Knee pain is one of the most common issues we hear about at Sunup Physiotherapy. Knees can be injured by trauma, repetitive strain or as a result of deficiencies in motor control and muscle balance. In any case, it is important that you have your knee pain assessed by a medical professional be it a physiotherapist, chiropractor or Physician. It is important to seek treatment for your knee pain early as possible to avoid developing stubborn compensations strategies that make the rehab process longer and more challenging.

Why is the Knee Joint Unique?

The knee is constructed for a lifetime of weight bearing and weight transfer. The joints that compose the knee include:

  • Tibiofemoral joint – thigh bone to shin bone
  • Patellofemoral joint – knee cap to thigh bone
  • Superior tibiofibular joint – on the outside of the shin just below the knee connecting the two lower shin bones to one another.

The knee joint is complex due to the meniscal (cartilage) structures that sit between the tibiofemoral joint. These two cartilaginous ring structures deepen the groove of the knee, providing joint lubrication, nutrition and also provide sensory feedback to our brains. The meniscus can be injured with a sudden movement, poor mechanics, or can get worn down with age and with repetitive poor movement strategies.

Along with the meniscus there are several ligaments, muscles, tendons and bursae that are part of the knee complex and each of these structures can also be the cause of knee pain.

What are the Causes of Knee pain?

Ligaments Sprains

Ligaments connect bone to bone and surround joints to help with joint stability in order to prevent excess movement at the knee. When you sprain your knee, it can disrupt one or more of the ligaments. These ligaments are stretched when the knee is taken beyond its natural limits. This generally occurs as a result of a trauma or specific event but can also sometimes occur gradually when there are boney alignment and muscle imbalance issues. The four main ligaments of the knee are the Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL). It is always important to see a medical professional if you think you have sprained your knee.

Muscle Strains or Tendinopathy

There are numerous muscles that cross the knee on the front, back, sides and over the knee cap. When excessive demand is placed on one or more of these muscles they can become strained and an inflammatory response will ensue. This can happen instantly when injured or may occur over a period of time with repetitive loading in a dysfunctional manner. The part of the muscle that attaches to bone (the tendon) can also be injured in a similar fashion, either by a forceful contraction of the muscle or non-adaptive repetitive loading. When the tendon goes through cycles where it is injured, then heals and then gets injured again, the cells within the tendon start to become unhealthy and can permanently die. This is why you should seek attention from a qualified professional such as a physiotherapist or chiropractor at the onset of any muscle or tendon injury. Your trusted health care provider will identify the root problem and help you build strength in your muscle and tendon to prevent re-injury in the future.

Knee Bursitis

Bursae are small fluid filled cavities that are specifically placed to prevent friction when muscles and tendons slide and glide over bone and other tissues. The bursae can get irritated and injured when there is overuse or excessive pressure on the knee joint. There are 11 bursae within the knee. Two of the most common areas of bursitis in the knee are: (1) the supra patellar area (above the kneecap) and the Pes anserine area (below and towards the inside of the knee). Although this condition can be extremely painful, it can be successfully managed through physiotherapy.

Meniscal Injuries

Injury to the meniscus can be degenerative developing over long periods of time or they can happen instantly with trauma most likely the result of an excessive twisting force on a bent knee. Common signs and symptoms of a meniscal injury include clicking and/or popping deep within the knee, locking of the knee (feeling like it is stuck and needs to be shaken out) in addition to pain on twisting, pivoting or walking on uneven surfaces. You also may notice some swelling and that you cannot fully straighten your knee when standing. Scientific studies indicate that the majority of meniscal lesions respond best to conservative management and not surgery. If you suspect you have injured your meniscus it will be important to get assessed by a physiotherapist or chiropractor to determine the best course of treatment.

Patellofemoral Pain Syndrome

This is a generalized syndrome that is characterized by anterior (or front of knee) pain that is typically caused by mal-tracking of the knee cap along the grooves formed by the thigh bone. The knee cap is the largest sesamoid (or floating bone) in the body and has the thickest cartilage. The muscles and connective tissue that surround and attach to the knee cap will pull and guide it as we bend and straighten our knees (ideally through the Centre of the groove). When there are muscle imbalances or dysfunctional foot, knee or hip alignment, and/or there are other factors that cause the knee cap to glide outside of the groove and tracks, knee pain will occur. This condition can be successfully managed through physiotherapy treatment but there is no quick fix. You will need to work diligently on your strength and flexibility program and may need to adapt your activities for a short while. Your physio may also guide you on how to slowly and gradually load your knee joint again so that you can build back up to your desired capacity.

