Tag Archives: Knee Pain

Achilles tendon, Fracture, Knee Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

Running Injuries: A Physiotherapy Guide

If you’ve ever had that nagging pain during or after your runs, or if you find yourself having to change how you’re running, this guide is for you. For many of our patients that are passionate runners, it can be hard to know when to push through and when an injury might be serious. In this blog, we’ll go over the most common injuries we see, and how to overcome them. First, let’s start with how they develop.

How do running injuries develop?

Trail running is easier on the tissues due to a softer landing. With running injuries, running surfaces, combined with footwear and mileage are the biggest culprits

Running injuries are almost always a result of overloading a tissue. Whether it’s an increase in training volume, skipping too many rest days, or a muscular imbalance, when it comes down to it, one area is getting over stressed. With repetitive high impact activities like running, the body produces and has to absorb huge amounts of force over long periods of time. Without enough time to repair your body, or without training your body’s ability to deal with these forces properly, injury happens.

Our runners will often say they have:

  • Increased mileage in the past couple of weeks
  • Changed shoes
  • Changed from soft trail to hard pavement or other surfaces
  • Started a new activity/sport on the side

What kinds of running injuries can develop?

Generally, we see a lot of the same issues with runners. These are obviously structures that have to handle he most pressure with running. While not restricted to these, we see most commonly:

  • Runner’s knee (aka PFPS or patellofemoral pain syndrome)
  • Shin splints (aka MTSS or medial tibial stress syndrome)
  • Achilles tendinopathy

Let’s go through a quick summary of each and what Physiotherapy rehab might look like with each one.

Runner’s knee

This feels like a dull aching pain around or beneath your kneecap. Normally, it will feel worse when going downhill or down stairs. It develops when there is an imbalance of muscles at the hip/thigh, causing an uneven pull at the knee cap. Normally our knee cap slides up and down very smoothly in the groove, but with an altered line of pull causes increased friction and irritation. Oftentimes, people with this problem have a gait pattern with the knees or feet falling in.

Your Physiotherapist will help you determine where the root cause is arising, whether it’s your run pattern, lack of foot or hip stability and control, or something else. They will give you specific strengthening exercises and help you correct your running form if needed.

Shin splints and stress fractures

This feels like a throbbing aching pain along the inner edge of your shin bone. Most people say they feel it when they start their run, feel better as they continue, then worse afterwards or even the next day. This condition is a continuum that starts as a more minor soft tissue injury and can progress to a stress fracture if untreated.

Shin splints management will depend on where in that continuum you currently fall. Your physiotherapist will perform some tests with you to determine whether you need to stop running for a time (if a stress fracture is present), or if it’s just soft tissue irritation. They will give you advice on how to modify your runs or how long you have to stay away for, and give you strengthening exercises in the meantime. Additionally, they will create a graded back to run plan to ensure that you can return safely with minimal complications. In the meantime, you could do some cross changing like cycling or walking as long as there is no pain.

Achilles tendinopathy

One of the strongest tendons in the body, our Achilles bears the brunt any kind of jumping impact. This feels like a pain in the heel, anywhere from the bone to a few inches above it. People will complain of a warm up pain, especially worse for the first couple of steps after running, or pain whenever they land on it.

Treatment will involve a full assessment on the lower body to determine if it being brought on by a different issue in the body. Otherwise, modification of your current run habits and tendon retraining involving heavy slow resistance is the gold standard. Your physiotherapist will guide you on the proper place to start to not irritate the tendon, and help you create a safe running plan. This might look like altered mileage, more rest, walk:run intervals and more.

When do I need to see a Physiotherapist?

A little bit of muscles soreness after a workout is normal, but a pain that lasts is not. Don’t let your issues build up into a bigger one. Pain is your body’s way of alerting you to something wrong, don’t ignore it! Even if it is a more minor injury, you can recover faster with a professional’s eyes on it. Physiotherapists are experts with movement and the human body. Not only will they help you address the current issue, but give you tips and advice to prevent future injuries as well.

Running injuries are frustrating, if you’ve had an issue for a long time it is still never too late! Look for PhysioNow today. We have 10 locations across the West GTA including Burlington, Oakville, Mississauga, and Etobicoke ready to help you. Book with PhysioNow today for your first assessment and treatment for a running injury, sport injury, or pain.

Custom Knee Brace
ACL Tear, Custom Knee Brace, Custom Knee Bracing, Knee Pain, Physiotherapy, Total Knee Replacement

Custom Knee Braces: Do I need one?

