Andrea Dowd at Precision Sports Therapy INC

07/05/2025

Knee Pain: Find your balance, Unlock the Secret to Stability

The Tibialis Posterior muscle can contribute to knee pain through its influence on foot mechanics and alignment of the lower kinetic chain, here are some examples:

1. Tibialis Posterior Function:
• It supports the medial longitudinal arch ( maintains arch and supports foot)
• It controls pronation- especially eccentrically during GAIT (foot falling in)
• It assists in inverting and plantarflexing the foot (pointing toes down and in)

2. Chain Reaction to Knee:
a. Tibialis Posterior Dysfunction (Weakness or Tendinopathy):
i. Leads to overpronation and collapse of the medial longitudinal arch (common in flat foot)
ii. Causes tibia (shin bone) to internally rotate ( rotate in) excessively during GAIT
iii. This alters the alignment of the knee joint increasing stress on the following:
1. Medial knee structures (MCL & Medial Meniscus- inside of the knee)
2. Patellofemoral joint (kneecap maltracking)
b. Knee Valgus Stress:
i. Overpronation from poor tibialis posterior function contributes to dynamic knee valgus (knee caving in)
ii. This increases shear and compressive forces on the knee, especially during running, squatting and single leg activities.
3. Compensation and Muscle Imbalance:
a. When the tibialis posterior isn’t stabilizing the foot effectively, other muscles may compensate, creating tension and imbalance throughout the leg.
b. Over time, this can lead to pain patterns in the knee (especially anterior and medially- at the front and inside of the knee)

28/04/2025

Unlock the secret to beating IT band pain: The hidden role of Hip Rotation:

When runners or active individuals complain about persistent lateral knee pain, IT band friction syndrome (ITBFS) is often the culprit. The usual suspects- weak glutes, poor footwear, overtraining, get plenty of attention. One biomechanical issue that flies under the radar is limited hip internal rotation.

What is hip Internal Rotation:
The movement of the thigh rotating inward to the midline of the body. It controls the leg alignment during running, squatting.

The connection to IT Band friction Syndrome:
The IT band is a thick band of connective tissue that runs along the outside of the thigh, travels from hip to knee. The job of the IT band is to stabilize the knee. In ITBFS, the IT band becomes irritated generally from repeated rubbing over the lateral femoral condyle, especially when the knee is repetitively bent and straightened.

Why is Hip Internal Rotation important?
You need to have hip internal rotation as it allows us to put force into the ground when running. During hip extension moving towards 0 degrees (when the foot is directly under the hip) Internal rotation needs to happen so the sacrum can rotate forwards and the hip can rotate backwards.

Hip internal rotation also needs to occur during 60-100 degrees of hip flexion (squatting), the posterior internal rotators of the hip- gluteus Medius, gluteus minimums, and the TFL help in producing more internal rotation of the hip, and thus improves the sacrum moving forwards.

What does Limited Internal Rotation cause:

1. Limited internal rotation causes the entire leg to rotate outwards, shifting the stress to the outside knee.
2. Limited internal rotation can cause pelvic instability due to lack of pelvic control. When the pelvis drops excessively during movement, tension along the IT band increases.
3. Limited Internal Rotation causes altered GAIT mechanics, the restricted movement changes stride length, leading to inefficient movement and strain on the IT band.

Why does lack of internal rotation get missed?

Most rehab protocols focus on foam rolling, stretching, and strengthening the glutes- particularly the gluteus Medius. It’s important to address the hip immobility and the hip restriction to ensure things are moving properly.

Test:
• Lie on your back, having your knees at 90 degrees, rotate your knee inwards towards the midline of the body.

Check out the hip mobility level 1 and glut level 1 videos here to assist with hip internal rotation: https://precisionst.ca/hip-videos-1

14/04/2025

What Happens to the Shoulder and Low Back when you have excessive T-spine Kyphosis?

Excessive thoracic spine (T-spine) kyphosis often called “hunchback” creates a chain reaction affecting the shoulders and low back. Here is how:

1. Forward Shoulder Posture: the excessive curve pulls the scapulae (shoulder blades) into a rounded position, leading to muscle imbalances.
2. Reduced Shoulder Mobility: the rounded posture limits overhead reach, and shoulder external rotation increasing the risk of impingement and rotator cuff injuries.
3. Weakening of the Posterior Shoulder Muscles: The Rhomboids, lower traps, and rear delts become overstretched and weak. While the pecs and anterior delts tighten.
4. Increased Risk of Shoulder Injuries; Can contribute to shoulder bursitis, rotator cuff tendinopathy, and frozen shoulder.

