Vancouver Physiotherapist Sports and Manual Therapy Rehab Clinics – Adrienne Chan

Adrienne: Hi, my name is Adrienne and I'm a physiotherapist at Insync. So I guess today is getting to know you segment.

Wil: What do I love about being a physio? 

Adrienne: Oh, that's a tough one. I think I like a lot of aspects about physio. My favourite part, I think, is definitely connecting to a person. Get to talk with them. Get to know them. You get to witness their lives, essentially. They're coming in and you're learning about their story and then their goals, and then you get the whole privilege of just helping them achieve what they're coming in for. And even more. Just goal-setting and just blasting through it and just coming up with more and then achieving more, and it's just partnership and it's work and it's communication. It's just a whole lot of fun talking with people and just laughing. That's my favorite part really, connecting with people.

Wil: Nice. So what kind of things do you love to do outside of like helping people and treating people. And I want to know a little more about you. 

Adrienne: Oh, that's tough too. Well, I guess I like being off the grid. Anywhere that doesn't have reception, I love it there already. So into the mountains, hiking, backpacking, thru-trekking, kayaking, paddle boarding, biking, just kind of got into that and maybe last two years, but biking. So my next project would be bike touring. So I need a) a new bike and view some new routes. So just exploring the grid really. I would say travelling, but I guess that's a big no-no right now. So right now it's just like, a lot of nature stuff and just projecting things through different ways to get to different places in different means. 

And just being outside and just re-nourishing the soul through sky, rain, mountains, crafts, everything. That's how you want to rejuvenate. That's how you want to move. Exploring movement in the outside world unrestricted basically. So yeah. 

Wil: If you weren't a physio, then what do you think you'd be doing instead? 

Adrienne: If I wasn't a physio? Probably just trying to get into Physio  school then, really. But if you really had to shove me and I really can't go into physio school either, I would say, oh my goodness, and I would say this was a hundred percent of influence that Vancouver has on me, but it would definitely be a journalist. I would love to work for a journalist for Nat Geo, National Geographic and just going to different parts of the world and collecting stories and just witnessing the lives of different people in different settings and different environments.

And I guess that's kind of why I love physio because you got the privilege of doing all of that, but to a specific person, really. So I guess just, journalism for a specific magazine and you're getting to do all of that, but I guess in a very different way, I get to see a narrative and express a narrative in a completely different way as well.

Wil: Yeah, that's so cool. I totally love National Geographic. So if you look at, in your profession as a physio then, what would you say is your special area focus on your interest side? 

Adrienne: Special area of focus. I actually really enjoy motor sequencing. So I like treating a variety of things like knees, ankles, or jaws, neck, everything. But what I love about every single part is motor sequencing. Is how you're doing a movement, how you're finessing a certain movement and how your finessing like a certain way you're moving, expressing what you want to express. And with that, it's just a combination, a lot of manual therapy. I mean, it's fun touching people. Yes. Yes. I know. But this is a controlled setting and through clinical Pilates, where you get them to feel that sequence and get them to feel that flow, that natural free flow of movement, find that muscle, find that joint, find how you're expressing it and putting it together.

That was definitely what I say I really like and resonate with, because then that means you're achieving those goals.It's not about pain-free, it's achieving your goals and achieving everything you want to do in life and not being scared of doing those things, which I think is like so important. Sometimes overlooked in a lot of rehab. Yeah.

Wil: And what is the areas of physiotherapy that you specialize in that I guess. 

Adrienne: Oh, I do a lot of clinical bodies, manual therapy, dry needling, IMS, and exercise, prescription, a lot of exercise prescription because that's essentially what we all need to be doing irregardless of what you're coming in for, so yeah.

Shin Splints Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. One of Vancouver's most popular physiotherapy clinics, many time winners of best physiotherapists in Vancouver. And today we're going to talk about a really common issue shin splints. How are you doing Simon?

Simon: How's it going Mark,  thanks for having me today. Yeah, shin splints Mark. I'll talk a little bit generally about the topic and I might relate it to a recent case study, I had a bit as well. We've all heard about shin splints, the layman term, but we call it ATSS, which is anterior tibial stress syndrome, which sounds a bit fancier. 

That's more so pain to the front of the shin and more to the outside of the shin. And then you have MGSS, which is media tibial stress syndrome. That's probably the more common one where you feel it more distally or at the end of your leg sort of on the inside of the shin bone. So a lot of people kind of get this pain when they're kind of increased their running too quickly essentially. A lot of pain down the inside of that shin, or sometimes it can be a change in footwear a change in surface and things like that. So it's important obviously to diagnose, did the person take up running or any sort of activity, like lots of jumping, lots of high-impact activity, that's kind of leading is kind of pain.

And it's also very important not to run through this pain because you can develop stress fractures or another thing called exertional compartment syndrome. So our job would really be deciphering, is it actually true shin splints because that's like an umbrella term or is it one of those other two things. But very important not to run through that pain. Some injury yes, it's okay to run through it a little bit and just kind of monitor it, but certainly if you keep going, you can develop that stress type fracture and the pain is very on the shin. Shin splints is more diffused where you kind of feed it along the shinbone for like three or four inches. That's kind of how we decipher that a little bit as well.

And obviously an x-ray will tell you if you do have a stress fracture and the exertion and compartment syndrome, usually pain just comes on after you start the exercise, because blood is filling into the compartment of the lower leg. And then it expands and there's a mesh around the lower leg and it can expand out actually.

