Bryan Cobb RMT.

Since 2005, Bryan has been dedicated to helping all people with chronic and acute pain caused by soft-tissue damage.

His training and experience make him uniquely qualified to treat a wide variety of pain and dysfunction and to give instruction on prevention and self-care.

Bryan is the only Massage Therapist in Manitoba — and one of the few in Canada — to be certified by the Certification Board for Myofascial Trigger Point Therapists (CBMTPT).

Bryan holds a degree as an Advanced Remedial Massage Therapist (ARMT) from the Massage Therapy College of Manitoba.  Course work at MTCM includes
• over 2,000 hours of practice, as well as
• intensive course work,
• a supervised clinical practicum, and
• community outreach placements.

MTCM has a credit transfer affiliation with the University of Winnipeg, ensuring that its courses are held to the highest level.  When Bryan studied at MTCM, the college was the only massage therapy college in western Canada accredited by the Commission on Massage Therapy Accreditation.  Today, the college is a member of the Canadian Council of Massage Therapy Schools.

Bryan is a member in good standing of the Natural Health Practitioners of Canada.

Bryan also has a background in Anatomy, Exercise Physiology, and Sport Sciences from the University of Manitoba, and he has worked as a personal trainer and fitness leader.

He is an avid natural bodybuilder and fitness enthusiast, and has a blue belt in Brazilian jiu-jitsu.

Chondromalacia Patellae; sounds dramatic, usually isn’t.

The term “Chondromalacia Patellae” (CMP) describes painful damage to the cartilage behind your kneecap. CMP may begin at any age and is commonly found in teenagers. The likelihood of developing CMP increases with age, and the condition is more common in females. You are more likely to develop CMP if you are overweight or have had a prior knee injury.
One of the most common causes of CMP is an imbalance between the muscles that help to guide your kneecap and its “V-shaped” groove at the end of your thigh bone. Repeatedly flexing and extending a misaligned kneecap leads to pain, swelling, and eventually cartilage damage. Misalignment of the kneecap (patella) is often secondary to problems in your hip and foot, especially weakness of your gluteal muscles or flat feet.

CMP causes a dull pain behind your kneecap that is aggravated by prolonged walking, running, squatting, jumping, kneeling, stair climbing, or arising from a seated position. The pain is often worse when walking down hill or down stairs. Popping, grinding, or giving way may occur from long-standing misalignments.

Conservative care, like the type provided in this office, is generally successful at relieving your symptoms. It is important for you to minimize activities that provoke your pain, especially running, jumping, and activities that stress you into a “knock-knee” position. Do not allow your knees to cross in front of your toes when squatting. Some athletes may need to modify their activity to include swimming or bicycling instead of running. Performing your home exercises is one of the most important things that you can do to help recover. The use of home ice or ice massage applied around your kneecap for 10-15 minutes, several times per day, may be helpful.

I’ve got a sharp burning pain in my foot, what could it be? 

Morton’s neuroma is a benign (non-cancerous) enlargement of one of the nerves in your foot. The problem most commonly occurs between your third and fourth toes, but can occur elsewhere. Morton’s neuroma is a nuisance for 10% of the adult population, with females being affected 5 times more often.

The irritation is thought to be brought on by activities that require repeated or forceful back-bending of your toes, like dancing, walking, squatting, and running- particularly running on your forefoot, or on hard surfaces. Wearing high heels or shoes that are too tight can provoke your symptoms.

You may experience brief, intermittent episodes of sharp burning pain that are followed by a persistent dull ache begins near the ball of your foot and radiates into the toes. You may feel as though you are “walking on a marble.” Occasionally, numbness, tingling, or cramping may accompany your pain. You may find relief by removing your shoe and/ or gently massaging your foot. Be sure to tell us if your symptoms affect your entire foot, if you notice any weakness, or have pain that starts in your back and travels into your thigh and leg.