Low Back:
1. Compensatory Lumber Hyperlordosis: To maintain balance, the lower back often curves the opposite way (hyperlordodis) increasing stress on the facet joints.
2. Increased Risk of Low back Pain: The excessive Lumbar extension can lead to disc degeneration, and facet joint irritation.
3. Core Muscle Dysfunction: A rounded upper back often leads to poor engagement of the deep core stabilizers, making the lower back more vulnerable to strain.
4. Pelvic Tilting: the excessive lordosis can cause anterior pelvic tilt further disrupting the posture and biomechanics.

What Happens to the Shoulder and Low Back when you have excessive T-spine Kyphosis?

Excessive thoracic spine (T-spine) kyphosis often called “hunchback” creates a chain reaction affecting the shoulders and low back. Here is how:

1. Forward Shoulder Posture: the excessive curve pulls the scapulae (shoulder blades) into a rounded position, leading to muscle imbalances.
2. Reduced Shoulder Mobility: the rounded posture limits overhead reach, and shoulder external rotation increasing the risk of impingement and rotator cuff injuries.
3. Weakening of the Posterior Shoulder Muscles: The Rhomboids, lower traps, and rear delts become overstretched and weak. While the pecs and anterior delts tighten.
4. Increased Risk of Shoulder Injuries; Can contribute to shoulder bursitis, rotator cuff tendinopathy, and frozen shoulder.

Low Back:
1. Compensatory Lumber Hyperlordosis: To maintain balance, the lower back often curves the opposite way (hyperlordodis) increasing stress on the facet joints.
2. Increased Risk of Low back Pain: The excessive Lumbar extension can lead to disc degeneration, and facet joint irritation.
3. Core Muscle Dysfunction: A rounded upper back often leads to poor engagement of the deep core stabilizers, making the lower back more vulnerable to strain.
4. Pelvic Tilting: the excessive lordosis can cause anterior pelvic tilt further disrupting the posture and biomechanics.

https://youtu.be/R0UwVZdqgTs

27/02/2025

What is the interosseus membrane, and what does it have to do with my forearm pain?

The interosseus membrane (IOM) is a fibrous connective tissue that helps distribute forces between the radial and ulna, stabilizing the forearm during movements like gripping, lifting, pronation and supination.

How do we get pain?
1. Increased Tension on forearm muscles:

• If the membrane becomes tight or restricted, it can alter muscle function, leading to increased strain on surrounding muscles like the flexor digitorum profundus, pronator quadratus, and supinator muscles.
• This can result in aching, burning or sharp pain especially gripping or twisting.

2. Overuse and Repetitive Stress:
• Activities that involve repeated wrist and forearm movement (typing, weightlifting, racquet sports, or climbing) can cause microtrauma, leading to stiffening of the interosseus membrane.
• This overuse can create chronic tension in the forearm, restricting movement and causing discomfort.

3. Radial and Ulnar Joint Dysfunction:
• The IOM plays a key role in the force transmission between the radius and ulna.
• If the IOM becomes tight, it can affect the joint mechanics, making forearm rotation (pronation/supination) painful or limited.
4. Compartment Pressure and Nerve Irritation:
• Increased tightness in the IOM may contribute to increased compartment pressure, potentially irritating nearby nerves (anterior interosseous nerve or posterior interosseus nerve).
• This can lead to radiating pain, weakness or even difficulty with motor movements.

What can help?
• Forearm stretches (wrist flexor and extensor)
• Soft tissue mobilization (massage and myofascial release
• Strengthening Exercises (eccentric loading of the wrist and forearm)
• Manual Therapy if there’s stiffness in the radius/ulna joint

20/02/2025

The Relationship between the Popliteus and Knee Osteoarthritis (O.A)?

