Hi, I'm Samantha and I'm a physiotherapist at Insync Physio. I enjoy being a physiotherapist because I like being able to create connections with other people and being able to help others overcome their challenges or reach their goals.

Just from my previous experiences, I know that pain and injuries, they can really affect a person's life either physically or mentally. And I find it really rewarding being able to help people and guide people through their recovery process.

So Insync is a really great place to work just because we have such an awesome team. You know, we're always talking, we're always collaborating on different cases and we're all really here to help each other out. We also do a lot of in-services, so that just helps us keep up to date with current practices and evidence.

So I like working with people of all ages and abilities, but I do focus mostly on sports and orthopedics. Outside of work, you know, I rock climb and I play bassman volleyball. So naturally I am just drawn a bit more to working with shoulders and knees.

I also really enjoy the outdoors, so outside of the clinic, I'm also camping a lot in the summer or I'll be snowboarding in the winter time. Aside for that, I'm usually looking for my next travel destination.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. Well, let's say they're one of the best physiotherapy clinics in Vancouver. Today we're gonna talk about a probably a pretty common thing, I would guess is heel pain from running that's due to tendinopathy. Is that what's causing this kind of pain typically? 

Wil: Yeah, yeah. Well, thanks Mark. That's exactly it. So quite often heel pain that starts to happen with running, you know, you can get what's called Achilles tendinopathy. So what it is, is basically an overuse syndrome or dysfunction. And it doesn't happen overnight.

So you can start to see the bigger picture like, when someone comes into our clinic, and I can think of someone that came in and saw one of our physios, you know he was telling me about this particular individual, and the picture was pretty clear how it all started.

And so essentially, you're looking at all the factors of like did you start running? And like where is the current fitness level at? And are they doing other types of activities that involve a lot of loading in the heel as well.

And then what are the previous injuries or past history of this person? Like, do they have a colourful history? It doesn't even have to be in the heel or the foot or leg. It could be even in the back, because that can add compensations into your mechanics with running. And then even just you know talking about this with you earlier, maybe the person is a little bit more overweight and if they're a beginner runner and you add that to the mix and then the mechanics are off, then with that actual little weight, that's also gonna, you know, basically cause more excessive, abnormal loading in the heel.

And giving you a lot more tightness into the calf, obviously. And then you're gonna overuse your calf to generate power as opposed to your glute muscles, which you really need that power with the extension of your hip. So then as a result, that tightness and that overuse of the achilles of the calf muscle specifically then causes the Achilles to be tight. And then usually the Achilles tendon is the weaker link, not the actual calf muscle itself.

Mark: So, when you're diagnosing this, what's most important? Is it history, to really dig into what's going on with somebody? Or is it testing? 

Wil: Well, history is a big thing in terms of like giving us a bigger picture of how this was caused and started. Cause that way we don't want it to come back. And we also want to address the ongoing mitigating factors that keep aggravating it. So that's huge. And then also as we assess, that's also gonna help with like, okay, yeah, this is what's contributing to it, these are the impairments and these are the actual things they can work on.

And then the other thing is looking at the, like assessing and looking at like, okay, so if it is a tendinopathy, you're gonna get soreness when you palpate around the area. So that's actually a really easy do it yourself home test. If you're feeling sore, when you're palpating yourself on that tendon, then it's most likely that. 

Because one of the other things that you could be getting, it could be like maybe a, what's called a bursitis in your Achilles. And so that's basically the fluid filled sac that protects the achilles tendon from rubbing on the bone. And so you might have a flare up of that. But if it's all along the tendon, like right on the superficial, like inside or outside or right on top, then usually it's most likely the tendon. But it could still be like some kind of bursitis or it could be something else, but most likely it's that. 

And then you look at, you know, other factors, even if you are an experienced runner, which we do treat a few experienced runners and you know, they take a break and then they start training again and they maybe do some hill training. And so that's gonna cause more stress and strain on that Achilles, just the overloading of that Achilles. Because you're always in that motion where it's more outstretched and lengthened and you're loading it more because you're going uphill. 

So that combined with intensity and frequency workouts and runs. And then just like, how long have you been running for? And then, well, what else are they doing? So maybe this person is doing other things like, you know, maybe they're doing a lot of other activities and sports that require 'em to be on their feet all day and then they go for a run. They don't do any recovery things. Those things are all important factors. 

Mark: So we've diagnosed it, we know what the symptoms are, the possible causes, the diagnosis. What's the treatment look like and how long does it typically take? 

Wil: Yeah, it varies. Depends on how long it's going on for, because when you're starting to have symptoms it's probably been going on well before you started to have symptoms. So you sort of reach a threshold until it becomes symptomatic. And you may sort of sub like you're below the threshold of having symptoms, but it's a problem. But you probably have noticed that, yeah, my calf muscles are a bit tight, you know, or I feel a little bit tight, but you don't really do anything about it until it's too late usually. So that's an important thing to look out for.

