Tag Archives: Knee Pain

Training Tips: Leg Extension vs Squats

What’s the difference between leg extension and squats, and which ones better for you?

If you find are an avid gym goer yourself, you’ve probably heard some version of this argument. When discussing leg workouts, there is much debate surrounding the importance of leg extension versus squat movement. Although both of these exercises can be performed in a gym setting, they provide different results based on how each exercise incorporates various types of movement patterns into your workout regimen. 

Breaking down leg extensions vs squats

Let’s begin with understanding the basis of these two exercises.

Leg extensions are a targeted movement for the quads (your big thigh muscles), providing an extremely isolated contraction. In this context, isolated means that the quads are the only muscles performing major work, the other muscles groups contributions are minimal. Consequently, the result is a complete and intense contraction of your quads at the end of each rep. If you want to develop a teardrop shape in your quad muscles, leg extensions are a great exercise to add to your routine.

On the flip side, squats are the undisputed king of compound movements. They engage your entire lower body and core, making them the perfect exercise for building overall strength and functional fitness. Plus, squats are just plain awesome for building those glutes and hamstrings, in addition to quads. Because of this difference, leg extension and squat exercises cannot replace one another and serve different purposes in your leg training program.

Comparing the pros and cons of leg extensions vs squats

The benefits of leg extensions are their ease of use and isolation. Leg extension machines require little balance and coordination since the movement is machine guided and non-weight bearing (seated). Thus, leg extension devices are excellent for beginners or after an injury (rehabilitative) if prepared correctly. Leg extensions enable direct overload of the quadriceps without the involvement of other muscle groups and can help to correct imbalances in muscle development and increase volume in the quadriceps at the end of a workout.

However, due to their isolation nature, leg extensions have a number of limitations. Leg extensions are performed with a seated base and a fixed movement pattern, which do not replicate the natural leg movements we undergo in our daily lives or the leg movements performed in sports. Also, leg extensions place a large amount of stress on the knee joint, mainly when they are performed with heavy weights or with poor technique.

Conversely, squats are considered one of the best lower body exercise options available. They imitate the motions we use each day, like sitting down and standing up, lifting objects from the floor and more. They also help improve joint range of motion especially at the hips, ankles, and knees and developing strength usable throughout life. Additionally, squats recruit multiple muscle groups to perform an activity. This allowss for maximum overall strength development, an increase in muscle mass, and a higher volume of calories burned. As physiotherapists, we refer to squats as functional movements due to their real world carry over and ability to reduce the chance of injuries.

So which one is better?

So now the question arises, which type of exercise will best suit you? Most people who exercise should include squats in their routine as the foundation of their leg workouts. Squats allow the development of overall leg strength as well as improve balance, and when done correctly, squats promote good long-term joint health for those doing a lot of sitting and standing. Although not every person who trains their lower body will be an athlete, having strong legs is an important aspect of staying active and fit. A strong leg foundation is also beneficial to those who are trying to lose fat or improve daily movements, as good leg strength helps create a solid base of stability for any physical activity.

While squats are excellent for developing strength and balance, leg extensions also have a place in a complete lower-body workout program and can be an effective way to work on isolated quadriceps strength, to address a specific weakness and for increasing muscle definition without putting a high demand on the rest of the body.

Instead of trying to choose between squats and leg extensions, the most effective approach is to combine the benefits of each exercise, so everyone benefits from both improving their lower-body strength and developing good muscle definition. Prioritizing squats while supplementing with leg extensions will enable everyone to build strong and functional legs while still having a strong focus on building muscle, thus giving the best overall performance and appearance.

Have more questions?

Look for PhysioNow! We have expert clinicians ready to assist you with any training questions you may have. If you are struggling through any kind of knee pain, leg pain, or even anticipating an upcoming surgery whether it is a total knee replacement or an ACL repair, we will help you through it all! One of the most important parts of training is learning how to stay injury free, so book with PhysioNow today for you first assessment and treatment! Look for us at one of our 10 west GTA locations including Burlington, Oakville, Mississauga, and Etobicoke! P: 289-724-0448 Email: applewood@physionow.ca

Meniscus Strain: How to Treat Your Knee Pain

When knee pain shows up, it can impact everything from walking, climbing stairs, playing sports, even just sitting comfortably. One of the most common reasons people feel that sharp or nagging pain inside the knee is a meniscus strain. The good news? Many meniscus injuries heal well with the right care and guidance.

Let’s break down what the meniscus does, how strains happen, and how physiotherapy helps you get back to moving confidently.

What is the meniscus?

Diagram of a right knee depicting the menisci along other structures
The menisci are optimally located between the 2 bones to provide support and cushioning.

The meniscus is a C-shaped piece of cartilage inside your knee. Think of it like a cushion to help reduce friction and pressure. Each knee actually has two sitting side by side, one closer to the inside of your knee (medial meniscus) and one closer to the outside outside (lateral meniscus).

These small but important structures help your knee by:

  • Absorbing shock
  • Improving stability
  • Distributing weight evenly
  • Guiding smooth movement

When the meniscus is irritated or stressed, it can quickly lead to noticeable knee pain.

What is a meniscus strain?

A meniscus strain means the tissue has been stressed or mildly injured, not fully torn. A meniscus tear is a more significant injury where the cartilage fibers are completely disrupted.

Meniscus strains commonly happen from:

  • Twisting or pivoting on a bent knee (very common in sports)
  • Deep squatting or lifting heavy weight with poor form
  • Sudden stops or quick changes in direction

While strains are less severe than tears, they can still be painful and limit how much you can bend, straighten, or put weight through your knee.