Degenerative Changes

Osteoarthritis of the knee can occur as we get older and typically presents in middle to late aged individuals. The degenerative process and natural wearing of the knee joint can also occur earlier in the lifespan if there has been a traumatic injury to the knee or previous surgery. During this natural process of degeneration (similar to wrinkles that develop on our skin) the cartilage that lines the bones of the knee joint starts to thin and wear down. As the cartilage thins, there can be more pressure against the boney surfaces of the joint. The increased pressure can stimulate a response in the bone causing bone thickening as well as boney outgrowths (osteophytes). The sequela of events can lead to inflammation, pain and stiffness in the knee joint. To prevent further wear and also to manage the pain and discomfort it is important that you keep the muscles that influence the knee strong and flexible. It also is helpful to maintain a healthy body mass and active lifestyle. Physiotherapists and chiropractors can help you overcome a flare up and can advise you on an individualized home program so that you can learn to manage your condition successfully.

Chondromalacia Patella

As mentioned above the cartilage behind the kneecap is the thickest in the body. This is reflective of the amount of force and pressure that will be directed through the knee joint, quadriceps and through the knee cap during a lifetime. With this condition, the cartilage behind the knee cap begins to deteriorate and wear down. Typically, this process is instigated by poor alignment of the knee cap along the thigh bone in combination with repetitive loading activities. Often, muscle imbalances around the hip, feet and knee can be linked and correcting these imbalances can help to improve the alignment of the bones as well as the tracking of the knee cap. This treatment strategy can halt further progression of the condition and can keep symptoms under control while still being able to participate in the activities you love. Your trusted physiotherapist at Sunup Physiotherapy will help to assess your knee and develop an individualized treatment program that will get your knee cap back on track.

Lumbar Radiculopathy As A Cause of Knee Pain

In some instances, you may experience pain in your knee but the origin of the pain is stemming from your low back. There are nerves that exit your low back and travel down your leg to innervate the muscles, skin and tissues of the lower body. If one of those nerves is irritated or compressed, it can refer pain down your leg. There are specific nerves that can result in pain around the knee. If you have this condition, you may also experience pain and/or stiffness in your lower back and may even notice that specific back postures influence the knee pain. It is important that you have a thorough assessment from your trusted Physiotherapist or Chiropractor to determine the true source of your pain so that treatment can be geared to the right area of the body.

How can Physiotherapy, Chiropractic and Massage Therapy Help you Recover from Knee Pain?

A team of healthcare professionals can personalize your treatments to address your specific injury and help you return to your lifestyle goals, be it climbing the stairs pain free, running, skiing or something else that is important to you. Treatments with your trusted Physiotherapist or Chiropractor will often start with pain control strategies. Your therapist may use modalities such as shockwave therapy, laser, ultrasound, acupuncture or dry needling to help. Once your pain is under control, your Physiotherapist or chiropractor will use hands on techniques to improve mobility at your hip, knee or ankle joints through mobilizations and manipulations. They will also give you exercises that will maintain your treatment gains and help you build strength and control through your lower extremity. Soft tissue release is also an important aspect of care. Some of this will be done by your Physio or Chiro and in some cases, referral to a registered massage therapist may be necessary. Education regarding lifestyle modifications, pacing, posture re-education and gradual reintegration of activities will be covered. Your therapist may also recommend a knee brace or tape to support your knee and in some cases, orthotics can be recommended. If your knee pain has not resolved in 1-2 weeks or is getting worse from its initial onset it is highly recommended that you seek the advice of a trusted Physiotherapist or Chiropractor who will conduct a thorough assessment and offer conservative treatment strategies that can help you get back on track again.

How Long Does it Take to Recover from Knee Pain?

Depending on the cause, severity, duration of the pain and your ability to get the proper treatment, recovery can take a few weeks up to a few months. In some cases, such as when there is a large meniscal tear or full ACL rupture, arthroscopic surgery may be required. If surgery is required, it is always best to receive pre-surgical rehabilitation (prehab) and post surgical rehabilitation (rehab) to ensure your surgery is a success. Remember to be patient and consistent with your prescribed home exercise program. Keep in mind that your trusted physiotherapist or chiropractor sees these types of conditions regularly and will be the best person to advise you on the best course of treatment. They will inform you if your symptoms are not progressing as expected and if you should book a consultation with a doctor for further investigations or alternate treatment options.

What are the Best Exercises to Help with your Knee Pain?

A well-rounded program should address hip, knee and ankle range of motion and will incorporate a graduated strengthening program. Exercises should always be individualized to your particular needs and goals.

Some of the most common exercises are as follow, to help you get started. These exercises should be performed in a pain free range and modified or stopped if pain increases during or after the movement. For motor control focused exercises, it is important to perform these by in perfect form and in a slow and controlled fashion 3 sets of 10 repetitions.

  • Squat
  • Lunge
  • Clam Shell
  • Calf Raises
  • Bridge
  • Step Up And Step Down
  • Quadriceps Stretch
  • Hamstring Stretch
  • Calf Stretch
  • Adductor Stretch
  • ITB Release

How to Treat Knee Pain at Home?