And so how we actually treat it, you can't actually address the strengthening of that Achilles. You wanna produce what's called collagen synthesis. And so basically what you're doing is you're promoting an increase of strength around the tendons where it's been effected. So you're reinforcing that tendon. So you're getting stronger all around it. And that's the key. So doing specific exercises that are based on research, also not just on clinical aspect of where we found successful, is like things that actually address and target specific and then strengthening. So starting off with what's called isometric strengthening.

You know, where you're putting constant tension force of the muscle where it's not moving. To then eccentric, which is basically constant tension force of the muscle while it's lengthening. And that's key because now you're working on getting more of that, what I described earlier as collagen synthesis are the building, the basic blocks of strengthening that tendon around that injured area, which will help with the full recovery. And we've seen some good success with this. 

Mark: If you're having some ankle heel pain from your running. Get in, get it diagnosed, get your gait checked. Is that a fair thing to say almost for any runner, get your gait checked regularly to see if there's any imbalances, cuz you can't see when you're running, you don't see what you're doing, you're just running. Is that fair assessment? 

Wil: Absolutely. 

Mark: Probably a good idea. 

Wil: Yeah, because there's many other factors to consider when you're getting your gait checked. Like how many steps you're taking per minute. And so that's your cadence and then how your form looks and whether or not your centre gravity forward enough and if you're getting enough power through your extensors. So it's a really good thing to do. 

Mark: People to call, the experts are at Insync Physio in Vancouver or in North Burnaby. They have two offices. You can book online either office at insyncphysio.com. Or you can call them. The Vancouver office is (604) 566-9716. North Burnaby is (604) 298-4878. Thank you, Wil. 

Wil: Thanks, Mark.

Hi. So today we're going to do deadlift. And this exercise is great and I really like it because it strengthens globally. And it strengthens our lower back. And it helps elongate the hamstrings and just helps us getting better movement globally in a functional chain. 

So this is what it looks like. What we're going to do is have our hands shoulder width apart, just making sure that they're going straight down. We're hinging through our hips here. And you're not going down like a squat, but moving your hips backwards, making sure that your shoulder is nice and set, your back is straight. From here come up, hinge again at your hips and then slowly coming straight down. And you can do this exercise three to four sets of 10, if you're able to. If you're going at a higher weight, come down with the reps in a little bit. So about eight to 10 reps, three to four sets.

So I chose physio because from a very young age, I really liked everything to do with movement. I was very involved with sports and through that I really wanted to push the boundaries of what human movement can do, especially because I did dance as well. So that was something that was already an interest of mine. 

Going into university, I went into kinesiology, so more about the human body and human movement. And from there I had some opportunities to find work and try different things. And I realized that I wanted to know more about not just what the body was capable of, but also how and why. And from there it was like a natural progression for me in terms of physio just seemed like the next step. And from there, I worked really hard to get into physio school and here I am, and I felt like it's been a perfect fit ever since. 

I think Insync has a lot of the things that I really align with as a person. They really care about the community and it's a place where I feel like I can really make an impact and connect with people. And I think working in this team just makes me feel like I can grow and learn from a lot of the different clinicians and people here as well. And that's something that really brings me joy to be at a clinic that supports and surrounds me with so many good things. 

Yeah. So I speak English primarily but I was also raised in Hong Kong, so I come from a background of Cantonese and I can speak a little bit of Mandarin as well.

Orthopedics is something that is an interest of mine within physiotherapy. So I've done my level one in the manipulative levels. And that is an area of interest of mine because I feel like it really enables me to learn how I can go through assessing different people of different injuries but also knowing how to manipulate and move the body and yeah, just to find out what the root of the problem is and help people from there.

Sport injuries and other neck injuries, just day to day work things where we don't really notice, but stress kind of accumulates and different areas of the body gets tense. And I think those are also things that my interests of mine. Outside of the clinic, I still very much like to keep active if I'm able to. So I'm a big sports person. I like to play primarily ball and racket sports, so basketball, tennis, volleyball. Those are like my big ones right now. 

During the winter, of course, Vancouver's great where we can go up to like Whistler or Cypress and other mountains, so I really like snowboarding as well. And yeah apart from that, I also like to find all the hidden gems for food in different places. So, yeah.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver, one of Vancouver's best pair of physiotherapy clinics. And we're gonna talk about rotator cuff tears from rock climbing. This sounds really sore and hurting already Wil. 

Wil: Yeah. So what is a rotator cuff tear? So, first of all, your rotator cuff, there's four tendons and muscles that make up what's called your rotator cuff in your shoulder. And there's one on the front that's called your subscapularis, they basically attach from your shoulder blade all onto your humerus, which is basically the bone of your arm.

And the subscapularis is the one in the front and then you have one on the top called your supraspinatus. So that's one of the major ones as well. And then your other two, which is in the posterior part or the back part of the shoulder blade, which is basically your infraspinatus and your teres major.

So those are the four that make up your rotator cuff muscles. Now essentially when we look at which one usually tends to get injured, it's typically your supraspinatus. Or your infraspinatus and your teres major, sorry I said teres major before, I meant teres minor. Teres minor is the fourth rotator tear cuff. So the terrace minor and the infraspinatus are the two posterior ones that attach on the back of the shoulder blade. And then one that attaches on the top is the supraspinatus. Those are the ones that tend to be more prone. 