What are the signs and symptoms?

You may be dealing with a meniscus strain if you notice:

  • Pain on either the inner or outer side of your knee, along the joint line
  • Swelling or stiffness after activity
  • A feeling of catching, locking, or buckling
  • Reduced range of motion, especially with maximal bending
  • Discomfort when bearing weight or twisting your knee

If symptoms are sharp, persistent, or increasing, it’s important to get checked. After even just a minor strain, the body can lose significant amounts of strength. Unfortunately, this can predispose you to another injury, including a full tear. As a result, it is crucial to rehab your knee after a meniscus strain.

How is a meniscal strain diagnosed?

Health care provider palpating a patient's knee

A physiotherapist or healthcare provider will usually:

  • Ask about how the injury happened
  • Assess how your knee moves
  • Assess your strength
  • Perform special tests like McMurray’s or Apley’s that check for meniscal injury specifically
  • Recommend imaging (like an MRI) if a tear is suspected

The goal is to understand what movements are contributing to your knee pain, and develop a treatment plan to help you recover to your full strength.

How does physiotherapy help?

Most meniscus strains do very well with conservative treatment (non-surgical treatment), and physiotherapy plays a major role in reducing pain and rebuilding strength.

1. Early Phase (0–7 days)

Focus: Reduce swelling and protect the knee from farther injury

  • Resting from painful activities
  • Ice, compression, bracing
  • Elevating the leg to manage swelling
  • Light, pain-free range-of-motion exercises
  • Early muscle activation (like quad sets or easy straight leg raises)

2. Recovery Phase (1–3 weeks):

Focus: Get your knee moving more seriously again

  • Low-impact cardio like cycling or swimming
  • Controlled bending and straightening exercises
  • Balance work (single-leg stance, gentle weight shifting)
  • Building early strength in the quads, hamstrings, and glutes

3. Strength & Return-to-Activity Phase (3–6+ weeks)

Focus: Continue building stability and prepare for real-life movement

  • Resistance training for the lower body
  • Functional exercises like step-ups and mini-squats
  • Sport-specific drills (if needed)
  • Education to prevent re-injury

Your timeline will vary based on pain levels, pre-injury fitness, and how severe the initial injury to the meniscus was, but gradual, guided progress is key.

Can I prevent a meniscus strainB?

It is not possible to completely remove the chance of injuries, but you can lower your risk with a few simple habits:

  • Engage in a thorough warm up before sports or workouts
  • Strengthen your lower-body muscles, especially glutes, quads, and hamstrings
  • Avoid sudden twisting or pivoting under load
  • Use proper lifting technique
  • Give your body rest when it needs it

Looking for help with knee pain?

Look for PhysioNow! Our expert Physiotherapists, Manual Osteopaths, Massage Therapists and Athletic Therapists can help you recover from knee pain, sports injuries and more! We have 10 locations across the west GTA including Burlington, Oakville, Mississauga, and Etobicoke. Please feel free to contact us by phone: 289-724-0448 or email: applewood@physionow.ca with any inquiries. Book with PhysioNow today for your first assessment and treatment!

Custom Knee Brace

ACL Rehab and Why It’s a MUST After Injury

ACL REHAB is very important for you to get back to your normal life! Injuries, even minor ones, can lead to pain, inflammation, instability and a risk of further harm.

What is the anterior cruciate ligament (ACL)?

The ACL is a very important ligament in your knee that prevents your tibia (shin bone) from moving too far away from your femur (thigh bone). This ligament is used extensively in all our daily movements including walking and standing. During sports, it must withstand huge amounts of forces during acceleration, deceleration, cutting, pivoting, jumping, and more! As a result, it is crucial that any ACL injury gets addressed with a comprehensive sports injury rehabilitation plan.

What is the mechanism of injury?

Most ACL injuries happen from non-contact movements such as a sudden rotational force that occurs when the foot is planted on the ground. Other movements can include sudden deceleration or landing awkwardly from a jump. As a result, these injuries are very common in sports like soccer, basketball, and skiing. Secondly, ACL tears can happen from direct contact injuries, usually a blow directly to just below the knee.

What are the symptoms of an ACL tear?

  • Instability and pain during movements, especially when walking and coming down stairs
  • Decreased balance, strength and control in the muscles
  • Decreased ability to put weight on the injured side
  • Pain and locking of the knee associated with MCL and meniscus injuries, commonly injured together with the ACL

ACL rehab or surgical repair?

Unfortunately, there isn’t a straight answer to this question. The response after injury will depend on the severity of the tear. Surgical repair may be needed for a fully torn ACL, depending on the level of physical activities you want to return to. With minor injuries, it is possible to avoid surgery if proper ACL rehabilitation is done with a skilled Registered Physiotherapist.

Custom knee braces for ACL rehab

ACL REHAB
A Custom Knee Brace for ACL tears that can be worn during ACL rehab

In addition, wearing a custom knee brace can allow you to fully support your knee without having to do surgery. Custom knee braces can be very helpful once the initial swelling goes down. They can allow you to return to all or most of your previous activities without surgery. A Custom Knee Brace “replaces” the support and stability lost from the torn ACL ligament. Alternatively, individuals wear these braces while awaiting their ACL surgeries, and post-surgery can wear them as extra support when they start returning to normal activities. There are several types of Custom Knee braces available in the market. The most popular brands are DonJoy, Bledsoe and Ossur. At PhysioNow, we carry off the shelf knee braces and Custom Knee braces from all of the major suppliers.