  • If you have acute pain in your knee, you may want to try ice first especially if there appears to be swelling or you recently hurt your knee in the last day or so. If the pain has been developing gradually over time, or has been lingering on and off for some time then heat might be the better choice. You may also choose to apply both intermittently as long as they help your symptoms and make you feel better after application. Remember to always protect your skin from the hot or cold temperatures by using a thin cloth or wet towel between the source of heat or cold and your skin. Always perform skin checks to ensure your skin is not getting irritated. Try not to leave the hot or cold on your skin for more than 10-15 minutes at a time and be sure to allow your skin to return to room temperature before you re-apply.
  • You should also try to understand the positions and activities that aggravate your knee pain. Try to modify these positions or avoid them temporarily until you can gradually reintroduce them back into your routine.
  • Posture Re-Education and Activity Modifications: to prevent further aggravation and If you notice your knee mobility is starting to cease up, try working on your range of motion (ROM) with gentle movements.Bend and straighten your knee 10x every 5 hours within a pain free range so it does not become stiff. Perform some isometric (no movement at joint but muscles on) strengthening of the muscles 5x every 5 hours.
  • Isometric Quadriceps – Lying on your back, with a small towel rolled under your knee, press the back of the knee into the towel and tighten your quadriceps muscle group. Hold for 5 seconds, gently release and repeat.
  • Isometric Hamstrings – Lying on your back, bend your knee so that your heel can be placed on the floor with your foot flexed, dig your heel into the ground as if you are pulling your heel towards your buttocks. You should feel some activation in your hamstrings muscle group. Hold for 5 secs and gently release. Repeat.

If your knee pain continues, we highly recommend visiting a trusted physiotherapist or chiropractor so that they can conduct a thorough evaluation of your knee and determine a treatment plan that will help you get back on track quickly. The physiotherapists and chiropractors at Sunup Physiotherapy have a great deal of experience and expertise with the knee and are here to help if you require it. Contact us to book your initial consultation today.

Total Knee Replacement

Total Knee Replacement (also known as Total Knee Arthroplasty) is a surgical procedure that replaces the existing knee joint with prosthetic components. The joint surfaces of the thigh bone (femur) and lower leg bone (tibia) are replaced with metal implants that cover the ends of the bone. The surgeon may also remove the undersurface of the kneecap (patella) if indicated and replace it with an implant as well.

What Injuries/Conditions Cause a Total Knee Replacement?

Total knee replacement surgery is indicated when there is degeneration in the knee that causes pain, swelling and impaired function that did not respond to conservative treatments. Degeneration in the knee is commonly caused by arthritis. When the cartilage in the knee wears down and the joint surfaces are now carrying load, it will produce these symptoms, which will lead to functional limitations such as walking, stair climbing and even getting up from a seated position.

How can Physiotherapy Help with Total Knee Replacements?

Physiotherapy will help with decreasing pain, regaining your range of motion and increasing your strength after surgery. Your physiotherapist will answer your questions and help you achieve your lifestyle goals. They also play an important part of ensuring the surgery is successful with achieving range and strength gains in the initial weeks post-op. Prior to surgery, it is recommended that you try a 6-8 week strengthening and treatment program with a physiotherapist to help prolong or prevent the need for surgery.

What Should be Avoided with a Total Knee Replacement?

The surgery will help to diminish your pain and with physiotherapy you will re-gain your range of motion and strength to meet your daily functional demands. It is really important following surgery that you are seeing your physiotherapist regularly. However, you will need to avoid high impact activities (such as running or jumping) as that will accelerate the degradation of the prosthetic.

How Long Does it Take to Recover from a Total Knee Replacement?

Recovery from a total knee replacement usually takes around 3-4 months of rehabilitation. It will be important that you maintain a level of exercise and weight management so you continue to have success with your new knee.

What are Safe Home Exercises for a Total Knee Replacement?

It is important to begin rehabilitation immediately after surgery. Please follow up with Phase 1 exercises described in booklet given to you at hospital post surgery.  Your physiotherapist will guide you through exercises and ensure proper technique. Some safe home exercises to do are as follows:

  • Straight Leg Raise
  • Knee Extension Over Roll
  • Active Assisted Knee Flexion

To continue your post knee replacement rehabilitation with our experienced physiotherapist. Contact us today!

ACL stands for Anterior Cruciate Ligament which is one of the four main ligaments that stabilize the knee. In many medical circles it is considered the most important stabilizing ligament of the knee. When torn or injured it often means a long recovery period which could involve surgery or conservative therapies.

“You have a torn ACL”. These are typically the last words an athlete ever wants hear. Below you will find an information on how this ligament gets injured, who is at increased risk, the approximate recovery times as well as rehab and prevention methods.

