Expert advice: Stretches and Exercises for your Knees!

5-stretches

If you’re a runner, chances are you have had a knee issue at some stage. Or at least been worried about it happening. We all tend to have this belief that running is inherently bad for our knees, but is it true? In the first part of this two-post series, we seek advice from the experts to help answer this question. They help us to understand the bigger picture of how running affects our knees, provide us with a simple test we can use to gauge how injury-prone we might be, and detail the different types of injuries, conditions or running technique that might cause knee pain.

In this post, we will explore what to do if you already have knee pain, and some stretches and exercises that might help runners’ knees! The information in these two posts have been researched and written wholly by the team at the Bowskill Clinic in London along with some medical experts they work with… specifically for you (us!), which is pretty awesome.  Only minor edits (and a few cheeky comments) by me.

A gentle reminder from the experts before we start… While much of the information in this blog will help reduce the incidence of injury, unfortunately even with the best advice it is not possible to completely avoid any risk of injury when starting a running programme. But hey, we never said running would be easy, right?

If I have knee problems, should I avoid running? 

There are many different things to take into consideration if you have knee pain and are a runner. Some kinds of aches and pains may simply come and go and can be ‘run though’, while others may need some rest and specific medical advice and treatment or a rehabilitation programme.

Below are listed some of the factors that mean you should stop running and see a doctor or physical therapist.

According to Dr Jonathan Rees,Consultant in Rheumatology and Sports Medicine, injuries commonly occur in the joints, bone or tendons. He explains that it is therefore important that you ‘listen to your body’. While there is also no substitute for a formal assessment by an experienced physiotherapist or sports doctor, the following are Dr Rees’s guidelines for when you should consult with a specialist:

  1. Pain. It is not normal to have pain (wait, what?). Not only that but pain will affect how you run. You need to know what is causing the pain and why.
  2. Any pain accompanied by swelling in a joint is of concern and you should not run on a swollen joint. It risks potential further damage to that joint.
  3. Pain at rest, at night or on gentle activity could indicate a stress fracture and it is essential that this is checked out medically.
  4. Pain that is worse initially, eases during a run and then recurs late that day or the following day is also a concern.

Another important factor in assessing knee injury in runners is understanding some of the implications of imaging findings. In other words, if you have x-rays, ultrasound or MRIs of your injury, it is important that they are interpreted by the radiologist with a full understanding of your sporting background, level of competition and history of training.

Dr Simon Blease, Consultant Musculoskeletal Radiologist and elite fell runner explains:

As radiologists we have to be aware of the additional changes that occur in the body in response to exercise. We call this phenomenon ‘Adaptive Change’ and it is important to realise just how much a knee may adapt to exercise compared to a sedentary person. For example, the knee cartilage will change its appearance in a way that would indicate disease in a sedentary person but can be, in fact, quite normal for an active runner. In addition to this, an elite athlete can tolerate pathological damage to the joint that would stop an ordinary person in their tracks. Training, conditioning, mental approach and determination all alter the individual response to joint damage and a radiological report must be take this into account in order to be meaningful for further management.

So, in my experience, if you get MRI results back that seem rather scary, get a second opinion, particularly from someone who is used to working with athletes! I’ve experienced this with scans, but also with ECGs of my heart. My ECGs always come out strange, causing doctors initial alarm, because of my enlarged heart and slow heart beat. It’s apparently called ‘Athletic Heart Syndrome’, and while perfectly normal for an endurance athlete, it can look like heart disease in someone more sedentary. (Read “Six Reasons Your Doctor Needs To Know You’re a Runner” in Runner’s World).

Returning to running after knee pain

If you’ve had knee pain in the past and are returning to running, it is important to concentrate on a) stretching appropriately and b) strengthening your legs.  A graded return to activity that gradually increases volume and is created with cross training also in mind will help to reduce the chances of re-irritation.

a) Five stretches to help runners’ knees

Here are five stretches to help to maintain flexibility around the knee joint. However, as a reminder, if you have a particular issue you should always consult with a medical professional.

Hold each stretch for 30 seconds gradually and gently progressing the stretch as you feel able.

  1. The three plane hamstring stretch
  • Sit on the edge of a bench with one leg straight and then other bent.
  • Bring the arms straight in front of you pointing downwards.
  • Lift the chest and fold from the hips to feel the stretch.
  • Perform with toes up and turned in and out to vary the different heads of the hamstrings

2. The 90/90 glute

  • Sit with both knees at 90 degrees
  • Fold forwards from the trunk keeping a straight back.
  • Perform to the knee, half way down the shin and outside the knee.

