Patellofemoral Pain Syndrome

A quick introduction on the Patella

blogpic.anterior-knee Patellofemoral Pain SyndromeCommonly called the “knee cap” its function is to create a more efficient pully system when straightening your lower leg; this is known as knee extension. An example of knee extension is the forward movement of your lower leg when kicking a soccer ball.


The patella tracks in a grove in the lower portion of your thigh bone (femur) – this association between the patella and its groove in your thigh is known as the patellofemoral joint. The “tracking” of the patella in this groove requires a balance of forces to keep it centred in the groove – an imbalance can lead to pain or altered function that may lead to knee or other pain in this area.


What is it?

blogpic.anterior-knee Patellofemoral Pain SyndromePatellofemoral Pain Syndrome (PFPS) is an overuse disorder that often presents as poorly localised pain around, behind or at the front of the patella. It can give an ache or a sharp pain and at times can lead to the knee “giving way” or buckling.


It is the most common cause of knee pain accounting for 25-40% of all knee problems seen in sports injury clinics. Women are more commonly affected than men at a ratio of almost 2:1.




How does it come about?

blogpic.anterior-knee Patellofemoral Pain Syndrome

Due to conflicting results and a lack of reproducibility, no consensus exists in the literature regarding how exactly it comes about, or what factors/activities are most responsible for causing this pain.


Potential Risk factors:

There are several proposed risk factors that may initiate or lead to an increased risk in developing PFPs. They include overuse, malalignment, trauma, a higher BMI and a high training regime.



Knee pain from PFPs worsens with squatting, running, prolonged sitting or when ascending/descending steps.



Factors influencing malalignment:

  1. Static: leg length discrepancies, foot/toe morphology, hamstrings and tight hip muscles, abnormal patella mobility, angular/rotational deformities of the lower leg.
  2. Dynamic: muscle weakness/imbalance, hip weaknesses, abnormal ground reaction forces, excessive foot pronation, insufficient foot pronation.


Treatment Regimeblogpic.anterior-knee Patellofemoral Pain Syndrome

With so many factors influencing PFPS it is imperative you get assessed by a qualified chiropractor or therapist who understands the biomechanics of your body. Our goal is to first decrease pain and then improve tracking and alignment. Getting a correct assessment and treatment will help you to understand where the issue has come from and decrease the pain and dysfunction longevity. Remember in some cases the longer you leave an issue the longer the recovery time; you have to first break the pain cycle and then re-train the dysfunction into proper tracking and alignment.


Treatment for this issue from a chiropractor may include: muscle release work; adjustments where needed, taping, dry-needling and rehabilitation.



Some Self-Help Tips:

  • Avoid pain activities.
    • Decrease volume of training or if really bad then stop all together.
    • Decrease hills/stairs etc. Can use bicycle, swim or other so long as no pain.
  • Ice
  • Barefoot running/minimalist shoes = can help decrease peak patellofemoral joint stress by 12% (mainly barefoot running).
  • Short term anti-inflammatory use
  • If the pain decreases within the first week then progress onto:
    • Hamstring and quadriceps stretches
    • Strengthening your hips (closed chain exercises with a focus on core and hip stability)
    • Quadriceps strengthening.
  • Get assessed and treated by a chiropractor!


Other potential methods:

Foot orthoses, glycoaminoglycan and corticosteroids have limited evidence in helping.



blogpic.anterior-knee Patellofemoral Pain Syndrome

Written by Todd Daniels

Are you getting tension headaches?

Migraines. Headaches. Stress.

Headaches are tricky to figure out because there are different kinds of headaches and multiple variables involved.
Nutrition, posture, and hormones can all play a roll for example.

Today I’m going to focus on one particular type of headache- tension headache. 

The most common reason for these headaches are from tight muscles and connective tissue in the neck and head.

These headaches are painful and distracting, but very manageable!

