Knee Pain in Weightlifters

Knee Pain in Weightlifters

Knee pain is quite common in the spot of Olympic Weightlifting. Being an Olympic weightlifting coach and a manual therapist, I see a lot of injuries that could have been prevented.

In Olympic weightlifting, the athletes catch the barbell in a deep squat position with the knee fully (or close to) flexed. Many people say this is unsafe for the knee, but from my experience, I would say it’s the complete opposite.

I believe that when the knee is flexed to 90 degrees, it puts the most amount of stress on the knee joint. Breaking parallel (or even staying above parallel) is a lot more mechanically safe for the knee joint and distributes the force evenly along different structures of the knee.

On the other hand, I often see power lifters and they complain about a nagging, dull pain on the outside of the knee. This is because in a power lifting competitions, you are only required to break parallel oppose to squatting into a full, deep squat position.

Like I mentioned before, the vastus medialis is isolated in the first and last 10 – 15 degrees of flexion/extension. This is one of the main reasons why knee pain happens in the first place. Performing squats to parallel depth puts an enormous amount of stress on the knee and mainly isolates the vastus lateralis (outside of the quadricep).

If you compare the quadriceps of a Powerlifter to an Olympic Weightlifter, you will see a huge size difference between the inside head of the quadriceps.

From my clinical experience, I would say that I see a lot more power lifters than Olympic weightlifters with knee pain, and this is mainly due to the depth of the squat. Assuming you have no mobility issues, I would highly recommend squatting as deep as possible to keep the knees safe and healthy by isolating the vastus medialis.

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Manual Therapy for the Knee Joint

When working with lifters such as bodybuilders, power lifters and weightlifters, one of my favorite manual therapy techniques is to strip the quadriceps muscles.

If you’re a lifter, you probably spend a lot of time on working the leg muscles. When muscles become overworked, they develop excess tension and restrictions that could lead to problems in the future.

Stripping the quadriceps muscles is very beneficial because it relaxes the muscle, increases circulation, decreases restrictions and promotes balance between the stronger/weaker muscles.

In the video below, you can see me stripping one of my athlete’s quadriceps to loosen everything up for his upcoming weightlifting competition.

A video posted by James Lu (@lustrengththerapy) on


Knee pain is often seen in weightlifters, but can be avoided if you know how the knee works. Strengthening and lengthening the muscles that act upon the knee to correct muscle imbalances can alleviate the pain that you are experiencing.

Re-evaluating your depth and form in a squat will also play a huge role in knee joint safety and longevity. Squatting to a deeper depth will help isolate different muscles to help stabilize and strengthen the knee to prevent future injuries from occurring.

For more information on how to correct your knee pain, please visit our Sports Massage Therapy page.

The Importance of Thoracic Mobility

In this article, we will break down the importance of thoracic mobility and how it plays a role in daily activities and in weightlifting. My definition of mobility is the joint’s ability to move through a range of motion, whereas flexibility is the ability of a muscle to lengthen through a range of motion.

Mobility is mainly influenced by how the bones of the joints glide, slide and roll over each other and whether or not there are any restrictions in the joint capsule. Flexibility has to do more with the nervous system and how it communicates with the muscles.

Now that we know the difference between mobility and flexibility, let’s talk about thoracic mobility.

What is Thoracic Mobility?

The thoracic spine (middle back) is composed of 12 vertebrae and connects the cervical spine (neck) with the lumbar spine (lower back).

The lack of thoracic mobility (ability to move through a range of motion) can definitely have an impact on the neck and lower back. For example, if you find yourself hunching forward a lot, your thoracic spine is “flexed” forward. Your cervical spine has to compensate and “extend” backwards in order for you to straight.

Your lower back has to “arch” backwards in order to keep your center of gravity. This means that it’s a possibility for neck and lower back pain to stem from poor posture (in this case, hunched forward) from the thoracic spine.

The thoracic spine was designed to flex and extend, as well as rotating and bending to the sides. We often find ourselves hunched in front of the computer most of the time.

This causes our thoracic spine to “flex” forward (hunch back) and causes restrictions in the joints over time. Hunching of the thoracic spine predisposes you to neck, shoulder and lower back pain and can limit your ability to perform specific exercises such as squats, deadlifts and many other exercises.