Now the reason why is because they tend to be the ones that get compromised in a few different ways. So you can either have an acute tear, which means like it's, you know, basically a traumatic thing can happen. You can fall on your shoulder and then all of a suddenly tear it and strain it. Or you can have something that's kind of more of like a chronic sort of overuse thing that happens over time.

I previously talked a little bit about shoulder impingement and how to distinguish between that and a rotator cuff. There are certain tests that we do to figure out if it's one or the other. But essentially, when you're looking at the more chronic aspect of a rotator cuff, it's sort of like that slow you know, boil. It's kind of like the frog and the hot water. You know you've done something like as soon as you go into the hot water, you know it's hot and something's happened. That's like the acute tear. 

Whereas like, you know, you kind of keep training and you go to the gym or you're going into the climbing crag outside, you know, three days a week or whatever you're doing. And you start to just get a little bit tighter. You start to notice it and you may not be doing any stretching or any mobility work, and then you just, like suddenly you just wake up one morning, it just feels a little bit more sore. And then now you start to get a bit of that impingement stuff. So it can present like an impingement type of pain for sure.

But then there's certain tests that we can determine whether or not that pain that you're getting is a result of like, maybe something going on more sinister like. In the rotator cuff, like a tear. And ultimately we can only assess in probability. You know, and based on our clinical experience that you know, you look at certain tests that can help you sort of determine whether it is or it isn't. But ultimately the better standard is getting some scans and that'll give you some more information. But rehab is actually very good for even rotator cuff tears. 

Mark: And what does the rehab actually consist of? 

Wil: If it's an acute sort of tear, then we wanna obviously address any of the acute inflammation or anything like that that's happened, like initially. And then as it kind of moves past to like, you know, as it starts to heal, we always wanna consider what that healing timeframe, right? You know, for any kind of soft tissue. But then particularly when you look at a rotator cuff injury tear you know, it's gonna be a little bit longer. So, typically you're looking at anywhere from four to six weeks as sort of a minor tear.

And even something that's more moderate, it can fully heal and it does really well with rehab and physiotherapy. So there's a lot of good studies out there that show that and our clinical experience, we've had a lot of good results with that. And so essentially you know, when we treat it, we wanna also treat the acute aspect of it looking at starting to like build the strength back up into that injured rotator cuff, that tear. But then we also need to address a lot of what's going on in the muscle imbalances, particularly in the shoulder blade. 

So if it was more of an impingement type of issue, where it's chronic, and it kind of led up to more, you know, like this last straw that broke the camel's back kind of thing. Then we want to look at, Okay, well why did this happen? And usually there is a lot that kind of stuff going on, you know, with climbing where there's imbalances. And so we need to address those at the same time because if you don't, then you're not really able to address the proper mechanics of what you wanna have occur in the shoulder joint as you start to rehab the actual tear.

Because you need to actually have a proper moving functioning shoulder blade with all the muscles working properly. Cause you have so much different motions even in and around the whole shoulder blade that help with your actual area of that rotator cuff. So it's not just like your arm and your shoulder moving.

Your shoulder also consists of your shoulder blade, which is called your scapula. And so there's that shoulder blade moves, it actually assists with the whole mobility of that whole shoulder joint. So that becomes a little bit more complex and we address what those deficits and deficiencies are.

And then if there's like tightness in certain areas in the capsule, then we need to address that and do a lot of things to help facilitate that manually. And then exercise is a really important aspect of making sure that we reinforce the mobility gains, and then also just proper specific ones for whatever's going on, like with a tear. So you make sure that we're not going too hard too fast, if you've come in acutely. Or, you know, doing the appropriate things when you've waited a long time and getting you activated. 

Mark: So if you're having some shoulder pain and you suspect maybe it's a tear, get some expert diagnosis with the experts at Insync Physio. You can reach them and book at insyncphysio.com. They have two locations, one in Vancouver. You can also call to book if you wanna talk to a human being, (604) 566-9716. You can book, both clinics online or you can call the Burnaby office (604) 298-4878. They'll get you back moving well, back climbing again. Thanks Wil. 

Wil: Thanks Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. He's the clinical director. He's the big cheese, the chief cook and bottle washer. He's the chief joint manipulator. Maybe that's even better, at Insync Physio. And we're gonna talk about something that's a little tricky. Hip pain running injuries. How you doing Wil? 

Wil: Hey I'm doing really good, thanks, Mark. Yeah. Actually, funny enough, I used to be a chief bottle washer at a restaurant when I was growing up, and in some ways I still am at home with the young babies. Yeah. Yeah. So this is actually a really good topic to talk about because you know it, this is definitely peak running season with the weather that we're having.

You know, it's cooler, which is perfect. And it's prime running season too, cuz it's not rainy. And so people are getting out and what I'm seeing is a lot of people coming in with hip pain from running. And one in particular is a woman, a client who came in to see her physio team.

And you know, we do share the caseload here. And this one patient had a pain going on her hip and she started up running in the fall and then did a couple races and I think she ended up doing Turkey trot or whatnot just as a sort of like a training race. And she was having trouble just like even like sitting for more than 15, 20 minutes and the pain was going down basically right into the outside of her bum cheek area and then referring a third of the way down her thigh, on the backside.