Check out this link for a few of the braces we currently offer at PhysioNow in Mississauga.

How can physiotherapy help with ACL rehab after a tear?

In the early rehab for a tear, the role of a physiotherapist after an ACL tear is:

  • To control pain
  • Increase/maintain ROM
  • Control swelling
  • Early muscle activation and strengthening
  • Protect the injury by providing aids like crutches, splints etc

Pain is controlled by using different modalities such as ultrasound, and interferential therapy. A graduated exercise program will help you to improve your movement. Here is another interesting article about ACL REHAB.

Exercises will focus mainly on:

  • Strengthening quadriceps and gluteal muscles
  • Restoring normal range of motion in the knee
  • Proprioception techniques (you will likely lose some of your natural ability to balance after an ACL tear),
  • Stretching of the hamstring muscles.

ACL REHAB
Possible ACL REHAB Exercises

Please do not attempt these exercises at home without the advice of your doctor or a skilled Registered Physiotherapist!

Eventually, you will progress past these exercises but since rehab is on such an individual basis and dependent on your goals, the following exercises might look very different! This is where the Physiotherapist comes in as they can create a personalized plan for you specific to your interests and current abilities. Then, they can supervise you and ensure you are safe and controlled at all times in your rehab.

Looking for some help>

If you or someone you know has had an ACL tear, we at PhysioNow would be happy to help! If you want to discuss Physiotherapy Treatment or to see if a Custom Knee brace might be helpful for you, book with PhysioNow today!

Rheumatoid Arthritis and What You Should Know

Rheumatoid arthritis (RA) is an inflammatory disorder that can affect multiple joints, usually on both sides simultaneously. In other words, if it affects your wrists, it would likely be both, not just one. RA is an autoimmune disorder. Essentially, a flare up is when your immune system starts to attack your own body’s tissues. Ultimately, it has systemic (body-wide) effects and can damage your skin, lungs, heart and blood vessels in some cases.  RA mainly damages the lining of your joints causing large amounts of pain and swelling that can eventually result in joint line erosion and deformities. In most cases, the damage is permanent and leads to a decreased quality of life and increased disability.

What increases the risk of developing Rheumatoid Arthritis?

The ultimate cause of rheumatoid arthritis is unknown, but what we do know is certain things increase the risk of development. This includes:

  • Family history
  • Smoking
  • Obesity
  • Environmental or external factors (exposure to pollutants, stress, infection etc)
  • Sex: Women develop RA more often than men

What are the signs and symptoms of Rheumatoid Arthritis?

The symptoms depend on the current stage the condition is in, and it cycles between two stages:

  1. Relapsing: Also known as a flare up, symptoms appear and are more intense
  2. Remitting: Symptoms including pain will decrease or are absent, but structural deformities will persist  

During a relapse/flare up, symptoms include:

  • Pain in the joints, usually 4 or more joints at a time
  • Warmth and redness around the affected joints
  • Swelling 
  • Tender to the touch 
  • Morning stiffness
  • Fever
  • Fatigue

In the early stage of RA, the small joints of the body like the fingers or toes are more affected. As the disease progresses, the larger joints become involved like the wrists, knees, ankles, elbows and hips.

How is rheumatoid arthritis diagnosed?

Primarily, RA is identified through a combination of a physical exam, analysis of your health history, x-rays and other imaging tests, and blood work looking for markers that may indicate the presence of the disease.

Physiotherapy Management of Rheumatoid Arthritis

  1. Education about the condition and the key role of interprofessional and collaborative care in the management of RA:
    Managing your Rheumatoid Arthritis requires coordination of care from a variety of health care professionals.

    Your Physiotherapist can help you understand the condition, identify early signs and advise you on how to proceed or where to seek help. For example, they may help connect you to a medical doctor and a rheumatologist (professional that specializes in the care of inflammatory conditions) for specific management of RA. Additionally, these specialty clinics may provide additional resources for the management of the condition. 

    2. Activity modification

    During a flare up, strenuous activity should be avoided and rest becomes the priority. This may include things like lifting, climbing stairs, and even walking can put excessive pressure on the joints. To help, your Physiotherapist may give you strategies to help you manage fatigue, conserve your energy, and prescribe you with a gait aid or other adaptive devices. For example, using a walker or cane to offload the lower body, or installing railings or raised toilet seats.

    3. Therapeutic exercise

    During periods of remission, therapeutic exercises will be used to maintain normal muscle strength and prevent deterioration. The duration, severity, and types of exercise will be determined after a thorough assessment. Your Physiotherapist will uniquely adapt the exercises to an appropriate level for your condition. Overall, these exercises could include range of motion and stretching, aerobic conditioning, and strengthening.

    4. Manual therapy

    Manual therapies like soft tissue release, gentle joint mobilizations, and other massage techniques are useful for relieving pain and swelling and improving flexibility. It is also beneficial for promoting a general feeling of well being and increasing mood, which is often affected in this condition. Thus, it is an important part of the management of RA.

    Where can I find help?

    If you are experiencing difficulties with RA or any kind of joint pain, look for PhysioNow! We have many expert Registered Massage Therapists and Physiotherapists that can help you with your recovery today. With 10 clinics across the GTA from Burlington, Oakville, Mississauga, and Etobicoke, our highly accessible locations are ready to serve you! Book with PhysioNow today for your first assessment and treatment!

