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IT band syndrome is a common condition that causes pain on the outside of the knee. This 2024 review article updates the current understanding of iliotibial band syndrome (ITBS).

Diagnosis
ITBS usually appears during repetitive activities and tends to worsen the longer someone runs or cycles. Clinical tests exist but have limited reliability.

Some key features:
• Pain develops on the outer knee after a period of running or cycling.
• Often described as sharp, burning, or increasing over time.
• Tests such as the Noble and Ober tests are inconsistent (orthopaedic physical exam tests).
• MRI is typically unnecessary; diagnosis relies mainly on symptoms and history.

Risk Factors
ITBS develops through a combination of anatomical structure, muscle function, and training habits.

• Older theory suggested the IT band rubbed over the thigh bone.
• Newer evidence shows the IT band does not slide very much.
• Pain is likely due to compression of fat and nerve-rich tissue beneath the band at about 30 degrees of knee bend.

Things we can’t change:
• Anatomical features such as leg alignment or prominent bone structure. This includes natural variations like being slightly knock-kneed or bow-legged, having a more pronounced lateral femoral epicondyle (the outer knee bone), or having tighter fascia around the thigh.

Things we can change:
• Weak hip muscles, especially hip abductors and gluteal muscles, which can allow the knee to drift inward during running.
• Training errors such as sudden increases in mileage or frequency.
• A large trial showed similar ITBS rates whether runners increased volume or intensity, suggesting rapid changes are the main issue.

Treatment
Treatment centers on reducing irritation, improving strength, and retraining movement patterns. Functional rehab generally works the best!
• Temporarily reduce or modify painful activities in the short term.
• Strengthen hip abductors, gluteus maximus, and stabilizing muscles- has been proven to be one of the best approaches!
• Include balance, single-leg control, and running-specific movement retraining + slowly easing back into the sport that generated the pain.
• Shockwave therapy may help when exercise alone is not enough- something worth considering if you have a stubborn case.
• Steroid injections and surgery have weaker evidence and are used rarely

Research Gaps
While the understanding of ITBS has improved, more consistent and higher-quality research is needed to determine the best treatment strategies.

Some flaws:
• Research methods vary widely between studies- it’s hard to compare them because of how differently they were conducted.
• Limited high-quality trials on specific rehab programs- which exercises are best? We don’t really know.
• More comparison studies are needed for conservative and non-conservative treatments.

Take-Home Message:
• ITBS is mainly driven by compression, not friction
• Outer-knee pain increases with repetitive activity
• Hip weakness and rapid training increases are major contributors
• Best treatment involves structured rehab focusing on strength and movement control
• Shockwave therapy can help in tougher cases
• More research is needed to refine and compare treatment approaches

If you have IT band syndrome and have more questions, for out chiropractors or physiotherapists, feel free to contact us or book online HERE.

Does spinal manipulation actually help with acute neck pain? A recent systematic review and meta-analysis took a look HERE.

Acute neck pain , meaning neck pain that lasts less than three months, is very common and can lead to disability or persistent problems. The authors wanted to investigate how effective and safe SMT is specifically for acute neck pain, since previous reviews often mixed acute, sub-acute, and chronic cases, which makes interpretation difficult.

Methods
The researchers searched several major databases (PubMed, Embase, Web of Science, PEDro, Cochrane) up to March 20, 2023, for randomized controlled trials (RCTs) involving SMT versus control in adults with acute neck pain lasting less than 3 months. Outcomes of interest were pain intensity, cervical range of motion, and disability. They included 8 RCTs, with a total of 965 patients.

Key Findings

  • Pain: SMT significantly reduced pain compared to controls (mean difference 1.53 points lower on the pain scale, 95% CI 0.83 to 2.22)
  • Cervical range of motion: SMT improved neck movement in all directions (flexion, extension, rotation, lateral flexion). Flexion improved by a mean of 11 degrees (95% CI 9.10 to 12.93)
  • Disability: Patients receiving SMT had lower disability scores than controls (mean difference 6.20, 95% CI 2.59 to 9.81)
  • Safety: No serious adverse events were reported. One patient had a mild, transient arm sensation episode after SMT

Clinical Implications
Despite limitations (small sample sizes in some cases, dose/response not established), the review suggests SMT can be an effective and safe option for acute neck pain: it reduces pain, improves neck movement, and lowers disability in the short term. SMT is best considered alongside other treatments, such as exercise and education.

This study is a good start, but more research is required to determine which patients benefit most, how much and how often it should be performed, and which SMT techniques work best.

If you suffer from neck pain, or have more questions about this study, feel free to contact us HERE.

What the study is about

A January 2025 article published in the Journal of Clinical Medicine examined lateral elbow tendinopathy, also known as tennis elbow, which causes pain on the outside of the elbow and often affects adults between ages 35 and 50. When rest and physiotherapy don’t help, doctors sometimes use injections. The researchers compared four options: Platelet-Rich Plasma (PRP), corticosteroids, hyaluronic acid (HA), and saline to see which reduced pain and improved function the most over one year.