Custom Knee Brace

Custom Knee Braces are a helpful tool in many knee injuries and degenerative conditions. If you’ve been dealing with knee pain, then you know how frustrating and life altering it can be. You want to play sports, you want to take the stairs, you need to go get groceries, but all of these things are difficult because of your knees. In this blog, we’ll discuss who benefits from custom knee braces and how they differ from off the shelf braces (pre-made).

What is unique about a custom knee brace?

Unlike a standard brace which is made to predetermined measurements, a custom brace is made especially for you. One of our Physiotherapist will take precise measurements of different parts of your knee to fit it perfectly to your shape, providing support where you need it the most. There are also different types of custom braces, and your health care provider can help you determine which one suits you best, depending on your current situation.

Who uses custom knee braces?

Brace for ACL Injury
An example of an ACL brace by DonJoy, that can be made custom to fit each knee

These braces are extremely sturdy and provide lots of stability, support, and can restore function. They are used in several different areas mainly:

  • Post-surgery such as meniscal repairs
  • Relieving pain from osteoarthritis (OA)
  • Extra support during sports or physical tasks
  • Protection while awaiting surgery
  • Stabilizing the knee after a ligament tear (ACL, MCL, PCL, LCL)
  • Delay a total knee replacement surgery

For example, in OA there is often one sided pain from the joint surface wear. A special brace type called an unloader is specifically designed to shift pressure away from the affected side of the joint. In some cases, surgery may be inappropriate or more risky than desired for a patient, a brace can help them return to their activities, even sports, after a severe injury.

How do I know if I need a custom knee brace?

Most minor strains do not need custom bracing and can benefit from off the shelf versions. Working with a health care expert like a Physiotherapist during your injury can help you determine what is right for you. Some clinical signs that they may look for include:

  1. Instability: Including buckling, giving way or feeling like the joint can’t support you
  2. Have been diagnosed with knee OA, especially if severe
  3. Ligamentous laxity
  4. Limited by pain, weakness in activities of daily life or sport
  5. Awaiting a knee replacement, or want an alternative
  6. Recent surgery that needs protection

These are just a few of many things they will look at. Our Physiotherapists are trained to assess and take each individual’s unique factors into account.

Will my insurance cover it? What is the process

In Ontario, some extended health care (EHC) plans will provide coverage for medical equipment including custom knee braces. Since each plan is different, you will have to contact your provider to ask for the coverage available, oftentimes they will be given in a % amount. Additionally, most insurances will also request a physician prescription.

On the clinic side, we will arrange an assessment with a trained Physiotherapist provider to assess how you’re moving, your symptoms, your fitness level, and goals to determine which type of brace would suit you best. Then, they will take specific measurements of your leg which they will submit to the brace manufacturers. After your brace has been made, they will ship it to the clinic and we will call you to let you know. Your physiotherapist will then have you wear it in clinic and perform some movements to ensure it fits well and comfortably. Any brace adjustments needed in the future can be done free of charge for you!

Our clinic will provide you with an invoice with all information necessary needed to submit to the insurers and receive reimbursement. While we are unable to do direct billing for medical equipment, rest assured that your Physiotherapy and Massage Therapy appointments can be!

Looking for more information about braces or knee pain?

Look for PhysioNow! We are one of the west GTA’s most trusted Physiotherapists, serving the area for over 20 years. We are happy to answer any inquiries and help you get started in the process. You can find us at 10 locations across Burlington, Oakville, Mississagua and Etobicoke! Don’t let your knee pain stop you anymore, book your first assessment and treatment with PhysioNow today!

Knee Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy, Surgery

Sports Injuries: Bucket Handle Meniscus Tears

A “bucket handle” tear is a serious type of meniscus injury occurring in the knee. Unfortunately, these typically require surgery. Let’s explore why.

What is a meniscus?

The meniscus (singular) or menisci (plural) are a pair of C-shaped cartilage structure which sits in our knee joints, between our femur and tibia bones. 

There lies two menisci in each knee, the medial (inner) and lateral (outer) meniscus. The main function of the menisci is to absorb shock, making them an essential protector for our knees. For example, whether it’s a sport or just walking our menisci are helping to safely disperse pressure and prevent more delicate structures from getting injured.

In a bucket handle tear (seen below, a large vertical section of the meniscus flips in towards the middle mimicking the motion of a bucket handle. This displaced fragment typically results in pain and an inability to fully straighten the knee. Bucket handle tears are most commonly associated with the medial meniscus and can also occur alongside ACL (anterior cruciate ligament) and MCL (medial collateral ligament) injuries. Altogether, these are known as the terrible triad.

How does a bucket handle meniscus tear get diagnosed?