Classification of tension headaches:

  • Pain is typically described as “pressing” or “tight”
  • Also known as a stress headache
  • Pain is located around forehead and both sides of the head (bilateral)
  • Pain is mild to moderate in intensity
  • Neck and shoulders feel tender and sore (1)

If you feel like your fall under this category of symptoms, don’t panic! Here is what you can do to start getting rid of that headache.

selfmassage-300x200 Are you getting tension headaches?1. Self Massage

Place both hands on either side of the head, just above the ears. Using a “bear claw” shape with your fingers,  start gently pushing into the head muscles. Perform tiny circles with your finger tips. Work into your temples and around the hair line.

2. Neck Stretches

These simple stretches can be done at the computer desk or while you are waiting at a red light. Your neck and shoulder will thank you later for keeping a healthy range of motion with in the muscles, there for keeping away tension. Click here for some simple neck stretches by “Dr. Jo.”

3. Understanding Balance selfmassage-300x200 Are you getting tension headaches?

If you are getting tension headaches too often, then take a step back and observe the amount of stress your are putting yourself through. If you are working non-stop, eating fast food, or not getting enough sleep, than your muscles will not be able to keep up. If you want to manage these headaches, then find time to undo and unwind. If you sit for 7 hours a day, then allocate at least 1 hour a day for some kind of healthy movement. Balance!

Side thought- If you are driving your car non-stop and never get it serviced, the car will stop working eventually. Our bodies are very similar! It is the machine that keeps us going. If you are a busy person, then you need to be getting even MORE bodywork done to outweigh the physical and mental stressors in our world today.

selfmassage-300x200 Are you getting tension headaches?4. Restrain from using painkillers

Painkillers are just band-aids when it comes tension headaches. Try something topical like a deep heat if you are desperate, but popping pills to mask the headache pain will slowly damage your internal organs.

These four bullet points highlight what YOU can do for short term relief from tension headaches.

For long term results, come see one of our health care professionals for you a more hands on and  individual treatment plan.




(1) Ann Indian Acad Neurol. 2012 Aug; Tension type headache.


selfmassage-300x200 Are you getting tension headaches?

Sydney LaVine
Dip. Remedial massage
ATMS 24132

The Art of Foam Rolling

Take home advice is something that I love to give my clients to help ensure they are caring for their bodies and muscles the best they can. One of the most common pieces of advice I often find myself giving is to practice self-myofascial release at home to assist in recovery and restoration of healthy muscle tissue. Self-myofascial release (SMR), more commonly known as “foam rolling”, is becoming a familiar recovery tool for people of all fitness levels. It can be performed with a foam roller, spiky ball, lacrosse ball or anything of the like. Foam rolling assists in relaxing tight muscles and breaking up any adhesions/knots in the muscle layers. While at times uncomfortable, it is an effective way of reducing muscle pain and improving range of motion to enhance performance.

The most common responses I get from my clients are along the lines of “it hurts too much” or “I don’t know if I’m using it correctly”.
It is important to find a SMR tool that suits you and your body. They come in all shapes, sizes and densities to cater for all body types and muscles.
If you find the pain unbearable when rolling out your muscles try looking for a softer, larger tool that allows you to distribute your weight more comfortably and control the pressure more effectively. (That’s the beauty of SMR – you control it!)
For those who are unsure how to utilise their SMR tool effectively, here are my top 3 rolling exercises to reduce pain and increase flexibility. I recommend spending about 60 seconds on each muscle. Find a tender point, hold, release and repeat!

backRolling The Art of Foam Rolling

Foam Rolling on the Back
Lying face up, place the foam roller horizontally under your shoulder blades. Keep your knees bent and feet grounded. Use your hands to support your neck. Switch on your core, lift your hips and press your feet into the floor to slowly roll back and forth up and down the back.

Tip – tilt back side to side to target different areas of your back.

backRolling The Art of Foam Rolling



Foam Rolling on Hamstring & Calves
Place the foam roller under your calf. Keep your hands flat under your shoulders with fingers pointing towards toes. Rest ankle on top of bottom ankle. Slowly roll from ankle to knee using your arms to control the movement. Continue up the leg to target hamstrings.

