Ankle Ligament Injuries: One-Leg Looped Band Bridges

Wrap a looped resistance band around your thighs just above your knees. Engage the core muscles below the belly button by pulling them inwards while you keep breathing. Ensure your knees are aligned with your ankles and your hips while you take up the slack in the looped band.

Push through your heels with the feet flat on the ground and bridge the butt up keeping both sides of the pelvis level with each other. Then straighten out one leg, hold it here for 10 seconds, and then bend your knee and lower your butt back down. Repeat this for 10 repetitions doing 3 sets daily. 

This exercise progression helps to further strengthen and rehab the functional strength of your ankle whether it’s a been long time ongoing chronic issue or more from an acute injury that you have experienced.

If you have pain or are unsure about what you are doing consult a local physiotherapist before continuing. 

AC Joint Shoulder Injuries with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. Multi time award-winning physiotherapy clinic. Wil's the owner, the big cheese and he's booked out all the time. It's really hard to get into because he's so good at what he does. Today we're going to talk about AC joint shoulder injuries. How are you doing Wil? 

Wil: Good. I'm good. Thanks Mark. Hey Mark, I was just wondering, you know, I know that you always love pumping up my tires, that's great., I thank you for that. But we also have a great team of other physios that actually, you know that, since we're talking about shoulder injuries that actually have a special interest in shoulders too.So I just thought I'd mention that. 

Mark: Of course, I having been to your clinic many times. I know that that's the case. You're the guy here that's the face of the business right now today though. So that's why I did that. All the team, you hold everyone to a really high standard. I know that's how you operate. That's just your nature. And so that's how the team is at Insync Physio. How does someone actually injure the AC joint? And what is it? 

Wil: Yeah, so let's start off with what it is first. So when we think of like the shoulder joint and shoulder injuries, we quite commonly think of like a part of the shoulder. That's the ball and socket. It gives us this 360 degrees range of motion. Well, we also have another part that's part of the shoulder complex, which is where the collarbone connects to your shoulder blade, which is basically called the AC joint or short for acromioclavicular joint. And it's not injured as common or the injuries that happen in the AC joint are not as common as the ball and socket joint area, but we are still seeing this in the clinic. 

Over last couple of weeks, we've had a few people that have come in with it. And so I thought we talked about it. And usually it's from a blunt force or trauma. So in the athletic population, you know, impact sports, when you have like a shoulder to shoulder contact. Really good example is we've had some of our therapists who've worked with hockey teams and they see one of their players get checked into the boards, kind of face first and the shoulder impacts the boards and that's a very common way of injuring the AC joint.

 And another one, it doesn't have to be from athletics or from sports, but it could be like a car accident. Like you got the seatbelt on and it's an impact force with the seatbelt over the collarbone area. And then it's just a sudden jarring motion. 

Another one is also where you could be just maybe moving. I know a client of ours, one of the physios, they were helping someone move and then they're kind of holding something heavy in this position. And then they ended up just having a shoulder to shoulder sort of contact by accident. And then it caused a mild sprain in the AC joint. 

Mark: And I guess falling, that would be another cause, like with your arm out. Could that also do injury to that joint? 

Wil: Yeah, it can actually cause some impact loading forces onto that joint as well, causing some strain. And actually not what we're talking about. Sort of, other types that's non traumatic. It can actually be non traumatic. It can be something that presented as more wear and tear. And so there's special tests that we do in the clinic that kind of determine if your AC joint is affected. We don't just have one test. We have a few different ones that we do, and we cluster them and it actually provides good reliability and accuracy.

Mark: So once you've diagnosed it, which I'm sure is pretty complicated because it could feel like it's referring from the ball and socket joint into the AC, or is it specific to the AC, like someone's going to feel it there in the clavicle, in their collarbone, kind of where it inserts into the scapula. What's the symptoms that someone might notice?

Wil: Yeah, you definitely get like swelling. So there's the more obvious ones is you see it and be red hot and swollen. There's definitely pain and loss of this function. So even with an acute injury, that's something that you want to actually immobilize right away because it's going to be painful and you want to just let things settle down.

So if it's like an acute sprain into that AC joint and you see swelling in there and the pain and dysfunction is obvious. You want to just put it in a sling, for at least a few days you know, to let it settle down. But you do want to get it moving a little bit after that obviously. But you want to give it a chance to really settle down and heal. But the other symptoms too, that if you look at the AC joint, you have a lot of ligaments in there. And so we actually can test for it. But sometimes it can get to a degree where it's so severe where you can see not only a step deformity, so it's very obvious, but then you also get a lot of pain with that too.

Quite often too, if it is fully torn. And there's a step deformity, there can be no pain. Which is almost contradicting. And the reason why, and we've seen this a lot before, is because when there is a step deformity, but there's no pain is because the ligaments have been totally ruptured and the nerve supply is basically not there anymore. And so you can't feel it. But like there's a loss of range of motion. I mean, they feel the initial pain and swelling, but once that goes down and the step deformity is still there. They still have the dysfunction, but it just doesn't hurt. But they had the loss in strength and the loss and stability in that area.

Mark: So how would it present? Is it going to present similar to a broken collarbone? If that was up in that nearer to that area? 

Wil: No, that's a really good question, Mark, thank you. So when you're looking at the sprain of the AC joint, it's kind of more on the outside, closer to that ball and socket, and you can see the swelling in that joint area. And so in that area that you'll have the swelling. And whereas like with a fracture, you can feel along the line of the bone. And if it's a hairline fracture, it's gonna be a little bit tougher because you'll feel maybe sensitivity. It could be muscular is kind of hard to tell.

But if it's like something that's more obvious, then you're going to see a little more of a step deformity in there too. And that's obviously not good. But the presentation is different. And if there's any question, you know, especially if it's trauma related, then we probably want to go get that checked out more medically too. And that's important as a next step. 