The popliteus muscle tends to get tight in people with knee O.A. due to a combination of joint instability, altered movement patterns, and protective muscle guarding, here is why it happens:

1. Protective Muscle guarding:
a. When O.A. causes pain, inflammation, or instability in the knee, the body naturally responds by activating muscles to protect the joint.
b. The popliteus, which plays a key role in stabilizing the knee (esp. during walking and weight bearing), the muscle often becomes overactive and tight as a protective mechanism.
2. Increased Knee Joint Instability:
a. The popliteus helps control internal rotation of the tibia and prevents excessive movement of the posterior cruciate ligament (PCL)
b. In O.A. the cartilage wears down, leading to increased joint laxity. This forces the popliteus to work harder to compensate, leading to tightness and discomfort
3. Decreased Knee Extension Range of Motion:
a. Many O.A. patients struggle with full knee extension due to degeneration.
b. Since the popliteus is responsible for initiating knee flexion, a lack of full extension can cause it to remain in the shortened position, further increasing tightness

How to Relieve Popliteus Tightness:

• Sit upright, have your leg supported by two books/yoga blocks
• Place a lacrosse ball behind the knee- on the books or blocks
• Take the other leg and place on the bottom leg to create weight. Sink into the ball and roll the ball in the back of the knee up and down and side to side.
The Relationship between the Popliteus and Knee Osteoarthritis (O.A)?

The popliteus muscle tends to get tight in people with knee O.A. due to a combination of joint instability, altered movement patterns, and protective muscle guarding, here is why it happens:

1. Protective Muscle guarding:
a. When O.A. causes pain, inflammation, or instability in the knee, the body naturally responds by activating muscles to protect the joint.
b. The popliteus, which plays a key role in stabilizing the knee (esp. during walking and weight bearing), the muscle often becomes overactive and tight as a protective mechanism.
2. Increased Knee Joint Instability:
a. The popliteus helps control internal rotation of the tibia and prevents excessive movement of the posterior cruciate ligament (PCL)
b. In O.A. the cartilage wears down, leading to increased joint laxity. This forces the popliteus to work harder to compensate, leading to tightness and discomfort
3. Decreased Knee Extension Range of Motion:
a. Many O.A. patients struggle with full knee extension due to degeneration.
b. Since the popliteus is responsible for initiating knee flexion, a lack of full extension can cause it to remain in the shortened position, further increasing tightness

How to Relieve Popliteus Tightness:

• Sit upright, have your leg supported by two books/yoga blocks
• Place a lacrosse ball behind the knee- on the books or blocks
• Take the other leg and place on the bottom leg to create weight. Sink into the ball and roll the ball in the back of the knee up and down and side to side.

05/02/2025

How the Vastus medialis Obliques (VMO) keeps the kneecap tracking properly and then helps with knee pain

The VMO is a crucial muscle for proper knee function, particular in patellar tracking and knee pain reduction. Here is how it works:

1) Keeps the kneecap tracking properly: the VMO is part of the quad muscles and attaches to the inner (medial) side of the patella. The VMO exerts a medial pull on the kneecap balancing the lateral pull from the vastus lateralis, this balance ensues the patella moves smoothly within the trochlear groove of the femur. Weakness in the VMO can lead to lateral patellar maltracking, which may cause conditions like patellofemoral pain syndrome (PFPS), or runners knee.

2) Helps with knee pain: Shock absorption-a strong VMO helps dissipates forces travelling through the knee joint, reducing stress on the cartilage. Stabilization- the VMO supports the knee during movements like squatting, running, and jumping preventing excessive strain on ligaments. Injury Prevention, weakness in the VMO can contribute. Injury prevention, weakness in the VMO can contribute to conditions like patellar tendinitis and chondromalacia patellae, both common causes of knee pain.

Sterengthening the VMO
• Terminal Knee Extension
• Step ups and downs
• All sits with ball squeeze
• Short Arc quad exercises
• Single leg squats

How the Vastus medialis Obliques (VMO) keeps the kneecap tracking properly and then helps with knee pain

The VMO is a crucial muscle for proper knee function, particular in patellar tracking and knee pain reduction. Here is how it works:

1) Keeps the kneecap tracking properly: the VMO is part of the quad muscles and attaches to the inner (medial) side of the patella. The VMO exerts a medial pull on the kneecap balancing the lateral pull from the vastus lateralis, this balance ensues the patella moves smoothly within the trochlear groove of the femur. Weakness in the VMO can lead to lateral patellar maltracking, which may cause conditions like patellofemoral pain syndrome (PFPS), or runners knee.