Mechanism of ACL Injury

The Anterior Cruciate Ligament (ACL) is responsible for stopping your shin bone (tibia) from translating forward past your knee’s normal anatomical limits. The most common mechanism of injury is a cutting or pivot type of motion, where there is a sudden change of direction when the foot is planted. Other ways to injure your ACL includes improper landing techniques from a jump or fall, or a direct hit to the front of the knee. The vast majority of ACL injuries are non-contact.

Grades of Ligament Sprains: (applicable to ACL)

Grade 1 – Ligament fibers are stretched with no tear. There is minimal tenderness or swelling and no instability.

Grade 2 – Ligament fibers are partially torn with moderate swelling and tenderness. Increased instability with anterior translation but still has a solid end point.

Grade 3 – Ligament fibers are completely torn, there is tenderness but normally minimal pain. Knee is unstable and no ligamentous end point is felt.

Who is at Risk of ACL Injuries?

ACL injuries have the highest chance of happening without physical contact and are normally caused by a type of twisting movement through the knee. They usually occur in fast paced sports with rapid changes in direction. The highest incidences are found in sports such as soccer, basketball, football and skiing. Other potential risk factors include footwear such as cleats on artificial turf. Additionally, weaknesses and imbalances to muscles surrounding the knee and hip are contributing factors.

Women possess greater risk for tearing their ACL than their male counterparts. The reason for this is that women have a wider pelvis and therefore have a greater angle from the top of the femur (thigh bone) down to their knee, known as the “Q” angle. This increased “Q” angle means hip stabilization and knee strengthening are going to be vital in preventing ACL injuries in female athletes. Furthermore, women tend to have more ligament laxity (mobile joints) as compared to males which can also predispose a female to higher chances of injury.

ACL Recovery Time

Once the grade of ACL tear is determined, a proper recovery protocol and timeframe for rehab can be given. In general, a grade 1 or 2 sprain of the ACL can take from a few weeks to a couple months to properly heal. These usually do not require surgical intervention and conservative therapies are recommended. If you have a grade 3 tear however the recovery time is much longer because now there is a decision to make, which is, do I need surgery? With or without surgery it can be approximately 6-12 months before return to sports.

Rehab and Prevention of ACL Tears

Rehab for ACL tears is commonly centered on first reducing symptoms of pain and swelling. Following this achieving full range of motion is normally next on the agenda. While your health care practitioner is working on increasing the range they will also work with you on building strength and improving your balance. There are many medical protocols that exist for recovery but in general the process will involve corrective exercises, muscle stimulation, acupuncture, ultrasound, aquatic therapy, biking and other methods to speed along the recovery times. Shockwave therapy can minimize pain, improves scar tissue, break soft tissue adhesion, speed up healing, and improves mobility quickly.

To prevent ACL injuries in the first place it is highly recommended to work with a qualified therapist and trainer in areas of strength, balance, jump and agility training and stretching.

If you already have an existing ACL injury and need additional information about your options, please contact us today to speak to any of our highly trained Physiotherapists and/or Chiropractors at Sunup Physiotherapy

Lateral Collateral Ligament (LCL) Injury

What is the Lateral Collateral Ligament (LCL) of the Knee?

A ligament is connective tissue that connects bone to bone across a joint to help stabilize that area of the joint against excessive forces. There are four ligaments that help stabilize the knee joint. The Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL), and the Lateral Collateral Ligament (LCL). The LCL is a ligament on the lateral (meaning outside), portion of the knee. It travels from the lower end of the outside of the femur (the thigh bone) to the upper portion of the fibula (outside lower leg bone). Its main purpose is to stabilize the knee when any force is put through it from the medial (inside) to lateral (outside).

What is an LCL Injury (Sprain or Tear) and How Common is it?

The LCL is less commonly injured compared to the other ligaments of the knee. It is rare to have an isolated LCL sprain or injury, it is usually accompanied by damage to other ligaments and soft tissues of the knee. The most common form of LCL injury is an LCL sprain. Depending on the severity of the injury, there are 3 grades of ligament sprains which are described below:

Grade 1 (Mild)

  • A stretch in the ligament causing only microscopic tearing
  • Light bleeding and swelling
  • Mild to moderate pain
  • Range of motion is normal – minimally decreased

Grade 2 (Moderate)

  • Partial tearing or rupture of the ligament
  • Moderate swelling and bleeding
  • More severe pain
  • Range of motion is moderately to severe decreased

Grade 3 (Severe)

  • Complete tear of the ligament
  • Extensive bleeding and swelling
  • Severe pain
  • Range of motion is severely decreased
  • Could feel like complete dislocation

What are the Signs and Symptoms of an LCL Injury?

Signs and symptoms of LCL injury vary depending on the grade of sprain. They can include:

  • Discolouration/bruising
  • Swelling
  • Pain
  • Decreased range of motion
  • Instability (especially this feeling the outside of the knee is going to give way)
  • Hearing or feeling a “popping” or “snapping” when injury occurred
  • Injury that occurred when force contacted the inside of you knee and bent it outward in an unnatural way

How Can I Treat my LCL Injury at Home?