So, a lot of the times when you kind of start having that stuff coming on and if it's like after a run or during a run, you know, can be a little bit troublesome or a little bit worrisome. And then after the run, it doesn't go away, then you should try and do something about it. I mean with this particular client, she was trying to do exercises to relieve it that she found online and she was just trying to do some self massaging on it and nothing really worked. 

So we ended up assessing her and it turned out that she had, what's called a thicker iliac joint or SI joint dysfunction happening. On further questioning, it turned out that she has had a couple kids and because of that, she's got some hypermobility in that whole SI joint and pelvis. And then when we looked at things a little bit more, there's a lot of imbalance going on. And this is someone that's also quite an avid runner.

And at one point she has done quite a handful of half marathons, a few marathons. So she's not like new in the game. And she was having this kind of ongoing hip issue, and it was getting worse and worse. And then I think she ended up going on a trip and she was away with her family for a couple weeks and then it got really bad and then she came back, sat on the plane and, you know, and she was like, Oh, I could barely move the next day. 

So that's usually, you know, the presentation that we see people finally like, this is sort of the cherry on top, I can't take anymore, and you know, the straw that breaks the camel's back.

When we looked a little bit more closely at what was going on, there was a lot of imbalances. And in addition to looking at what's going on with SI joint, there was some ligament instability. She could walk and all that stuff okay, relatively easily, but the main issue was running hurt it. She started in the first like five minutes was kind of okay, then it started getting worse. And then sitting for more than 15 minutes was bad. So she was quite rotated out of alignment. 

And so we were looking at why she was like that. It turns out that it was because she had this instability in through there, all these ligaments that were really loose, probably from her pregnancies before in the past. Her kids are like 10 and 7 or something like that. And then she has these imbalances where a lot of things are just so tight. And then that tightness was just not allowing other things to actually activate and turn on. 

So these imbalances were affecting her actual running pattern or what we call her running gait. And so when we looked at it, we were like, Oh, you're totally not activating this. And then when we actually went in there specifically, look at how strong she was, it was astonishing for her where her one side where she was getting the pain, it was like she was failing. It was like 40%. Like she could barely hold that up.

And then on the other side, she didn't have any problem. They were like, Oh, wow, that's crazy. So we looked at why that was going on and we had to like do some adjustments to kinda get things aligned and it was affecting our whole back, all the way up into her lower back. And so we assessed that obviously, and it wasn't coming from her lower back or upper back in terms of the main cause.

So we think that that unstable SI joint had been trickling up and everything's just been seizing and everything was sort of like, I guess lack for better word, stuck, in the thoracic segment of the mid back area. So we essentially did a bunch of adjustments first and kind of realigned things that in itself kind of helped her, but that wouldn't sustain it, and I'll tell you why in a second.

So we did all these adjustments and then her strength where she was failing went from like 40%, to like 70%. And she was like astonished at how much of a difference that made. But then that bringing it up from 70 and keeping it even at 70 to bringing it up to 90 and potentially up to 95, maybe a hundred, possible, is only possible if we actually prescribe the right exercises.

So we assessed her and looked at, this is totally like this. It's not actually opening up. The mobility is actually not great when it goes into an extension and as a result you're not able to activate certain things. So what we ended up doing was reinforcing certain things. We had to do a lot of soft tissue releasing as well, and then suggesting certain other modalities to release that soft tissue.

So whether it being massage therapy or other forms of deeper releases like IMF or just working on some more active relief stuff with other therapists, that was important. Make sure we gained that mobility and then reinforcing it by working on opening up those areas that are tight and strengthening. So we call that up training. The areas that are not actually turning on that are down trained. And then those areas that are up trained that are just on too much, we gotta settle those down. 

So we sent her on her way with a bunch of prescribed exercises specifically for her, and she was doing great. I said, You know, like you can check in with me if you want. And she was pretty functional, but I said, You can check in with me in about a week, or you know, a couple weeks or something like that. And she was doing really great. But then she stopped her exercises and she ended up having to go away somewhere and she didn't do her exercise for a week and then came back and she was frustrated.

Because she didn't have enough time, she was only able to do them for like four or five days, and then because she didn't have time to do exercises, it came back, same thing. And then that physio basically treated her and got everything going again, and she's good again now. She's really on top of her stuff. That's the homework, so to speak. 

And she's looking at running another half marathon as sort of a training run before she does the the BMO next summer. And that's her goal. She hasn't really been running in a while and she wants to get back into that running routine. So that's been two weeks since we last saw and we haven't heard from her. And we said check in with us in about two, three weeks. So I think the physio is seeing her next week. 

Mark: So it's an important part, and we've mentioned this before, an important part of your healing process is to, I don't know, I keep thinking repattern or retrain the proper firing of muscles. Once they've loosened up, once you've rebalanced and readjusted everything so that things are firing in the right order, the right way they should be doing. And that takes practice, basically. You gotta have some reps in so that you rewire your neurology to work right. Is that a fair assessment? 