How the study was done

The study included 60 adults who had tennis elbow for at least three months without improvement. They were randomly placed into one of the four injection groups and each received a single injection. All patients followed the same stretching and strengthening program afterward. They were tested before treatment and again at 1, 4, 12, 24, and 52 weeks, measuring pain, arm function, and muscle strength. The researchers originally planned for 120 patients but were only able to enroll 60.

What the study found

  • All four groups improved over time in pain, strength, and function.
  • After one year, results were very similar across all injection types.
  • Corticosteroids reduced pain faster in the first few weeks.
  • PRP, HA, corticosteroids, and saline showed no major long-term differences.
  • Some patients in the PRP and saline groups had short-term pain increases.
  • No serious side effects were reported.

What this means

The results suggest that while these injections can help tennis elbow, none clearly outperformed the others in the long run. Corticosteroids worked faster early on, but one-year outcomes were similar to the other treatments, including saline. Since PRP and HA are more expensive, the findings raise questions about whether they are worth the cost. And in general, since non out-preformed saline, your best bet is likely to avoid injection all together and continue with rehab exercises and being patient- these things take time!

If you have more questions, feel free to book online or contact us HERE.

By: Dr. Sean Delanghe BSc (Hons) DC

Migraines are a highly prevalent neurological condition that can significantly impair quality of life for many. They include symptoms such as severe headache often behind one eye along often with an aura that may include flashing lights, blind spots, blurry vision or other visual impairments. This 2023 study systematically reviewed randomized controlled trials (RCTs) to assess the durable effect of acupuncture in adults with episodic migraines- these are migraine attacks occurring intermittently but not chronically.

Methods

  • The researchers included 15 RCTs encompassing 3,035 participants.
  • Acupuncture interventions were compared against:
    1. Sham acupuncture (placebo control)
    2. No treatment or waitlist control
    3. Pharmacological migraine prophylaxis (e.g., flunarizine, metoprolol)
  • Outcomes assessed 3 months post-treatment included:
    • Number of migraine days per month
    • Number of migraine attacks per month
    • Pain intensity, measured using the Visual Analog Scale (VAS)

Findings

  • Acupuncture vs. sham: Acupuncture significantly reduced both migraine frequency and migraine days at 3 months post-treatment.
  • Acupuncture vs. no treatment: Acupuncture showed a clear benefit in reducing migraine frequency and intensity compared to the waitlist.
  • Acupuncture vs. preventive medication: Acupuncture performed comparably to pharmacologic prophylaxis, with some measures favoring acupuncture.
  • Adverse events were generally mild (e.g., minor bruising or localized pain at needle insertion sites). No serious adverse events were reported.

Should you try it?

  • Acupuncture appears to provide a sustained therapeutic effect for episodic migraine that persists at least three months after the treatment period.
  • This finding is clinically relevant because conventional preventive medications typically lose efficacy once discontinued.
  • However, evidence beyond three months is limited, making long-term durability uncertain.

Questions?

If you would like to try acupuncture, feel free to let us know or book online HERE. Physio Sayaka offers it at the clinic if you would like to discuss more before booking!

A new study in the European Spine Journal looked at how often people develop a herniated disc in the lower back and what increases the risk. A lumbar disc herniation happens when one of the discs between the bones in your spine bulges or breaks (i.e. the inner jelly protrudes through the outer fibrous layer). They can cause pain locally, or even down the leg at times in the form of sciatica if the nerve roots are being pinched.

The study reviewed many past papers and found that the problem is fairly common, especially in adults between 30 and 50 years old. It is less common in younger people but can affect anyone. How often it happens depends on how it is defined. Only a few people per thousand each year need surgery, but many more have milder symptoms that do not require it.

Several clear risk factors were found. Smoking and being overweight both make the spine weaker over time. Health issues like high blood pressure, high cholesterol, and diabetes also raise the risk. People who often bend forward, lift heavy objects, or sit for long hours at work are more likely to develop disc problems. Vibration from heavy machinery, night shifts, and high stress at work may also contribute, especially for women.

The good news is that most of these factors can be improved. Staying active, keeping a healthy weight, and using proper lifting and posture techniques can help protect your spine. Managing overall health, especially heart and blood pressure, is important too.

Tips to Protect Your Back

1. Don’t smoke, as it reduces blood flow and weakens the discs.
2. Maintain a healthy weight to lower pressure on the spine.
3. Stay active with regular walking and core strengthening.
4. Use good lifting form – maintain a neutral spine
5. Take breaks from sitting and set up your workspace properly.
6. Manage your blood pressure, cholesterol, and blood sugar.
7. Reduce stress and get enough sleep to help your body recover.

If you have more questions about your back pain, feel free to contact us or book online!

Our awesome physio, Sayaka, is expecting her second child and needs help keeping her patients strong and healthy!

Sayaka works with a diversity of patients ranging from Parkinson’s rehab, surgical rehab all the way to strength training for athletes. We are looking for somebody who works with a strong emphasis on strength work/ rehab- we want to put that gym space to use!