3. The triple angled calf stretch

  • Place your arms against a wall with the back leg straight.
  • Bend the arms to feel the calf stretch.
  • Place the toes in and out to change the stretch
  • Bend the front knee at the same time to stretch the lower calf of the front leg at the same time.

4. Quadriceps stretch

  • Hold one leg behind you bringing the heel towards the glute.
  • As you pull the heel back tighten the abdominals to try to posteriorly tilt the pelvis

quadriceps

5. The lateral sling lean

  • Straighten your back leg with the front leg bent.
  • Reach over your head towards the wall.
  • Lean away from the wall to feel the stretch.

sling-lean

b) Five strengthening exercises to help with knees

These general exercises can help to develop strength around the pelvis, knee and hip joints, but again (you guessed it) if you have a particular issue you should always consult with a medical professional.

1. The belt and ball squats

This exercise improves strength of the muscles that control inward and outward movement of the upper leg.

  • These squats should be performed over 4-6 seconds lowering and lifting but maintain pressure on the ball or against the belt.
  • Feet should be parallel or slightly turned out if more comfortable for this version.
  • Hips and knees should bend with the same relative timing.

Lower for 4-5 seconds pause for one and rise over 4-5 seconds. Repeat 12-15 times for 1-3 sets with 45 seconds of recover between sets.

2. The toe touch drill

This exercise improves tracking of the knee and balance and proprioception.

  • Stand on one foot and reach the other foot forwards.
  • Reach out as far as you can maintaining balance and keeping the knee over the region of the second toe.
  • Perform this slowly 3 times to 45 degrees, 90 degrees, 135 degrees and 180 degrees.

Reach out over two seconds and back over two seconds for three repetitions at each position. Repeat one full circuit before repeating on the other side. Rest for 45 seconds and repeat for 1-3 sets.

3. The hip thruster

This exercise improves strength of the muscles that extend the hip.

  • Lie back on a ball or bench with your arms cross your chest. You may use a weight on your hips as your progress.
  • Drop your hips to the floor and then push upwards clenching your glutes together as you drive upwards.
  • Slowly lower and repeat

Push up over three seconds, pause for one at the top, and then lower down over three seconds. Perform 12-15 repetitions, resting for 45 seconds between sets for 1 -3 sets.

4. The swiss ball leg curl

This exercise improves strength of the muscles that control the back of the leg.

  • Lie on the floor with your feet on the ball.
  • Push up through the hips and at the same time bring your heels to your backside.
  • Aim to keep the knees, hips and shoulders in line at the top of the movement before lowering to the floor.

Push up over 2 seconds and back over 2 seconds. Perform over 12-15 repetitions rest for 45 seconds between sets and complete 1-3 sets.

5. The forward ball roll

This exercise improves core control and hip and trunk dissociation.

  • Make a box with your trunk, arms and hips.
  • Hold a straight position of the back and then roll the ball forward from the hands and the hips.
  • You should only roll as far as you can hold the spine still.
  • Hold for 3 seconds and then slowly roll back again.

Roll out over 3 seconds, hold for three seconds and return for three seconds. Perform 12-15 repetitions rest for 45 seconds and then repeat for 1-3 sets. 

A huge thanks to the Bowskill Clinic and their team of experts for providing us with all of this information. It’s no easy task to pull this all together. These guys are top notch, so I’m really stoked they agreed to do this! They have the UltraRunnerGirl stamp of approval (they helped me overcome injuries in 2010 and again last year in 2016 before Tor des Geants).

Contributors

The Bowskill Clinic is an interdisciplinary centre specializing in rehabilitation of orthopaedic and sports injuries.

jon-bowskill-portrait-photoJon BowskillCorrective exercise specialist / performance strategist, founder at Bowskill Clinic

Jon is an exercise specialist with a particular interest in creating bespoke strategies for rehabilitation and performance. He works with his team to bring together the right specialists to help resolve a range of different sports injuries.

andrew-jackson-physiotherapist-london-w1Andrew JacksonMusculoskeletal Physiotherapist at the Bowskill Clinic

Andrew is a specialist in physiotherapy and movement mechanics. He works closely with Jayesh to develop treatment and exercise prescription for runners.

jayesh-thakrar-bowskill-clinicJayesh Thakrar, Musculoskeletal podiatrist at the Bowskill Clinic

 Jay is a specialist in running biomechanics and uses the very latest VICON motion capture system along with in shoe pressure analysis to precisely understand runners’ needs.