For less pressure, simply uncross your legs.


backRolling The Art of Foam Rolling


Foam Rolling on Quadriceps
Lying face down, place foam roller above knee and roll from knee to hip. Make the movements slow and controlled. Be sure to support your upper body with both forearms firmly pressed into the ground.

I prefer to put a cushion or towel under my elbows.




backRolling The Art of Foam Rolling


Foam Rolling on Iliotibial Band (ITB)
Lie on the side you wish to target with the foam roller under your hip. Cross the opposite leg over and place your foot flat on the floor. Support your body with your forearm and the resting flat foot. Rest your other hand on your hip and keep your head in line with your spine. Press your flat foot into the ground to control the slow roll down the side of your leg from hip to knee.

Take this one slow, as it can be the most uncomfortable area to roll.




Foam rolling exercises are the perfect recovery after a workout or hard day at work. Try do them as often as you can. Coupled with stretching and regular massage, foam rolling will have your muscles reaping the benefits for optimal performance. So, choose your weapon and start foam rolling! If you have any questions do not hesitate to ask one of our health practitioners at your next appointment.

Shin pain? It could be shin splints.

shinsplintphoto-1-300x257 Shin pain? It could be shin splints.

If you have pain along the inside of your shin, you might have been told that you have shin splints. Shin Splints has been renamed to Medial Tibial Stress syndrome, as it considered more medically accurate. Medial Tibial Stress syndrome is caused when muscles in the calves pull on the Tibial bone where they attach and it is this irritation to the bony attachment surface that causes the shin pain.

The condition is common amongst military personal and athletes. Running related activities typically worsens the condition. Risk factors for developing Medial Tibial Stress syndrome or shin splints include;

  • poor foot/ankle biomechanics
  • training errors
  • improper footwear
  • surface type
  • fatigue and poor lower limb flexibility

The foundation of treatment for shin splints is based on activity modification and symptomatic relief. Identifying aggravating activities and modifying them is crucial in the short-medium term. It is also important to have your chiropractor assess your foot, ankle, knee and hip biomechanics as these regions often have a role when it comes to Medial Tibial Stress Syndrome aka shin splints.

Remember you should always get a professionals opinion before you self diagnose!

Three exercises that will solve lower back pain

Chiro-Hands-1170-360-1024x315 Three exercises that will solve lower back pain


It’s time to put away the Panadol and grab your exercise mat! There are 3 basic movements that you can do at home that will set you up for a pain free lifestyle.

  • “What are the best exercises to perform to prevent low back pain?”

This is a question we hear a lot in our clinic. The below exercises are my ‘go-to’ for prevention of low back pain. They are straight forward and effective. They have been termed ‘The McGill big 3’ – named after the researcher Stuart McGill.

Stuart McGill is a spinal biomechanics researcher from The University of Waterloo, Canada. The goal of these core exercises are to create spinal stability and endurance – which is essential for                                                                                                                      creating a stable foundation for the lower back.

  • “How do core exercises help my lower back?”

    Let’s talk briefly about muscle movement first. Whenever a muscle contracts to perform a movement, this muscle is considered the “Agonist” muscle. Every agonist muscle has an opposite muscle that is generally relaxed. This is known as the “Antagonist” muscle. The definitions are below:

*Agonist muscles cause a movement to occur through their own activation.

*Antagonist muscles are simply the muscles that produce an opposing joint torque to the agonist muscles.

Chiro-Hands-1170-360-1024x315 Three exercises that will solve lower back painWe experience this every time the arm moves to pick something up. The bicep and tricep muscle in the arm work together as a team. When one is contracting, the other is relaxing. The arm does not bend unless both muscles are involved.

Similar to the team work between the bicep and tricep muscle, the abdominal and back muscles are opposites. Both are required for efficient movement of the torso. When one side of the team is not engaging properly or is weak, the opposite muscles will get over loaded and fatigued.

By strengthening the core muscles, you are training the torso to work together as a unit. When the core is strong, the lower back does not have to work as hard.