Wil: Yeah, absolutely. And I think the other key factor here is knowing what ones to do. Of course. Because I mean, she was trying to do all this stuff before she saw us on her own and she didn't know what to do and she was just like, Oh yeah, I'm tight here. And then trying to do stuff that was almost there, but just little tweaks that maybe she wasn't getting right.

And then also when you're so stuck, and use this quotations, stuck and out of alignment, that it doesn't matter how much you're even doing the exercise correctly, you gotta give yourself a fighting chance. What I mean by that is that you're gonna be on good neutral ground where everything's all on alignment now. Then we can actually have a fair fight.

Mark: Yeah. Let the healing grow from a place where the soil has been tilled a little bit and is ready to take that seed of the exercises. If you're having some running issues, if you've got some hip pain or even back pain, from ramping things up cuz suddenly it's running season. The guys to see are Insync Physio. You can reach them on their website, insyncphysio.com. They have a North Burnaby office as well. And to call the Vancouver office, (604) 566-9716 to book your appointment. You have to call and book. They're always busy. Thanks Wil. 

Wil: Thanks, Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver, one of Vancouver's best physiotherapy clinics. And we're gonna talk about something interesting knee pain from kicking soccer balls. What's this all about Wil? 

Wil: Yeah, so quite often we think about soccer injuries and we think of like a contact injury. And so with non-contact and you just have the ball and you're kicking, I can bring up a specific client that one of our physios saw and came in with just that. He used to be a more competitive, avid soccer player, used to play like Div Two, Div One soccer.

But now this plays like a little bit lower level, but likes to maintain it once per week. And very active otherwise. Rides a lot and runs for fitness. So this is actually really important in terms of understanding like what else you do. So that's why I'm bringing up sort of this profile, is because this specific type of injury, when you think there's no contact, and this person's experienced pain immediately on kicking a ball and there was no one near him and he went to go kick the ball and just suddenly felt pain in the back of his inside of his knee. 

When he came into physio, saw the physio, and the physio like assessed him, you know, asked him a bunch of questions of what he did first. And but yeah, the other thing was that this particular individual had a desk job, so he sat, you know eight hours a day. And and didn't do any stretching postgame. Didn't do any other mobility work but loved to play soccer. Go to the gym for weight lifting, light weight lifting, and ride his bike a lot. 

So upon assessment, turned out that there was no, like anything sinister going on in terms of like a tear of anything, you know, whether it was ligament, meniscus or even like a muscle strain or anything like that. Those are the big concerns that the patient had coming in seeing one of our physios. And so what it ended up happening was that as we assess it, it turns out that it was a hamstring tendon overuse issue. So more specifically it's called a hamstring tendinopathy.

Mark: So you'd think that with, you mentioned he did some running, is that not enough? Like what's going on that there's a tendinopathy in his hamstring into his knee? 

Wil: Yeah. So when the physio looked at everything in big picture, his running was like, he wasn't generating power in his stride through his glutes, in his big power house muscles for extension, because he wasn't able to extend through his hips.

And so, as a result of not being able to extend through the hips, and you could see it very clearly is what the physio was saying, is that when they assessed him on the treadmill and the gait, that he was basically, oh and this is an interesting thing, like he could still play. He's still playing and you know, it's just like, he gets pain the next day after playing. So that's the other presentation of his symptoms. And so he's able to play a full game still. He plays once a week, but it's just like it's not getting any better until he started seeing the physio and having this addressed. So he came in for a second visit and finally getting better because he is getting this addressed.

So the other thing that needed to be addressed, are those tight hip flexors, his posture, he's sitting a lot. We changed them up until like standing, but making sure that not only is he standing, but then he has that mobility in order to keep his hips open on the front side. And the activation portion, making sure that he's using his gluteus medias muscles, which is butt muscles, basically that stabilizes his pelvis.

And then his radius medius maximus muscles, which are the muscles that help him extend hip. And so if he's not activating those properly, then he's gonna compensate and he's gonna try and use other muscles. And then with him, he is trying to overuse his hamstring to compensate. The other piece of information that was really interesting is that he rolled over his ankle pretty badly about a year ago. And he didn't do any rehab for it because he was pretty proactive in his mind and he just kind of did exercise and got back at it and didn't have any problems until this more recent thing with his hamstring. 

Mark: If you're having knee pain when you're kicking the ball playing soccer or it could be from your hamstrings of all things, and you need to get it diagnosed by experts. Get in to see the experts at Insync Physio. You can book online at insyncphysio.com. It's really simple. They have two locations, one in Vancouver, one in North Burnaby. Or you wanna talk to human. Call them (604) 566-9716 in Vancouver, (604) 298-4878 in North Burnaby. Thanks Wil. 

Thank you Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver, one of the best physiotherapist office in the Lower Mainland. And we're gonna talk today about rock climbing knee pain. Now, this isn't something I would normally think happens, Wil, what's going on here? 

Wil: Yeah, Mark being a rock climber myself, there's, well, first of all, I think to understand rock climbing and knee pain, you have to understand like sort of the way the knee is involved when you're climbing. And so essentially there's a lot of factors to consider. So normally you think of like trauma or you think of some kind of like acute incident. And that's reasonable to think that. 