    Hamstring Injuries Caused by Deadlifting: Prevention and Recovery

    Deadlifting is a highly effective exercise for building strength, especially in the posterior chain (glutes, lower back, and hamstrings). However, improper technique or a lack of foundational strength can lead to injuries, especially in the hamstring. If you are an avid lifter or just looking to get started with deadlifting, here is a quick guide on preventing and recovering from hamstring strains related to deadlifting.

    What do the hamstrings do in a deadlift?

    The hamstrings are a group of three muscles located at the back of your thigh: the biceps femoris, semitendinosus, and semimembranosus. These muscles are primarily responsible for bending the knee and extending the hip. During a deadlift, your hamstrings play a key role in two ways:

    1. Hip extension: As you stand up with the barbell, your hamstrings work alongside your glutes to extend your hips (bringing them forwards).
    2. Knee flexion: While not as heavily involved as in hip extension, the hamstrings also help stabilize the knee during the lift, especially in the bottom position of the deadlift.

    Because deadlifting places significant load on these muscles, improper technique or weak hamstrings can increase the risk of injury.

    How do the hamstrings become injured during a deadlift?

    1. Poor form

    Firstly, one of the most common reasons for hamstring injuries during deadlifting is improper form. Usually, deadlifting requires precise movement mechanics to avoid unnecessary strain on the muscles. If you are unsure about your form, you can always ask for help from a fitness or exercise professional such as a licensed personal trainer, athletic therapist, sports physiotherapist and more. For example, a few common form issues that can lead to hamstring injuries include:

    • Rounding of the lower back
    • Overextending at the top of the lift
    • Incorrect hip positioning over top of the bar

    2. Weak hamstrings or muscular imbalances

    Secondly, weak hamstrings can be a contributing factor to injuries. The hamstrings may not be able to handle the load, especially when lifting heavier weights. Alternatively, if other muscles in the lower body are weaker or have been injured, the hamstrings may compensate for them by taking on excessive load.

    3. Sudden increase in load or frequency

    Additionally, jumping into heavy deadlifts without gradually increasing the load can overstress the hamstrings. Consequently, progressive overload and sufficient rest, both key principles of exercise training, are essential for proper muscle growth and injury prevention.

    4. Lack of mobility or a warm-up

    Finally, a lack of proper warm-up can leave the hamstrings (and other muscles) stiff and more prone to injury. Neglecting mobility work or stretching can lead to tightness or stiffness, limiting your range of motion and increasing the risk of overstretching the hamstrings during the lift. For example, during deadlifts some people lack sufficient hamstring flexibility to perform the lift with proper form. As a result, when they go to bend forward in the lift, it is already stretched maximally or past its safe limit, putting it in a vulnerable position.

    How to Prevent Hamstring Injuries When Deadlifting

    1. Master proper form

    Initially, ensuring you have proper technique is the number one way to prevent injuries, including hamstring strains. For example, key tips for deadlifting with proper form include:

    • Start with your feet shoulder-width apart and the barbell close to your shins
    • Maintain a neutral spine (no rounding of the back) throughout the lift
    • Keep your core tight and engage your glutes and hamstrings as you lift
    • Use your hips, not your back, to initiate the movement, and make sure your back remains straight as you stand
    • Focus on hinging at the hips rather than bending at the waist
    Proper form in a deadlift includes keeping the bar close to your body, and maintaining a neutral spine as seen above

    2. Strengthen your hamstrings

    Additionally, incorporating other exercises that strengthen the hamstrings can help prevent injury. Some of the most effective exercises for hamstring strength include:

    • Romanian deadlifts: These focus on the hip hinge and engage the hamstrings
    • Leg curls: Using machines or resistance bands to isolate and strengthen the hamstrings
    • Glute-ham raises: A great bodyweight or weighted exercise to target the hamstrings and glutes

    Ultimately, building hamstring strength and addressing muscle imbalances can help your body handle all loads more safely.

    3. Gradually increase weight, take rest days

    To avoid overstretching or overloading the hamstrings, progressively increase the weight you’re lifting over time. Also, avoid training the same muscle group 2 days in a row, especially if you’re lifting heavier. Even experienced lifters can suffer from overtraining, everybody needs rest days! Instead, think about doing some cardio or training a different body part while the hamstrings recover.

    5. Incorporate mobility work

    Hamstring flexibility and mobility are crucial for preventing strain. Regular stretching, yoga, or foam rolling can help maintain or improve the flexibility of not just the hamstrings but the hips, knees and ankles as well. If you take care of your body properly, you’ll reduce the risk of injury during deadlifts.

    I need help with a hamstring injury, what do I do?

    If you have experienced a hamstring injury while deadlifting, first follow the R.I.C.E. protocol (rest, ice, compression, elevation) immediately after the injury. Some strains may heal on their own, but it is always recommended that you engage in a rehabilitation program afterwards to ensure you recover full mobility and strength.

    For more serious strains, or if your function is impaired after, such as difficulty walking or putting weight on it, you should consider Physiotherapy. Your Physiotherapist will work with you to help you safely recover from your injury and then return to your normal activities and sports. If you are looking for help with a hamstring injury or any other sports injury, look for PhysioNow with clinics across the GTA. Book with PhysioNow today for your first assessment and treatment.

    Prevent Injuries to your Knee: Quads Strength is the Key!

    Strengthening the quadriceps is crucial for minimizing the risk of knee injuries. Notably, the quadriceps (the group of muscles on the front of your thigh) play a key role in stabilizing and supporting the knee joint. As a result, regular training and maintenance of this muscle group is crucial for knee health. The following are 6 reasons why you should train your quads strength!

