave her some exercises to reinforce that mobility. 

The third thing was, is really applying something. So her muscles were like this, and looking at how can we actually help to relieve that tension and that compression in all those multiple segments, so that way things can move better overall as a whole. One of the really effective treatment techniques was using something called IMS, and IMS stands for intramuscular stimulation. What it is is the application of acupuncture needles that basically restores these neuropathies and releases these is the spasms in these tight muscle bands, so that way it relieves pressure on the joints and allows things to move better. 

Essentially it allows like sort of a reset if you wanted to describe it, for that whole neurophysiological system. And then the last, actually major component of the treatment - so those are the three main areas, but then you have to actually look at helping the client understand the actual dysfunction or the issue and what this is, because the education component is actually one of the key things. Educate her about what neuropathy is and how we can fix it.

So those are the key things. And we do all these things and they make it a little bit better, but they're not going to get 100% better. They're not going to also understand how to prevent this from happening, because as much as I want to keep treating her, you know, lots and lots and lots, I don't like that actually.

What I want to do is I want to actually be able to help her in three visits. After the first visit, she no longer had any more of those symptoms, and all I did was treat her neck. It wasn't even carpal tunnel syndrome. 

Mark: So what was the final outcome of the treatments? 

Will: Basically she came in for third session earlier this week and she was pretty much she went from coming in to see me. She was like at 55, 60% over overall functioning and impairment to like almost a hundred percent. And she like hadn't played golf and then she would go and play golf this weekend for the first time.

Mark: Nice. So there you go. If you have a problem with your neck or any kind of phantom pains that are suddenly turned chronic, it's been a few months, the guys to see our Insync Physio. You can reach them at Vancouver office (604) 566-9716. They're on Cambie Street really convenient to find or in North Burnaby, (604) 298-4878. You can book online as well at the website. - both offices. You have to call and book. They're always busy. They're always popular. They're always helping people and they will help you get better and moving freely. Thanks Wil.

Will: Great. Thanks Mark. Hope that helps.

Julia Boyle Testimonial

One of the things that I really love about Insync Physio is that Adam, my physiotherapist, helped me get to the root of my problem of my back injury, where I've been having a lot of hip issues as well in my lower back. A lot of physiotherapists that I'd seen before, just kind of treat the symptoms and look at gaining strength.

But with Adam, he really did a full assessment and helped to understand what the core issue is. So, it helps me manage my injury on my own and when I have flare ups to understand what's wrong and what I should be doing. So I really appreciate that kind of education is empowerment and I feel a lot more empowered to deal with my injuries and a lot more confident to deal with it.

So for me, it was a huge win getting into Insync and I'm meeting with Adam and just really learning more about my body and how to take better care of it. So I definitely 100% recommend and Insync Physio and their team is really kind and caring and really care about helping people get back on their feet.

So I am a proud and happy client of Insync Physio.

Knee Cap Pain Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. They're award-winning physiotherapists multi time award-winning best physiotherapists in Vancouver as voted by their customers. And we're going to talk about knee pain from kneeling. How are you doing today, Simon? 

Simon: How are you doing, Mark? Thanks for dialling in, sir. I'm doing really good today. So yeah, we're just going to talk a little bit about that kneeling pain. The umbrella term we use is patellofemoral pain syndrome, PFPS for short. 

Like you so rightly said, a lot of people get pain when they kneel directly on the knee from direct compression of the kneecap against the femur. Someone like a tiler, there are someone who's working on their knees a lot in their job or your occupation. Other times people have a going up and down stairs. Particularly on the way down, actually, because it lowers that joint more. Coming down the Grouse Grind or any of the hikes we have here around Vancouver, especially would be sore.

Generally, it's more gradual in onset, not a very specific event. And then you get a lot of swelling and a lot of pain and it just tends to get worse if you don't know exactly how to treat it. 

Mark: So do you have a specific case example that you could kind of walk us through  what the presenting problem looked like? What the treatment was and then the result?

Simon: Absolutely Mark. I had a guy come in, he was a 28 year old. He's actually a mountain biker. So I think it was at the start of the Covid time actually, just before he came in, he was doing a lot of mountain biking and he said he went in a seven hour mountain biking ride there and started to feel a lot of discomfort in the knee. Now mind you, seven hours is a pretty long time. And that was a bit more than he was used to doing. So that could be part of the reason why his knee started to become sore. But also we had to decide what it was first. 

So like I said earlier, you know, we look at the different diagnosis. The fact that it was nonspecific. And what I mean by that is, you know, his foot wasn't stocking the ground and he changed direction. There wasn't a lot of swelling on presentation in the clinic. Sometimes with patellofemoral pain syndrome, you can have a minor bit of swelling. And he couldn't remember a specific event. This was what he was tying it to the seven hours of mountain biking. 