The best precautions to take after a suspected LCL injury is to apply the PRICE principle until you are able to get it checked by a professional

  • REST
  • ICE

What are the Best Exercises to Help with LCL Injuries?

Before beginning any exercises, it is important to go see a health care professional to be sure of the anatomy harmed and the extent of the injury. A full history, physical examination, and plan of management will be conducted by a chiropractor or physiotherapist.

After being assessed for severity of injury the first step is to begin with pain free ranges of motion exercises if your range of motion is limited. Next will be strengthening and stretching the area in order to prevent the injury from occurring again. A few examples are shown below:

Exercise 1: Range of Motion Exercises:

  • Lie on your stomach with both legs straight
  • Bend one knee up as far as you can and then straighten out so it is straight again
  • Repeat 10 x 3 in pain free range

Exercise 2: Quadricep Stretch:

  • Bring foot up toward buttock with the same side hand
  • Pushing hips forward and leg back you should feel a stretch through the front of your thigh
  • Hold for at least 15 seconds repeat 3 x

Exercise 3: Strength:

  • Take a resistance band and put it on your lower leg
  • Your feet should be hip width apart, squat down like you are going to sit in a chair
  • Step out with one leg wider then hip width, and follow afterward with the other leg, returning to hip width
  • Repeat 10×2 in each direction and perform 3 times a day

*This exercise should be pain free

What Should be Avoided if I have an LCL Injury?

  • Range of motion that cause the pain
  • Anything that causes the pain to become more than a 4/10 on your perceived pain scale*
  • Agility training or sports including: lateral movements, cutting, jumping, running on uneven surfaces

* perceived pain scale: on a scale of 0-10, 10 being the worst pain you’ve ever experience and 0 being no pain at all.

How Long Does It Take to Recover from an LCL injury?

Recovery time of any injury is dependent on many different variables. Some of these variables we can control and others we cannot. Here are some examples in the chart below.

A reasonable timeline for recovery of a lower grade sprain is 6-8 weeks and a higher-grade tear could take 3-6 months of rehabilitation until you have returned to agility activities.

Prevention of Re-Injuring the LCL

Following your plan of management provided by your health care provider will always help to speed up healing and prevent it from happening again. Being diligent with your strengthening exercises and listening to your body is important to keeping the entire knee joint strong and stable. Depending on the severity of the injury, some individuals might want to get a brace that can be used when partaking in activities.

To continue your LCL rehabilitation with our experienced physiotherapist. Contact us today!

Iliotibial Band (ITB) Friction Syndrome

One common injury that will present in physiotherapy clinic during summer is Iliotibial band (ITB) friction syndrome. The annoying pain that affects the outside of the knee results from a little too much, too soon. Read below to find out more about this injury, how you can treat it yourself, and what we can do for you.

What is Iliotibial Band Friction Syndrome?

Iliotibial band friction syndrome (aka IT band friction syndrome) is a common overuse injury to the lateral (outside) aspect of the knee. The IT band is a thick band of fascia (connective tissue) which runs from the pelvis, over the hip and down to just below the lateral aspect of the knee.

With activities involving repeated bending and straightening of the knee, a tight IT band can create a lot of friction and compression of the underlying tissues, particularly at the bony prominence on the outside of the knee called the lateral femoral condyle. Over time, this friction can cause inflammation and pain.

What Symptoms are Associated with IT Band Friction Syndrome?

The most common symptom associated with IT band friction syndrome is lateral knee pain, often experienced as a sharp, burning or stinging pain. Generally, the pain is brought on by an activity involving repeated bending and straightening of the knee, and it may get worse during the length of the activity until rest is allowed. Sometimes, if inflammation is present, the pain will remain for a period of time after the aggravating activity has stopped. Usually rest will allow the pain to resolve, although if the underlying cause of the pain is not addressed, it will continue to come back when you return to the aggravating activity.

Some common aggravating activities include:

  • Running
  • Stairs
  • Dancing
  • Hopping and Jumping
  • Sporting Activity

What Causes Iliotibial Band Friction Syndrome?

There are several factors that can contribute to the development of IT band friction syndrome.

The following is not an exhaustive list but it includes some of the more common factors, which we have control over:

  • People with tight IT bands are more likely to experience the above symptoms because a tight IT band creates more compression of the underlying tissues.
  • Weakness or imbalances in hip musculature can also be a big contributor to this condition, as the muscles around the hip are extremely important for proper knee alignment and tracking.
  • Excessive foot pronation can also alter the mechanics of the knee and increase the friction under the IT band.
  • Overuse, performing an activity without proper training, faulty techniques, over-training, or training in an imbalanced or poorly aligned way can also contribute to the development of ITB friction syndrome.