The exercises aim to tighten up the front and sides of the core, while supporting the spine and remove gravity from the equation. The exercises are of a low intensity and are safe to perform;


Chiro-Hands-1170-360-1024x315 Three exercises that will solve lower back pain

Curl up – 3 sets of 10-12 reps

Bird dog – 3 sets of 10-12 reps

Side Bridge – 3 sets of 8-10 seconds holds, each side.

If the above rep scheme is too hard, you can always modify it by reducing the number of reps and work your way up to the noted rep scheme.

Try doing these exercises before training as well, as it has shown to tighten and stiffen the core.

Perform these exercises once a day, not into pain. If you do have questions, pain or discomfort when performing these exercises, come in and see us and we can either correct your technique or advise you on alternative exercises.



Chiro-Hands-1170-360-1024x315 Three exercises that will solve lower back pain



McGill, S.M. (1997) The biomechanics of low back injury: Implications on current practice in industry and the clinic. J. Biomech. 30: 465-475.


McGill, S.M., Low Back Disorders: Evidence based prevention and rehabilitation, Human Kinetics Publishers, Champaign, Illinois, 2002.


Everyday activities that might be causing your neck pain

Being a massage therapist is more than just treating the issue at hand. You may think we are just being chatty if we ask you a few questions, but really we are trying to understand the bigger picture of your lifestyle and what can be causing your pain or tension. Here are a few everyday activities that can make a big impact on pain and posture.

1. Chewing Gum

While gum chewing isn’t a health threatening habit to have, over time it can make an impact on the muscles around our mouth. Our bodies weren’t designed to be chewing for hours at a time, so when you chew gum it is possible to overwork the jaw and surrounding muscles in the neck and head. I encourage my clients to be mindful of the time they spend chewing, and make a note if they are getting tension headaches related to chewing (especially during stressful times). Why not take a “gum detox” and just see what happens?

2. The Handbag

Handbag, or shoulder bag as it usually ends up being, is a main cause for shoulder and neck pain. Your body works really hard to keep you balanced when you are carrying 5kgs on one side, and has to make changes to the alignment of the spine to keep you centred. Many of my clients will take a purse, laptop bag and gym back to work and come in with shoulder pain every single month. While it might not look super trendy, a backpack with a chest/stomach support strap (this is very important!) is very effective in distributing the weight and reducing back and shoulder pain.

3. Your Pillow

When was the last time you changed your pillow? Do you love your pillow?

We spend 5+ hours a night attached to it, so it had better be treating us well! The main rule of thumb when purchasing a pillow is that you should feel comfortable on it. This especially applies to density. As for shape of the pillow, a higher pillow will be better for side sleepers (so your neck isn’t angled to the side), medium for back sleepers (ideal sleeping position, ideal posture), and low for stomach sleepers. If you are a stomach sleeper and are experiencing regular neck pain, there is a good chance your sleeping “posture” is contributing to that pain. It’s a hard habit to break, but I would encourage you to try sleeping on your back if possible (even for a couple hours at the beginning of your sleep cycle).

We stock several types of pillows at the clinic – check them our next time you’re in and we can answer any questions you might have.

4. Grinding of Teeth

Some people have a subconscious habit of grinding or clenching their teeth when they are stressed, or when they sleep. Solutions can be discussed with your dentist, but something as simple as a bite plate worn at night can reduce jaw tension, pressure on fascial muscles and prevent damage to teeth. If you are a regular “clencher”, perhaps at work or when you are doing sport, both massage therapists and chiropractors can help to relieve tension in the face by performing soft tissue work to the affected muscles.

While the list isn’t extensive, these common actions and habits can go undiscussed for years at a time and end up contributing to huge amounts of tension build up in the neck and head. A simple change can create a world of difference, so if you are curious about making any of the changes suggested here,  just try it out for a week and see how you feel.