To find out more of what our runners rehabilitation and management programmes involve contact jon@bowskillclinic.com or see more of our physiotherapy and biomechanical gait assessments at www.bowskillclinic.com

dr-reesDr. Jonathan Rees, Consultant in Sports and Exercise Medicine and Rheumatology at the Fortius Clinic

Website         www.drjrees.com
Email              info@drjrees.com

Dr Rees is a specialist in sports medicine with a particular interest in running and tendon injuries.  He was physician to the 2012 London Olympics and 2008 Team GB paralympic team.


simon-bleaseDr. Simon Blease, Consultant Musculoskeletal Radiologist

Website         www.advancedskeletalimaging.com
Email              info@advancedskeletalimaging.com

Dr Blease is a specialist in musculoskeletal imaging especially relating to sports injuries. He provides second opinions on scans for complex or non resolving issues.

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Top Five Most Awkward Massages

As an ultrarunner, I rely on frequent massages to help keep the muscles loose and to prevent injury. In my line of work, this means that I have had massages all over the world in many different cultures and contexts. I’ve had some of the best massages of my life on a beach in Borneo, in the ‘Valley of Longevity’ in Ecuador and after a race in Nepal. But the downright cringe-worthy massages are the ones that really stick in my mind. The ones where you are lying there on the table squinting and squirming with your face planted into the little hole, asking yourself the question, “do I really have to stay until the end of this?”

If you think about it, getting a massage has got to be one of the most awkward  things you can do. In what other circumstance do you get into a room with a complete stranger, take your clothes off, and have them rub you all over for money? Okay, you know what I mean. For a service that is meant to be relaxing, there is incredible potential for awkwardness. My years of primary research has identified five main categories of awkward massages, each given a score from 1-10 on the awkward meter (1 is the equivalent of watching a romantic comedy with your mother; 10 is the equivalent of watching 50 shades of grey with your mother-in-law).

1. The Overly Sexual Massage

These are the worst of the bunch. When a massage therapist either blatantly or suggestively makes a move or a comment that forays into the sexual realm, that is the quickest way to make me want to run away from the massage room screaming (unless of course it falls into category #2 below – sorry guys, we’re complicated). I don’t think some of them actually mean it, but it is often hard to tell. Like when a therapist ‘accidentally’ grazes against something they shouldn’t. If you don’t say something, you feel violated; if you do say something, you feel horrible that you might have made a mistake (if you’re Canadian, that is). Either way, it is awkward.

However, in some instances, it is not so subtle. During a recent massage I had at a very fancy hotel in Jerusalem, I asked the therapist to concentrate on my glutes (tight glutes, common runner problem). Instead of discretely uncovering one glute at a time and leaving the other one hidden under the towel, he went for the full moon approach. Weird, I thought, but other than being uncomfortably exposed, I wasn’t completely sure he was being unprofessional (maybe this is standard practice in Israel?). However, when I asked for deeper pressure, he responded with a comment about “strong Canadian buttocks” and how they apparently could take a beating. Seriously? There I was lying on the table literally caught with my pants down wondering if my massage therapist was going to pull out the whips and chains. Dear god. Last time I ask for work done on my glutes again.

Finally, there is one technique that deserves mention in this category, which I think should be forever banned. You know when you are getting a back massage and your therapist wants to get a better angle so he moves around to the head of the massage table to apply pressure from the shoulders downwards toward your pelvis? Sounds great, right? It is, until you realize that your massage therapists’ balls are basically pressing into the top of your head as he reaches down your back. Yeah. Awkward.

Awkward score: 10

2. The I-wish-it-were-overtly-sexual-massage

Now here’s where I’ll get in trouble if I give too many details. Ahem. Let’s just say I had a massage therapist in the past knottywho looked like he had walked out of a daytime soap opera. And I was definitely young and restless. You’d think this would be a fabulous scenario: dim lighting, candles, handsome man with strong hands romantically rubbing me down…. Okay I’ll stop there. Sounds lovely (and ridiculous), but we all know the reality is completely different, especially when you are getting a sports massage. My therapist would do this technique called myofascial release, which basically involved picking up layers of my thigh fat and squeezing them over and over again. Of course, this was all down under fluorescent lighting, which can make even a supermodel look like zombie-fied cottage cheese.  Nothing more awkward than having an attractive man get up close and personal with your cellulite and jiggly bits. Ugh.