And I think where it becomes a little bit harder to imagine rock climbing where there isn't trauma and then you just kind of start to develop sort of gradual knee pain. So in more of the traumatic sense, like, you know, let's say you have a fall or you twist your knee or you land on it kind of funny, and that's very reasonable to think that you've injured a ligament or the shock absorber in there called your meniscus. Or maybe you strain tendon or something like that. But typically even that in itself is rare. And so specifically speaking, when you look at the knee injuries that actually happen in rock climbing, a lot of it's more the gradual stuff. And when you look at sort of the bigger picture of like the person that comes in. 

So I'll give you an example of a client that come in to our clinic who's the rock climber. He is pretty avid rock climber and also relatively strong for a non-competitive climber. And so this person started developing knee pain gradually. And it had been going on for like months. So, you know, it's one of those things where you start to get pain and then you don't think it's that bad. You try and do stuff on your own and then kind of stays and then certain other events happen where it makes it worse.

So this person also sits a lot for work, on the computer. And then it happened to be that they went on a trip, they were sitting on a plane and they came back and he was just like trying to get outta bed and then all of a sudden he felt more pain in the knee. 

So the kind of climbing that this person has been doing was also more of like just basically route climbing, basically on ropes and leading in rock climbing where you're taking the rope and putting in the clips. And another type of climbing called bouldering. So the route climbing of the routes and ropes is basically, you're going up in the gym up to like 15 metres or 20 metres or whatever. And outside, up to 20, 25 metres. And then bouldering is just more shorter distances of where you can jump off indoors on a rock or outside, where you're up on a big boulder and you jump off on a landing crash pad.

So one of the biggest things that can happen and the gradual injuries, is that the mechanical aspect of mini is that you do this thing called a drop knee. So the drop knee is like the technique that's involved in rock climbing and you're turning in your hip and you're using all those muscles in the hip and you can injure things in the knee, yes. 

But the interesting thing is that there's also a lot of things happening with the muscles. You're always using those muscles. Now you take that in consideration with what the person does for work and what they're always doing on everyday basis. So they're sitting a lot when they're not climbing. And you know, this person also traveled a lot for work. Sitting on plane again, a lot of sitting. 

So we assessed the knee and so the physio that actually looked at him, was like, yeah, everything's okay with the knee. Nothing is screaming here. Like all the tests for the ligament stability, for the shock absorber, the meniscus seemed normal. Doesn't seem like theres any muscle strain. However, one test came up positive as we kind of scanned up a little bit higher and then the hip and then the SI joint. It was interesting cause when we looked at it, things were, imbalanced. 

This person was also an avid skier in the winter. Avid snowboarder, more of a snowboarder and skier had taken some falls in the past, landed on his butt on that side where he is getting pain with the knee.

And so as a result, you know, when we looked at his alignment, taking his history into consideration, we're like, Oh, that whole SI joint or the sacred iliac joint, that part of that hip or pelvis wasn't moving, was totally stuck. And the other thing we're also looking at is the muscles all along that hip were so tight.

So there's three muscles that make up your hip flexors, but this one in particular called the tensor fasciae latae, which is the hip flexor that attaches directly to this band that that goes all the way down to outside of the side of the knee called the IT band.

So that IT band was pulling onto his knee, giving him the knee pain. And he was pointing directly at where he was getting a lot of friction on the kneecap in his leg or in his knee, and his pelvis was rotated. So when the physio adjusted him and released the things in his hip, he was able to actually do a full squat without any pain.

And he was like, Wow, this is crazy. And his strength before that was like 50%. He could barely hold his knee up and his mobility was like horrible, 50%. Just realigning things and releasing some stuff, he was up to 75, 80% and his strength was also 75, 80%. So then the next step was looking at, okay, what do we need to do to keep it this way? 

So one of the biggest things addressing his sitting because that shortens that hip flexor and his SI joint probably from all the impact that he had falling when he was snowboarding in previous years, probably had stretched out some ligaments, which felt looser after the adjustment than the other side that was non effected. So in essence, addressing the alignment from previous trauma and rebalancing a lot of the stuff that's just imbalanced.

So taking things that were just like really super tight and releasing it and then starting to get the right muscle activation pattern. So in the end gave him some exercises after working on doing things that needed releasing and to be realigned, he didn't have any knee pain. He came back to see that physio two weeks later, for another problem, for some wrist pain. And it was funny because I remember the physio telling me this and he said, Yeah, he came in and so how's your knee, man? And it was like his second visit, and he goes Oh, oh, oh, actually it's fine. I'm actually here from my wrist.

Mark: If you're having some knee pain from your climbing and you're not sure what the heck's going on. You might have knee pain from other things too, from other sports. The guys to see are Insync Physio. Get experts working on diagnosing exactly what's going on because they can fix it fairly quickly sometimes, sometimes it takes a little longer. Depends on your body, how long you've been toughing it out for. You can reach them at insyncphysio.com to book an appointment. The Vancouver office, call them (604) 566-9716 to book. You can also go to the North Burnaby office and you can book online for them as well. Thanks Will. 