First, the mechanism of injury will be considered. In most cases, the menisci are injured during these types of movements:

  • Sudden twisting or pivoting on a planted foot 
  • Deep squatting with rotation
  • From a contact sport 
  • Traumatic/impact injuries especially in younger athletes 

Second, the signs and symptoms will be evaluated. Individuals will complain of or experience:

  • Locking/inability to fully straighten the knee 
  • Clicking especially when trying to straighten
  • Sudden pain 
  • Acute swelling (within first 24-48 hours)
  • Joint line tenderness 
  • Feeling of instability 
  • Pain with twisting of the knee

Finally, if indicated, imaging will be used to determine the type and severity of the injury.

An x-ray will rule out fractures and ultrasound may only be able to detect large tears or extrusion of the meniscus peripherally. However, as a bucket handle tear would displace centrally, an ultrasound can miss the tear or displacement completely. An MRI would be the gold standard as it clearly visualizes the full meniscus and displacement.

What are other differential diagnoses?

Other common diagnoses with similar signs and symptoms may be a normal (non-displaced) meniscus tear or another form of loose body (ie. a piece of bone) stuck in the joint. While several knee injuries can share some of the above signs and symptoms, the main way to distinguish a true bucket handle tear is locking of the knee which rarely resolves without surgery.

What treatment options are there for menisci injuries?

Conservative treatment with physiotherapy will be the pathway for most individuals. The criteria for recovery without surgery are usually:

  • Small, stable tears 
  • Degenerative tears, commonly >35 years old
  • No mechanical locking and full range of motion
  • Pseudo-locking of knee (reversible)
  • Symptoms improving 

The second pathway is surgical repair (arthroscopic surgery for a repair or meniscectomy).  

  • Population is usually younger, athletic patients 
  • Traumatic mechanism of injury 
  • True-locking (bucket handle tear) that does not improve conservatively
    • Full extension can be achieved temporarily with manual therapy and movement but will redisplace
  • Associated ACL injury 

Arthroscopic surgery is minimally invasive surgery compared to traditional open surgery and has the benefit of faster recovery times, less post-operative pain and risk of infection, and less scarring.

What does the surgery pathway look like?

As mentioned above, there are 2 main types of arthroscopic surgeries: 

  • Meniscus repair – suturing of torn fragment
    • Preferred when possible 
    • Best for younger patients, especially athletes 
    • Preserves meniscus leading to better outcomes for long term knee health 
    • Full recovery: 4-6 months 
      • Requires bracing in full extension and minimal weight bearing early on
      • Takes longer and more precautions as sutured meniscus has to heal
  • Partial meniscectomy – removal of displaced fragment
    • Only if unable to repair tear 
    • Faster recovery but higher risk of arthritis in the long term 
    • Full recovery: 6-8 weeks 
      • Faster as no healing of tissue required 
      • Focus on strengthening immediately during rehab 

John Hopkins offers a more detailed look into the procedure and what to expect here.

Either way, pre and post-surgical rehabilitation should be undertaken. Beforehand, maximizing the strength and stability of the joint results in a quicker recovery with less risk of complications. Afterwards, rehabilitation is necessary to ensure the joint heals well and to regain full mobility, strength and function. Without proper care after the surgery, the knee may not heal fully and will be limited in the tasks it can perform.

Looking for help with knee pain?

Whether it is a bucket handle tear and you’re awaiting surgery, or a more minor knee injury which can be managed conservatively, your physiotherapists at PhysioNow are here to guide you on how to best manage your injury. We have 10 locations offering sports injury physiotherapy, sports rehabilitation and post-surgery care across the west GTA. These locations include Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment! Or reach us by email: applewood@physionow.ca or phone: 289-724-0448

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Knee Pain, Performance, Physiotherapy, Sports Injuries, Sports Physiotherapy

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.

Man performing a barbell squat to show involvement of multiple muscle groups
Woman performing leg extension on machine to demonstrate the quad isolation of the movement

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

Custom Knee Bracing, Knee Pain, Sports Injuries, Sports Physiotherapy

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 Rehabilitation, ACL Tear, Knee Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

ACL Rehab and Why It’s a MUST After Injury

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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!

Arthritis, Hand Pain Treatment, Health and Wellness, Hip Pain, Physiotherapy, Shoulder pain, Wrist pain

Rheumatoid Arthritis and What You Should Know

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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!

    Knee Pain, Sports Injuries, Sports Physiotherapy

    Hamstring Injuries Caused by Deadlifting: Prevention and Recovery

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    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.

    Exercise, Health and Wellness, Knee Pain, Sports Injuries

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

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    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
    ACL REHAB, Knee Pain, Sports Injuries, Sports Physiotherapy

    Torn Meniscus: What to do Next

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    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.