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Patellofemoral Pain Syndrome


Patellofemoral pain syndrome or Runner’s Knee, is a softening of the cartilage covering the underside of the kneecap and gliding against the thigh. This generally occurs because the kneecap is not tracking as it should. It is supposed to glide easily up and down the leg as it helps the quadriceps muscles achieve good mechanical leverage. But with excess pronation, the patella or kneecap deviates to the inside.


When this happens, the cartilage that lines the surface underneath the patella erodes or breaks down. Under stress, the cartilage softens and then slowly develops tears and cracks. This can result in a crunching, clicking rough feeling motion of the patella and of course, pain.

Iliobtibial Syndrome


The iliotbial band runs down the side of your leg from your hip to just below your knee. One of the areas where it attaches is the head of the fibula, the smaller of the two major leg bones. That area is most often the source of pain when this band is injured.

One major cause of the ITB injury is too much pronation in the foot and ankle. This happens because the ITB’s attachment to the front and outside portions of the leg tries to give lateral internal rotation of your lower leg. The resultant pain from the ITB’s attempts to resist this excessive motion almost always occurs at the point where this band pulls the biceps femoris muscle, at the head of the fibula.

Another cause of the ITB problems is lack of flexibility in this band, which can be the result of weakness in some hip muscles. Even though fascia has little ability to stretch, the muscles that attach to it, including the big gluteus maximus of your buttocks are able to lengthen.

Because the exercise designed to stretch the ITB is somewhat awkward, very few people incorporate it into their flexibility routines.

Frozen Shoulder


Adhesive capsulitis refers to the gradual loss of shoulder ROM. The scapula and shoulder compensate, masking the motion and function loss.

There are three phases of this condition:

  • Freezing is when pain and stiffness build gradually and cause progressive loss of range of motion,
  • Thawing is when pain diminishes and moving the arm becomes more comfortable, but range is still limited,
  • and Frozen is when some range of shoulder motion returns, but not to its original level.


It affects people between 40 and 60, usually, and women are more prone to getting it. It often takes months of therapy to resolve. When pain is severe, cortisone injections are often recommended.

Shoulder Arthritis


The primary symptom of shoulder arthritis is deep seated pain that progressively worsens.

As a result of wear and tear, articular cartilage is prone to chondral defects and loose bodies that compromise smooth motion and increase friction. The painful inflammation that results from this and/or from other parts that have gotten overdubbed or overstretched is called osteoarthirits. Inflammation escalates as the time goes on.

Subluxation and Dislocation


If the shoulder partially pops out, it is called a subluxation. If it is out all the way, it is a full-blown dislocation. It often takes years of subluxations before a shoulder is dislocated, stretched all the way out to a point where only a doctor can put it back in.

The joint can dislocate forward – by far the most common direction for subluxation and dislocation, an occurrence whereby the upper arm bone is forced out of the front part of the joint, or it can dislocate backward or downward.


After this occurs, you have to rest your shoulder for a few weeks and keep it in a sling for a few days. You then need to introduce stretches as instructed by your Physical Therapist. You can move on to resistance exercises that restore holder strength to proven ta recurrence.

Shoulder Separation


A separation does not have to be the result of a tackle on a football field or a collision on an ice rink.

Grade One Separation

A mild, or grade one separation overstretches the two AC ligaments and causes the area over the AC joint to be tender, which makes lifting the arm somewhat painful.

Grade Two Separation

A grade two separation includes particle tears in one or both AC ligaments accompanied by significantly more pain, and perhaps a slight bump over the AC joint.

Grade Three Separation

If you have a grade three separation, your shoulder will be visibly deformed and one or both ligaments are completely torn.

Rotator Cuff Tear

Most tears are the result of repetitive overuse and or aging and attrition. This is common among major league baseball pitchers.


Some signs of a tear include:

  • atrophy or thinning of the muscles around the shoulder,
  • pain when lifting the arm,
  • pain when lowering the arm from a fully raised position,
  • weakness when lifting or rotating the arm,
  • crepitus a crackling sensation when moving the shoulder in certain positions, and
  • night pain especially when lying on the involved side.