You should avoid wearing high-heeled narrow or unpadded shoes. If you are a “forefoot” runner, you may consider transitioning to a mid-foot strike. Your treatment will likely consist of wearing a specially designed felt pad to help take stress off of the irritated nerve. Most patients report relief by modifying their shoes and undergoing conservative therapies, like the ones provided in our office.

I’ve got ITB Syndrome Doc! Now What?

Your iliotibial band is a fibrous band of tissue running from the crest of your hip, down to your knee. A muscle near the crest of your hip called the tensor fascia lata, attaches to this band to help control movements of your leg. Your iliotibial band passes over the point of your hip and over another bony bump on the outside of your knee called the lateral epicondyle. When the band is too tight, it can become painfully inflamed as it repeatedly rubs over the top of either of these bony projections. Irritation at the bony bump near the knee is called iliotibial band friction syndrome.


The condition usually presents as pain on the outside of your knee that becomes worse with repetitive knee flexion or extension. This condition is the leading cause of lateral knee pain in runners, especially slower “joggers.” The pain usually develops 10-15 minutes into the workout. You may sometimes feel or hear a click during movement. Symptoms generally ease at rest. Running on slick “wintry” surfaces may aggravate the condition. Excessively worn running shoes may be a culprit.

This problem is commonly caused by weakness in your gluteal muscles. When these muscles are weak, the muscle that attaches to your iliotibial band must contract harder to stabilize your hip. Having one leg longer than another is a known aggravating factor.

Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track, as well as wet or icy surfaces. Runners should reverse directions on a circular track at least each mile. Bicyclists may need to adjust seat height and avoid “toe in” pedal positions. Avoid using stair climbers or performing squats and dead lifts. Sports cream and home ice massage may provide some relief of symptoms.

Runner’s Knee Sucks.

Patellofemoral pain syndrome (PFPS) describes a painful irritation of the cartilage behind your kneecap. Although anyone may be affected, it is often the result of overuse of the knee in sports that require jumping or running so it is sometimes referred to as “Runner’s knee”. PFPS is the most common cause of knee pain in the general population, affecting an estimated 25% of adults.

One of the most common causes of PFPS is an imbalance between the muscles that help to guide your kneecap in its V-shaped groove at the end of your thigh bone. Repeatedly flexing and extending a misaligned kneecap leads to pain, swelling and eventually arthritis. Misalignment of the kneecap (patella) is often secondary to problems in the hip and foot, especially weakness of your gluteal muscles or flat feet.

PFPS produces a dull pain behind the kneecap that is aggravated by prolonged walking, running, squatting, jumping, stair climbing or arising from a seated position. The pain is often worse when walking downhill or down stairs. Longstanding misalignment can cause damage to the cartilage, which results in popping, grinding or giving way.

Conservative care, like the type provided in this office, is generally successful at relieving your symptoms. Initially, it is important for you to minimize activities that provoke your pain, especially running, jumping and activities that stress you into a “knock-kneed” position. Don’t allow your knees to cross in front of your toes when squatting. Some athletes may need to modify their activity to include swimming or bicycling instead of running.

Performing your home exercises consistently is one of the most important things that you can do to help realign the patella, relieve pain and prevent recurrence. The use of home ice or ice massage applied around your kneecap for 10-15 minutes, several times per day may be helpful.

What is Tarsal Tunnel Syndrome?

The tarsal tunnel is the space behind the bump on the inside of your ankle. The tibial nerve lives in this tunnel along with some tendons. Tarsal tunnel syndrome means that the tibial nerve is being irritated within the tunnel. This results in pain, numbness or tingling into your heel and the arch of your foot.

The tibial nerve may be irritated by compression (from trauma , arthritic spurs, or swelling of other tissues within the tunnel), or more commonly by constant stretch (from flat feet). Research has shown that tarsal tunnel pressure increases almost 30 fold in people with flat feet.
Tarsal tunnel is slightly more common in women, and high heels are suspect. The condition often affects both feet. Conditions like diabetes and thyroid disorders may aggravate nerve problems like tarsal tunnel. Plantar fasciitis commonly accompanies tarsal tunnel syndrome.