Awkward score: 7

3. The New Agey Massage

Chinese gongs, healing incense, strange breathing and other new agey type of techniques deserve no place in a proper deep-tissue-massagemassage (in my humble opinion). Perhaps I’m not ‘enlightened’ enough, but these airy-fairy methods of massage are known to send me into fits of laughter or simply bewilderment. Another stellar massage I had this year involved the massage therapist placing hot stones on strategic locations on my back while humming something in sanskrit (it could have been pig latin for all I knew actually). I know what you’re thinking, this all sounds fine, right? Well, perhaps I have strange anatomy, but somehow, one by one, each one of these stones preceded to slide off my oily body and right into my butt crack. Yes, there I was, part of some strange ritual with a pile of flaming stones piling up in my crotch. Not relaxing. What’s worse was that the therapist just kept humming along leaving me thinking, “was this actually supposed to happen?” I tried to surreptitiously dig the crotch stones out and quietly drop them on the floor, which ended up just adding some unique percussion elements to the sanskrit humming. Can we not just work on my quads like a normal massage, please? Sigh.

Awkward score: 6

4. The Nervous Massage 

If you get stuck with a newbie massage therapist, chances are he or she will be a little nervous – it’s only natural. However, you’d hope that they would at least try to hide it. I had one massage therapist in Manhattan who was on his first day of the job and he was sweating buckets. Literally. I wasn’t sure if it was hot oil he was drizzling on to my back or if it was perspiration dripping from his forehead (gross). His hands were shaking so much that it provided a mild vibration effect (which was actually not bad). All in all, I just wanted to give the guy a hug – or maybe a fist pump as he was becoming increasingly drenched with sweat as the massage went on – and just tell him that everything would be okay. As long as he never gave another massage to anyone ever again.

Awkward score: 4

5. The Unhygienic Massage

There are a number of variations of this type of massage. Unhygienic massages could involve nasty surroundings (unclean sheets, rancid massage oil, smelly towels) or worse, an unhygienic massage therapist (body odour, hangnails, overly hairy arms). In Vietnam after my first ultramarathon, I booked a massage through my hotel to help kickstart my recovery period. A few hours later, I answered a knock on my hotel room door and opened it to find a woman carrying a box of tissues in one hand and a bottle of Johnson’s baby lotion in the other. Not exactly off to a great start. The woman massaged me with one hand (the other was constantly blowing her nose) and she sneezed on my back twice.

Awkward score: 6

To be fair to the massage therapists of the world out there, I bet they have a ton of stories as well. As clients, we can make things pretty awkward too. I can only imagine the number of times they’ve had to deal with farting, accidental erections (so glad I’m not a guy) and inappropriate behaviour. Remember that Friends episode when Phoebe massages Monica and she won’t stop making, er, Harry-met-Sally noises? I bet there are a few of you out there who have been guilty of that. I have inadvertently created a few awkward massages in my day, I must admit. Like the time I accidentally wore a pair of red underwear that said ‘Chase Me’ in sparkles across the front (don’t judge, I was in my 20s). Imagine my horror and my therapist’s amusement-turned-awkwardness when my ridiculous lingerie was exposed. Or the time when I had a pelvic fracture, but was convinced it was a bad hamstring pull that hurt right at the insertion point. I was so desperate to get my injury fixed that I insisted my massage therapist spend the entire hour on an area that was, oh, centimetres from the ‘special’ zone. I’m not going to flatter myself and think that this was fun for him. Or finally the time when I was getting a massage in the same room with a friend of mine in Zanzibar. We were at a place that hired and trained people with physical disabilities to become massage therapists. Great idea in theory… Problem was that I kept forgetting what disabilities our therapists had. I thought that mine was blind so I had no qualms exposing my entire chest while he was working on my quads (he was hearing impaired, sigh). And I openly shared intimate details in front of my friend’s therapist, who of course was not hearing impaired as I believed but rather visually impaired. Way to make things awkward.