How can a Physiotherapist and/or Chiropractor Help with Iliotibial Band Friction Syndrome?

If you suspect you may have IT band friction syndrome, it would be a good idea to book an assessment with a registered physiotherapist and/or chiropractor. Overall, they will help you speed up recovery time and get you back to the activity you enjoy.

Often, the root cause of IT band friction syndrome is not in the knee but stems from elsewhere in the chain. Your physiotherapist or chiropractor will thoroughly assess you to determine the source of your pain and also the root cause of why you are experiencing it. They will educate you so that you can understand what is going on, what caused it and they will develop a treatment plan to help reduce your pain and address the problem.

Treatment plans will include rehabilitative exercises, myofascial release, manual therapies, shockwave therapy, and education. There may also be a mix of therapeutic modalities including acupuncture, cupping or dry needling in addition to hands on manual therapy. They may also recommend a referral for massage therapy, custom orthotics or a physician consult.

What Should be Avoided with Iliotibial Band Friction Syndrome?

If you do have IT band friction syndrome, it is recommended, at least initially, that you stop or reduce any aggravating activities as much as possible to avoid further injury.

Try not to sit cross legged. This may tighten the muscles in the hips and pelvis.

You also want to avoid waiting too long to get it assessed if your own attempts do not alleviate your pain, get the help you need to get out of the vicious cycle of inflammation that your tissue is experiencing.

How can you Treat Iliotibial Band Friction Syndrome at Home?

If you are just experiencing the onset of symptoms or have caught it early enough you may be successful with the following strategies.


When you are inflamed or aggravated from an activity be sure to ice with some compression over the area for 10min x 3 times a day. This will help to control the chemical process that occur with inflammation.

Check your Running Shoes

Ensure that your shoes are providing the proper support for your feet. If you have flat feet and tend to over pronate you may need to use a stability shoe that supports your arch during your activity. If your shoes are well worn and the surface of the sole has changed, it may be time to replace them.

Modify Activities and Cross Train

Make sure you stop the activity or decrease the intensity or duration to prevent the pain/inflammatory cycle. You may choose another activity that does not cause the symptoms to worsen, such as strength training, yoga, or swimming with just using arms for cardiovascular fitness.

Strengthen and Stretch

Depending on the root cause of your IT band pain your exercise program will vary, this is why it is important to consult with a Physiotherapist and or Chiropractor.

What are the Best Exercises to do with Iliotibial Band Friction Syndrome?

  • ITB Stretch
  • ITB Release
  • Gluteal Muscles and Core Strengthening
  • Bridge
  • Bird Dog
  • Adductor Strengthening

How Long Does it take to Recover from Iliotibial Band Friction Syndrome?

Recovery from this soft tissue injury should take about 6-8 weeks, provided you have modified your lifestyle and have participated in your active exercise program regularly. In certain cases, recovery and return to sport may take less time and in more severe cases it could take longer. Overall, it is really important that you seek the professional help you need as soon as you recognize that your condition is not resolving. You do not want to delay and miss out on the limited time we have to spend outside during summer in our beautiful city.

Sunup Physiotherapy has some excellent physiotherapists, chiropractors, and massage therapists who would be happy to help you with your knee pain and answer any questions you might have. We also have therapists that specialize in running injuries and are highly educated to get you back to running faster. Please do not hesitate to contact us and book an assessment today.

Patellofemoral Pain Syndrome

What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome is a common condition that affects the knee joint and can be related to discomfort in the knee while participating in weight-bearing activities. The cause of the pain is related to abnormal contact between the kneecap and the femur (the thigh bone) due to imbalanced forces from muscles and tissues around the kneecap. Often there is a stronger pull on the outside of the kneecap from structures such as the iliotibial band (ITB) the lateral retinaculum or the vastus lateralis (outer quadriceps muscle) that cause the kneecap to be pulled outwards. Normally, the kneecap sits in particular grooves on the femur and tracks up and down while our knee bends and straightens (similar to a train on train tracks). When an imbalance of muscle and tension exists, the kneecap is shifted off the grooves. When this situation is combined with repetitive motions of the knee such as in running, injury and pain can develop.

How do you know if you have Patellofemoral Pain Syndrome?

Usually individuals with patellofemoral pain syndrome complain of pain during weight bearing activities such as walking or running. The pain is usually localized to an area under the kneecap or around the knee cap. Also, individuals who suffer from patellofemoral syndrome report increased pain when walking down stairs more than walking up stairs. There may have been a specific trauma to the knee but more often this condition develops gradually over time as a result of repetitive activities and muscle imbalances.

Physiotherapy or Chiropractic treatment of Patellofemoral Pain Syndrome?

The most effective, long-term and result oriented treatment for patellofemoral pain syndrome is treatment from a physiotherapist or chiropractor.