Wil: Thanks Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto, he's the clinical director, the owner of Insync Physiotherapy in Vancouver. And we're gonna talk about your health. We're gonna talk about knee injuries today. How you doing Wil? 

Wil: I'm good. Thanks. Yeah, I want to talk specifically about knee injuries in Ultimate Frisbee. 

Mark: So, is there something different about knee injuries that have to do with this sport? 

Wil: The reason why I wanna talk about Ultimate Frisbee knee injuries as well is because I I have some experience with it personally. I used to play competitive Ultimate Frisbee and I've sustained a knee injury. And it just seems like a growing sport that keeps growing here in the lower mainland. And there's a lot of cutting and there's a lot of fast starting and stopping type of movements and then pivoting and then things that basically cause you to plant your foot and then you have to like change directions really quickly. 

A little bit more so than like soccer. Football's a little bit different, but like football you get tackled below the knee. But I think it's something that's worth talking about because there's actually a high rate of knee injuries related to sport.

And I used to work a lot of Frisbee tournaments and teams. And having my experience working with national teams and at world championships and world games. Definitely see it at the high level to the more recreational levels. So you can classify the knee injuries as either overuse repetitive type of injuries or more like acute and traumatic injuries.

And so I think it's really important to get a feel for like, when you have an injury, if it doesn't get any better after like 48 hours. And especially if it goes three or four days and it's still not getting better. Then you should probably get it looked at because you wanna really get an accurate diagnosis of what's going on.

And so this is where, like, if you have a repetitive type of injury, then you wanna really see, okay, well what's going on in there. You may not have had a contact the knee or let's say you did, but maybe you're not really sure. Because you can get things like overuse, repetitive tendinopathy, And this is an overuse injury in the tendon of the quads that attaches below the knee, and that's very common. Or you can get an overuse syndrome in the kneecap where it's like pulling on what's called the IT band. And so there's this syndrome called IT band syndrome. And so those are two of the more common type of overuse type of injuries in the knee. 

And especially with younger athletes and with Ultimate Frisbee now being taught in the school curriculum. So you have these kids who are growing and they're playing the sport and they're starting to play it at a competitive level. And so you can get a condition where it may seem like an overuse injury, which it could be, but then there's this condition called Osgood Schlatter. It can be a serious condition where, you know, like it's the insertion point of that tendon onto the bone because with maturing bones and maturing athletes, their bones aren't fully formed yet. And so it can cause disruption of that attachment point, which is important to treat and to really look at and manage. 

So that's sort of the repetitive and overuse side of things. And then things that we see a lot of in the clinic as well is the acute stuff. So whether it's a ligament injury from your medial or your lateral ligaments, which is called the medial collateral or the lateral collateral ligaments, or some of the more major ligaments in your knee, like your ACL, which is the anterior cruciate ligament. And then usually if you have like something bigger happening within that, you can also have an injury to your meniscus, which is basically the shock absorber in the knee, but it also acts not just as the shock absorber, but also provides more normalization of your movement of that knee.

So quite often, when you have an injury to like say your ACL. The major ligament in your knee that provides stability. And this can commonly happen, if you're planting your foot and then you go to pivot and then change directions really quick, or someone just hits you lightly, but you're planted, it can injure that ligament or your MCL, or your meniscus. Quite often, there's a term it's called the triad of injuries, which basically involves all three. So your ACL, MCL and your meniscus.

Mark: If this has happened, I've hurt myself playing Ultimate Frisbee, my knee is hurting. It's not getting better after 48 hours, like you said, but I can't get in to see my doctor. That's a really common thing these days. Is it actually alright for me to get in to see a physio who can diagnose exactly what's going on. And if I need referral to a doctor, you're gonna refer me to a doctor? 

Wil: Exactly. And it's actually even better if you come see physio first. Unless like there's the rare occasion where I have some clients who their doctor is really adept and they can get in to see them and they're able to like, Hey, yeah, know exactly what's going on.

But typically what you wanna do is you wanna come see your physio first and we do work with your doctor or doctors and that's the healthcare team. For example, we had a gal who injured her knee earlier this year, actually, I think it was back in January. I can't remember how she did it, but she ruptured her ACL.

Fortunately was just the ACL and there was nothing else going on with meniscus or MCL. And she wasn't really sure what to do and she was very uncertain and she was starting to train. She wanted to do like her first Ironman. And then felt really deflated. But when we looked at it, I said, you know, you gotta get some scans done, get this looked at.

So I sent her back to her family doctor, but also in that visit to her family doctor, I recommended that she's the specialist that I connected her with. And then also recommending that maybe we should get some scans. Turns out that she had that blown ACL, complete rupture. And you know, and there's different options for that, but it's just good to know that diagnosis and that's what I was suspecting. 

But if we have that accurate diagnosis whether it's like assessing it through us at the physio clinic, but then getting more detailed through scans that we recommend. It's gonna help us guide you towards the management of this injury or injuries whatever's going on because we wanna like, you know, okay, so this is what's happening, it's not just an overuse injury. So we have to be careful with it and this is kind of how we wanna progress. 