Why is Thoracic Mobility Important?

Let’s do a test.

Sit and slouch forward as much as you can and raise both arms forward towards the ceiling. Now sit straight, with proper posture and raise both arms towards the ceiling.

Do you see how the arms are more perpendicular to the ceiling than when you were slouching forward? This is very important because often times we find ourselves complaining about shoulder pain and mobility. If we simply fixed the root cause (in this case, thoracic mobility) then the symptoms will eventually alleviate (shoulder pain/mobility issues).

Another reason why thoracic mobility is important is for the safety during exercises such as squats and deadlifts. During these exercises, one of our main concerns is to keep a relatively neutral spine throughout the exercise. If you cannot maintain thoracic extension in these exercises, your form will start to deteriorate and injuries such as herniation, strains and sprains will definitely happen in the future. Imagine lifting up a loaded barbell from the ground with a hunched back. All that weight that’s suppose to be distributed all along the spine is now focused on a couple of segments of the spine.

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How do I Correct my Thoracic Mobility?

There are several ways to increasing/correcting your thoracic mobility from self care exercises to visiting different health care practitioners such as chiropractors and physiotherapist. Because mobility issues tend to happen over the course of years, and will probably take a while to correct itself. This is why consistency is key to correcting mobility. Here are a list of different ways to increase your thoracic mobility (extension).

Mobility Tools
Mobility tools such as a foam roller and/or lacrosse ball will definitely increase your thoracic mobility. The key to using a foam roller is not to “roll” your entire body over it, but more so letting every segment of your thoracic spine to “sink” in towards the foam roller. Imagine wrapping your spine AROUND the foam roller oppose to continuously rolling over the foam roller. Keeping the hips on the floor will further increase the mobilization.

Lacrosse balls are also a great tool to increase thoracic mobility by mobilizing the joints as well as providing self massage to the surrounding muscles. A good trick is to place two lacrosse balls in a sock, place it on the lower portion of the middle back (with the lacrosse balls on the side of the spine) and SLOWLY roll your body up and down. This is a very painful exercise so be sure to take your time!

Below is a video that demonstrates how to effectively and correctly use the lacrosse ball(s).

Self Care Exercises
One of my favorite thoracic mobility exercises are Wall Slides. This exercise will definitely challenge your thoracic mobility and re-teaches the body on how the shoulder joint should move with the shoulder girdle and thoracic spine.

  • Place your back on the wall with your feet a couple of inches away from the wall. (Be sure to have the spine on the wall at all times.)
  • Place both arms up to 90 degrees (as if you were doing a shoulder press) and have the back of the forearm touching the wall at all times.
  • Slowly slide the arms along the wall towards the ceiling while keeping your spine on the wall.
  • Perform this exercise as much as you can to help promote proper movement in the thoracic spine as well as the shoulder girdle. It’s perfectly fine to hear a few cracks here and there.

Manual Therapy
Being a manual therapist and specializing in pain treatment, I can say that most individuals I see have poor thoracic mobility.

As I mentioned earlier, we often find ourselves spending countless hours on our computers/smart phones and our entire body starts to round forward. Neck, shoulder and lower back starts and could have been avoided if we practiced proper posture!

My main goal when treating somebody with chronic neck and back pain is to increase their thoracic mobility through different manual therapy techniques such as mobilizations, fascial stretches and muscle stripping. Working around their thoracic spine is quite painful, but the results are amazing.

Clients tell me how they can breathe better, their body feels more open and everything moves much better.

Below is a video of one of my favorite techniques to increase thoracic mobility.

A video posted by James Lu (@lustrengththerapy) on


Thoracic mobility is important because neglecting it could lead to poor posture and could predispose you to chronic neck, shoulder and back pain. Increasing your thoracic mobility with mobility tools, self care exercises and manual therapy will help reverse the process and prevent injuries from occurring.

Being consistent with the self care exercises and practicing proper posture will also contribute to increasing your thoracic mobility.

For more information on how to correct and/or improve your thoracic mobility, please visit our Sports Massage Therapy page.