2) Helps with knee pain: Shock absorption-a strong VMO helps dissipates forces travelling through the knee joint, reducing stress on the cartilage. Stabilization- the VMO supports the knee during movements like squatting, running, and jumping preventing excessive strain on ligaments. Injury Prevention, weakness in the VMO can contribute. Injury prevention, weakness in the VMO can contribute to conditions like patellar tendinitis and chondromalacia patellae, both common causes of knee pain.

Sterengthening the VMO
• Terminal Knee Extension
• Step ups and downs
• All sits with ball squeeze
• Short Arc quad exercises
• Single leg squats

21/01/2025

How does the Toe Extensor Contribute to Hallux Rigidis?

The extensor Hallucis Longus (EHL) and Brevis (EHB) are the primary toe extensor muscles- they can contribute to the development or worsening of hallux rigidis through biomechanical and functional mechanisms:

1. Excessive pulling on the 1st Metatarsophalangeal (MTP) joint: the EHL and EHB extend the big toe during gait, especially during the swing phase. In cases of overactivity or compensation (due to weakness of other stabilizers like tibialis posterior), these muscles may exert excessive tensile force on the dorsal aspect of the 1st MTP joint. Repetitive or excessive tension can irritate the joint capsule and lead to micro trauma or inflammation accelerating cartilage wear and joint degeneration.

2. Increased Compression Forces at the Dorsal Joint Surface: When EHL is overactive, it can pull the proximal phalanx of the big toe upward (dorsiflexion) excessively, leading to impingement at the dorsal aspect of the joint. This impingement can result in the formation of osteophytes (bone spurs), a hallmark of Hallux Rigidis, further limiting range of motion.

3. Compensation during GAIT: When the Plantar flexor muscles (i.e. flexor hallux longus, or stabilizers (tibialis posterior) are dysfunctional, the extensors of the toes may compensate by engaging more to stabilize the foot. This leads to overuse of EHL/EHB causing additional stress of the MTP joint.

4. Muscle Tightness or Imbalance: tightness or hyperactivity of the extensor muscles can limit natural big toe plantar flexion. This increases mechanical stress on the first MTP joint over time, contributing to cartilage wear and stiffness.

Prevention and Management:

• Strengthening and Stretching: Stretch tight extensors and complementary muscles (towel crunch, roll bottom of foot with a gold ball)

• Orthotics: Can offload excessive stress on the 1st MTP joint

• Joint Mobilization: helps improve range of motion
How does the Toe Extensor Contribute to Hallux Rigidis?

The extensor Hallucis Longus (EHL) and Brevis (EHB) are the primary toe extensor muscles- they can contribute to the development or worsening of hallux rigidis through biomechanical and functional mechanisms:

1. Excessive pulling on the 1st Metatarsophalangeal (MTP) joint: the EHL and EHB extend the big toe during gait, especially during the swing phase. In cases of overactivity or compensation (due to weakness of other stabilizers like tibialis posterior), these muscles may exert excessive tensile force on the dorsal aspect of the 1st MTP joint. Repetitive or excessive tension can irritate the joint capsule and lead to micro trauma or inflammation accelerating cartilage wear and joint degeneration.

2. Increased Compression Forces at the Dorsal Joint Surface: When EHL is overactive, it can pull the proximal phalanx of the big toe upward (dorsiflexion) excessively, leading to impingement at the dorsal aspect of the joint. This impingement can result in the formation of osteophytes (bone spurs), a hallmark of Hallux Rigidis, further limiting range of motion.

3. Compensation during GAIT: When the Plantar flexor muscles (i.e. flexor hallux longus, or stabilizers (tibialis posterior) are dysfunctional, the extensors of the toes may compensate by engaging more to stabilize the foot. This leads to overuse of EHL/EHB causing additional stress of the MTP joint.

4. Muscle Tightness or Imbalance: tightness or hyperactivity of the extensor muscles can limit natural big toe plantar flexion. This increases mechanical stress on the first MTP joint over time, contributing to cartilage wear and stiffness.