In most cases, non surgical treatment is recommended and may include:

  • rest,
  • limited overhead activity,
  • use of a sling, but not for long,
  • anti inflammatory medication,
  • steroid injection,
  • strengthening exercise, and
  • physical therapy.

Labrum Tear


Sports injuries, falls, and other traumatic injuries as well as the overuse most of us are prone to at one time or another, can cause tears to the doughnut of rubbery material that crowns the glenoid. It buffers the space between the ball and socket and gets compressed with every shoulder movement.


Some symptoms of a labral tear include:

  • catching,
  • locking,
  • popping,
  • grinding,
  • occasional night pain,
  • pain with daily activities,
  • a sense of instability in the shoulder,
  • decreased range of motion, and
  • loss of strength.

Tarsal Tunnel Syndrome


Tarsal Tunnel Syndrome is one of the newest injuries diagnosed in runners.

Essentially, it is an injury to a nerve that runs along the inside of your ankle. It is similar to carpal tunnel syndrome in the wrist, which is pain usually associated with repetitive motions such as typing.

We used to think that numbness or tingling along the inside of the ankle or on the bottom of the foot was needed to confirm tarsal tunnel syndrome. But now we know that pain felt while pressing just behind the ankle bone is enough to signal this problem.


Some symptoms include:

Plantar Fasciitis


The plantar fascia is a long, fibrous band of tissue that begins at the heel and travels forward under the arch. It then splints off and attaches under the metatarsal heads at the ball of your foot.

When you pronate excessively or your arch begins to fall, the plantar fascia takes the strain and tries to help your foot. Since it pulls at one location into the heel, you will normally feel the strain under the heel bone.


The fascia tears under the stress of pulling. The tears always heal with scar tissue, which easily becomes inflamed. This becomes an unpleasant cycle.

Chronic low grade stress to the fascia also may cause a heel spur to develop; this is the body’s way to try to strengthen the heel bone where the plantar fascia inserts. The pain most often directly under the heel, is most severe when you first get out of bed or after you sit for a long period of time. The pain may fade as you walk or run.

Achilles Tendon


The Achilles tendon connects two big muscles of the calf, the gastrocnemius and the soles, and attaches them into the back of your heel bone. These muscles are designed to forcefully pull your foot downward while allowing enough flexibility to bend your foot upward when running.

Running tends to cause these muscles and the Achilles tendon to tighten up. Without proper flexibility, the Achilles is forced to do much more work that it can handle.


This causes the tendon to become inlayed and it can tear or rupture if thou continue to work it. The Achilles, like all tendons, heals its injuries with scar tissue. This makes it weaker and more susceptible to further injury.


You must treat Achilles injuries quickly, before too much tearing or scarring occurs.

Shin Pain


Shin splints can mean any pain around the front, inside, outside portion of the lower leg.



Tendinitis of the lower leg can occur from overstress or excess pronation. The pain will normally be felt along the inside of your shin bone, but may occur on the front or outside portions.


Inflammation of the bone covering or periosteum (the material that covers your bones) can also lead to shin pain. There is too much shock or jarring, and the bone becomes inflamed, generally along the inside of the shin bone.

Stress Fractures

Stress fractures can occur in the leg or the foot. Normally, the fracture will appear low on the fibula, where the bone is thinnest.

Nerve Irritation

Nerve irritation can also occur. The tibial nerve runs down the inside of the leg and around the inside of your ankle. It can become inflamed on the lower portion of the leg if it gets caught between muscles or veins that have become enlarged.

Compartment Syndrome

Compartment syndrome also sometimes happens. The muscles, tendons, nerves, veins, arteries, and bones of the leg run through four different compartments. Each is tightly wrapped with a cellophane type fascia. When fluid builds up in the compartment or muscles enlarge too quickly, pressure builds up there that can diminish blood flow and cause pain.

Ankle Sprains


Ankle sprains are graded according to how much pain and disability they cause.

Grade One Sprain

A grade one sprain with stretching and inflammation of the ligaments, causes mild pain and slight swelling and normally resolves within a few days.