Some general facts about the job:

  • Flexible hours
  • Expected duration: 1 year
  • Part-time or full time- we will take what we can get if the practitioner is a good fit!
  • Your own treatment room and access to gym space
  • Jane practice software
  • Patient- focused, evidence-based work environment
  • Plenty of parking with store front entrance into the clinic
  • Reception coverage for 40 hours/week with the option to work outside of those hours

There’s always the option to work beyond the locum if it makes sense for all, but for now the focus would be on maintaining Sayaka’s patients and other new physio patients that come into the clinic.

E-mail seandelanghe@gmail.com if you want to learn more!

By: Sayaka Thiessen, Waterloo Physiotherapist

I am sure most of use have experienced a muscle that feels tight and stiff. Most people immediately think to stretch the affected area, but is that always the solution? 


If you have stretched to the ends of the earth but you still feel tight, it might be time to change the approach and try to strengthen it. The sensation of “tightness” doesn’t always mean a short muscle. It could, in fact, mean that the muscle is weak or that a joint lacks motor control and needs to be trained. 


Getting assessed by a healthcare professional, like a physiotherapist, you can determine if stretching, or strengthening, or a combination of the two is the way forward. 

Looking for a physiotherapist in Waterloo? Sayaka might be a good fit for you, read more HERE.

Exercise is always better with friends, which is why we are excited to formally offer individual and small group workout sessions guided by Physio Sayaka!

Strength is a key component of any good rehab program, and is invaluable for staying healthy, regardless of if you are an athlete or not. Plus, we all know there are many ways to go wrong when trying to implement it, so why not get work with a regulated health practitioner to make sure you are doing things the right way!


These one-hour exercise sessions are tailored to your group’s needs, such as:

  • prehab for your sport or everyday activities
  • prenatal/postpartum rehab and strengthening
  • peri/post-menopausal strengthening
  • maintaining fitness in a safe environment with consideration for your previous injuries

Sessions are scheduled in advance to reserve the same time every week. We’re flexible on the duration, but 4 weeks minimum is usually a good place to start.

COST: 
Cost will be scaled to the size of the group:

Prices for the group session:

  • 4 people: $68 per person/session
  • 3 people: $78 per person/session
  • 2 people: $93 per person/session
  • Solo: $124

Covered under your physiotherapy benefits!

Note: Anyone looking to claim this under their PT benefits will need to come in for a short assessment to ensure we are delivering appropriate care for your PT goals. 

Reach out today if you’re interested! sayaka.physio@gmail.com

We’re excited at the clinic that we’ve decided to take on the Run Waterloo Grandway 5K as a team!

Completing 5Ks isn’t just about racing to your limit- conquering it in any capacity can do wonders for your health. Here at the clinic we all have all different goals for this event depending on factors like family, work schedule and our fitness starting point. Here is how everybody hopes to do and how they are going to prepare!

Dr. Sean

GOAL: Something that’s less than 2 minutes slower than my personal best- anything faster than 17:30.

TRAINING GOAL: I hope to run 50-60K/week most weeks with 1 interval workout and one longer run most weeks.

Chiro Intern Taylor

GOAL: Finish without walking! Anything under 40 would be great.

TRAINING GOAL: 1 run/week (3-5 km), 1 distance walk/week (3-5km), carrying around my 10-month old all the time otherwise!

Physio Sayaka

GOAL: To come in around 22:30 give or take 10 seconds. 

TRAINING GOAL: Run 3x/week and nail the weekly H+P interval workout. 

Karen Kennedy

GOAL: Why is Sean making me do this?

TRAINING GOAL: Walking 3x/week.

Jackie Hergott

GOAL: To complete the race with a brisk walk, and not be worn out when done.

TRAINING GOAL: Walking 2-5x/week, 3-5K total!

Lance Dawson

GOAL: Under 25minutes, enjoy the race.

TRAINING GOAL: A mix of cardio and weights every week. Playing in my band and drinking teas with 4-7 sugars.

Meet our Waterloo Chiropractor and Physiotherapy Team

Our team of Waterloo Chiropractors, physiotherapists, and registered massage therapists are here to help you get out of pain, and back to the life you enjoy as soon as possible. We use only the necessary treatments, nothing more.

We always take the time to conduct a full history and physical exam to identify exactly what is causing your pain. You will always be provided with a precise diagnosis, an explanation of your injury, a variety of treatment options, and a prognosis so that there are no surprises.

We are Evidence-Based

Our treatments are based on what only the newest and best scientific research is showing- you do not have to be concerned with pseudoscience or poorly understood concepts.

Dr. Sean Delanghe & Dr. Rebecca Blackburn both graduated from the most highly regarded chiropractic school, CMCC.

We strive to prevent recurrence

Our goal is not only to help you become pain-free, but also to stay pain-free.

With every injury, there will always be an option for different interventions to help prevent your injury from returning. This may include options ranging from ergonomic training to custom exercise plans.

Book your appointment

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