Mark: So you've diagnosed it. If there need to be x-rays done. Medical consultation. Their course of treatment is underway, but now they come back. Okay. Now I want to get my range of motion and strengthening and proper function again. How does that course of treatment usually run?

Wil: Yeah. So stability is the key thing, because stability is the number one thing that we want to try and achieve in that joint, above strength and making sure that we progress that stability throughout the whole range and full mobility. And so we don't want to start doing things to strengthen it right away until we achieve that stability strength.

So what I'm talking about is like, you don't want to be doing like pushups and presses and stuff like that. Sort of an old school thinking of like, you know, if we can just strengthen it, which in other areas like your ankle, that's really good. You want to strengthen, you sprained the ligaments. In the AC joint, you got to really work on stabilizing strength. Specific things to actually really stabilize that joint, to make sure that then we can progress through the stages of healing properly.

And so depending on the severity of the injury, there's going to be different stages that you move through in terms of progressing back to like sport, especially, or to work if that's a big thing where you need to use your shoulder for. 

Mark: So what's the difference between them? What kind of exercises is that that are the stability, what you would classify as the stability exercises or steps that someone would need to take that you would guide them through?

Wil: Yeah so, a lot of it is like functional core starting off with basic core and progressing the functional core stuff. The rotator cuff strengthening is really essential. It will help and then working on a lot of stuff around that area to target certain muscles in addition to the rotator cuff, like into the shoulder blade. So there's all these stabilizing muscles.

So there's tests that we can do to look at which muscles are definitely weaker. And usually someone that has an injury, they'll show these patterns right away. And if you have a preexisting injury, like I'm thinking about a client who came in to see one of our physios, that had a pre-existing rotator cuff injury, didn't actually have trauma in the AC joint, but had some pain there as well, you know, they're presenting with other stuff.

So this is where we need to tailor and personalize the things that we need to do with you on a hands-on, you know, one-on-one sort of, okay, we gotta get this moving this way and realign the shoulder blade in this way, and then retrain the specific movement pattern for you. 

Mark: And movement pattern is really important for the shoulder joint. Is that a useful assumption?

Wil: Absolutely 100% because especially when I talked about earlier, that in the shoulder socket where it's ball and socket, it's 360 degrees of movement. And then you have your shoulder blade, which is basically a floating, it's like it's got all these other muscle attachments. And it's sort of floating around in there and it's only real attachment to like, your arm bone, and then your collar bone. So then you have all these other muscles that control and dictate how your shoulder moves. And so having that movement pattern and optimizing the best way to get it working again, especially after you know, like a sport injury, you want to get back to playing sports or work, you know, to be able to do, doing the repetitive motion, or whatever it is that you need your arm to be able to be in that position, is super important.

Mark: In other words, it takes an expert really diagnose it and help you through the process because you might think it's okay because you're free of pain and then you actually are using other muscles and other functioning is happening to take over something that didn't heal properly or hasn't been activated properly. Is that right? 

Wil: Yep. Pretty much. And then you made an interesting point about feeling like it's okay. And a lot of people, they get up to like maybe 85% and then, or they get back to being able to play their sport and they feel like they're 85% and we can get by. You know, and this is also where I talked about the getting intervention in terms of maybe on a medical aspect because like there's a lot of ligaments in there and the classification is quite complex, but you know, it may warrant a referral to see a specialist about what's another route to take. If the rehab approach is just not successful.

Mark: That whole knife thing. Perhaps. 

Wil: Possibly. So that's why we want to work with a team of sports medicine doctors as well and other doctors to kind of get that process going for that. Possibly. 

Mark: If you want a team that's going to really help you diagnose exactly what's going on, whether you have pre-existing injuries, whether it was a blunt force trauma, whether it's arthritic or some kind of thing like that. Insync Physio are the guys to get in touch with. You can reach them at their website You can book for either office in Vancouver or in North Burnaby. And of course, if you want to book and see Wil, you can reach him at 604-566-9716. Or any of the team, they're all top notch. He wouldn't have them there if they weren't. Thanks Wil. 

Thanks, Mark.

Elbow Injuries – Bicep Curls

Hold a dumbbell in each hand. To target the biceps specifically begin with the palms facing the midline of your body. Lift the weight and turn your palm facing upwards, or into supination position, as you flex the arm keeping the elbow pointed down.

Then lower the weight back down reversing the motion to the original start position. Perform 3 sets of 10 reps on each side.

When done correctly this exercise helps with the recovery of your elbow injuries. Your elbow is weaker, usually after a strain or ligament injury. The biceps muscle helps to facilitate support and stability to the dynamic nature of it.

If you have any pain or are unsure about the exercise please consult your local Physiotherapist before continuing.

Ankle Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many times voted best physiotherapists in Vancouver and in North Burnaby. And again, just recently, one of the top three physiotherapists in Vancouver, and we're going to talk about ankle pain today. How're you doing Wil?

Wil: I'm doing good. Thanks. Thanks. Thanks for that. Yeah, I'm doing really good. 

Mark: So ankle pain. What's the, I'm sure there's many different kinds and types. Let's talk about a specific one. What do you see the most of? 

Wil: Well, you know, I'm just thinking about like a few people that I've seen over the last few weeks that have come into the clinic. And one of the biggest things that they complain about is that in terms of ankle pain, is that they have trouble with squatting. Or doing like a lunge and basically having the ankle, like coming into a direction where it forces it into that motion. And so that's one of the biggest complaints with this type of a loss of mobility that I've been seeing with regards to ankle pain.

Mark: And is ankle pain then that's kind of in the front of the ankle. 