Grade Two Sprain

A grade two sprain is more severe and involves tearing or partial tearing of one or more of the ligaments. It takes weeks for scar tissue to heal the tear. Since scar tissue isn’t as pliable as the normal ligamentous tissue, the ankle will always be somewhat weak and prone to injury.

Grade Three Sprain

The grade three sprain is the most severe, involving a complete tear of all three ligaments. This creates a completely unstable ankle and in an active individual usually necessitates surgery.

Cervical Radiculopathy


Known as the phone shoulder syndrome because people who hold the phone to their head often get this. It is a compression of C5, C6 or C7 discs in the neck and makes head movement extremely painful. Poor posture can contribute to this condition.



There is lateral and medial epicondylitis. Lateral epicondylitis is known as tennis elbow and medial epicondylitis is golfer’s elbow.


Patients experience pain when attempting to straighten out the arm. Tennis elbow pain is caused by resisted wrist extension and Golfer’s elbow pain is caused by resisted wrist flexion.


There are a variety of stretches and strengthening exercises to apply for this condition, as well as effective modalities such as acupuncture, ultrasound, bracing, ice, etc. that can really help.



With this condition, symptoms don’t neatly fit into diagnostic categories. They can span across the:

  • nervous system,
  • ear-eyes-nose-throat,
  • musculoskeletal,
  • dermal,
  • gastrointestinal, and
  • genitive-urinary systems.

One can experience:

  • fatigue,
  • irritability,
  • nervousness,
  • depression,
  • apathy,
  • insomnia,
  • pain, and
  • morning stiffness.

Pain can be throbbing, burning, stabbing, grabbing, or a combination of these. Many management techniques must be learned to deal with this condition.

TMJ Disorders


Symptoms can include:

  • facial pain,
  • headaches,
  • pain in jaw,
  • pain while closing mouth,
  • clicking or grating in jaw,
  • locking of jaw,
  • ear pain,
  • neck and shoulder pain,
  • difficulty chewing,
  • tooth grinding,
  • morning jaw pain, and
  • difficulty swallowing.


Treatment can include:

  • joint mobilizations,
  • heat,
  • ultrasound,
  • acupuncture,
  • ice, and
  • strengthening and stretching exercises.

Improving Posture


Shift your body weight so that your feel your weight balanced over your arch or middle of your feet. Stand with your knees straight, not bent. Do not have your hips rotated too far forward or backward. Tone and train your abs as the deep ones are important stabilizers for good posture. Don’t slouch and ensure you do not have a forward head posture.

Stress Management


Stress does affect all muscles and many other areas of your body so it is important to stay on top of managing stress.


Breathe! This will help you get out of your fight or flight response and get into a rest and digest mode.

  • Sweat and stretch if off. Exercise is a common and beneficial stress reliever.
  • Meditate, visualize and imagine. Set time to relax.
  • Establish a safe environment and socialize with friends and family.
  • Think positively.
  • Understand and overcome your fears.
  • Organize and prioritize.
  • Do a kind deed or gesture.
  • Seek professional help.


Scoliosis is an abnormal side curve of the spine.  Often the vertebrae are also rotated.  The condition can be genetic.  In most cases, however, the cause of this is unknown.  It affects females more than males and often shows up in adolescence. 
It rarely causes back pain on its own.  If there is pain, it is generally from a disc or joint issue resulting from the abnormal curve.  Scoliosis can also occur later in adult life when deteriorating vertebral discs and joints can cause curvature.
Treatments vary and can include bracing, stretches and strengthening in a physiotherapy setting and in the home. 

Sacroiliac Joint Dysfunction

The triangular bone at the end of your spine that fits into your hips is called the sacrum. It is a naturally fused set of three to five vertebrae.  The joint between the sacrum and your pelvis is called the sacroiliac or SI joint.  Problems in this joint can cause pain in several areas including the lower, back, the buttock, the groin, the legs and the top of the hip bone.  Pain is usually only on one side of the body.  The symptoms tend to worsen in static positions such as standing, sitting, or lying down. 
Sometimes it is felt when going up the stairs or bending forward.  Causes can include a sprain in the ligaments that surround the joint, muscular imbalances, abnormal walking patterns and laxity of ligaments due to pregnancy.
Relief can be felt temporarily by going into the fetal position (lying on the side with the knees bent).  A pillow between the knees sometimes helps.  Physiotherapy can help by strengthening muscles and correcting muscular imbalances. 

