Category Archives for "pain"

Knee Ligament Injuries

Background: The knee and the injuries that are involved in this joint are proved to be common and difficult to rehabilitate. In this blog, we will focus on injuries specifically to one of the four ligaments of the knee as shown above. Ligament sprains/strains/tears are most commonly acquired through sport related activities. The most common by far is the ACL tear which usually requires surgery to fix and can force an athlete to miss entire seasons before training again. 

The best way to prevent a ligament sprain and especially a tear, is to maintain stability and strength in the muscles of the legs, glutes and core, ensuring you are warmed up before a workout/practice, and consulting a physiotherapist if you experience any sudden pain. Also, for prevention of any injury, be sure to stretch, ease into new exercises, and ensure you have a proper form with a stable base of support before and during an exercise (even in sports, think about how kicking a soccer ball for example affects your joints).

If you have injured your knee in the past, are currently rehabilitating, or would like to work at strengthening the ligaments of the knee for your personal athletic ventures, check out our latest series on the INSYNC youtube channel such as the ones here below!

Anterior Cruciate Ligament Knee Injury: Roller Bridges

Knee Ligament Injuries: Looped Band Bridges

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

pTHealth Canada. (2018). Ligaments of the Knee [Photo]. Retrieved from

Core Stability – Why does it matter?

What is the core, and why is it important?
The core is the center of our body, and its function is to stabilize the trunk while the arms and legs move. The core consists of muscles that stabilize the hips, torso, and shoulders, therefore having a strong core can help us prevent major injuries, while improving balance and stability. Building a strong core can make it easier to do most physical activities, whether it just be daily tasks or sport performance. Weak core muscles can lead to poor posture, low back pain, and muscle injuries, therefore it is crucial to build a strong core alongside your daily exercise routine. 

Benefits of core strength/stability include:

  • Injury prevention
  • Low back pain prevention
  • Improved posture
  • Balance and stability doing every day tasks such as housework
  • Improved athletic performance. 

Exercises for core stability strengthening

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Healthwise Staff (2017). Fitness: Increasing Core Stability.
Retrieved from

Temporomandibular Joint (TMJ) Disorders

What is a TMJ Disorder?

The temporomandibular joint (TMJ) connects your jawbone to your skull. You have one TMJ on each side of your jaw, and any type of pain in this jaw joint and muscles that control the jaw movement can be a symptom of a TMJ disorder. The exact cause of a TMJ disorder can often be difficulty to determine, therefore visiting a specialist can give you a better diagnosis. The pain can come from a combination of factors such as arthritis, jaw injury, consistent teeth grinding, and genetics. 

Signs and Symptoms

  • Pain or tenderness of the jaw
  • Pain in the TMJ’s
  • An aching pain in and around your ear
  • A clicking or popping noise when opening and closing the mouth 


  • Improving posture in the neck and upper back muscles 
  • Ice or cold packs to areas of the joint during onset of inflammation
  • Avoid excessive gum chewing 
  • Massages or gentle self-stretching of the jaw and neck muscles 

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Canadian Dental Association (n.d.). Temporomandibular Joint Disorder.
Retrieved from

How Do YOU Experience Pain?

Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components (Williams & Craig, 2016).

Positive pain refers to non-injury pain that is exertional and related to reappraisal, whereas, negative pain is injury and damage-causing pain that is associated with catastrophizing. Catastrophisizing include feelings of hopelessness, inability to cope with situation, or ruminating on pain and injury, all of which may lead to avoidance behaviours that increase the risk of injury.  Negative pain is potentially correlated to neuromuscular deficits such as Achilles tendinopathy which reduces muscular endurance or meniscal tears which lower muscle activation. It can delay or prevent return to a sport or possibly lead to chronic pain development (McDougall, 2017).
Elite athletes are able to withstand higher levels of pain and make better use of pain in performing well in their sport.
What can you do to better cope with pain?