The truth is, the whole massage situation is ripe for awkward moments, so perhaps we need to have a little more understanding for our therapists and a good sense of humour to get through them.

Have any awkward massage moments of your own? We’d all love to hear about them! Post a comment below.

Chiropractic Care for Runners: Info and Advice from an Expert!

I’m a sports treatment junkie. It’s true – the more treatment I get, the more I want!  From physiotherapists to massage therapists to neuromuscular skeletal specialists, I want them all. I love learning more about how my body works, where the trouble spots are, and how I can make it work better. Living in Afghanistan I have realized how much I miss having access to my extended team of miracle workers in New York, London, Vancouver, and of course back home in Ontario.  In addition to the fully-stocked fridge and unlimited wine supply, one of the best benefits of visiting my parents in Kingston, Ontario is that I get to pop in to see Dr. Peter Pain, chiropractor extraordinaire at the Live Well Centre, to put my abused running body back in working order.

Before I left Canada for my Afghan Adventure, I asked Dr. Pain (yes, I know, ironic name for a chiro but he should really be called Dr. Awesome) for a crack good enough to last me for an entire year. Tall order, but I have to say, almost three months in and going strong!

I asked Dr. Pain if he would do an interview for my blog because I think it is SO important to have all of the information at hand about what kind of treatment is out there – whether you’re a runner or not.  Dr. Pain answers some key questions I had about what chiropractic care is all about – read on!!

Dr. Peter Pain, BSCH, DC at the Live Well Center

Ultra Runner Girl: What are the most common problems you see in runners?

Dr. Peter Pain:  The most common injuries we see in runners are related to the foot and lower leg, such as shin splints, knee conditions and foot pain, followed by hip and spine injuries.  Most injuries will be related to simple over-stressing the supportive tissues. The muscles, tendons, fasia and ligaments, especially if they are inadequately supported.  This means it is important to look at the structures that support proper running biomechanics, both intrinsically (your own muscles and joints) along with the types of footwear you are using.

Think about a car that has the proper supporting undercarriage and struts.  This is what your lower body needs to absorb the shock and impact of running while giving you the power to propel you forward.  The proper strength and mobility is crucial to support the repeated demands of running.

Along with adequate leg strength, we also have to look at the runner as a whole. The central part that stabilizes the whole body that many runners are deficient in is the core.  These are the muscles that stabilize our body.  Without a properly firing core, it is hard for any body part to work properly.  Think about trying to fire a canon from a canoe, versus a massive ship to absorb the impact.  The loads on the extremities have to be stabilized and distributed properly through out the body to ensure adequate and normal compensation patterns are followed.

The next major issues to think about are the surfaces you are running on, and the training schedule to ensure adequate rest and recovery.  Even with the right mechanics, if you are running in extremely stressful conditions without the rest your body needs, eventually we will see injuries.  The key here is to train the body properly to handle these conditions and to minimize the risk.

Ultra Runner Girl: (mentally taking note of the fact that Dr. Pain is advocating for adequate rest…. hmmmm…..) So, okay, Dr. Pain, I come to see you every time I’m visiting my parents, but how often should a runner ideally see a chiropractor?  Only when experiencing pain or on a more regular basis?

Dr. Peter Pain: An active athlete should definitely see a chiropractor any time there is pain, muscle imbalance or joint restriction.  This may sometimes be felt in a runner as just not being smooth, or something is not quite right, as a more experienced runners develops an innate sense for how their body should feel.  There is usually a poor compensation pattern or imbalance before the outright signs of an injury, and for this reason, it is often a good idea to be assessed by a chiropractor every 2 to 6 weeks during high training periods for prevention.

Ultra Runner Girl:   Cool. How do you feel about flying out to Kabul every 2 to 6 weeks then?  Afghanistan is LOVELY this time of year!

Dr. Peter Pain: (Silence)

Ultra Runner Girl: Okay, fine, moving on.  What are the benefits of chiropractic care?

Dr. Peter Pain:  Chiropractic simply helps with keeping the body moving efficiently, to ease the mechanical loads and stress on the body, whether it is a marathon you are training for or simply everyday repeated movements.  A trained and experienced chiropractor can also help determine the likelihood of a future injury by identifying muscle imbalances or joint restrictions.  These lead to more physical wear and tear on the body, will produce compensations which may be harmful in the long term and eventually an injury.