Wil: Yeah. So I'm thinking about these specific clients that I've been seeing, is that they actually have pain on the front outside part of the ankle, which is very consistent with like every time they squat. And they came into the clinic basically having those issues of not being able to do proper squats.

Mark: They're not feeling it when they're walking. They're not feeling it when they're running necessarily, but when they squat, when they kind of hyper flex the ankle joint, that's when they're feeling that pain. 

Wil: Yeah. Yeah, exactly. That's it. I mean, to a certain extent with these specific clients I had seen over the last few weeks, one was a runner, one was a rock climber and the other actually was an ultimate Frisbee player. So out of the three, the ultimate Frisbee player actually could feel it with a little bit more running But the interesting thing is that they can present in different ways.

So what I mean by that is that, you know you can either have a previous injury. So if you've sprained your ankle before, which you know, two out of the three of them did, it can cause a block in the range of the motion in the ankle, which was what was going on with two out of the three of them. 

Now, the other person, which was really interesting, they had no prior injury. But they were actually ramping up their training load and doing a lot of plyometric training. And so it's that repetitive nature. And so that imbalance of what was going on in the ankle that was causing the impingement. And the impingement for this person was located in a bit of a different area too.

So but what I see a lot more and what's more common is sort of that loss of mobility or what they call ankle impingement, which is basically located in the front outside part of the ankle when you try and do like a squat range of motion.  

Mark: So when you say impingement, it's like the something in the joint is kind of rubbing, there's not enough room in there somehow, is that what's going on? 

Wil: You can describe it more as a blocking sensation. So a blocking sensation when the ankle comes up, so like when you bring sort of the toes to the nose, range of motion, and sometimes you can get swelling, so there could be swelling in there. And so I'm describing the symptoms here a little bit. And there could be sort of this feeling that it's not stable. It's definitely some limited ankle motion. And like I was saying, the pain of the squatting is the big one. Sprinting, also climbing stairs or hill climbing and sometimes normal walking, like normal, just day-to-day walking can be affected if it gets bad enough.

Mark: So what's causing this? 

Wil: Yeah. So there's, I mean, first of all, this type of issue, there's a broad range of things that can come. So ankle, this type of ankle pain, related with the loss of mobility or ankle impingement. There can be many different issues that could be related to this. So it's such a broad spectrum, right?

I mean, when we look at the sort of extreme end of it, it could be something like a stress fracture. It could be like maybe a nerve trapping or ankle, or even higher up in the knee. It could even be something related to your back. Believe it or not. You know, when you have the pain, right. So that's why, you know, you need a proper physio assessment, let's say you could be doing a squat and be getting the pain, but you need a proper assessment to see, is it coming from the back or is it really the ankle? 

And then something more sinister. So I'm just talking about sort of the more like sinister stuff here again it could be something like a tumour, so you want to get all that stuff, like sort of checked out. And then it could be things like maybe it's like wear and tear, it could be like, if it's an old injury, like an old sprain, then something's just not moving well. And the joints aren't aligning properly. But then once again, it could be, if it's an old injury and it's been like this for awhile and it's been giving you problems ongoing, there might be a little bit of like that wear and tear with sort of like a little bit of calcium formation or osteophyte formation developing in your ankle joint, causing that block. 

Another issue that could be result of this ankle pain is maybe an overuse injury happening in one of the tendons. We don't know, so we'd have to assess it. But one of the most common things, like after someone that's had an ankle sprain, it's usually a blockage, but then there's these other things that you want to rule out.

Mark: So essentially there isn't going, because it's got such a wide range of possible causes. There's no typical course of treatment. You really need to dig into what is actually happening in the ankle in order to then go, okay, well, here's what we do now. 

Wil: Exactly. So we have to figure out what the actual limitation is and what's causing that. And then also, you know, if it's something that we think is possibly more you know, on the sinister end, then we would actually go more towards like referral to the doctor if that was the case. But we would obviously look at treating what we can treat and manage where we can manage based on our assessment and objective findings.

Mark: So if old the ankle sprains are, let's just make a crazy assumption, let's say old ankle sprains are what is causing the majority of the problems in most cases, what would be the typical course of treatment for that? 

Wil: Yeah. So then assuming that that's causing a shift in how the ankle is moving, we would want to restore that range of motion. And then after restoring that range of motion in the actual ankle joint, then we obviously on the assessment, you know, usually there's a bunch of other things going on. Like in terms of imbalances and in terms of stress issues and weaknesses that that would be presented. So quite typical, I mean, not all the time, but I would say nine out of ten times that you know, there's a lot of muscle imbalance. The calf muscles will be really tight. You gotta work that out because that will really pull on the ankle. Make things stiffer and put it out of sort of improper mobility or improper belt mechanics. So you wouldn't have an optimal type of movement pattern going on in there.

And then you would address all the issues that are related to balance and strength and all that stuff from not just the ankle, to the knee, but even right up to the hip and the core. Because all that can affect you know, this thing called the lower kinetic chain. So what that means is basically, you know everything is all connected.

So I know that's a big term, the lower kinetic chain, but what it is, is it's basically how when you think of chain, we think of like, you know the links of all these rings, you know, and how they all affect one another. And kinetic means movement. So how does the movement and how is the strength movement in the hip effect that in the ankle?

And so that's how that's all related. And so we want to affect everything. And obviously if someone comes in with presentation of pain and it has swelling, then we want to deal with that. So we want to take the swelling down. That's also really important to deal with. So we're looking at a bunch of different issues. Like if it's an acute thing we want to deal with that. And then take it through the the stages of healing when it calms down. Start looking at you know, the strengthening and we can even start to address the strengthening and a lot of the mobility things, even as the swelling is still starting to come down or even in the acute stage, as long as you're not reproducing a lot of bad pain in that area.