The discomfort is often described as “burning”. Symptoms may increase with long periods of standing, running or exercise. Almost half of patients report increased symptoms at night.

Your doctor will make the diagnosis of tarsal tunnel syndrome based on your history and an exam. Your doctor may take an x-ray to rule out other problems like arthritic spurs or a stress fracture. In severe cases, more sophisticated nerve testing may be necessary.

The first goal of treatment is to allow you to return to pain-free activity as soon as possible. The second goal is to correct the mechanical problem that allowed this condition to begin with.

What is knee tendonitis?

Tendons are strong bands of fibrous tissue that connect your muscles to your bones. Your “patellar tendon” connects your kneecap (patella) to your shin bone (tibia). “Patellar tendonopathy” results from repetitive straining and micro-tearing of this connection, resulting in pain and inflammation. The condition is referred to as “jumper’s knee,” since damage is thought to often result from repetitive jumping.

The condition should probably be called “landing knee,” since forces on the patellar tendon are twice as great during landing as compared to those created during take off.

Patellar tendinopathy is common, affecting almost 20% of all athletes with a rate as high as 50% in sports that require repetitive forceful jumping, like basketball and volleyball. The condition may affect one or both knees and may be slightly more common in males.

Weakness in the quadriceps muscle of your thigh can allow excessive bending of your knee when you land following a jump. This places your patellar tendon at a greater risk for injury. Having strong quadriceps muscles protects your knee from excessive flexion and injury.

Symptoms of patellar tendinopathy include pain or swelling just below your kneecap. This may begin without an identifiable injury and may come and go for months or years. Symptoms are usually aggravated by activity, but most athletes have been able to continue playing through the pain. Pain often increases during activities that require strong quadriceps contraction, like jumping, squatting, arising from a seated position, stair climbing, or running. Walking down stairs or running down hill seems to be more bothersome than going up.

Some athletes may have unconsciously learned to protect their knee by developing unnatural jumping mechanics. This could include landing with a more rigid knee, or allowing too much hip flexion. You may need to become more conscious of landing with the right amount of knee flexion with your foot in a neutral position and avoiding excessive hip flexion. Your doctor would be able to answer any questions you have about good jumping mechanics.

Patellar tendon straps, like a Cho-pat, can help reduce stress on your patellar tendon and relieve pain. Three fourths of the people who use patellar tendon straps for patellar tendinitis report improvement.

Patellar tendinopathy is treatable. Patients who follow a well-planned strengthening program show similar outcomes to those who have undergone surgery for the problem. Initially, you may need to decrease your training intensity to help protect your knee. You should stay away from activities that produce more than mild pain. You should avoid complete rest, as this could actually increase your risk of recurrence. Using ice packs or ice massage for 10-15 minutes at a time, especially following activity, may help to reduce inflammation.

The all too common knee cartilage tear.

The meniscus is a piece of tough, smooth, rubbery cartilage in the middle of your knee. Each of your knees have a meniscus on the inside (medial meniscus) and another on the outside (lateral meniscus). Each meniscus attaches to the top of your shin bone (tibia) and acts as a shock absorbent guide for your thigh bone (femur), which rests above.
Meniscus

Damage or tears to the meniscus are common. Males are affected three or four times more often than females. Tears may occur at any age. In children and adolescents, the menisci are more durable and rubbery, so most injures are “traumatic” as a result of a forceful twisting injury. As we age, our meniscus grows weaker, and “degenerative” tears become more likely, often resulting from simple or even unrecognized injuries.

Symptoms of meniscus injury depend on the type and severity of damage. Patients sometimes hear a pop or snap at the time of initial injury. Patients with acute injuries may have difficulty bearing weight and may develop a limp. Stiffness is a common complaint. Clicking, catching, locking or giving-way is possible. Meniscus injuries are usually aggravated by movement and become particularly uncomfortable with deep squatting.

