Category Archives for "Knee Injuries, Pain, acl"

Knee ligament Injuries – Big Ball Curls

When you injure your knee ligaments an important part of the recovery process is to begin to strengthen it properly. Big Ball Curls do just that!

Lie down on the ground with your lower legs and the back of your calves and heels on a big ball. Keep your arms on the ground, knees straight and the inner core muscles for your lower back engaged so that your back stays in neutral.

Then lift your butt up off the ground while maintaining your balance and then curl the ball in towards your butt with your heels activating your hamstrings and posterior hip muscles. Hold this for a good second with the knees fully flexed and then slowly straighten the knees push the ball away from you.

Keep your butt off the ground the whole time for ten reps and then come down for a rest after one set of 10 reps. Do 3 sets of 10 in total.

This is a great exercise to build more functional core and knee strength after injuring it. If you have any problems or questions with this exercise consult your local Physiotherapist before continuing. 

Knee Pain – Heather Camenzind

Mark: Hi, it's Mark from Top Local. I'm here with Heather Camenzind and she's a physiotherapist at Insync Physio in Vancouver in the Cambie Street area. And we're going to talk about knee pain while running. How are you doing Heather? 

Heather: I'm good. Thanks for having me Mark. 

Mark: So knee pain from running. This is a new thing, or there's been an increase in it because of something. 

Heather: Yeah, it's not a new thing, treated a lot of it before. But I'm seeing an increase in the past year. I think with the current status of our globe and with the pandemic, we're seeing a lot of people that have taken up running as their form of exercise with the gym schedules being modified and closed. So I'm seeing an uptake in the clinic with knee pain. 

Mark: So is there specific things that cause knee pain from running? 

Heather: There's many different causes. But a lot of them that we're seeing is a breakdown for the underside of the knee cap. So it's basically, it's a rubbing on the underside of the kneecap on the end of the femur bone. And there can be different causes to why that breakdown is happening. And so that's why a physiotherapist can help with that. 

Mark: So what's the protocol. What does treatment look like when you're faced with a client coming in? 

Heather: Yeah, a typical treatment will start with a history of how long that they had the pain. Where does the pain, can they describe it? And you just have a good chat about that. And what are some factors that may be contributing to that? So changes in current training schedule, have they significantly increased how much they're running or the terrain that they're running on? 

Other things that can affect it are their footwear? Have they made a change to their shoes? Or lifestyle changes. So that's what we're seeing a lot of right now is the lifestyle changes. I think people are trying to be active, but we're also told to stay at home a lot right now. And so I think people are sitting more than they typically would in the past.

Mark: So give us a couple example things of how you would treat this. Couple of causes, a couple of treatments. 

Heather: Yeah, so different ways that we can treat it is sometimes it's just that the hip flexors and the quads are more tight. And so we have to release the tension through there. So the physio might work with some manual therapy on that, and then give you some exercises such as foam rolling, and some stretches to open up the quad and the hip flexors.

Another common thing that we're seeing is that people are weak in their glute muscles. So, especially their glute medius muscle. That's the muscle on the side of your hip that helps control the alignment of your knee. And a lot of just like leg lifts out to the side. Or like your figure four stretch is a very common stretch that people know, are ones that can help with that hip tightness that will help with the alignment of the knee.

Mark: And what's I know it's case dependent, of course, but what would be a more typical treatment program and what might it affect how effective it is? 

Heather: Yeah, so different things that can affect like how much progress you see is a, I counsel people on is kind of like, the more often you do your exercises and how frequent you do them, you'll get a better bang for your buck so to speak. If you're consistent with them, you'll notice progress sooner and faster. If you're maybe do them once a week, yeah, you may get there. It will improve. It'll probably just take a lot longer. So the more consistent that you are at home the better it is. You only really see your physio probably once a week maybe for maybe half an hour, 45 minutes an hour, if you're lucky. So there's so many more hours in the day that you can be working on things yourself. 

The other thing is just, can the physio diagnose and figure out what is the major contributing factor for you? Is it just a modification that needs to be done to your training program? Have you increased things too quickly? Or can they narrow in on the specific weaknesses that are contributing to your knee pain. Such as glute weakness, or maybe it's your running shoe? So it's proper diagnosis of what is the main cause. And then you'll start to see progress. Typically we see progress within six to eight weeks that you're seeing significant progress with it.

Mark: And I guess depends on how much the pain is and the cause whether somebody has to totally stop their running program in order to let the healing happen. How does that work? 

Heather: Exactly. So some people come in and they're, they're very flared up. Everything is hurting, just walking and it's very sore. Those people benefit from just allowing their nervous system, allowing their body, the inflammation that's there to calm down.

So we have to say, I'm sorry, you have to stop running right now. Others it's maybe their knee pain only comes in 45 minutes into their run or something. It comes on later and then their body tolerates it quite well. They don't really get too aggravated after. So those people we're able to work with them and just modify their running program and get them doing the right exercises. And then we're able to maintain their running. So it depends on the person. And sort of a case-by-case basis on what I typically recommend for them. 