Mark: And so, of all the ways that you can hurt your ankle, this is one of the more common ones would you say? 

Wil: In terms of, well, in terms of spraining and then having, yeah, I would say like, it's one of those injuries that I would say that it bites you back if you don't take care of it. It's one of those injuries that can haunt you.

So you sprain your ankle. And especially if you're very athletic and you do a lot of sports involved with cutting and running jumping. So if you're a volleyball player, basketball player, and you do a lot in play and you sprain it, but you don't really rehab it properly, and it feels better, but you know, you may have this issue down the road.

 So you really need to look at rehabbing it. And so what that means is addressing those things that I just talked about, like all those deficits, because over time, you may not feel it, but there's sort of this like slow, gradual, imbalances starting to creep in. As it creeps in more and more then we get used to it until it becomes like symptomatic, then we think, oh, I don't know what happened. And then we think that this problem just suddenly appeared. Whereas an actuality you know, your old ankle sprain, especially if it was a particularly bad one where you healed from, but you didn't rehab from. So there's a big difference. 

So you heal from it, but you didn't rehab from it. You're not really addressing like all the other things that I talked about. Like, well, what about the strength and the balance? You may have addressed some of the general strength and balance and mobility issues. But if you're going back to doing a lot more running, or if you say just started to take up running or started up a new sport and you have this old ankle injury.

Then you want to start to look at doing some things to maybe assess. Okay, do I have an issue that I need to deal with? So this is also a concept of making sure that you prevent an injury before it starts. So this concept of prehab, which is preventing an injury from happening by rehabbing it and getting it stronger and really making sure that the movement area that you injured the past and also other adjacent or areas like above or below. So if it's your ankle, then your knee, and your hip and your back are all working together properly. 

Mark: If you have some ankle pain, get it diagnosed. Get into Insync Physio in Vancouver. You can call them at (604) 566-9716 to book your appointment. They also have a North Burnaby office, (604) 298-4878. Of course you can book online at

Both locations are available there. Get in there and get that ankle pain looked after. Get the prehab rehab all done. So you have your new sport or old sport, much more enjoyable for yourself. Thanks Wil. 

Wil: Yeah, no problem. You bet.

Shoulder Rotator Cuff Injury – Progressive Planks

To begin, each plank will be done with wide arms in 3 different hand positions putting the rotator cuff muscles at 3 different angles and then progressing each of them by flagging one foot out to the side. Engage your lower core by trying to make yourself skinnier below your belly button at your waist line.
The first plank position is with your fingers facing straight ahead. Hold it for 10 seconds. The second is with the fingers facing 45 degrees. Hold this for 10 seconds. The third position is at 90 degrees facing outside. Once again, hold it for 10 seconds. Hold each wide arm plank positions for 10 seconds. Then when doing all three wide arm planking positions with your foot flagged hold these for 10 seconds as well. Do one set of 10 reps for each of these on both sides after a training session or workout.
Being a rock climber, I came up with these exercises to progress the functional core, rotator cuff and entire shoulder strength to become stronger for rock climbing after recovering from a shoulder injury. You can also utilize this exercise for many different sports requiring similar static core and shoulder strength.

If you have any abnormal pain or are unsure about what you are doing, consult your local Physiotherapist before continuing.

Testimonial Sandy Wong

Hi, my name is Sandy. I've been going to Insync Physio for almost two years now. Due to a problem with my left hip, I hardly can go for my favourite golf game. Two years ago, I even have to wake up middle of the night because of pain on my knee and part of the heel.

Ever since I got the IMS treatment from Wil Seto I'm slowly can get back to my golf game, sleep wonderfully at night, and also enjoy my regular exercise activities.

Once again Wil, thank you so much for giving me back my enjoyment. 

The Pain in Your Neck, Is it Your Shoulder?

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. And we're going to talk about the pain in your neck. Is it really your shoulder? How are you doing Wil? 

Wil: Hey, I'm doing great. Thanks, Mark. Yeah. So the pain in your neck, is it coming from your shoulder? So it's a really interesting topic because, you know, I've been seeing a lot of this and especially during the pandemic. But even like before the pandemic, I see this a lot too. And so the common thing is people come into the clinic, even actually, you know, my athletes that I treat, they come in or they come up to me and they say, yeah, I've got this pain right here.

You know, I'm not sure if it's coming from my shoulder and what's wrong with my shoulder and, you know, and really like upon closer examination and also history taking in terms of asking them some more questions, it's actually coming from their neck. 

Mark: So what would the typical symptoms be? 

Wil: So, first off a lot of it is a restriction in range in motion. That's huge, in terms of like their inability to turn and usually it's painful, and stiff, soreness, and it can be like a constant dull type of pain. That's a low grade. And it can also be aggravated a little bit more with the movement that's restricted.

And then even like, and this is the thing can throw them off too why they think it's shoulder possibly because they may try to raise their arms and reach for something in the cupboard up above their head and it causes some stiffness and pain. And that's because the muscles around that shoulder blade, which is technically part of the shoulder is connected to your neck.

Mark: So what are some of the possible causes? 

Wil: So I think strain is number one. And so what do I mean by that? So strain being like, if you over exert those muscles they get really tight. And then you can start the feel the muscles around there being really, really super locked up and basically that can restrict the motion and that can cause that pain that you're feeling or tightness.

Usually it's kind of more of a tightness feeling, which when it gets really tight like that, the other symptom that I didn't mention was you can also present with like a touching type of headache. And the other cause is if you have like a lot of stress, so a stress in your life, that can basically you know, start to manifest up into that area. So the reason why stress is a big factor and this will play into like, if they've also had an injury, is because your fight or flight in your nervous system, those nerves that actually, you know, cause you to get into that fight or flight mode, they basically connect in with the spinal cord and then they have the same connections that kind of come back out to give that flow of feedback back to the muscles that basically cause everything will be tight. 