1) Education: better knowledge of pain and ways to reduce pain or anxiety

2) Goal Setting: specific, measurable goals that provides direction

3) Imagery: a method used in a rehabilitation setting to reduce stress hormones by anticipating pain 
4) Graded Exposure: exposing oneself to fearful situations to show no more harm

5) Social Support: increase support from family, friends, and teammates

6) Relaxation: reduce tension and anxiety with deep breathing and low-intensity activities
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.


Understanding & Tackling it!

What an interesting concept Pain is! According to the International Association for the Study of pain, pain is described as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The first part regarding actual damage makes sense to most, however the second part of this definition leaves something to be desired. You might be thinking right now, are you telling me that I can have pain without having actual tissue damage? Absolutely, and this is what makes pain such a fascinating thing.

To better explain, its best to take a step backwards and explain why pain exists and what purpose it serves for us as busy, moving, functioning human beings. We have learned a lot about pain in the last 20 years and treatment of pain has really changed now that we understand more. At its roots, pain is a fantastic protective mechanism! 

Take for example, burning your finger on a hot stove element: if your finger touches the element, the receptors in your skin immediately send a danger signal to your brain (important note: NONE of our body’s tissues have pain receptors, only ones to send danger signals). 

Once this DANGER signal gets to your brain – which thankfully takes milliseconds – based on previous experience with hot stoves, likely having burned your fingers or other body parts before, and awareness of the situation, your brain will interpret this as a real danger and quickly send a PAIN signal to the finger. As a result of this PAIN signal reaching your finger, your brain reacts quickly to the rescue and you pull you finger away and run it under cold water to protect it and help it heal! Naturally, it’s a perfect protective mechanism.

As you can see from this example above, PAIN IS EXCLUSIVELY CREATED BY THE BRAIN.

Just In Your Head?

Does this mean that all pain is just “in your head”? No, all pain is real but it does mean that because its created by the brain, there are lots of factors that can influence this pain system. Some of these factors include stress, anxiety, emotions, beliefs around pain, expectations, fear, and activity levels. These all contribute to the sensitivity of ones pain experience – some will increase it (e.g. stress, anxiety, fear, negative expectations) and some will decrease it (good activity level, low stress, positive beliefs and expectations). This is why its important to talk to a health professional to figure out what may be contributing to your pain as research has shown that pain education is one of the most effective management tools.

Nocebo Effect

Lets re-visit the idea of having pain with no actual tissue damage. There is an emerging concept in pain science called the “nocebo” effect which tells us that symptoms like pain and illness can emerge from simply believing or expecting that we have been exposed to painful stimuli or potential illnesses! For example, in drug trials, a certain percentage of participants are given a fake drug (i.e. sugar pills) and told that they are taking the real medication and that there are some potential side effects. What we see with these trials is some of the participants report these side effects from a drug that they ARE NOT EVEN TAKING! (Source: nocebo effect). These participants think they are on the real medication and therefore think themselves into the side effects. Similarly, in research around perception of pain, subjects reported amplified pain ratings even with harmless stimuli when they were told to expect a painful stimulus! (Moseley & Arntz 2007).

As you can see, pain can be a tricky thing and because of this, it’s important to tackle your individual pain with a tailored approach. It is always easy and tempting to consult Dr. Google or ask your friends or family members that have had similar aches and pains but it is important to recognize that no two injuries or pains will be quite the same.


There are a few key points regarding pain that apply to almost all types of painful situations and injuries:

1. All pain is real and all pain is created by the brain
2. Many factors influence the pain experience and this makes it a very individual thing
3. Education around why you are in pain one of the most effective management tools!

Jeffery Jukes, Registered Physiotherapist Send Email
MPT, B.Sc., CAFCI(Acupuncture), IMS
Jeffery Jukes - Portrait
Jeff Jukes is a registered physiotherapist at INSYNC Physiotherapy in Vancouver. He has lots of experience working with chronic pain populations and therefore has done extra training and individual research to effectively help with all kinds of pain. Jeff’s treatments are multi-modal in nature and include hands on treatment, pain education, acupuncture, Intramuscular stimulation (IMS), and therapeutic exercises. Talk to Jeff regarding any type of injury or pain!

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.