Ultra Runner Girl: Is there any danger of going to a chiropractor?

Dr. Peter Pain: As with visiting any health practitioner, there is a risk of inappropriate treatment being used instead of the right treatment in a misdiagnosis.  Again, this can happen in any profession, so be sure to research who you choose to see, to get the right diagnosis and the fastest resolution.

Ultra Runner Girl: What is the difference between a chiropractor and a physiotherapist?  Is there a need to see both?

Dr. Peter Pain: There are a few similarities, sometimes some overlap, but also a few differences.    In my view, a physiotherapist will typically treat damaged tissues, primarily using modalities and exercises, while a chiropractor will look at function and screen for injury prevention.  Physiotherapists are best used when treating damaged tissues in extremities, ie complete muscle tears, joint sprains.  A chiropractor is most capable at treating spine-related injures and nerve related problems.  Often times you will get one professional doing both, but  be wary of a jack of all trades and master on  none.  If there is definite injury and tissue damage involving an extremity (knee), seeing a physio will help decrease the recovery time, while seeing a chiropractor will help the injury from re-curing in the first place.

Ultra Runner Girl: What general tips do you have for runners?

Dr. Peter Pain: There would be three key tips for runners.

The biggest issue we see in runners is balancing their training schedule to include some core stability and mobility work.  As said before, any limited joint function will cause compensation and eventually can injure.  Many athletes can adapt, but to ensure a long career that is healthy, make sure you are balancing out the running with things like yoga, pilates, or simply some stretching and core work.

The next is to always remember your form and include good posture when running.  This will minimize stress to your body, reducing fatigue and wear and tear.

The last is to make sure you follow a training schedule that builds milage and speed in a logical way.  It takes time and training to to be able to run big distances.  Break down your training into small goals using a calendar that extends far out.  We want to avoid over-training which can cause a nagging injury as the projected race day nears.

Ultra Runner Girl: I usually run to and from your office when I come in for an adjustment.  Is it okay to exercise after getting an adjustment from a chiropractor?

Dr. Peter Pain: Exercising right after an adjustment is actually a great time to exercise, as it will re-enforce the right motor pattern.  Think of the adjustment as a re-boot on your body’s musculoskeletal software system.  After you reboot your body, you want to reload the proper software by training lightly.  Keep the exercise light to moderate, ensuring proper technique and form.  You don’t want to exercise to the point of fatigue, just enough to get the body used to working with the new mechanics.  This lays the ground for continued neuro-communication, and re-enforces the proper patterns.  Thus the right firing pattern of your joints and muscles takes over, avoiding the faulty mechanics.  It also just feels great as your body just works more efficiently!

Ultra Runner Girl: Thanks Dr. Pain!!! So you’ll think about that offer to come out to Kabul every 2 to 6 weeks?

Dr. Peter Pain: I think I hear a patient calling…. Gotta run!

For more info on Dr. Pain and his practice, click here!

Dr. Peter Pain completed his undergraduate studies at Queen’s University with an Honors BSc. in Life Sciences, and his Chiropractic Doctorate at the Canadian Memorial Chiropractic College in 1997.

In 1989-1992, Dr. Pain was a member of the Queen’s Golden Gaels Football team, winning the National Championship Vanier Cup in 1992. The rigors of playing and competing in football also led Dr. Pain to chiropractic.

Dr. Pain worked as a certified Personal trainer with The Sports Clubs of Canada in Toronto for 4 years while attending the Canadian Memorial Chiropractic College.  He has continued to expand and maintain his expertise in sports injuries, exercise and fitness over the years with many courses. This includes meeting and learning from the world’s most highly regarded experts, including courses taught by Paul ChekPaul GagneStu McGillArnold Swarchenegger, Tudor Bhompa and many others inside the world of sports injuries and fitness.

This education and experience has given Dr. Pain the honour of being able to work with many athletes at all levels, including professional football and hockey players, Olympic athletes, provincial and national amateur athletes as well as the Weekend Warrior.

In addition, Dr. Pain enjoys running marathons and triathlons,cross-fit training, cross-country skiing and his latest passion, kite-surfing!

Constantly striving to give his patients the most up-to-date care possible, Dr. Pain will continue to attend post graduate courses in sports injuries, nutrition, pediatrics, whiplash, personal injuries and health and fitness.  Dr. Pain promises to always give you the excellent care that he is trained to within his scope of practice.