How to Correct Knee Pain with Exercises

How to Correct Knee Pain with Exercises

Knee pain can be classified as acute/chronic pain that is located in the knee, or the structures surrounding the knee due to injuries and conditions such as osteoarthritis and chondromalacia. Other common factors of knee pain are physical trauma injuries (football, basketball), muscle imbalances and repetitive motions (marathon runner, weightlifting) and system conditions such as osteoarthritis.

The Anatomy of the Knee

The knee joint is composed of the femur (thigh bone), tibia (shin bone) and the patella (knee cap). All three of these joints articulate with each other to form what we know as the knee joint. It is also considered a modified hinge joint that allows for flexion (bringing the heels towards your butt), extension (straightening the knee) and a small amount of rotation. There are also a lot of muscles that originate around the hip that run through the knee and can have a major influence on knee pain. Because the knee joint also allows for slight rotation, injuries such as sprains and torn ligaments are also very common in any physical activity that requires you to quickly change directions (basketball, mixed martial arts, weightlifting).

How Does Knee Pain Happen?

Knee pain can happen for a number of reasons; from muscle imbalances that pull the knee out of alignment to physical trauma from sports. One of the most common causes of knee pain is due to tightness and weakness of specific muscles that contribute to the knee joint. Muscles that are generally tight pull on bones and cause physical deviations. For example, if you’re a cyclist or runner, you may have pain on the outside of the knee because the muscles on the outside of the hip are pulling on the outside of the knee. This causes an imbalance between the agonist muscles (in this case, the outside of the thigh) and the antagonist muscles (inside of the thigh).

What Muscles do I Strengthen?

As mentioned above, knee pain could happen for a number of reasons. But in most cases, strengthening a specific muscle called the vastus medialis (inside of the thigh) can contribute to a stronger and more stable knee. This muscle is responsible for extending the knee and is considered to be one of the four quadricep muscles. However, this muscle is often neglected because we often find ourselves strengthening on the vatus lateralis (outside of the thigh) through different exercises such as walking, running and squatting. Instead, we should be focusing on strengthening the weaker muscles to correct the imbalances.

The vastus medialis is most recruited during the first and last 10 – 15 degrees (differs from person to person) on knee flexion and extension. Performing the last 10 – 15 degrees of leg extension at a lighter weigh for a higher repetition range would be a perfect exercise. Externally rotating the hips during the leg extension (having the knees face outwards) will further increase the recruitment of the vastus medialis. Alternatively, exercises such as high step ups will also isolate the vastus medialis but requires more stabilization and is considered a progression.

What Muscles do I Stretch?

Stretching the muscles (specifically the muscles on the outside of the knee) will lengthen and increase the muscle’s flexibility. The muscles on the outside of the hip and knee are generally tighter than the inside because daily activities such as walking focus more on the muscles on the outside. Some of the muscles that we should be stretching are the piriformis (small muscle that rotates the hip outwards), tensor fascia latae, vastus lateralis and the iliotibial band. Stretching these muscles will help alleviate the tension on the outside compartment of the hip/thigh to decrease stress on the knee.

Below is a video that demonstrates three different knee stretches. Hold the stretches for at least 30 seconds and perform them throughout the day or after exercise.

For more information on how to correct your knee pain, please visit our Sports Massage Therapy page.

Rounded Shoulders and Shoulder Pain

Rounded Shoulders and Shoulder Pain

Rounded shoulders is a postural condition where the shoulders roll forward and cause postural deviations such as hyperkyphosis (hunch back) and anterior head carriage (forward head posture). Over time, these postural conditions can progress and lead to other conditions such as chronic neck pain, thoracic outlet syndrome and lack of shoulder mobility.

Rounded Shoulders & Shoulder Pain

The shoulder joint is a ball and socket joint and composes of different structures such as muscles, bones, ligaments, tendons, nerves and blood vessels. When the shoulders round forward, it decreases the space in between the arm bone (humerus) and it’s articulation on the shoulder blade (acromion). This causes local irritation of the shoulder joint and has the potential to impinge different structures that pass the shoulders.

Structures such as nerves and blood vessels are often impinged in the shoulder and cause local shoulder pain as well as peripheral neuropathy (pain shooting down the arm). Other symptoms such as numbness, tingling and a “cold” sensation may be present down the arm. Shoulder flexibility and mobility is often hindered because of the spacing in the joint itself.