A physiotherapist or chiropractor will look at your whole lower extremity to determine where your imbalances stem from. Sometimes weak hip and core muscles can cause this issue. Tightness of IT Bend, Weakness of inner thigh, Injuries to knee ligaments, Weak ankles, Fallen arches or Decreased range of motion in one area of the lower leg can also be the culprit. Either way, the best physiotherapists or chiropractors will determine the root of your patellofemoral pain and will target their treatment accordingly.

Your treatment will consist of a combination of manual “hands on” treatment, specific prescriptive exercises and other modalities such as laser, electrical stimulation or ultrasound depending on how your condition presents. Your physiotherapist or chiropractor will also help you progress so that you know how to gradually return back to your sport or activity. Other treatment strategies include taping, bracing, registered massage therapy, acupuncture, dry needling or IMS. Shockwave therapy can minimize pain, improves scar tissue, break soft tissue adhesion, speed up healing, and improves mobility quickly too!

How can I Treat Patellofemoral Pain Syndrome at Home?

If you suspect that you have patellofemoral pain you will want to do the following things:

  • Ice the knees after aggravation
  • Modify your activity or cross train (to avoid further aggravation)
  • Release the outer thigh on a foam roller
  • Start a strengthening and stretching program.

Best Exercises to help with Patellofemoral Pain Syndrome?

  • Partial Squats
  • ITB Release
  • Gluteal Muscles and Core Strengthening
  • Quadriceps Stretch
  • ITB Stretch
  • Adductor Strengthening
  • VMO Strengthening

What should be avoided if I have Patellofemoral Pain Syndrome?

It is important that you modify or stop the aggravating activity at the onset of your pain, do not try to push through your activity and deal with it after. Also, if the symptoms are not resolving in a 2-3 week timeline it is best you book an assessment with a professional, be it a physiotherapist or chiropractor.

What should be avoided if I have Patellofemoral Pain Syndrome?

If the root cause of the pain is discovered and addressed you should be back to your activity in about 8 weeks, plus or minus a week or two. If your injury is more severe, becomes re- aggravated frequently or the root cause is harder to find (because there may be multiple factors all interfering with the condition) then recovery may take longer.

Patellofemoral dysfunction that results from gradual build-up means that your habits and poor movement strategies caused this issue. Once healed, you may have to continue with an ongoing maintenance exercise program to prevent these bad habits from re-surfacing. For example, if your activity is running you will want to have a pre-running warm up that includes firing up the glut and hip stabilizers. This should also be complimented with a bi-weekly (or more) strengthening program focused on core, pelvis and hip stability.

Don’t wait too long before you have someone take a look at your knee. Contact us today to book with one of our experienced physiotherapists or chiropractors today so that you can get back to enjoying your activities and sports sooner and without discomfort! 

Infrapatellar Fat Pad Syndrome

What is an Infrapatellar Fat Pad?

The infrapatellar fat pad is also known as the Hoffa Pad. It is one of three fat pads in the front of your knee. It is located below the knee cap and above the patellar tendon, enclosed by the thigh bone and shin bone, and resting between the knee joint capsule and connective tissues of your knee. It is composed of fat lobules separated by thin fibrous cords, making it a flexible soft tissue structure which can accommodate the mobility of your knee. In addition, the infrapatellar fat pad is rich in nerve structures, having branches of the femoral, peroneal and saphenous nerves, which make it one of the most sensitive areas of the knee.

Why is the Infrapatellar Fat Pad Important?

Hoffa’s Fat Pad acts as your knee bones cushioning shock absorber. It reduces the friction between patella (knee cap), patella tendon, and the boney structure of knee. It also prevents pinching of the connective tissues that encapsulate knee joint. And even though it is one of the most sensitive areas in the knee, it is commonly overlooked as the source of anterior knee pain. This is because many of the symptoms associated with Hoffa’s Knee Pad Syndrome can also be present with a number of other knee injuries.

Symptoms of Infrapatellar Fat Pad Syndrome?

Symptoms of Infrapatellar Fat Pad Syndrome include:

  • swelling of the knee
  • front aspect knee pain
  • pain below the knee cap
  • pain with leg strengthening exercises
  • pain while squatting
  • pain while kicking
  • pain with prolonged walking
  • pain when wearing heels

Causes of Injury to the Infrapatellar Fat Pad?

Infrapatellar Fat Pad can cause pain and limitation when there is micro trauma, major trauma, post-surgical scaring, obesity, and/or osteoarthritis. Trauma to the fat pad can occur from a notable injury to the front of the knee or from something as minor as tight quadriceps muscle, hyper-extension of the knee and/or a forward pelvic tilt. The infrapatellar fat pad can also be pinched by the knee cap and shin bone. Once trauma has occurred, the resulting swelling and inflammation alters the knees’ movement pattern making it more likely for the micro trauma or pinching to reoccur. This is especially true for osteoarthritis in the knee as there is often repeated flare ups of knee inflammation. Obesity is also a risk factor for Hoffa’s pad syndrome as inflammation is triggered by the ongoing strain to the knee joint.