    1. Stabilizes the knee joint

    The quadriceps are the primary muscles that help extend your knee (straighten your leg). They work in tandem with the hamstrings (muscles on the back of the thigh) to provide balance and stability to the knee joint. Proper quadriceps strength helps to control and create motion of the knee, especially during activities like walking, running, jumping, or climbing stairs. If weak, the body may be forced to compensate with other muscles like the calves, glutes or hamstrings which may lead to overuse/strain injuries.

    2. Absorbs shock and reduces load on the knee

    Strong quadriceps muscles help absorb impact and control the load placed on the knee joint, especially during weight-bearing activities. For example, when you perform high-impact movements (like running or jumping), the quadriceps cushion some of the forces that otherwise would be transferred directly to the knee. This reduces wear and tear on joint surfaces and cartilage and helps manage conditions like osteoarthritis, patellafemoral pain syndrome, or bursitis.

    3. Helps maintain proper knee alignment

    The quadriceps contributes to maintaining the alignment of the knee, particularly in preventing the knee from collapsing inward (known as valgus) or being pushed outward (known as varus). These misalignments can put excessive stress on the knee joint and ligaments, increasing the likelihood of injuries such as meniscal tears, ACL or MCL tears/sprains, or patellofemoral pain syndrome.

    4. Protects the knee ligaments

    The quadriceps play an important role in protecting the knee ligaments, particularly the anterior cruciate ligament (ACL). Weak quads can lead to poor control of knee motion, increasing the strain on the ACL and potentially causing tears, especially during cutting, pivoting, or landing from a jump. In other words, strengthening the quadriceps can improve dynamic knee stability. Consequently, allowing you to better control the forces that act on the knee during athletic movements.

    5. Improves functional movements

    Strong quadriceps improve your ability to perform daily functional movements, such as stairs, squatting, bending, and standing up from a chair. Weak quads make these movements more challenging and can lead to compensation patterns that strain the knee or other body parts. Especially as we age, ensuring we build enough strength for our daily activities is the key to maintaining a good quality of life.

    Quads strength influences our ability to go up and down the stairs, especially quickly

    6. Prevents chronic conditions

    Chronic weakness in the quadriceps can lead to altered gait patterns, which may increase stress on the knee joint over time. This abnormal stress can contribute to the development of degenerative conditions such as knee arthritis or chondrosis that wears away joint and cartilage surfaces in the knee joint. Overall, strengthening the quadriceps helps to alleviate some of that excess stress and reduce the progression of arthritis.

    Looking for help?

    As can be seen, quads strength is vital for knee health. Whether you’re an athlete or someone or just enjoying activity recreationally, quadriceps strength can make a significant difference in knee performance and injury prevention. If you want to get stronger or having problems with your knees, PhysioNow has many experienced Physical Therapists to help you out. Book with PhysioNow today for your first assessment and treatment!

    ACL Injury to knee

    Torn Meniscus: What to do Next

    What is a torn meniscus?

    Torn meniscus types Different types of meniscal tears, depending on location and orientation

    The meniscus is a C shaped fibrocartilage in our knee joints, located between the tibia and femur. Importantly, they work as shock absorbers for the knee joint. Our knees are weightbearing joints and as a result, must withstand a lot of force. On each side of our body, we have one meniscus on the inside (medial), and one on the outside (lateral). Unfortunately, the medial meniscus tear is more common torn. Especially, in individuals who play contact sports and high impact sports.

    How does a torn meniscus happen?

    Usually, meniscal tears are traumatic, you can pinpoint the moment in time that the injury occurred. However, in rarer cases they can be insidious and feel like they happen without your knowledge. One of the main methods of injury are sports, a forceful direct impact or a sudden twist while foot is planted on the ground. Additionally, the incidence rate of meniscus injuries increases with age.

    What are the risk factors?

    • Overuse
    • Osteoarthritis (OA)
    • Obesity
    • Age
    • ACL injury
    • Previous knee injuries, especially if they were traumatic

    Signs and Symptoms:

    It is important to note that meniscal tears often happen in conjunction with other knee injuries such as ligament strains/sprains. As a result, the symptoms often overlap with other each other.

    • Decreased and painful range of motion
    • Knee feels like it will give out
    • Popping sensation at the time of injury
    • Joint swelling
    • Crepitus
    • Locking in knee
    • Pain around knee joint
    • Stiffness
    • Antalgic gait ex. limping
    • Pain increases with weightbearing activity like walking, stairs and squats

    Diagnosis:

    After taking a detailed history about the pain and injury history, your health care practitioner will conduct a physical examination for your knees.  They will check your range of motion, strength, integrity of the joints, check your sensation, balance, and more. Then, they might send you for further investigations like x-rays, ultrasound or MRI if they think it is warranted.

    Physiotherapy Treatment for a Torn Meniscus

    Torn meniscus physiotherapy

    Oftentimes, people think that meniscal injuries will heal over time on their own. In reality, the recovery process purely depends on the type and severity of the injury and symptoms being experienced. It is always recommended to be seen by a health care professional and undergo physical therapy to rehabilitate your knee after an injury. Ultimately, this will ensure your knee gets the proper care it needs and nothing severe will be missed.

    1. RICE Protocol

    • Rest: First, let the injured knee rest by putting less weight/pressure on it
    • Ice: Additionally, use an icepack around your knees several times a day for 15-20 mins
    • Compression: Importantly, will help to reduce the swelling around knee joint.
    • Elevation: Lastly, rest your leg using a pillow or something similar to keep it elevated and minimize swelling

    2. Protective Equipment:

    Braces and crutches may be used depending on the severity of symptoms. Ultimately, they will help protect the joint and prevent the injury from worsening.3. Modalities:

    3. Modalities

    Modalities such as electrotherapy (IFC, TENS), ultrasound, and laser therapy may help decrease inflammation, manage pain, and help with the healing process.