So when we get stressed, we also noticed that, you know, you tend to do this. And you're like, oh, I'm really tight. That's where our stress tends to manifest, is in those areas. And then you add an injury on top of that. So say you get into a car accident, and you get whiplash or something like that, then that can compound that. 

But for somebody who's never had trauma and like, say it's just something that's gotten like tight in there just from repetitive strain of bad posture. So that's another really good example of a, another way that they can injure it without actually doing anything. Because it's a repetitive sustained motion. So their posture may be off, or maybe it's not even off. If you're sitting all day long, it's just that mere posture of sitting and it can cause a little bit of a more non-optimal activation of those muscles, especially on a laptop or a computer all day long. 

Mark: I guess, as we get into more and more, maybe the Fall, the fires will calm down and people are getting outside more. Maybe falls would be another thing that I know that's one of the places like if you have an extended fall, like you can get that and that can happen in any sport pretty much. 

Wil: Oh, definitely, absolutely. So any kind of trauma, obviously, for sure where you get whiplash, so you're describing classic type of whiplash type of stuff going on. So you don't have to just be in a car accident and you can even just actually be bumped. I treated a rock climber once who was climbing up what's called lead climbing with his rope and he fell and hit the wall. He didn't hit his head on the wall, it was his body, but then he had a bit of a whiplash from that as a result. And he had some neck pain and stiffness. 

Mark: So typical course of treatment? 

Wil: Well typical course treatment, you know, what we find on the diagnosis and the assessment portion of what we go through. And so this is actually really important, when someone comes in with this type of pain and syndrome and they complain about this. We've got to figure out, you know, what's causing it. Is it just a muscle thing going on. Or is it also muscle related with some nerve stuff related to the neck. Quite often it could also be like a conjunction of muscle and shoulder. So the two things combined. So we have to address both. 

So is that pain the shoulder pain, the shoulder issue? Sometimes it can drive it, so we have to do a a proper assessment and really look at it and see what's causing it. So that really varies in that point of view.

And so we do Manual Therapy to really address what parts, in terms of the joints. So from the neck, from the middle part of the neck to the top part of the neck, or is it the bottom part? So there's all these different sections that we have to assess or is it the mid back. Because tightness in the mid back, you know, if that's not moving well, it basically translates to more usage and your upper neck taking more of the load. So that's important to realize as well. So even though you may not feel pain down in the mid back area, that's another issue. 

So there's all these things that we look at in terms of mobility. In terms of the joints. And then obviously the muscle mobility, because then now you're looking at the muscles that are causing the stiffness in the joints.

So they work hand in hand. There's the joint mobility and the muscle mobility. So then we want to do things to release the muscles. So we do manual therapy techniques to release that. We do IMS, which is a dry needling technique, which works really good for things that have sort of a nerve muscle connection relationship.

And when I say that it's a nerve muscle connection relationship, you know, it's basically a different type of tightness, than say if it's been overused muscle kind of thing. So there is a differentiation. And then obviously we would want to make sure we reinforce proper mobility patterns.

So there's specific things that we woud do to personalize and individualize an exercise rehab program to make sure that you're reinforcing like your optimal movements. So that's important, retraining the movement pattern and then to strengthen what's weak. And then to make sure that we keep whatever is like really tight, joint and the muscle aspect to be able to be more mobile.

And then lastly, you know, the most important thing is education. You know, just teaching you if you're coming in with a neck pain, that maybe is the shoulder, you know, about different things that are going on. And this is where we need to get a little bit more and extract more information from the history about, you know, what do you do for work? Oh, you're on the computer all day long, or, you know, maybe we need to get a sit to stand workstation for you, and maybe we need to change the keyboard, get a wireless keyboard on your laptop. So that's one aspect of it. 

And then maybe it's looking at like, okay, well, what are you doing like physical activity wise, like maybe there's something that you're doing in your workout routine and your training routine or running. Now here's a big one. Like a lot of people don't think that running can actually impact your neck, but that's a form of impact loading on your spine. And from your head all the way down to your tailbone and your pelvis is considered your spine.

So you want to make sure that you've got good proper mechanics when you're running. So if you're not actually you know, utilizing proper form and you're running with your technique off, that can effect the impact loading and that travels all the way up to your neck. So it all really depends on what's going on.

Like, if you're a rock climber, and you're like really, you know, gripping on things and your core is really weak because, your strong arms, you've got Popeye arms, but your core is just not even there. Then you're going to have lots of problems in that neck related to that, which then can actually lead to more peripheral stuff. So, yeah, it's a really good question, but it's like lots of stuff sort of related with it. 

Mark: Why you need to see a professional, get a professional diagnosis from somebody who knows what they're doing and finds the root cause. So what's the treatment? The treatment course of therapy to get, back what's the typical timeframe it takes? 

Wil: Yeah. So that's another good question. It all depends on how long this is going on for. So, because if you're moving patterns are like very chronic and you've developed a lot of non optimal movement patterns of the muscles and some are just like this and it takes a bit of time to retrain that. Takes a bit of time to try and break that pattern and reset that. And then get the joints moving properly in the muscle, and mobility moving properly. And then strengthening. Like I would say like, if someone that has had this problem for, I dunno, like very briefly, you know, it's something that's very fixable within four to six weeks.

And it's hard to say, like sometimes people just started developing the problem, but they've actually aren't aware of the symptoms. And then they've actually had the problem though with the movement dysfunction for years, but they've just gotten away with it without being symptomatic. So that's another issue to consider.

So it may only take, like I said, four to six weeks or sometimes it may take like, you know two sessions I've had that before too. And they're able to make all those changes that I suggest and then I get them going on an exercise routine and you reset things and it's like, boom. It's like amazing.

