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. 

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.

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. 

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. 

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.

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. 

Stand on the right side of your Bosu Ball on your left leg with your inner core muscles engaged. Slowly bend down at your Hips pointing your left finger to a spot on the floor in the nine O’clock position on the face of a clock.

Then straighten back up to standing pushing through your entire foot with a focus on your heel. Bend back down pointing to the floor in the 10 O’clock position and stand back up again. Continue to repeat this for the eleven, twelve, one, two and three O’clock positions.

Then perform a lateral hop onto the Bosu Ball and then onto the floor to the left side, and repeat the one leg squats from nine to three O’clock. Then repeating your second set on the right & left sides of the Bosu; you can now go backwards and point down to the floor starting from three to nine O’clock.

Remember that as you bend at your knee, you will be bending even more at your hips and you want to keep you knee over your ankle and aligned with your second toe. Perform 2 sets on each side for each leg daily. This advanced exercise will help you develop more progressive strengthening so you can fully overcome your knee ligament injury and connect with how you really want to move again.

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. 

Whether it’s returning to sport or just being physically active, part of the rehab for your knee injury is to regain the functional strength of your gluteus medius muscles with lateral movements.

Wrap a closed loop resistance band around the balls of your feet. Start with the feet about shoulder width apart. Keep your posture straight and tight and your core muscles engaged. Lift one foot up and out 3 inches to the side leading with the heels. Resist the lateral movement of the foot with the opposite foot, leg and hip that’s on the ground. Make sure that the knees don’t buckle into each other, don’t bob your head up and down, and keep the toes pointing forward (Avoid having the toes pointing outward with the hips externally rotated).

Repeat these robotic type of lateral movements for 5-10 steps going right to left and then left to right for 3 sets on each side.

Hold onto a 5 lb dumbbell with your right hand. Engage your inner core muscles and keep your posture in neutral.

Do a side step lunge with your left foot to the left side and keep your knee pointing forward and over your ankle while you bring the dumbbell down towards that left foot. Push back up through your left foot and bring your body weight over your right knee.

As you flex your left hip, perform a 1-arm shoulder press with the right arm. Make sure your knee stays in alignment with your second toe, and over your ankle as you perform this exercise. Do 10 reps, 3 sets on each side.

This exercise can help with progressive strengthening and rehab of your injured knee. It can help you become functionally stronger in jumping for Ultimate Frisbee like in skying the disc in those moments when you feel like you need a dynamically stronger core. It can also help you with your 1-legged jumps in volleyball, basketball, rock climbing, or any other jump and reach type of sports or activities.

If you have any pain or problems or injuries, book in to see one of our Physiotherapists at INSYNC PHYSIO at either the Vancouver or Burnaby locations. 

Hold onto a ten pound dumbbell with your hands on both ends and engage your inner core stability muscles below your belly button.

Then lunge backwards with your right leg performing a wood chopping motion with the upper body and arms turning only your torso. Push back up with the right foot to the start position. Repeat this for 10 repetitions doing 3 sets for each side.

This exercise is excellent for strengthening your knee and developing better balance and proprioception and more optimal neuromuscular activation patterns after a knee ligament sprain injury.​

If you have any problems doing this exercise, please contact one of our Physiotherapists at either of our locations in North Burnaby on Hastings Street or in Vancouver on Cambie Street.