    4. Exercise Therapy:

    As quickly as possible, we want to restore as close to normal range of motion in the knee. Then, strengthening of those muscles will make the knee stronger to resist future injuries.

    • Low impact exercises for cardiovascular training ex. biking
    • Isometrics exercises
    • Range of motion exercise
    • Stretching
    • Strengthening exercise of the joint muscles and areas around such as the hips, back and pelvic muscles:
    • Functional activity (ex. stairs, squatting, job specific tasks)
    • Balance and coordination training

    5. Surgical procedure

    Finally, in some severe cases, physiotherapy may not be enough to fully rehabilitate your knee, especially if the joint is being blocked by the tear. Thus, a consult with an orthopedic surgeon may be necessary to determine future treatment options for your knee. The meniscus may be able to be repaired, or you may require a partial/complete meniscectomy (removal of a part of the full meniscus).

    If you are experiencing a knee pain or torn meniscus that is limiting you, look for PhysioNow! We have many experienced Physiotherapists across the GTA from Burlington to Etobicoke that can help you feel better. Book with PhysioNow today for your first assessment and treatment.

    ACL Rehabilitation

    ACL injuries are very common.  Most people know at least one other person who has gone through some kind of ACL injury.  But what exactly is the ACL?  Furthermore, what is ACL Rehabilitation?

    ACL Rehabilitation is a term used to describe the physiotherapy treatment that takes place after an ACL injury.  It is an important part of the recovery so that individuals can get back to their work and sport

    ACL Rehabilitation – What is the relevant Anatomy

    The term ACL stands for Anterior Cruciate Ligament.  Ligaments are soft tissues that connect 2 bones together.  Ligaments provide stability to the joint.  The ACL is found in the knee joint.  It is one of the most important ligaments in the knee.

    ACL Rehabilitation – Where is the ACL located?

    The ACL is one of two ligaments found deep inside the knee joint.  The other ligament is called the PCL, or Posterior Cruciate Ligament.  These ligaments cross each other inside the joint, forming an “X”.  Together, they help keep the thigh bone (femur) connected to the shin bone (tibia).  The ACL stops the shin bone from sliding out in front of the thigh bone.  The PCL stops the shin bone from sliding back on the thigh bone.

    ACL anatomy

    ACL Rehabilitation – What is the function of the ACL?

    The ACL is more commonly injured than the PCL.  This is likely because the PCL is wider and stronger than the ACL.  However, the ACL is more important to the overall function of the knee.  Injury to the ACL means that there is too much forward movement of the shin bone.  This has huge impacts on the stability of the knee, especially when doing any weight-bearing activities.

    What are some of the signs and symptoms of an ACL injury?

    • A loud ‘pop’ or a ‘popping’ sensation in the knee
    • Severe knee pain and unable to put weight through the knee
    • Immediate swelling of the knee
    • Loss of range of motion
    • A feeling of instability or ‘giving way’ with weight bearing

    How does the ACL get injured?

    Another important part of ACL Rehabilitation is understanding how the injury happened.  This information helps explain why the injury happened and may help prevent a re-injury.  Specifically, the ACL can be injured in many ways.  Some examples of mechanisms of injury include:

    • Quickly changing direction while running
    • Suddenly slowing down or stopping
    • Incorrectly landing from a jump
    • Twisting the knee with the foot planted on the ground
    • Direct blow to the knee

    What are some of the risk factors for ACL injury?

    For ACL Rehabilitation to be successful, there has to be an understanding of risk factors.

    • Firstly, female gender seems to be a risk factor
      • Women have a higher incidence of ACL injuries according to the research
      • There are a variety of factors, including differences in anatomy, muscle strength and hormones
    • Additionally, certain sports have more risk for ACL injury
      • Sports that involve a lot of sudden direction changes and collisions are more likely to result in ACL injuries
      • Examples include soccer, football, basketball and downhill skiing
    • Lastly, poor strength through the hips and lower legs is an overall risk for ACL injury

    ACL injuries – Are they all the same?

    ACL injuries can vary from person to person depending on the extent of the injury.  The term for an injury to a ligament is called a sprain.  Sprains are graded based on how severely the ligament is damaged.

    ACL Tear

    Grade 1 – there is mild damage to the ligament

        • The ligament is slightly stretched
        • The knee joint is still stable
        • There is no requirement for surgery.

    Grade 2 – there is a partial tear in the ligament

        • The ligament is stretched to the point where it becomes loose.
        • There is still some stability in the knee joint.
        • There is usually no requirement for surgery

    Grade 3 – there is a complete tear or rupture in the ligament

        • The ligament has been split into two pieces
        • The knee joint is unstable
        • Due to the level of damage, there is usually requirement for surgery

    Additionally, other structures may be injured at the same time as the ACL.  Specifically, a lot of patients who injure their ACL, also injure their Medial Collateral Ligament (MCL) and/or medial meniscus.  This combination increases the overall severity of the injury.

    Unfortunately, ACL injuries can also lead to the early development of osteoarthritis in the knee.  The arthritis can vary in severity depending on the person but can contribute to long term pain for some people.

    How do we diagnose ACL injuries?