And then other times it takes like a good four to six months. And it also depends on whether or not there's other stuff going on related with that neck pain in relation in the shoulder, if there's anything else that radiates down into the elbow or arm. 

Mark: Would it be fair to say shoulder, neck is probably the most complex area of the body you treat. In terms of musculature, nerves. How it all chains together, has to fire in the right order, all that stuff. 

Wil: Yeah. I would say it's pretty complex. Primarily because there's just so many different, like connections related to the neck, mid back and the shoulder and how they all play together. And think it's a very complex area to really treat, but it's also very fun, for me a really fun sort of areas of the body to really work on. A lot of it is because I do a lot of sports and I've looked at these areas as specialties to really work with that. 

Mark: If you're having some neck pain, it might be your shoulder. Call Insync physio. You can reach them at 604-566-9716 to book an appointment, or you can book online, There's two locations, one in Vancouver on Cambie Street, or in North Burnaby. The phone number there for the Burnaby location 604-298-4878. Check them out. They'll get you feeling better quickly. Thanks Wil. 

Wil: Thanks Mark.

More Common Low Back Pain with Wil Seto

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver. We're going to talk about more common the most, maybe most, at least a common type of low back pain. How are you doing Wil? 

Wil: I'm doing really well. Thanks Mark. Yeah. 

Mark: Stumbling all over myself here. 

Wil: Yeah, and people stumble quite often over, you know what is the cause of the back pain. And what I want to talk about today is just a type of back pain that is actually very common, very common in athletes, and just like an everyday type of pain that comes up from lifting, twisting or even just sitting wrong. I mean, wrong in terms of posture, that's not really ideal or optimal. So type of back pain is basically caused by a strain in your iliolumbar ligaments, which is basically a connective tissue and ligaments that stabilize and connect the last two segments of your lower back vertebrae, which is your L4 and your L5.

And so basically you have five vertebrae that make up your lower back. And your L4 and your L5 is your last two vertebrae. And these ligaments, there's a couple of different bands and they connect under your pelvic bone. And that's called your iliolumbar ligament, or iliolumbar ligaments.

Mark: So when you actually like feel along the iliac crest or your pelvis in your back, is that where these are attaching, basically? 

Wil: Yeah, it's hard to feel because it's all so deeper. You have to like palpate basically through your muscle and you also have another layer of connective tissue. And so it is really tough. So when we're testing for, you know, we're obviously doing a couple of different tests to see if it is stressing that ligament. But then we're also ruling out on different things because, you know, with the presentation of this type of injury, it can also present itself as possibly other things too. And so we've got to make sure that it's not that as well. 

So there's always a barrage of different tests to really go through. And this type of back pain is also something that can, like when you have it for the first time, it may not be like, oh, it takes a day or two to heal. It may take a little longer because of the nature of how it stabilizes that lower back and that lumbar spine in the pelvic area. And especially if you've had it like as a chronic condition. So what I mean by that is, if it's been recurring, like, you know, you get over it, and then it happens again.

And so when it's a chronic condition, it doesn't necessarily have to be like a specific, like lifting or bending or twisting or athletic type of movement. So like I've seen it in rock climbers and soccer players and volleyball players, and you know, it's common in athletes. Very, very common. And I've seen it a lot. 

And then with non-athletes, pretty common too. So you can be really out of balance in that area, and then you do something like you're sitting kind of with non-optimal posture for awhile, or if you've been sick in bed for, you know, like week with the flu or, you know, in this case a few specific clients that have had COVID in they're in bed for a little longer and then pretty inactive. And then it ends up straining.  So those are the kinds of the ways that you know, it can be injured and it's a lot more common.

Mark:  Would possible ways of dealing with it be that you make core strength training, has to be part of your regular training regimen. Is that going to help? 

Wil: Absolutely longterm. Yeah, for sure. And we also want to do too, when you have this kind of injury, like, especially if it's not going away, like general rule of thumb, is that if you hurt your back, you're not really sure what it is. You know, iliolumbar ligament strains will usually, you know, it's more than just a 24 hour thing. You'll feel it for a couple of days, for sure. You want to get it assessed and see what's going on because you want to also address the specific deficits that's causing it. So it's not just the core strength issue. There's imbalances going on there that you need to address.

And then now that you have this strain, there's in essence, a type of hyper-mobility, or it's like, there's a little bit more play in there now. So it's less stable is what I'm saying. And so, because you have less stability in there. That core strength is very key and it's specific core strength too, to making sure that that actually becomes more stabilized in there. And especially if you're going back and doing anything physical, like if you have a physical job or sports for sure. And the reason why is because would that instability, it can lead to then like more serious injuries if you're not actually rehabbing it, like a disc injury. 

And studies have actually shown that when you actually have a lower back injury and you don't rehab it properly, you don't get the core strength and you don't get the muscle imbalances corrected, then there is actually a high recurrence of back injury and something more serious. And this is a good example of it. 

Mark: So what's a typical course of treatment? 

Wil: Yeah, so I'm thinking about a couple of people that came in with this type of injury recently. And the first thing I do is I address their mobility issues and figure out what's going on. So there's usually a lot of spasming and these people came in, I'm thinking about two specific patients that came in. One who is actually a little more athletic, recreationally. And then another client who's not athletic, but just sits a lot for her job. And they both present with the same type of things in terms of muscle spasms, a loss of mobility, and also a lot of imbalance happening.

And usually that's also really key too, because you want to look at what kind of areas are like really shortened in terms of muscles. And also you want to look at the movement patterns. So we're addressing the bigger picture of what's going on in their movement patterns and why that's caused it to strain. 