So for us, we have to build a picture off that you know that kind of excludes or includes a lot of differential diagnosis, like I said. So he did say that the pain was sort of in behind the kneecap and a bit more to the inside of the knee cap or the medial aspect I would say of the knee. Usually when it's on the outside, you might've heard of ITB band or runners pain. So that kind of excluded that just based off his subjective and what he was saying.

So basically when I actually asked him a few more questions, there kind of intrinsic factors. And then we asked him about his bike and bike size and biomechanics of his bike. And he actually said that his suspension system, which is filled with air, I believe I'm not an avid mountain biker, but he said that his saddle was quite low. Which meant that the knee angle was, his kneecap was being forced off his femur, a lot more on the ride than it usually would have been. So usually a higher saddle decreases the force of the kneecaps. So I really feel that that kind of factored in to why his knee really got aggravated on the mountain bike on the way down especially. So that was kind of his initial presentation, I suppose. 

Mark: And then what was the treatment course? What kind of torture did you put him through? 

Simon: Yeah, exactly, torture is right Mark. So a lot of the time, like I spoke about there, you know there's intrinsic factors. So generally with patellofemoral pain syndrome, you know, the structures on the outside of the knee, you know, your outside quad and your ITB band that I spoke earlier, are a lot tighter especially in, in cyclists. So the inside knee is weak, which is the inside quad call your VMO and the outside is your lateral vasteralis. So we kind of do a lot of soft tissue work down along the outside of the leg. And we do a lot of IMS, which is intramuscular stimulation. It's called dry needling because you're not actually injecting anything. It's just needling. So basically we do a lot of needling into the muscle called your tensor fasciae latae. Now, that joins onto the band that goes down outside your leg and joins  just below your knee. So a lot of times those structures can become sort of short and tight. 

So the whole goal of the treatment is to needle the muscle on the top. Deep, soft tissue massage down the outside leg. And that has just released all the outside aspect of knee. And then we strengthened the muscle on the inside of the leg. So this theory will allow the kneecap to come more to the inside or towards your other knee. But the knee cap travels in a groove and under in your femur.

So in other words, you're strengthened the inside of the knee. You rule out the outside of the knee and in then the kneecap travels, that's the intrinsic factors. The factors associated with this, are kind of a knee in position. So if your knee is coming very close to the bar, as you're cycling up and down, if the saddle is actually too low, like I spoke about earlier, that all increases the force of the kneecap on the back of the femur.

So you can do all the treatments you want intrinsically, but you really have to fix the extrinsic factors for more longer term results and relief. That's why it's very important to take a good, subjective examination. And that's kind of treatment that we would start to do far and sorry, the exercises under the knee coming in, you generally with a knee in position, you have weak hip. What we call external rotators or abductors. So keeping the knee away from the other knee. 

So a lot of strengthening exercises to get that knee into correct bio-mechanical position, along with satellites and key position. Even though he's a mountain biker, he probably wouldn't need key position, but they're all the kind of factors that we have to factor in when we're dealing with a client like this.

Mark: And so what kind of result, what was the prognosis and how did it work out for this client? 

Simon: Absolutely Mark. Yeah. So when he first arrived in, I forgot to mention it actually, you know, he was feeling pain after 10 or 15 minutes mountain biking, up and down. So by the time I finished with him a couple of weeks ago, he was up to like three or four hours again, pain free.

So I think most of it, like I said, it's a combination. He definitely had tight outside structures or lateral structures. We eased off all that. We strengthened the inside of his leg. I spoke to him a lot about the biomechanics and exactly how his knee can go up and down. So he was very, very pleased. He had no pain obviously, and obviously, initially you have to get rid of some of the aggravating factors like avoiding kneeling on his knee. Sometimes even seated positions can push the kneecap away. So he was doing a lot of sitting at a desk job as well. So when it's very, very irritated that can even be painful without direct compression, like kneeling on the knee, like I spoke about. And avoiding deep, deep positions at the knee like deep squats, they were all implemented.

So we got them back to pain-free, but obviously he wasn't back mountain bike. And so by the end of it, we just increased gradually fixed his satellite, fixed his foot position and then he gradually got better and better till he was up to three or four hours. So he was very, very pleased with the outcome. As was I. 

Mark: Great. So if you have some knee pain that you need expert diagnosis, and then a proper training program that will relieve the pain for good and the knowledge for yourself so that you know how to prevent it in the future, because these things can go on for a long time. I can speak from experience on this. Insync Physio. You can get ahold of Simon Kelly at the Cambie Street office, which is at (604) 566-9716. Or check out You can book online there. It's very simple, very easy to use. Or if you're in North Burnaby, they have a Burnaby location. You can reach them at (604) 298-4878. Again, you can book Thanks Simon. 

Simon: Cheers, Mark. Thanks very much.