Although some meniscus injuries may require surgery, most can be treated conservatively with the type of treatments provided in our office. Your age roughly correlates with the need for surgery. Approximately 2/3 of acute meniscal tears in children and adolescents will require surgery, but only about 1 in 20 patients over the age of 40 will require knee arthroscopy. Surgery is necessary more often in patients who cannot fully bend or straighten their leg, or whose knee locks and gets stuck in one place.

Home management includes rest, ice, compression and elevation (RICE). You should apply ice over your knee for 15 minutes at a time, three or four times a day. Wrapping an ACE bandage around your knee will provide compression to help minimize swelling. You may elevate your leg by placing a pillow beneath your knee to help reduce swelling.

You may need to limit your activity to prevent further damage while you are recovering from injury. Activities that involve twisting on a weight-bearing flexed knee are the most harmful. You may need to temporarily or permanently discontinue some high energy sports activity. Other activities, like water walking, may be substituted for higher energy sports, like soccer and tennis. Ice or ice massage should be used following activity.

Patients who have undergone surgical repair of their meniscus are more likely to develop arthritis. These patients will also benefit from a well-planned home exercise program.

What is Sever’s Disease?

Severs disease, also called calcaneal apophysitis, is a painful swelling near the insertion of the Achilles tendon on your heel.

As our bones develop, we have “growth plates” which are softer areas where the bone is still growing. In children, this growth plate is weaker than in adults. This means that children are more likely to suffer growth plate injuries than adults, especially during periods of rapid growth.

The powerful calf muscles attach onto your heel through the Achilles tendon. When your calf muscle contracts (like during running or jumping), it places a shear force on the growth plate of your heel. Severs disease is an irritation to this sensitive growth plate.

Athletically active children, who run and jump frequently in sports like soccer, basketball, gymnastics and track & field are most likely to suffer from this condition. Severs disease is slightly more common in boys and the condition affects both heels about half of the time.

Symptoms usually start as heel pain that gradually worsens during activity. Sometimes this can cause a “limp”. Rest usually temporarily relieves the pain.

Your doctor will make the diagnosis of Severs disease based on your history and an exam. Your doctor may take an x-ray to rule out other injuries like a stress fracture.

The first goal of treatment is to allow you to return to pain-free activity as soon as possible. This may require avoiding stressful activity like running and jumping for a short period of time. Cross training on a bike is usually acceptable. Ice should be applied for 15 minutes after any activity. You should always wear shoes with good arch supports and avoid walking barefoot. Your doctor may recommend a small heel lift to decrease strain on your achilles tendon.

What is a knee sprain?

“Ligaments” are made up of many individual fibers running parallel to each other and bundled to form a strong fibrous band. These fibrous bands hold your bones together. Just like a rope, when a ligament is stretched too far, it begins to fray or tear. “Sprain” is the term used to describe this tearing of ligament fibers.

Sprains are graded by the amount of damage to the ligament fibers. A Grade I sprain means the ligament has been painfully stretched, but no fibers have been torn. A Grade II sprain means some, but not all of the ligamentous fibers, have been torn. A Grade III sprain means that all of the ligamentous fibers have been torn, and the ligament no longer has the ability to protect the joint. Knee sprains commonly involve one or more of your knee’s ligaments including: the medial collateral, lateral collateral, anterior cruciate, and posterior cruciate.

Most knee sprains begin as the result of a sudden stop, twist, or blow from the side or front. Some patients recall a “pop” or “snap” at the time of injury. Knee sprains cause pain and swelling within the joint. Your knee may be tender to touch, and some patients report a sensation of “giving way” or difficulty walking.

Most knee sprains can be successfully managed without surgery but will require some work on your part. Initially, a period of rest may be necessary in order to help you heal. Mild Grade I sprains may return to activity in a couple of days, while more severe injuries may take six weeks or longer to recover. You can help reduce swelling by elevating your knee and using an ACE wrap for compression. Applying ice or ice massage for 10 minutes each hour may help relieve swelling. Depending upon the severity of your sprain, you may need to wear a knee brace to help protect you from further injury. If walking is painful, crutches may be necessary.