Prevention and Management:

• Strengthening and Stretching: Stretch tight extensors and complementary muscles (towel crunch, roll bottom of foot with a gold ball)

• Orthotics: Can offload excessive stress on the 1st MTP joint

• Joint Mobilization: helps improve range of motion

14/01/2025

How do you tell the difference between a high ankle sprain and a regular ankle sprain (low)?

1. Location of Pain:
a. High Ankle Sprain: Pain is felt above the ankle between the tibia and fibula (the lower leg bones). This area is called the syndesmosis.
b. Regular Ankle Sprain: Pain is typically on the outer side of the ankle (lateral) near the bony prominence, involving the ligaments connecting the fibula to the foot.
2. Mechanism of Injury:
a. High Ankle Sprain: Occurs when the foot is forcefully rotated outwards (External Rotation) relative to the leg or with an upward force, such as during sports that involve cutting or pivoting.
b. Regular Ankle Sprain: Often caused by rolling or twisting the foot inward, overstretching the ligaments on the outer side of the ankle.
3. Symptoms:
a. High Ankle Sprain: Pain increases with weight bearing or twisting of the leg
i. Swelling maybe minimal compared to the pain level
ii. Pain during the “squeeze test” where the tibia and fibula are compressed together above the ankle
b. Regular Ankle Sprain: Swelling and bruising are more prominent around the ankle joint.
i. Pain is located to the outer side of the ankle
ii. Walking or bearing weight maybe difficult but less severe than with a high ankle sprain
4. Recovery Time:
a. High Ankle Sprain:
i. Longer recovery time (6 weeks to several months) as the ligaments involved are critical for stabilizing the lower leg bones
b. Regular Ankle Sprain:
i. Recovery time varies based on severity, but it is usually shorter (a few days to a few weeks for mild sprains)
5. Diagnostic Tests
• High Ankle Sprain: May require imaging like x-ray or MRI to confirm a syndesmosis
• Regular Ankle Sprain: Usually diagnosed based on physical examination, though imaging maybe used for severe cases

If you suspect a high ankle sprain, its crucial to see a healthcare professional for proper diagnosis and treatment, as untreated high ankle sprains can lead to chronic instability or other complications.

How do you tell the difference between a high ankle sprain and a regular ankle sprain (low)?

1. Location of Pain:
a. High Ankle Sprain: Pain is felt above the ankle between the tibia and fibula (the lower leg bones). This area is called the syndesmosis.
b. Regular Ankle Sprain: Pain is typically on the outer side of the ankle (lateral) near the bony prominence, involving the ligaments connecting the fibula to the foot.
2. Mechanism of Injury:
a. High Ankle Sprain: Occurs when the foot is forcefully rotated outwards (External Rotation) relative to the leg or with an upward force, such as during sports that involve cutting or pivoting.
b. Regular Ankle Sprain: Often caused by rolling or twisting the foot inward, overstretching the ligaments on the outer side of the ankle.
3. Symptoms:
a. High Ankle Sprain: Pain increases with weight bearing or twisting of the leg
i. Swelling maybe minimal compared to the pain level
ii. Pain during the “squeeze test” where the tibia and fibula are compressed together above the ankle
b. Regular Ankle Sprain: Swelling and bruising are more prominent around the ankle joint.
i. Pain is located to the outer side of the ankle
ii. Walking or bearing weight maybe difficult but less severe than with a high ankle sprain
4. Recovery Time:
a. High Ankle Sprain:
i. Longer recovery time (6 weeks to several months) as the ligaments involved are critical for stabilizing the lower leg bones
b. Regular Ankle Sprain:
i. Recovery time varies based on severity, but it is usually shorter (a few days to a few weeks for mild sprains)
5. Diagnostic Tests
• High Ankle Sprain: May require imaging like x-ray or MRI to confirm a syndesmosis
• Regular Ankle Sprain: Usually diagnosed based on physical examination, though imaging maybe used for severe cases

If you suspect a high ankle sprain, its crucial to see a healthcare professional for proper diagnosis and treatment, as untreated high ankle sprains can lead to chronic instability or other complications.

17/12/2024

Just want to say thank you to those who donated to our fundraiser for Inn from the Cold and Calgary women's shelter, we raised over $8000.00.

