This is one of the most common conditions I see as a sports physiotherapist in my clinic. Patients generally describe a deep ache in the front of the knee. It is often felt ‘underneath’ the patella (kneecap). The pain is generally worse with activity which requires repeated knee flexion. Activities which make the pain worse include walking up or down stairs or hills, squatting and sitting for prolonged periods with the knee bent. The good news for people with this type of pain is that it generally does not mean that there is a structural problem with the knee. The pain is generally precipitated by a change in activity level as well as a number of biomechanical predisposing factors. Athletes with this type of pain may have tight muscles, be relatively weak or have anatomical problems – for example pes planus (flat feet). The pain generally improves or resolves when these are addressed.  The following program is a good starting point to treat this problem. It can be personalised to your exact needs if you are not seeing the improvement you would like.

Exercycle Program I feel, and research agrees, that this the single most important part of the rehabilitation program for patellofemoral pain. The idea is to set the bike up so the saddle is a little higher than you would normally like. This limits the amount of knee flexion you are working with. Aim to spin on the bike at a very low resistance (easy) and high cadence (aim of 80-90 revolutions per minute) for 30 minutes. Think ‘polishing the knee’ rather that getting a big cardiovascular workout. Try to do this everyday if possible.  You can increase the resistance as you get comfortable with this.  Keep the resistance constant rather than doing repeated intervals of higher intensities.

Muncie (Quads) Exercise This exercise was developed specifically for the rehabilitation of patellofemoral symptoms. Sit on the floor and flex the unaffected knee until the heel of the foot is in line with the painful knee. Lean forward and hug your good knee. Keeping the painful knee extended pull your ankle back towards you and turn your foot out to either 2 or 10 o’clock (depending on whether you are working on your right or left knees). Lift the heel up off the ground and hold for 5 seconds. Repeat this 20 times per day. To make the exercise easier pull the heel closer to your butt. To make it harder slide the heel away from your butt. Be sure and stay leaning forward. If you can’t find a place on the floor to do these then just sit on the edge of your chair with the affected leg out straight in front of you and repeat the above. There is no need to hug the knee in this position but you are able to lean slightly forward as above.

Gluteal (Butt) Exercise Lie on your side fully stretched out. You should lie on the opposite side of the hip you are trying to strengthen. Flex the top hip and knee until your foot is resting on the lower knee. Lean forwards onto your top arm. You should be in the position shown below. From this point slide the top knee a few centimetres away from you. Lift this knee 5cm off the ground and hold this for 5 seconds. I tell my patients to try and join ‘the 100 club’… i.e. to do 5 sets of 20 reps through a day! As with all problems it is important to have an accurate diagnosis to make sure that the rehabilitation is going to be successful.

If you are unsure about your diagnosis or are not getting better as quickly as you would like, make sure you book yourself in to see a physiotherapist or sports doctor. You can find me at my clinic The Body Refinery in Newmarket, or our new location in St Heliers, Auckland.


platesHow Meditation and Mindfulness Can Help

Plate spinning is a circus manipulation art where a person spins plates, bowls and other flat objects on poles, without them falling off. Plate spinning relies on the gyroscopic effect, in the same way a top stays upright while spinning. The actual art of plate spinning is not too dissimilar to what many of us try to do in everyday life. Stay upright while running to and from meetings; focusing on multiple goals; KPI’s; more meetings; remembering to have lunch; looking after staff; remembering to respond to that email from 3 weeks ago; booking the insurance for that holiday in 2 months time… And the list goes on! In the beginning, spinning plates can be fun, give us variety in our day, and can be quite rewarding as we manage to pull off achieving multiple goals in a day or a week. But after a while some things are forgotten, unfinished and become stressors in our already busy lives. To add to this forever growing to-do list, we have our smartphone constantly in our pocket, vibrating, ringing and reminding us of how many plates we actually have up in the air at one time. We have got into the habit of constantly checking our phones for new emails, Facebook status updates, Twitter feed, missed message and calls. Once upon a time we would leave work and begin to switch off. That phone from back in late 90’s and early 2000’s didn’t have data or a screen that could read more than 1-2 lines of text for that matter. By the time we reached home we would be ready to change down another gear, chat with family, sit down and watch a favourite TV programme, read a book. Ultimately, we would log out, switch off and unwind from the day we had just finished. What if we could use this technology we have now, to take time out of our day to switch off for very small periods of time and reset our minds? All of a sudden some of the plates we thought were important would vanish. Our minds would become more focused. Stress levels would decrease. Things would become clear and simple. Real focus and clarity would begin to creep in and we would all look much less like a circus act trying to spin a whole lot of unbalanced plates in mid-air while running down the road! I have been doing yoga for about 18 months now. It gives me both physical benefit from the stretching and strengthening of muscles, and the mental benefit of clearing my mind from the day-to-day clutter it accumulates. But I wouldn’t have time most days to do a class in the middle of the day, even though this is when I would benefit most. So recently, my very mindful, present and yogic partner put me onto the idea of downloading a meditation app for my smartphone. So I did! Since then I have been endeavoring to use the app at least once a day for 10 mins. I find it’s great for removing all those redundant thoughts and stressors which simply get in the way of me achieving what is important to me in my day. The app I am using at the moment is Headspace which has various guided meditations to suit you. So, my advice to you: click on the app store, search for ‘Headspace’, download, put your earphones in and press play! It’s only 5-10 mins out of your day, and the change that it can bring is absolutely incredible. Just do it!