Causes of Rounded Shoulders

The most common cause of rounded shoulders is poor posture. Because most daily activities such as using the computer/smart phone or reading a book require fine motor movements in the anterior muscles, our shoulders will naturally round forward and encourages poor posture.

Below is a list of possible causes of rounded shoulders:

  • Poor posture (sitting in front of the computer for a long duration)
  • Excessive weight training (bench press, bicep curls, shoulder press exercises)
  • Muscle imbalances (hyperactive anterior muscles, weak posterior muscles)
  • Stress and emotional factors (holding onto anger, frustration)

Signs & Symptoms of Rounded Shoulders

Every human body is created differently and the signs and symptoms of rounded shoulders vary from individual. The most common sign and symptom of rounded shoulders is a physical forward deviation of the shoulders rolling forward. The upper spine starts to round forward and the neck protrudes to create a center of gravity.

Below is a list of common signs and symptoms of rounded shoulders:

  • Rounding of the shoulders, hunch back in the upper spine and protruded head/neck
  • Lack of mobility and flexibility in the shoulder (difficulty putting the arms overhead)
  • Localized shoulder pain at rest and during movement
  • Chronic neck and upper back pain and tension
  • Numbness, tingling and/or electrical pain down the arm

How to Fix Rounded shoulders

There are many ways to correct rounded shoulders, and often responds very well to a combination of different methods. First off, we have to take a look on WHY you might have rounded shoulders. If you find yourself in front of the computer most of the day hunched forward, that may be the primary reason why. If you’re into sports that require a lot of pushing movements from the shoulder such as powerlifting/bodybuilding, squash and tennis, then correcting the muscle imbalances between the front and back of the shoulder will help with rounded shoulders.

But regardless of why you may have rounded shoulders, there are exercises that will strength the weaker muscles of the shoulder (rotator cuffs) and lengthen the hyperactive muscles (chest, biceps). Below you will find two useful videos on different shoulder exercises and stretches that will help correct rounded shoulders.

Alternative Methods of Correcting Rounded Shoulders

Manual Therapy
Manual therapy is the manipulation of different soft tissues in the body. Soft tissue consist of structures such as muscle, ligaments, tendons and fascia. In rounded shoulders, the anterior compartment of the shoulder and torso are often tight and pulls the shoulder forward and inward. Reversing the process by lengthening and stretching the anterior compartment will help the shoulders relax and bring the shoulders back into the proper position.


Acupuncture can decrease excess tension and pain in the shoulder by balancing the different meridians in the body. Thin, sterilized needles are inserted into specific acupuncture points in the body to stimulate the body’s natural healing process. Although acupuncture is mainly used to decrease pain, it can also be used to help correcting postural deviations by reteaching the body on how to effectively use the muscles.


Rounded shoulders is a condition where the shoulders round forward and is often associated with shoulder pain. The head and neck start to protrude forward, and the upper back starts to round. Pain associated with rounded shoulders can either be localized or radiate down into the arm and present itself with numbness, tingling and even sharp, electrical pain.

If you are trying to correct your rounded shoulders, correct your posture while performing daily task such as using the computer and practicing proper posture throughout the day. Perform different shoulder exercises and stretches to help re-balance the strength of the muscles that influence the shoulder joint.

If exercising and stretches show little to no improvement, alternative methods such as manual therapy and acupuncture may be an option.

For more information on how to correct rounded shoulders and shoulder pain, please visit our Sports Massage Therapy page.

Powerlifting Injuries and Muscular Imbalances

Powerlifting Injuries and Muscular Imbalances

Powerlifting injuries are inevitable. Powerlifting is a sport where the athlete is required to perform three exercises which are the squat, bench press and deadlift. In a competition, the individual is allowed three attempts on every exercise, making a total of nine lifts throughout the event.

A Breakdown of Each Lift

A squat is a lower body exercise where the athlete must squat down until their hip joint is lower than the knee joint. Different emphasis on muscle groups are generally dictated by the stance and variation of the squat. For example, a low bar squat mainly utilizes the posterior chain (hamstrings, glutes and lower back) whereas a high bar squat will primarily target the quadriceps and spinal erectors. Read my other guide on the importance of proper mobility here

Bench Press
The bench press is the only upper body exercise in a powerlifting competition. The athlete must bring the barbell down to their chest to a pause, followed by pressing the barbell back up into a locked out position. The primary muscle groups that are recruited in a bench press are the pectoralis major (chest), anterior deltoid (front shoulder) and triceps (back of the upper arm).