Or if it's like just an over, I mean, I'm not saying just, but it it's just an overuse thing happening and it's not like a major ligament injury at all and quite often people may think that it could be right because they're having pain and it feels clunky or whatever. Then we wanna start to progress it and work on the rehab and the treatment and the management of that non-acute aspect. So that way we can get it better, faster.

Mark: So diagnosis is really important. What's a typical course of treatment? 

Wil: Well, first and foremost, if it's you know, acutely injured, even if it's a repetitive thing, like it could be like a repetitive overuse, but it's just like recently flared up. We wanna just let that settle down for the first 24 hours, at the most 48 hours. Typically, with injuries, they'll settle down within 48 to 72 hours. So ice, compress, elevate. They'll follow the RICE PRICE principle. They'll protect it, rest it, ice it, compress it and elevate it. And then we wanna start to get it moving a little bit more and we start look at, well, the body's gonna compensate like you wouldn't believe, like within those first 24 or 48 hours. 

So we wanna start to normalize, not only the motion as best we can, but the ability for that knee to take on weight and to take on load and resistance. And that's important. And depending on what's going on with it, we wanna be careful what kind of load that we're gonna do.

So for example, if it's a completely torn ACL, we're not gonna do certain things within the first 48 to 72 hours in terms of loading it. Versus if it's an overuse thing, then we will load it in a different way. So that's important to know. Because like you don't wanna do certain motions if it's a torn ACL, versus if it's an overuse thing. We do wanna work through if it's a overuse of the patella tendon and whatever it is, we want to work through certain things to get it moving better. So then we know how to prescribe things. We know what to release and what things to really focus and get you back playing again.

Mark: If you've injured your knee, if it's hurting, get in to see the physiotherapist at Insync Physio, you can reach them in Vancouver, (604) 566-9716. Or on their website, you can book right there insyncphysio.com. They have two locations. They're also in North Burnaby. You can call them there at (604) 298-4878 or book online same thing. Thanks Wil. 

Wil: No problem.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Phsyio in Vancouver. We're talking about elbow injuries today. How you doing Wil? 

Wil: I'm doing well. Thanks. Yeah. I wanna talk about elbow injuries and elbow pain with rock climbing. 

Mark: So is there something different about elbow injuries from rock climbing?

Wil: Yeah, well, I think one of the things that we need to appreciate, and our team of physios see this quite often with rock climbers that come into our clinic, is that rock climbers actually bear a lot more load in their arms when they're climbing. In terms of like the repetitiveness of it and also the power and the nature of climbing itself is quite stressful on the forearms. And so there's typically two types of overuse injuries that can occur. And they're very synonymous to the ones that are probably familiar and that are out there and basically the first one is what I like to call it climbers elbow.

And so climbers elbow is when you get like an overuse, to the inside of the forearm muscles. So those are the forearm flex. And as you can tell with climbing, there's a lot of this sort of motion where you're using those for our muscles. And it's important to identify that and I think quite often, like when we're climbing, your arms really burn right out and you really wanna attune yourself to how your arms feel at the end of each climbing session. And even the next day. Because sometimes we have hard climbing sessions where we're either training or we're just climbing for fun or whatever, but then they start to feel sore and they're like, Oh yeah, that was because I climbed really hard. But if it's still hard and usually if you just touch, then you'll start to feel the pain in there and that's not necessarily normal. 

And the other rock climbing elbow injury that you can get is basically on the outside. So that's on the extensor part. So quite commonly, the inside one is called golfers elbow, that we all know about. And then the outside one is tennis elbow. And so the reason why both of these can happen with climbers is because when you're climbing there's a lot of like, so with the gripping, but then if there's also different types of holds that you're using. So if you're using holds that are larger and there's all of the antagonists, all those opposing movements. And so that can get overused. And we see this quite a bit. 

And I think the biggest thing with rock climbers in terms of preventing these from happening is really looking at warmups, doing a proper warmup. And really not jumping back into climbing if you've taken a lot of time off. Or if you're a beginner climber, trying to pace yourself at the beginning, because we see this a lot with beginner climbers, where they jump into the sport and they climb way too much.

And then part of that too is then learning how to recover. Understanding what recovery is because and once again we see this quite a bit too. We see either beginner climbers or climbers that have taken some time off and they jump right back into it and they don't start to incorporate recovery into their training, into their climbing sessions. So recovery means looking at doing things to, you know self release, mobilize and get things moving and really like allowing it to rest as well. 

If you have a climbing session in the morning, or you do a climbing session at night and you go to do your computer job, that's a lot of repetitive strain. So that means you have to take extra care and time to focus on mobilizing and getting things working in terms of the movement and blood flow and all that stuff after your climbing session.

Mark: If you're having elbow pain from your climbing sessions, don't just ignore it. Don't just tough it out. Get in and see some experts about what's going on to see if there's help that you can get to train properly, to recover properly, to make sure that you're not getting that repetitive stress type of injury that will affect your climbing for a long time. Insyncphysio.com is where you can book for either the Vancouver office or North Burnaby. You can call them at (604) 566-9716 in Vancouver or in Burnaby (604) 298-4878. Thanks Wil. 

Wil: You bet. Thanks Mark.