A high performing team can be defined as “a group of people with specific roles and complementary talents and skills, aligned with and committed to a common purpose, who consistently show high levels of collaboration and innovation that produce superior results.” Coming up with the definition of a high performing team is relatively easy, it is the development of a team that meets this definition that is the hard part. By taking what I have learnt from high performing professional sport and applying this to various corporate environments, I have found the following as fundamental to the development of a high performing team: 1) Very clear, visible and shared objectives that are linked across all members of the team, including the manager. These objectives should be defined as either high performing measures or general measures. The general measures are the ‘ticket to the game’; basically a measure of doing the role, whereas the high performing measures are what defines success in that role. Examples could be: • General measure: consistently completing 80 per cent or more of training programme each week (sport), completing all invoices on time (business) • Performance measure: achieving podium performance in every race of the season (sport), growing customer base by x per cent within the financial year (business) It is important to share these objectives within the team. This ensures everyone is working toward, and supporting each other, in achieving a common goal. 2) A documented development plan for each person in your team. Often development discussions are very abstract, usually starting with the question ‘where do you see yourself in 5 years’ time’. Although this might be a good question to start some thinking, it isn’t going to help that person reach their goals unless they are aware of what skills they need and how to go about developing them. Using a ‘development triangle’ has been useful for the teams I work with. The base of the triangle is the current role and/or skillset with the top of the triangle being the long term goal. In the middle are the next step roles and/or skillsets required to reach that goal. This should be reviewed at least twice a year to ensure relevance and active development of skills required. Ask any top level athlete and they will know exactly what their objectives are, and the required skills needed to reach them. When these objectives are shared in the team and everyone supports the individual development of each team member, an environment is created that will ensure high performance.
Three years ago, while working full-time, Anna left the corporate world to pursue her dream of becoming a professional athlete, competing around the world in Ironman triathlons. Anna now writes about her experience as a professional athlete and how her learnings can be applied to drive high performance in both individuals and teams. For further information visit:


Do you ever wake up in the morning to your alarm blaring? You get an initial fright, press snooze, drift in and out of sleep with thoughts of your to-do list for the day coming at you like trucks on a busy highway? Or are you awake 15 minutes before your alarm in anticipation of the day ahead and thinking back to those same ominous trucks from the day before that you didn’t manage to clear from you ‘brain highway’?

Brain highway. That’s what I like to call our conscious/ unconscious thought process. The hundreds, if not thousands of thoughts that pass through our heads everyday. Research shows that we actually have 2500-3300 thoughts every hour! Most of these thoughts pass through fleetingly and move on into the background. But some tend to stick around for a bit running tight circles in our head with their foot on the accelerator and blaring their horn, like a big scary truck! Just picture that. A big scary truck doing tight circles around you while blaring its horn at you! You can do nothing but notice it. In fact you are more than noticing it at this stage, the truck is huge in your field of vision and blocks everything else out. All you can do is concentrate on this one seemingly horrible, scary thing in front of you! Everything else that you were doing a few seconds ago is completely blocked out and your body starts getting into fight or flight mode. Your stress hormone cortisol starts to rise. You start to sweat and get anxious.

What if I told you that you could take control of this situation. You could get that nasty truck back on the highway with the other trucks and cars and off into the distance. As a physiotherapist I teach people every day how to perform exercises to strengthen a muscle or tendon in their body. They go away, do the exercise for a specific amount per day and week then come back with less pain and more strength. We can apply the same model to our brain and thoughts. The brain is the muscle and the stressful thoughts being the injury or niggle.

I was going through a particularly stressful time with my business at the same time. Thoughts were rife, my highway was the size of a Los Angeles freeway. The five-lane variety! Because my mind was so busy with trying to wear the many hats of a business owner working on and in my own business, I couldn’t decipher, allocate and file each task in its order of importance. I would get anxious, worried, angry, frustrated, down and tired trying to do it all!

This thought process and a little nudging from my partner got me started on a little app called Headspace. I made a conscious decision to take control of my thoughts, to give my head a little… space! I’m great at getting to sleep at night. I’m asleep within about 10 breaths of the light going out. It’s 4.30/5am that my mind decides to wake up with a jolt. Thoughts, concerns, stories left over from the day before. Scenarios played out in my head, which have not even happened yet. Numbers, figures, reports, forecasts… you get the drift. So this was my plan. I would start meditating 5 minutes after my alarm went off every morning. Just 10 minutes of headspace. I started with the intro pack, a nice way to dip my toes into the world of meditation. Two sessions in and no epiphany, no higher level of consciousness. I thought, this meditation thing doesn’t work, it’s a hoax! But a little voice inside me kept saying, just another session, keep it up. So I did. Five sessions in and I was still doubting. But on returning from work one day after maybe my tenth session my partner asked me how my day was? A very normal question which a few weeks previously would have got my heckles up, got me all frustrated with a short answer in tow. Not this time though. ‘It was good thanks, it was very productive, clear and I had lots of fun’ was my reply! Such a contrast from my previous mindset. Life was good again even though I was still dealing with the afore-mentioned stressor. I had clarity of thought and was less distracted, which led me to be much more productive in my day.

A few months later with the acute stress over I managed to meditate 100 days in a row. Pretty awesome for a guy who had no idea what meditation meant a few months prior.

Moral of the story: “Meditation” the art of calming and focusing the mind, give it a go! What’s the worst that could happen? 


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