Trigger points in the adductor longus and brevis.

These muscles are located in the groin. The longus originates on the pubic body just below the pubic crest and inserts on the middle third of the linea aspera.The brevis muscle originates on the inferior ramus and body of the pubis and has its attachment to the lesser trochanter and linea aspera of the femur. Trigger points in these muscles are the most common muscular cause of groin pain. Distal trigger points refer pain to the upper medial knee and down the tibia. Proximal trigger points refer into the anterior hip area.

A weak lateral chain will stop you in your tracks.

One very important job of your hip muscles is to maintain the alignment of your leg when you move. One of the primary hip muscles, the gluteus medius, plays an especially important stabilizing role when you walk, run, or squat. The gluteus medius attaches your thigh bone to the crest of your hip. When you lift your left leg, your right gluteus medius must contract in order to keep your body from tipping toward the left. And when you are standing on a bent leg, your gluteus medius prevents that knee from diving into a “knock knee” or “valgus” position.
Weakness of the gluteus medius allows your pelvis to drop and your knee to dive inward when you walk or run. This places tremendous strain on your hip and knee and may cause other problems too. When your knee dives inward, your kneecap is forced outward, causing it to rub harder against your thigh bone- creating a painful irritation and eventually arthritis. Walking and running with a relative “knock knee” position places tremendous stress on the ligaments around your knee and is a known cause of “sprains”. Downstream, a “knock knee” position puts additional stress on the arch of your foot, leading to other painful problems, like plantar fasciitis. Upstream, weak hips allow your pelvis to roll forward which forces your spine into a “sway back” posture. This is a known cause of lower back pain. Hip muscle weakness seems to be more common in females, especially athletes.

You should avoid activities that cause prolonged stretching of the hip abductors, like “hanging on one hip” while standing, sitting crossed legged, and sleeping in a side-lying position with your top knee flexed and touching the bed. Patients with fallen arches may benefit from arch supports or orthotics. Obesity causes more stress to the hip muscles, so overweight patients may benefit from a diet and exercise program. The most important treatment for hip abductor weakness is strength training. Hip strengthening is directly linked to symptom improvement. Moreover, people with stronger hip muscles are less likely to become injured in the first place. The exercises listed below are critical for your recovery.

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.

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 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 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.

Trigger points in the serratus anterior

The serratus anterior muscle is located along the sides of the ribs. It originates on the outer surface of the upper 8-9ribs, and inserts on the medial border of the scapula. This muscle acts on the scapula in several different ways. First it rotates the scapula to turn the glenoid fossa upward. It also protracted and elevates the scapula. And lastly it helps to prevent wining. This muscle is often shortened from prolonged sitting and work on a computer. Active trigger points in this muscle refer pain locally around the trigger point with spillover down the inside of the arm. Pain can also radiate into the inferior angle of the scapula.

What is my Fibular Head and why does it hurt?

The bone on the outermost portion of your lower leg is called the “fibula.” Your fibula is joined to the larger “tibia” at the ankle and the knee. These connections allow for better function and dispersal of weight (1/6th of your body weight is supported by the fibula).

Proper function of your knee requires natural gliding movements of the tibia/ fibula joint. The diagnosis of “Fibular head dysfunction” means that this joint has been “sprained” or has become “stuck” in an abnormal position. Fibular head problems affect all age groups but are particularly common in young females.


Problems involving the fibular head are often the result of an injury to your leg, hamstring, or ankle. Sports and activities that require violent twisting motions with the knee bent are particularly suspect. Athletes who participate in football, soccer, rugby, wrestling, gymnastics, judo, broad jumping, dancing, long jumping, and skiing may be more likely to suffer this type of injury. Patients who sprain their ankle or slip and fall with their knee flexed under their body may suffer fibular head problems. Sometimes, symptoms begin without an identifiable injury.

Patients with fibular head problems generally complain of pain on the outside of their knee. Symptoms become more intense with weight bearing or when applying pressure over the irritated area. Sometimes, the condition affects both knees at the same time. In more severe cases, you may experience numbness or tingling on the outside of your leg. Be sure to tell your doctor if you notice numbness, tingling, or weakness in your leg or ankle.

In most cases, fibular head dysfunction is treatable with conservative care, like the type provided in our office. Initially, you may need to limit excessive twisting movements and hyperflexion, (i.e. heel to butt.) Taping or bracing may help patients who have suffered a sprain or have an “unstable” joint.