The deadlift is another lower body exercise in powerlifting where the athlete must lift the barbell from the ground to the hips. Similar to the squat, depending on the stance and variation of the lift, the deadlift can place emphasis on either the posterior chain muscles (conventional, sumo deadlift) or the quadriceps and spinal erectors (Olympic Weightlifting “Deadlifts”).


Why do Powerlifting Injuries Happen?

As a manual therapist and coach, most powerlifting injuries happen for a number of reasons – they are either from technical errors (form), volume overload and general overuse. Powerlifting is a very physical demanding sport and if you were to look at a general powerlifting program, it would consist of high percentages of weight/intensity along with volume.

It is also important to note that a large percentage of powerlifters utilize the low bar squat along with the sumo deadlift (because of the decreased range of motion) which are both posterior chain dominant exercises. Not only will this put an enormous amount of stress on the lower back and hips, it will also create a muscular imbalance between the anterior (front) and posterior (back) within the hips.

Rounded shoulders and shoulder impingement are also quite common in powerlifting mainly due to the excessive amount of bench pressing. Muscular imbalances in the upper body are created from the high amount of volume of bench pressing and accessory work that is needed to supplement the bench press. Pull dominant exercises such as face pulls, reverse flies and YWT exercises are all recommended to pull the shoulders back into position.

How to avoid Powerlifting Injuries

Focus on form:
Re-analyze your form and see if that specific variation is working for you. If sumo deadlifts are creating pain in your hips, try incorporating conventional deadlifts to give the hips a break.

Decrease intensity and volume:
Check your program and see if there is adequate rest for muscle groups throughout the week. A perfect example of too much work is low bar squats and conventional deadlifts done back to back. Even though they are two different exercises, these two variations of lifts will tax your posterior chain and could potentially contribute to future lower back and hip pain.

Accessory exercises:
Working on your weaknesses will dramatically decrease your chances of injury. The exercises that you generally do not like and skip at the end of your workouts are the exercises that you should be doing! You are only as strong as your weakest link.

Managing your injuries

Maintenance is often overlooked in every sport. Similar to a car, the human body requires maintenance work especially with the high amounts of volume and intensity that is required in powerlifting.

Manual therapy:
Different techniques in manual therapy such as myofascial release, joint mobilizations and stretching will help decrease muscular tension and re-align soft tissues that were damaged. It can also help with circulation that will lead to a faster recovery time and decrease your chances of injury.

Below is a video of how manual therapy has helped one of my clients prepare for a powerlifting competition.

A video posted by James Lu (@lustrengththerapy) on

Mobilizing and stretching:
Foam rolling and self massage with a lacrosse ball are both great ideas for powerlifters. These tools will help increase your mobility in your joints which is much needed because powerlifters often lack mobility in their spine, hips and ankles. Stretching will also help temporarily increase your flexibility and range of motion – dynamic stretching should be done prior to a workout whereas static stretching should be done after a workout.


Powerlifting is a physically demanding sport that requires time and dedication. Pain and powerlifting injuries are inevitable, however, can be managed through training smart, keeping up with self care (mobilizing and stretching) along with focusing on correcting muscular imbalances. Listening to your body and knowing when to take a break is often overlooked – powerlifting is a marathon, not a sprint.

For more information on how we can help you with your powerlifting related injuries, please visit our Sports Massage Therapy page.

Acupuncture For Knee Pain Relief

Acupuncture for Knee Pain Relief

Acupuncture for Knee Pain Relief

In this case study we will be discussing acupuncture for knee pain relief. The patient presented with chronic left knee pain that was associated with discomfort and clicking with movement. The knee pain was from an old injury that happened while playing foot ball where he was hit from the outside of the knee, forcing the knee to collapse inwards.

The signs and symptoms were localized knee pain and instability of the knee joint. The assessment revealed that there was ligamentous damage as well as scar tissue formation. The goal of the treatment was to decrease the knee pain and reduce any inflammation present in the knee itself.