Physical Therapy Treatment Techniques for Fat Pad Syndrome

At Sunup your physiotherapist will create an individualized treatment plan based on your mechanism of injury, your movement patterns, your muscle imbalances and your overall treatment goals. The aim of treatment is pain reduction, normalized range of motion, improved strength through the leg as well as improved proprioception and control to avoid future re-injury. Treatment methods for Fat Pad Syndrome include, but are not limited to:

  • Ice to reduce inflammation
  • Shockwave therapy to minimize pain, improves scar tissue, and speed up healing
  • Manual therapies to improve lower extremity alignment and mobility
  • Ultrasound or laser therapy to promote tissue healing
  • Taping of the knee for support and to offload the inflamed tissues
  • Corrective exercises for strength, flexibility and proprioception

To book an appointment with one of our highly skilled physiotherapists and/or chiropractors, Contact us today.

Meniscal Knee Injuries

What are Meniscal Knee Injuries (a.k.a. Meniscal tear of the knee)?

The meniscus is a C-shaped pad made of cartilage within the knee joint. Each knee joint has two menisci, one on the medial aspect (inner edge) and one on the lateral aspect (outer edge).

The menisci provide several vital functions in the knee joint:

  • They provide lubrication and nutrition of the joint.
  • They increase surface contact within the joint for improved weight distribution, congruency.
  • They provide shock absorption during weight-bearing activities.

Meniscus tears often happen during twisting activities when the knee is bent and the foot is planted. It is also possible for the menisci to get injured gradually with age and overuse.

What are the Symptoms of Meniscal Knee Injuries?

Signs and symptoms of a meniscus injury include the following:

  • Swelling of the knee joint – the amount can range depending on the severity of the meniscus injury
  • Pain within the joint, often worse with twisting or squatting activities
  • A feeling that the knee is going to lock, buckle or give way without warning
  • A consistent click deep within the joint

A physiotherapist or chiropractor can use a number of special tests to determine if you have a meniscal knee injury. In some cases, diagnostic imaging is used to determine the extent of the meniscal tear.

Physiotherapy or Chiropractic Treatment of Meniscal Knee Injuries

Depending on the location and severity of the meniscal injury, it can often be treated successfully with conservative treatment. Physiotherapists and Chiropractors are trained to treat meniscus injuries through strengthening areas of weakness around the knee (or other areas of the body which may be contributing to poor mechanics at the knee). They can also use manual techniques and modalities to provide pain relief and they can give advice regarding activity modification and return to sport.

If the tear is too severe or in a location of the meniscus with poor blood supply, arthroscopic surgery may be required. If this is the case, physiotherapy or chiropractic treatment is still an important part of the process. It helps reduce swelling and strengthen before surgery and then after surgery it helps to improve range of motion, strength and stability of the knee joint with the goal of returning to full function as soon as possible.

How Can I Treat Meniscal Knee Injuries at Home?

If you suspect a meniscal tear and after an aggravating activity swelling occurs it is best to apply PRICE protocol.

You will want to start a rehabilitative exercise program early, which includes exercises similar or equivalent to the ones mentioned below.

You also may find some relief with a brace. The brace works by adding awareness of the knee in space with a tight compression sleeve around your knee as well this helps to control swelling.

If your symptoms are not resolving, your knee is locked (i.e. cannot fully straighten) or it is getting worse, book an assessment with our trusted physiotherapist or chiropractor to help direct your care, set goals and get you on the road to recovery faster.

What are the Best Exercises to Help with Meniscal Knee Injuries?

  • Squats
  • Lunge
  • Gluteal Muscles and Core Strengthening
  • Quadriceps Stretch
  • Hamstring Stretch
  • Calf Stretch
  • Adductor Strengthening
  • VMO Strengthening

What Should be Avoided if I have a Meniscal Injury?

The best rule to go by is avoid any activity that hurts during or after or causes your swelling to increase. Movements such as kneeling, twisting or pivoting on the knee especially when bent, jumping, running or walking on uneven surfaces will most likely be aggravating.

How long does it take to recover from meniscal knee injury?

If the injury occurs in part of the meniscus that has good blood supply and you are taking steps to help it heal you should see improvements in your pain and symptoms within 3 weeks and be fully recovered and back to activities by 8-12 weeks.

However, if your injury is more severe, meaning a large tear, indicated with your knee locking and swelling often. You most likely will have a longer recovery. This may include the need for MRI imaging and a consult with an orthopedic surgeon for arthroscopic surgery. After surgery, physiotherapy or chiropractic care will take about 6-8 weeks to get you back to the activities and sports you enjoy.

If you are suffering from this condition and would like to see one of our physiotherapists or chiropractors, please contact us today.