So for example, the person that sits a lot for her job, you know she does a sit and stand. So we corrected that. But also just looking at how she walks even something as simple as that and we need to really correct the alignment of that area and part of that is okay, you know what? Her hip flexors are super tight, pulling all that, compressing things. And then her other bigger back muscles are also super tight. In addition to the spasming, that's protecting the injured area. And then she's got weaknesses in certain areas that are not just from this injury.

And they're like chronic weaknesses that she's had which are very apparent because there's some atrophy going on. That's more than just like a week's worth of injury.  So those are important to address. She had a lot of tightness up in her upper back,  which meant that she wasn't moving through her upper spine and she's not getting this rotation movement. She is pretty active, but not athletic. You know, that she's going to move a lot through her lower back when she does things like gardening and everyday stuff. And so that puts more stress in that area. And then those muscles tend to get tighter and get used more like in the lower back area, causes it to be a precursor to something happening and she wasn't a big fan of stretching and mobility work and core work to begin with. And then we would address the muscle spasms and do things with manual therapy in that specific area, and also IMS, dry needling and stuff like that.

Mark: And what's the typical. Kind of treatment timeframes for this to get better. And of course it always depends on how bad it is, but, or how chronic it is, but what's a more typical recovery time. 

Wil: Yeah. So for someone who's experiencing that pain, especially like I'm talking about like these two individuals, you've had pain for a week and finally, like, I need to come and see someone about it because I don't know what's going on. And they're a little more concerned. You know, the ilia lumber ligament was specifically diagnosed then, you know, four to six weeks is a typical timeframe for it to heal. And it doesn't mean that you're not going to get any better. Like with both of these people within one session, they felt like night and day. So they went from like, basically a six to seven out of pain. Pain scale on a visual analog scale in terms of subjective rating, to like a three out of 10 within like 24 hours. Which is significant. 

And then when you look at that timeframe, like it's that healing process is important, because the soft tissue injury needs to heal where you strained it. And then once that sort of, you know, heals up. And then when we talk about the person who's more athletic, we get him doing more higher level core stuff, but, you know, he even came in to see me like six weeks later. And he was no longer having problems with that ilia lumbar area, but he was still having, yeah, it's like a one out of 10 pain Wil, and like, I can do stuff now. Six weeks later. But now he's like, I want to like start lifting more and, you know, it's sort of that process of like getting him ready physically to do that. And wanted to go in the gym and started lifting weights. And he liked to, you know, typical sort of gym routines that involve a lot of your traditional, like squats and deadlifts and bench press even too. So you gotta be careful with bench press even at this stage. 

Mark: So the basic message here is that the most common low back pain is not from discs. It's from this ligament you're talking about. 

Wil: Yeah. It's very common, which then can lead to possible disc injury, if you don't rehab it correctly and then make it a part of your daily routine. 

Mark: So if you're in Vancouver and you have lower back pain, you can call Insync Physio to book your appointment in Vancouver at 604-566-9716. In North Burnaby, they have a North Burnaby location as well, 604-298-4878. Or you can book online Thanks Wil. 

Thanks Mark.

Hip Injury Rehab – Squat Lunge Reach Ups

Having great functional mobility in your hips means also having great mobility in your middle and lower back rotation. Being able to move through your whole spine will greatly help the full functional rehab of your hip injury.

Start by lunging forward with your one foot and twist your body in the same direction while reaching straight up above your head with the same arm and hand. Keep your low back in neutral position and your inner core muscles below the belly button pulled in and engaged.

When you lunge forward make sure your knee stays over your ankle and aligned with your second toe, hip and shoulder and that the low back doesn’t arch. Avoid having your knee fall into the mid line of your body or going past the front of your toes. Push back up to the start with the front forward foot while unwinding the back and bringing the arm back down. Repeat this for 10 repetitions doing 3 sets for each side.

If you’re unsure about the exercise or have uncertainty about where you’re at with your hip injury, consult your local Physiotherapist before continuing. 

Anterior Hip Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, and they also have an office in Burnaby, BC, Canada. Multi award winning best physiotherapists in both locations, multi award-winning best physiotherapist in each location. And of course, today, we're going to talk about hip interior hip pain. What's interior hip pain?

Wil: Yeah. So anterior hip pain, which is pain in the front of the hip. And this is actually a quite common syndrome and dysfunction in the hip. So basically there's many causes of it. When we look at some of that comes in to the clinic that it has anterior, which is a hip pain, it can be caused by like bursitis. So bursitis is basically when you have an inflammation of the bursa SAC in the front of the hip. 

And then another common cause of that, it can be basically an overuse thing in the hip flexors of the hip. So that's more commonly called a hip flexor tendinopathy. So tendinopathy being that it's been more of a kind of a long-term thing. And so those are the two most common causes of hip pain that we see from, especially people who are really active in sports. You know, we treat a lot of sports injuries at our clinic and people were just generally active like hikers, bikers and doing a lot of field sports. 

So the other part of you know, aspect of anterior hip pain that doesn't really get looked at too much is it's something that's kind of more related to the bone and the structure of it. And so the terminology of this is called an FAI, which is femoroacetabular impingement. So basically what that is is there's a bony anomaly happening there, in one of the two bones causing impingement in that joint. And there's specific limitations associated with that on a clinical level when you assess it.

But all in all, when you either look at whether it's an FAI or if it's like a bursitis, overuse tendinopathy or even something that's more wear and tear where it could be a bit arthritic. There's usually a lot of imbalances in terms of the muscle structure around the hip. So a lot of weaknesses and a lot of stuff that's just too tight and not allowing the actual hip joint to basically move properly and optimally. 

Mark: So how do you diagnose that? 