Mark: So if you put the work in and you listen to your physio and have the right shoes and don't crank it up too much, within six weeks, eight weeks, you're probably back running as hard as ever and all the things you want to do without pain.

Heather: That's the hope. Yeah, definitely. 

Mark: So there you go. If you want some expert advice on how to deal with your knee pain while running, or any kind of knee pain or any kind of shoulder problems or neck or back, or you name it basically toes to the top of your head, this is a person to call. Heather Camenzind. You can reach her at Insync Physio to book an appointment. Insyncphysio.com book online. You can see there, they've got both the Vancouver and Burnaby booking systems are hooked up. Very easy to use. Or call the office at 604-566-9716. Thanks Heather. 

Heather: Thank you very much. Bye.

Knee Ligament Sprain Injuries – Airplane Transitions

Start with one lower leg length away from the wall. Plant the foot on the ground with the standing leg. Hip hinge into the wall and make sure you hinge at the hip and not bending through the knee.

Keeping your pelvis, navel, and the centre of your chest in a straight line and pivot through the hip, turning your pelvis over the standing leg. You should be feeling it through the side of your hip, back of your gluteal muscles, and the upper part of your hamstring. 

This is a great exercise to build more core strength to help with the rehab of your knee ligament injuries. 

Knee Ligament Injuries – One-Legged Squats

This is a great exercise to rehab & strengthen your knee injury after you have sprained it. It works the muscles of the lower quadrant to help provide more dynamic stability.

Keep both sides of the pelvis level and squat down on one leg pushing your butt back like in a chair. Keep the knee over the ankle and aligned with your hip and second toe and prevent it from moving past the toes as you squat. You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward. Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10 repetitions doing 3 sets on each side.

Knee Ligament sprain injuries affect the optimal activation of what’s called proprioceptive strengthening, or rather the balancing muscles of the leg and hip. The gluteus medius is a muscle that is important in this function.

If you have any pain or problems doing this exercise consult a local physiotherapist before continuing. 

Knee Ligament Injuries – One Leg Balance with Dumbbell

Stand on one leg holding a 5-10 pound dumbbell. Keep the opposite foot hiked up off the ground by engaging your gluteus medius muscles of your butt. Maintain your balance on that leg while transferring the dumbbell between your hands in a circular direction around your body.

Keep squeezing your glutes and activate your core muscles to maintain your balance. Pass the dumbbell in the opposite direction at the halfway mark while performing this exercise for 60 seconds in total. Do this for 60 seconds for 3 repetitions on each side.

This is a great exercise to gain more strength, balance and proprioception in your knee and hip and core stability after a knee ligament injury. If you have pain or are unsure about the exercise, consult your local physiotherapist before continuing. 

Knee Pain Overuse Patellar Tendinopathy – Spanish Squats

Place a strap over your leg at just below knee level. Keeping your knee in line with your second toe, sit back into a squat position, ensuring your knee stays back behind your toes. Hold this position for 10 seconds. Slowly return back to starting position. Repeat this exercise for 3 sets of 10 repetitions This exercise is useful for patellar tendinopathy, a condition that involves overuse of the patellar tendon.

Knee Pain Ligament Injuries – One Leg Bridge

Start out lying on your back with your knees bent. Hug one knee to your chest. With the opposite leg, squeeze your bottom and push through your heel to raise the hips up towards the ceiling. Hold at the top for 10 seconds. Slowly lower down. Repeat 3 sets of 10 repetitions. 

This exercise is great for knee pain to strengthen the gluteal muscles while offloading the knee. 

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. 

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 Insyncphysio.com. 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 online@insyncphysio.com. Thanks Simon. 

Simon: Cheers, Mark. Thanks very much.

Knee Patella Femoral Pain & IT-Band Syndrome – 2 Leg Squats

Start with a tall neutral spine posture and engage your core by drawing the inner core muscles below your belly button inwards toward your spine. Avoid arching the low back.

With arms in a ready position do a two leg squat with your body weight distributed equally over the toes and heels of both feet. Don’t go any lower than a ninety degree bend in the knees, keeping them in alignment with your second toe and over your heels as much as possible. This part of the squat is essential as you bend your knees and focus on bringing your bum backwards. You can imagine that you’re squatting down to sit in a chair. Perform 3 sets 10 repetitions twice daily.

This two leg squat may look like a basic strengthening exercise. However, what you’re doing here is retraining the neuromuscular activation pattern of your leg, hip and lower kinetic chain muscles in doing the squat more more effectively. This will produce a more optimal movement pattern to decrease the irritation in your knee. 

If you’re unsure about the exercise or have any uncertainty about where you’re at with your knee pain and doing painful squats or playing sports painfully that involve the squatting motion, consult your local Physiotherapist before continuing. 

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