Herniated Discs

Vertebral discs are tissues with a tough outer layer and a softer gel like inner layer.  The discs provide a cushion between the vertebral bones and are subject to wear and tear over a lifetime.  When a disc in herniated, it bulges out and can press on nerves and cause pain.  Depending on how much it is pressing on the nerve, pain may be mild or severe with a sharp or dull sensation.  It is quite possible, even for a disc bulge not to cause any pain because it is not pressing on a nerve. 

Piriformis Syndrome

The piriformis muscles are one of the several sets of muscles that rotate your hips outward, helping to keep you stable and upright when moving around.  Piriformis syndrome occurs when one of these muscles tightens and irritates the sciatic nerve.  You will feel a dull, annoying pain in your buttock that usually radiates down your leg, often accompanied by tingling or numbness.  This tends to get worse when you sit down, particularly for any length of time, or climb stairs or a steep slope.  Sometimes it makes walking difficult.  Most people in physiotherapy make a full recovery within four to eight weeks. 


This condition arises from the head being jolted violently back and forth, usually as a result of a sudden blow or impact.  This often happens in car accidents.  Initially you may feel little pain, but over the next day or so both the front and back of your neck and your shoulders will become stiff and painful, and possibly swollen.  You may also experience muscle spasms, limited neck movement, nausea, headaches, blurring of vision and ringing in your ears, along with a general feeling of fatigue and sometimes, difficulty thinking.  Most symptoms will disappear within a few weeks.  Extra rest in week one or two post trauma are important.  However, be careful not to overdo rest and ensure you initiate movements through a structured physiotherapy program.

Spinal Care for the Neck and Back

We see a large variety of spinal conditions, both acute and chronic.  We can approach a problem through many types of treatment means.  For example, we use spinal mobilization techniques (hands on treatments) to reduce pain and increase joint mobility in conjunction with exercises and guidance on correcting body movements.  We also use repeated movements and positions to assess the way your body processes and responds to pain and help you actively manage your pain. We educate you on which movements to perform at home to resolve your issue.   We also deactivate painful trigger points using myofascial release techniques, acupuncture and dry needling. 
Other very helpful treatments can include spinal decompression with use of our sophisticated computerized traction bed, and modalities such as Interferential Current, Ultrasound, Heat/Cold and Laser.

Multiple Sclerosis (MS)

MS is a chronic disease or condition of the central nervous system, likely autoimmune in nature.  MS causes symptoms by creating inflammation, scars, and atrophy.  Inflammation occurs when the attack is happening and certain immune cells start going after the myelin, and this process signals other cells to the area, causing swelling and irritation.    After weeks of this, remyelination occurs in an imperfect way leaving a scar in the form of a lesion, which often causes residual symptoms.  Atrophy also occurs; this involves the loss of brain and spinal cord tissue and it happens when the entire nerve structure has been destroyed. 
Education, physiotherapy treatment and family/community support are essential to manage MS optimally.  Our registered physiotherapist, Kirsten Labaj, is passionate and highly trained in working with MS and other neurological disorders.  She works with the MS Society and often lectures on important aspects of managing MS.

Spinal Decompression for Sciatica, Disc Herniations and other Conditions

PhysioMax Wellness has offers spinal decompression which involves the application of a gentle distraction tension to the spinal segment that is affected, without causing a reflex contraction of the muscles in the surrounding area.  This computerized electronic system has a sophisticated feedback loop system which monitors and changes the tension being applied to a patient every continuously.  This tension applied to the affected segments, creates a negative pressure, which helps to reduce the disc bulge and accelerate healing.
You may likely benefit from this treatment if you have the following:
         Disc bulge
         Disc herniation
         Degenerative disc disease
         Sciatica caused from a disc injury.
         Failed low back surgery & no hardware.
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