Wil: Well, so with the bony part of it is, you know, like it's, through specific ranges and limitation, but you ultimately need to have some scans and imaging done, and that's usually not related to trauma. So it can develop sort of when you're growing in the bones and in terms of how the structure of the bone start to then get maybe a little bit thicker in certain parts of the femur or the pelvis. And then so when you look at other injuries like, so I'll give you an example. 

I had a woman that came into our clinic who went on a five day hike at the West Coast Trail. And she's also a rock climber too. So she does a lot of like, you know sort of fluxion movements where their hips and then she bikes a lot. So anyway, she went on this five day hike and then two days into it she started getting anterior hip pain. And so it's funny because she was attributing that specifically to the hike, but knowing her and the fact that she was so active. You know, this was all set up to happen before. And the other interesting thing is that as I was assessing her, I realized that she had other stuff going on too.

So it wasn't just like in her hip joint that she was having all these imbalances, but her sacroiliac joint, which is basically an adjacent joint to the hip, was really, really stiff. And you know, just in digging a little bit more about her history, she had like a snowboarding accident many, many years ago and just landed on her bum and she couldn't walk for a couple of days. And it was one of these things that she didn't even really think anything of, but I was just like probing about, have you actually injured that hip or anything like that before? Oh yeah, now that I think about it. Yeah, I used to snowboard and I had fell on it really hard once and I couldn't walk for a day or two and then she was fine. 

It turns out that after I worked on mobilizing that sacroiliac joint, that hip area adjacent to the actual hip you know, her limitation and her hip pain was completely gone. But what still remained though, was a lot of the weakness and a lot of the tightnesses in her hip flexors. So she's been having this sort of a issue with this adjacent hip proper issue with the sacroiliac joint. That then I think started building up with all these imbalances and she's very active to begin with, but a lot of her activities involve hip flection and her hip flexor muscles, even after mobilizing and getting that sacroiliac joint moving was so tight that she didn't even have neutral range into hip extension. And that was actually one of her biggest things that she was complaining about too, is that hip extension was painful, but hip flection was painful too, but after we mobilized it, you know, her movement wasn't painful anymore, but she was just stiff.

So basically what we had to do then after mobilizing the areas that were stiff, we had to actually start to loosen those muscles around there that were also really tight and binding. Because what happens and then it just causes this sort of vice grip in the joint still. And like you're still not getting optimal movement in actual hip joint.

And then as a result, because she's always used to those muscles being tight and other muscles were just super, one specifically like interior iliocapsularis, which is a muscle in the front of the hip. And then her gluteus medius, which is basically the butt muscles. And gave her some exercises start off with, but she was like, miraculously got off the table, I can walk after one session. But it doesn't end there because then the muscle imbalances need to be addressed. 

Mark: What's a typical course of treatment? How long has it take in a more normal situation to get more pain-free? 

Wil: Yeah, so anywhere between you know, depending on the kind of injury, if it's an acute injury, it can take a little longer anywhere between like four to six weeks. If it's like an acute strain in the hip flexor or maybe longer. If it's a bursitis, those things can settle down pretty quickly, but then it's really now addressing the imbalances. Because the thing is like with this client, she wants to get back to doing all of her sports and her activities. And, you know, they're at a recreational level, but she's operating not at an optimal way of moving her hip and she has to relearn how to use those muscles. And so our job is to help facilitate that and make sure that the range of motion in the adjacent segments and the joints are actually moving properly, continuing to move properly and to basically reinforce that optimal movement pattern.

Mark: Cool. You mentioned, like you had a second client who was having this kind of interior hip pain. Yeah. 

Wil: Anterior hip it. Yeah. So this person, we actually suspect that might have a little bit more of what I mentioned earlier, FAI, femoroacetabular impingement syndrome. He had no trauma. I mean, no trauma that he can recall. And he's young, like 30, I think he's 30 something, really active guy really fit, likes to ski, but like pretty adamant, no trauma, he's always been really careful and stuff. Just serve development with chronic hip pain and also I think part of his history, like he hasn't been really good at stretching and working on recovery and stuff like that.

But the thing is, as I started to test him, he had all the symptoms and all the clinical signs of femoroacetabular impingement and those ranges and those loss of ranges and the weaknesses too.  I think that's one of the biggest thing is that he developed this imbalance and so we want to try and work on fixing that. Ultimately I kinda told him, like we think it's this, we can only really know, like if we get some imaging, but that's really up to you. You haven't had any trauma.

And so he has been in a few sessions to see us and it's interesting because when he works on his exercises, he gets really good. He's pretty consistent, but then he goes in bouts where he'll go hard on mountain biking, he'll be a bit more sore for a few days. So it's really interesting, like how the muscle imbalance does play a really big factor, but then at the same time, you know, if it continues on and it's ongoing, then you want to address that a little bit more.

And one of the things that we did was we did some things to actually address the limitation of the actual hip joint proper. That actually helped a little bit, but it was obviously, if it's going to be something more structural and bone, then that's not going to really be a solution because it's going to keep pinching in on the cartilage and then causing a continued stress and strain and aggravation.

 If that's the case, then that'd be where I'd be wanting to refer them back to the family doctor and saying, yeah, let's get some imaging done. And let's just see. I know you haven't had any trauma and I know you're operating at a high level of like your sports and activities, but if you want more information and data on what's going on, then let's take a closer look at this.

Mark: Yes. Taking care of it sooner rather than later, if it's something like you don't want, like a cyst growing or arthritis, et cetera, whatever they possibly can do. 

Wil: Yeah exactly when it persists like that, and it just doesn't seem to get fully better. 

So, if you want some help with your hip pain, anterior, posterior, medial, I don't care where it is the guys to see are Insync Physio in Vancouver. You can reach them in Vancouver at 604-566-9716. Or you can book They also have a Burnaby office. You can reach them at 604-298-4878. Same story. You can book online Thanks a lot Wil. 

Thanks Mark.