There were 11 of us who had to squat, lunge, push up, inverted row, sled drags, assault bike, pull ups, ab roll outs etc. Attached is the video for your viewing pleasure

We are LIVE at 130pm MT.You can GIVE to our Fundraiser by going to ZealPerformance.ca/GIVE. We have chosen to give to Inn from the Cold and/or the Women's Ce...

10/12/2024

How does cold therapy work on injured tissues?

Cold therapy, also known as cryotherapy, works by applying low temperatures to injured tissues to reduce pain, inflammation, and swelling. Here is how it works physiologically:

Vasoconstriction:
• Cold temperatures cause blood vessels in the area to constrict (vasoconstriction). This reduces blood flow to the injured site, which helps limit swelling and prevents excessive fluid build-up (edema)
• It also minimizes the leakage of the inflammatory chemicals into the tissues, which further controls inflammation.
Reduced Metabolic Rate:
• Cooling slows down cellular metabolism in the affected area. This reduces the demand for oxygen and nutrients, which can help prevent secondary tissue damage caused by ischemia (lack of oxygen).
• The decreased metabolic rate also slows the activity of enzymes and inflammatory mediators that contribute to tissue breakdown.
Nerve signal slowing
• Cold therapy reduces the conduction speed of nerve signals in the area, which decreases the sensation of pain. This is particularly beneficial for acute injuries where pain relief is a priority.
Muscle Relaxation:
• Cold therapy can temporarily reduce muscle spasms and tension around the injured area, which can improve comfort and mobility

When to use cold therapy?
Acute Injuries:
• Most effective within the first 48 hrs after an injury (e.g.: sprains, strains or bruises).
After intense Activity:
• Athletes use cold therapy to minimize soreness and reduce delayed onset of muscle soreness (DOMS)

Important Considerations:
Duration:
• Do not apply ice more then 15 mins at a time
• Always use a cloth or towel between cold pack and skin to avoid injury
• Contraindications: not suitable for those with Raynaud’s, cold hypersensitivity, and poor circulation

27/11/2024

For those that have used Athletic Therapy and have seen the benefits, our National Oragnization has hired lobbyists to educate our government on the benefits of this service. Take time out to fill in the survey and send in. Let's get Athletic Therapy recognized. Click the link and fill out a testimonial.

Please click the link to complete this form.

25/11/2024

This year we are doing something different, Precision Sport Therapy is joining the Zeal Community which is back for YEAR TWO to help support local Calgarians going through tough times this holiday season!

We've added TWO organizations in the city that we would like to support: (1) Women's Centre of Calgary (2) Inn from the Cold. These funds will be allocated to the area of greatest need.

We have a GREAT community of clients all over the world and we'd LOVE your support in helping us reach (and surpass) our donation goals!
The 2nd Annual 'Train the Trainer Fundraiser' was inspired by our member Fred. He said he would 'pay money to have coaches do the exercises he does.' Then he went on to explain this idea: Clients pay money for trainers to do our Clients' most beloved/hated exercises.
From there, we fine tuned some details:
- Each Exercise Set has a dollar value.
- Each Set can be 'prescribed' to a coach of your choice for a 2x multiplier.
- Coaches will get together to complete the prescribed exercises after the fundraiser is complete. This will be live streamed for your enjoyment.

You're thinking: "GREAT, how do I participate?! I love supporting great causes and I would LOVE to watch Mitchel do sled drags! or Andrea suffer through some torture outside of her clinic"
(Step 1) Give "$X" to our cause by using our fundraising page.
(Step 2) We receive an email notifying us of this gift.
(Step 3) We will follow up with you on how you would like to 'prescribe' your value of exercises. If you would like us to choose for you, we will do so. See example of Exercise Sets and their monetary value.
(Step 4) Receive your Charitable Tax Receipt and feel great about helping out a local cause! Watch our LiveStream of this wonderful workout created by YOU!
Our coaching staff plus Precision Sport Therapy will get together after December 15th 2024 to crush this workout as a team.

Here is the link to donate: https://www.canadahelps.org/en/pages/2024-train-the-trainer-zeal/
The link is through canada helps and money can be donated to either one of those organizations.

We are back for a 2nd Annual Train-the-Trainer. You GIVE to one of our Calgary-based charities and we lunge, jump, push, squat - and more!