Another goal of the treatment was to increase circulation. Ligaments are considered avascular (low or little blood supply) and generally takes longer to heal oppose to muscles (highly vascular). Therefore, increasing circulation to the knee was another goal of the treatment. This was achieved by stimulating specific acupuncture points in the body to further increase the body’s natural healing process.

The Treatment

Needles were inserted along the right elbow to decrease pain on the left knee. This works because the knees and elbows are considered a mirrored image of each other. Other points were also included on the forearm, opposite lower leg and the same foot to further stimulate the acupuncture points and increase qi/blood circulation.

Needles were retained for roughly 30 minutes and active movement was encouraged every couple of minutes to further increase qi/blood circulation.

Acupuncture points used for this case study were:

  • Contralateral ashi points around LU5, LI11 and HT3
  • Contralateral PC 6 and GB 34
  • Ipsilateral LV 3

Post Assessment

Upon re-assessing the knee, the pain had dramatically decreased during movement and in a standing position. The discomfort and clicking that was associated with the pain had also subsided drastically. However, minor pain was still present in the back of the knee. A couple of more acupuncture sessions a long with exercises to strengthen the muscles of the knee will provide pain relief and prevent the re-occurrence of injury in the future.

For more information on how acupuncture can help you with knee pain, please visit our Acupuncture page.

What is Cupping Therapy?

What is Cupping Therapy?

Cupping Therapy is a technique used in Chinese Medicine where local suction is created on the skin to lift the different soft tissues of the body. There are different types of cupping such as dry cupping, wet cupping and needle cupping. Unlike tissue compression (from massage therapy), cupping works by creating negative pressure by pulling the connective tissue apart and creating more space in between soft tissue such as muscle, fascia, tendons and ligaments. Think of it as a reverse massage!

The History of Cupping Therapy

Cupping therapy, sometimes known as cupping, has been around for thousands of years. One of the first methods of cupping were cups made from animal horns to help remove toxins from the body. Cups made from bamboo were soon used to replace animal horns because of their durability. During the 20th century, glass cups were introduced and were preferred over the other types of cupping since bamboo cups were easily deteriorate from the repeated heating and use.

Cupping is generally left on for anywhere from 10 – 20 minutes (depending on the sensitivity of the patient). The skin could become red or even purple due to the stagnation of the blood underneath the tissues. The cups are removed by applying manual pressure along the side to relieve pressure. Depending on the severity of the stagnation, bruising and discoloration could appear from the cups.

Benefits of Cupping Therapy

Cupping therapy has a wide variety of benefits from increasing circulation to decreasing hypertonicity in muscles. One major advantage to cupping is that it is gentle and virtually painless. Below are some benefits to this therapy:

  • Improved local circulation to the soft tissues
  • Decrease hypertonicity (tension) in muscles
  • Helps move stagnation and drains fluids
  • Loosens up adhesions and scar tissue
  • Provides a gentle stretch to the muscles and connective tissue

Who can Benefit from Cupping Therapy?

Everybody! Anybody that experiences muscular aches and tension can greatly benefit from cupping therapy. Whether you’re the average Joe or an elite competitor in a physical demanding sport, this technique should and can be used by everybody. As a health care practitioner, I generally introduce cupping therapy to individuals that experience muscular aches and tension such as individuals that take part in combat sports (Brazilian Jiu Jitsu, etc), powerlifters, weightlifters, and CrossFitters.

Below is an example of how cupping helped with one of my weightlifting patients:

A video posted by James Lu (@lustrengththerapy) on

What Conditions can Cupping Therapy Help With?

Because of the improved local circulation and decreased hypertonicity in muscles, cupping therapy is generally used in musculoskeletal conditions. It also works on a myofascial level which general stretching and self care cannot target. Below is a list of different conditions that cupping therapy can help with:

  • General muscular tension and aches
  • Entire back pain
  • Tendonitis and repetitive motion disorders
  • Sprains and strains
  • Tension headaches
  • Nerve impingement (Sciatica) from muscular tension
  • Myofascial pain syndrome


Cupping Therapy is a modality of Chinese Medicine where local suction is created on the skin to help increase circulation, decrease muscular tension and alleviate pain. It is recommended for anybody that is experiencing pain and tension along and can be utilized by individuals participating in sports such as Brazilian Jiu Jitsu, Powerlifters and Olympic Weightlifting.