Did you know Chiropractic care does impact pelvic floor control

 Pelvic-Floor-Chiropractic-1024x410 Did you know Chiropractic care does impact pelvic floor control

Just Published, Ground-Breaking Results: Chiropractic And Pelvic Floor Control

Story at a glance:

  1. Adjusting pregnant women appears to relax the pelvic floor muscles at rest.
  2. This may mean that chiropractic care could be of benefit to pregnant women, as it may help them have a natural vaginal delivery.
  3. The pelvic floor muscles have active roles in pregnancy and childbirth, as well as in spinal stabilisation.  When the pelvic floor muscles are damaged or stressed over time, health issues like incontinence and vaginal prolapses can crop up, which are problems with massive emotional, physical, social and financial costs across the world and a significant cause of stress for these women.
  4. The primary findings of this study are incredibly encouraging, especially given the fact that quantitatively assessing the effect of spinal adjustment on pelvic floor muscle function has not previously been done.

This is big news for women and chiropractors alike. 

This study [1] demonstrates that chiropractic care has an important impact in pregnancy. It’s just been published and in it Dr. Heidi Haavik and her co-investigators, Dr. Jenny Kruger and Professor Bernadette Murphy, show that adjusting vertebral subluxations alters pelvic floor muscle function.

  • The study demonstrated that adjusting the pregnant women appears to relax the pelvic floor muscles at rest. As there were no changes seen when they adjusted the non-pregnant comparison group, this finding in the pregnant women appears to be an effect unique to pregnancy.
  • This relaxation of the pelvic floor muscles seen after they were adjusted may mean that chiropractic care could be of benefit to pregnant women, as it may help them have a natural vaginal delivery.
  • A secondary interesting finding of this study was that the non-pregnant chiropractic students in the comparison study were able to contract their pelvic floor muscles to a degree previously seen only in elite athletes. We don’t yet know exactly why, but a possible explanation for this is that they were chiropractic students who were regularly getting checked and adjusted and this may have been why they had such amazing control over their pelvic floor muscles. It’s also possible this would have a preventative effect against future pelvic floor dysfunction such as stress urinary incontinence! But the researchers say this needs to be followed up with future studies

Why the Pelvic Floor Study Matters

The pelvic floor muscles (the Levator Ani muscle complex) are known to have active roles in pregnancy and childbirth, as well as in spinal stabilisation. When the pelvic floor muscles are damaged or stressed over time, health issues like incontinence and vaginal prolapses can crop up [1]. We know these are problems with massive emotional, physical, social and financial costs across the world and a significant cause of stress for these women.

For a woman in labour, the ability to relax pelvic floor muscles (as well as contract them) to allow the baby to move through the birth canal is incredibly important, especially as the baby crowns.

The primary findings of this study are incredibly encouraging, especially given the fact that quantitatively assessing the effect of spinal adjustment on pelvic floor muscle function has not previously been done.

The researchers studied the women pre and post adjustment.

“We were expecting to see changes on the squeezes and the pushes and all of that, but we saw nothing. But what was really interesting is that the actual (hiatus) hole itself got larger at rest. What it suggests is that those muscles that form the Pelvic Floor rim that holds all our internal organs and that move to give birth to the baby, must have relaxed,” said Heidi Haavik in a recent interview with Spinal Research.

“That alone is extremely exciting…Opening up those muscles is so important to be able to give birth.”

What could this study mean? 

Again, it’s early days in terms of understanding the full impact of this study’s findings. We do know that adjusting women in pregnancy gives them a greater ability to relax the pelvic floor. We also know that something very unusual occurs in chiropractic students who are being adjusted regularly.

For pregnant women, this has the potential to give them a greater degree of control over the pelvic floor muscles, which in turn may make vaginal childbirth easier. At this point, we can only speculate on what the impacts could be in terms of reduced need for medical interventions, or increased well-being of mother and child. But it does show us that chiropractic may be of benefit to pregnant women.

Haavik concedes that these are big ‘ifs.’ Once again, more research is required but the flow on effects could be far reaching.

Read more about this study.


[1] Effect of Spinal Manipulation on Pelvic Floor Functional Changes in Pregnant and Nonpregnant Women: A Preliminary Study. Haavik, Heidi et al. Journal of Manipulative & Physiological Therapeutics , Volume 39 , Issue 5 , 339 – 347

Orignally posted by Australian Spinal Research Foundation, June 9th 2016