    A doctor or Registered Physiotherapist can assess the knee after the injury.  They may perform some physical tests that may confirm an ACL injury.  However, these tests are not always 100% accurate.  Additionally, with a very acute injury, it is difficult to complete the tests properly due to intense pain and swelling.

    As a result, imaging is usually required  to confirm an ACL injury.  Understanding the severity of the injury is important because it will determine if surgery will be required.

    Magnetic Resonance Imaging or MRI is the most commonly used imaging test to diagnose an ACL tear.  An MRI uses radio waves and a strong magnetic field to create images of the tissues in the body.  An MRI will be able to show the extent of an ACL injury and any other tissues that may have been damaged.  However, there is usually a lot of swelling soon after the injury happens.  As a result, an MRI is usually not done immediately afterwards.

    ACL Rehabilitation – What are the treatment options?

    Physiotherapy

      • For grade 1 or 2 sprains, the treatment is usually conservative.
      • This means that the doctor would refer the patient to physiotherapy to regain range of motion and strength.
      • The physiotherapist will assess the patient and work on restoring their function
      • The physiotherapy treatment may involve:
        • Electrical modalities to reduce inflammation
        • Hands on treatment to release muscle tension, promote circulation and improve flexibility
        • Exercises to help regain range of motion and recover strength and function through the knee
        • The physiotherapist may also recommend a custom knee brace to help protect the knee from instability
        • Education regarding home management and using any necessary gait aids or braces if required
      • The time required for recovery varies from patient to patient, but generally ranges from 8-12 weeks

    Surgical repair

      • For sprains that are severe, the family doctor will refer the patient to an orthopedic surgeon.
      • The surgeon will assess the patient and determine if they need surgery for their injury
      • Circumstances where surgery may be recommended include:
        • The patient is an athlete and their sport involves a lot of jumping, cutting or pivoting movements
        • There is injury to more than one structure in the knee
        • The knee buckles regularly with everyday activities

     How does surgery affect ACL Rehabilitation?

          • Once the surgery is finished, there will be a recovery process
          • Firstly, to keep the knee from bending, the patient will be placed in a brace
          • Additionally, to be able to move around safely, the patient will be given crutches
          • The surgeon will refer the patient for ACL Rehabilitation
          • The surgery repairs the torn ligament, but the knee will not be able function normally at first
          • Physiotherapy is needed to recover the knee movement, strength and stability.
          • The recovery time after the surgery can range anywhere between 6-9 months. This can be up to 12 months if the patient is returning to high impact sports.
          • For more information about ACL surgeries, please click here.
    • However, there are some patients who can choose not to have the surgery if they can regain function through physiotherapy and if their lifestyle doesn’t place too much stress on the ACL.
    • For example, surgery may not be needed for people who are:
        • Relatively inactive
        • Engage in moderate exercise and/or recreational activities
        • Play sports that put less stress on the knees

    Whichever treatment pathway the patient requires for their ACL injury, physiotherapists play a huge role in their recovery.  It is important to seek out treatment as soon as possible to prevent chronic problems from developing.  Furthermore, starting your treatment sooner than later, helps you get back to your life.

    Call PhysioNow today to book your appointment!

    Patellofemoral Pain Syndrome

    Patellofemoral pain syndrome

    Patellofemoral Pain Syndrome

    Patellofemoral pain syndrome happens when your knee cap does not track properly.  The knee joint consist of two joints.  The tibiofemoral joint which is between the two long bones in your leg and the second one is the patellofemoral joint.  This  is between the femoral condyle (end of thigh bone) and the knee cap. The cartilage on the back of the knee cap glides on the cartilage on the front of the condyles of the femur. The knee cap usually sits in a snug groove at the end of the thigh bone.

    Knee movements are controlled by a number of muscles connected to the knee cap. Your  thigh muscle helps to stabilize the knee cap and enables it to move smoothly in the groove.  When this is pulled out of the groove, you can develop Patellofemoral pain syndrome.

    Causes of Patellofemoral pain syndrome or Anterior knee pain

    Patellofemoral pain syndrome, is one of the most  common causes of pain in the knee. Pain is usually felt under the knee cap.  This is where it glides on the femur/thigh bone. If you have patellofemoral pain syndrome, it hurts when you bend and straighten your knee . There are a number of factors which can cause the pain.

    Common Causes of Patellofemoral pain syndrome

    • Weakness in the hip and thigh muscles-Weakness in the thigh muscles can cause increased load which may lead to pain. Pain in your knees will further limit the activity of your muscles and over time can cause further weakness. Weakness of the inner thigh muscle  will affect the movement of the knee cap as you do your normal activities. Weakness in your hip muscles also can affect activities like climbing stairs and walking.
    • Excessive loading or rapid increase in the load for muscles around the knee-Depending on your usual activities, your knee will have a level of activity that is tolerated by your joint. Rapid increases in loading of activity may lead to a highly irritable or sensitive joint. This can cause Patellofemoral pain syndrome.
    •  Posture or position of hip, knee and feet-Flat feet or excessive turning in of feet can change movement mechanics further up the leg and cause excessive strain in your knee cap.
    • Tight muscles around the knee-Tightness in the muscles can reduce the movement of your knee and affect  how your joint works . This will lead to excessive loading during activities. The common muscles that become tight are your hamstrings, Quadriceps, Iliotibial band and calf.
    • Previous injury or dislocation of knee cap
    • Desk top work, where a lot of sitting can cause pressure on the kneecap.
    • Irritation of fat pad around the knee
    • Tendinitis of quadriceps tendon
    • Bursitis around the knee
    • Osteoarthritis

    When poor biomechanics are repeated with each step of your walking and running it may lead to a highly sensitive joint and Patellofemoral pain syndrome.

    Symptoms

    • The onset of  knee cap pain is normally gradual rather than traumatic.
    • Pain at the front, back and sides of the knee with or without swelling.
    •  Bending and straightening of knee can cause pain.
    • Pain after prolonged sitting or when you keep the knee bent for longer periods of time.
    • Clicking or grinding when you bend or straighten your knee.
    • Pain when you go up and down the stairs, up hill /down hill, squatting, running or jumping.
    • Poor knee control or stiffness

    Physiotherapy Treatment

    Patellofemoral Pain Syndrome treatment

    • Physiotherapy is the most effective treatment for short- and long-term management of Patellofemoral pain syndrome. Your Physiotherapist will fully assess you on your first visit to identify your functional limitation. They will also help to set goals and identify contributing factors for the pain.   They will  provide a customized rehabilitation program.
    • In the initial phase of rehabilitation, treatment is directed towards reducing the pain, swelling and muscle inhibition. To do this PhysioNow will  use electrotherapy modalities, acupuncture, rest, taping, gentle motion or joint mobilization and muscle setting exercises.
    • Once the pain and swelling reduces, treatment is focused towards modifying the  factors that have been identified as a cause for the problem.
    • Rehabilitation typically emphasizes increasing strength and pain free movements.  It also will address postural correction, improving the  stability of the pelvis, balance and functional abilities.
    • Stretching exercises to address the tight muscles and strengthening the weak muscles will improve your load tolerance.
    • Successful rehabilitation requires adherence to your exercise program .
    • You will also need to reduce the aggravating movements and slowly build the endurance and strength for those activities over time.
    • Prior to discharge you will be given a safe progression of exercises and functional activities.
    • For long term management, your foot and knee control will be assessed by your Physiotherapist.
    • As a result, you may require  custom foot orthotics to correct your foot position.
    • This will  help to improve foot and knee control.
    • Others might need a hip stabilization program and your Physiotherapist will be happy to discuss with you the long term rehabilitation plans if this is needed.Custom orthotics for Patellofemoral Pain syndrome

    How long it will take to get better?

    We expect to see improvements with Physiotherapy over a 3 to 6-month period.   Further improvements continue beyond this period. Adherence to your specific exercise program is important in maintaining the improvement. Most people will get back to their normal function with rehabilitation in the short term. Many patients can continue in their chosen activity during rehabilitation.  Some modification of activity may be all that is needed.

    If you play sports, you will need to do sports specific exercises to ensure a safe return to sports. It is good to wear proper supporting footwear to help keep your feet in a good position.  This will  improve alignment of your knees.

    How to book an appointment with a Physiotherapist at PhysioNow?

    We have four Physiotherapy clinics of which three are located in Mississauga and one is in Etobicoke. You can call 289-724-0448 to book into any of these clinics  for an appointment with a Physiotherapist.

    Most of the time we can arrange your initial visit on the same day in a location which is nearest to you. Your initial appointment will be a one to one 40-60 minute session with a Physiotherapist which includes treatment as well on the first day.

    Your follow up appointments  will typically take  40 minutes.  Normally, we would recommend 2 to 3 sessions per  week depending on the factors identified on initial assessment, treatment plan and your goals.  If you have limited funding available, we will be happy to work with you to develop a home exercise program.

    Please call today to get started on your treatment for Patellofemoral Pain Syndrome at PhysioNow!

    Heat therapy

    Heat and Cold therapy

    How it works

    When we apply Heat therapy, it improves circulation and blood flow to  that area due to increased temperature. Heat therapy can relax and soothe muscles and heal damaged tissue.

    Heat therapy

    Types

    • Dry Heat therapy includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
    • Moist Heat therapy includes sources like steamed towels, moist heating packs, Theratherm heating pads that take moisture from the air, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.

    Contraindications

    • diabetes
    • dermatitis
    • vascular diseases
    • deep vein thrombosis
    • multiple sclerosis (MS)

     Heat is useful for relieving:

    • osteoarthritis
    • strains and sprains
    • tendonitis, or chronic irritation and stiffness in the tendons
    • warming up stiff muscles or tissue before activity
    • relieving pain or spasms relating to neck or back injury, including the lower back

    Cold therapy

    How it works

    Cold therapy is also known as cryotherapy. It works by Louis- hunting reaction theory. When we apply Ice to an injured site, it reduces the blood flow by vasoconstriction. After some time, it causes vasodilatation and increases the blood flow to the area. This process goes on continuously. This reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.

    Types of Cold Therapy

    There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

    • ice packs or frozen gel packs
    • coolant sprays
    • ice massage
    • ice baths

    Cold treatment can help in cases of:

    • osteoarthritis
    • a recent injury
    • gout
    • strains
    • tendinitis, or irritation in the tendons following activity

    Contraindications

    • people with sensory disorders
    • uncontrolled diabetes
    • You should not use cold therapy on stiff muscles or joints.
    • Cold therapy should not be used if you have poor circulation.

    Here’s a general guide that helps you to decide which to use heat or ice : https://www.healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#cold-therapy

    In General,  use ice for the first few days after an injury.  Beyond that, heat usually does the trick.  There is some evidence that suggests that using ice beyond the first few days can actually slow down injury healing.  It pushes away the healing agents that help you to get better.

    If you have been injured and need advice or treatment, please call PhysioNow today.  We are always happy to help!