So that's when you know, that's the difference in it. And you might have tingling in your lower leg. It's very important not to continue that because you can create nerve damage and things like that. 

Mark: So how do you diagnose it, just by the pain? 

Simon: Yeah, good question Mark. Well, first of all, you'd take the history and you kind of ask them are they doing lots of running. It doesn't have to be running necessarily. It can be like lots and lots of walking even. A lot of people are doing 10,000 steps lately. I don't know why humans have a fixation on it. You do 10,000 steps every day and you're not used to it, you can benefit from walking as well, or even just a combination of running and walking might just throw you over the edge to develop this, too.

 When the person comes in, they usually say, yeah, I feel this at nighttime or sometimes after the walk, you don't always feel it while you're doing the activity actually. So will you feel it at rest and you will feel it when you push along the inside of your shinbone or the outside of your shin bone.

So that's kind of how we diagnose it. As opposed to exertional compartment syndrome is more, you just feel it after a few minutes of getting into the exercises that increased the blood flow, but the minute you stop, there's no pain at rest. There's actually no pain when you push it either.

So there are kind of too big differentiating factors. And you don't want to keep running through it. Like I said, it's very important that you don't. I know it's important that we look at the footwear and the surface, if you're, a lot of the times people run on concrete, which is quite unforgiving under the foot, and it's better to run on maybe grass and some trails are sometimes better if there's not huge amounts of inclines and declines. So we try and alter that as well. 

Usually for the treatment part of it, I just stop them running for maybe a week or two completely, and then just reload it very, very gradually. And we do a lot of stuff here in the clinic, a lot of  massage, some needling of those muscles that join onto of the inside of the shin especially, it usually stays behind the calf muscle that joins in at the back, which is responsible when we come down from running or from the jump.

Just micro tearing on the inside and basically the micro tears aren't getting a chance to heal before somebody goes running again. And then it just develops into this lots of pain. 

Mark: So the treatment protocol is pretty straightforward, but what if I wanted to prevent it? If I'm going to up my mileage, I'm going to engage in a new fitness program. Is there things that I could do that would help it? Would rolling my shins, very unpleasant experience, but would that help? 

Simon: Yeah, you could roll out your shins Mark and honestly it really is just listening to your body a little bit. You know how much you can load, how quick, you know, and there's no real magic answer to that. There's every individual is slightly different on how much, but usually people will come in and say, they might say something like after my fifth kilometre, it starts to come on a little bit and then it's worse afterwards. So you kind of have an idea in relation to that individual, like five kilometres is kind of where we're at right now. So that's your limit, and maybe they might take a day off and back again, or they might do it again the following day. So you'd really have to just, a bit of trial and error there really. Rolling it out, strengthening up your calf muscles in particular are definitely stuff to do to try and prevent it from happening.

Sometimes if it's more chronic or you've tried a few techniques here in physio, you can go maybe to a podiatrist and look at insoles. There is a bit of a link in some of the literature saying like an over-pronated foot or a flat foot, and definitely predispose you as well. So I'd like to try and not give people insoles right off the bat and see if we could get it right but that's something I might come back here with, if we tried everything in our tool bag and it didn't work, that would be something I'd look into. 

Mark: And this is just from a personal interest kind of point. Is there any research around the new kind of movement towards going more towards barefoot shoes? Like the really non-supportive shoes that you wear that strength your foot has to strengthen rather than being over supported? 

Simon: Yeah. There's a lot of research out there, Mark, and even there's, I think it's like everything in the world, you can find 10 research papers that say that for the pros of barefoot running and that's how we were back in the wild, back in the day, running her own hunter and gatherers. Like there was no need for all the support. Why do we have it now? But then there's other arguments saying like, well, we didn't have tarmac and concrete and a lot of hard surfaces that we're running on now.

So that's a very good question. It's a very good question. When I started my physio career, I was sort of told that insoles where to where to go. But as I developed throughout my career, I sort of, it's only from a personal perspective that I don't want someone to have something in their foot, forever. If they really don't need it. But I'm not negating getting an insole or if you've tried everything else, then I kind of go back to the insoles, as I think it is beneficial indefinitely some scenarios, for sure. Especially someone who's an athlete and really want to continue through their running or they're in competition and they can really afford to wait, then we go towards insoles for sure.

Mark: And what kind of length of treatment are we looking at? What's a typical, I know it's individual, of course, maybe this is really individual, but what would be the, is it three weeks? Six weeks. 

Simon: Yeah. And you're on the money there, Mark. You know, some people like literally, if you just stop running for two weeks and you just slow gradually, it could just literally be four, six, eight weeks. It just really depends. Every physio might be slightly different. It might get you to run and just cut down your mileage and you still might be okay. I just like to go for two weeks, just give it a total break, until it's not too tender on to palpation or on touching clinic here. And then we'd obviously do all the strength and exercise in those sessions. And then we'd go back to do more higher impact stuff because it has the higher impact stuff. 

So like running and jogging that really do create a lot of tension on the inside of that shin bone. So yeah, you're probably looking at four, six, eight weeks max, for sure. 

Mark: So there you go. If you got shin splints, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver. You can book your appointment at (604) 566-9716 or check out the website insyncphysio.com. You can book online there. Or if you're in North Burnaby or the Burnaby area, they have a clinic there as well. You can reach them at (604) 298-4878 or again, book online at insyncphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thank you.

Hip Pain Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly. He's a physiotherapist at Insync Physio in Vancouver. One of Vancouver's favourite physiotherapist clinics, many time winners of best Physio in Vancouver. And Simon is going to talk to us today about frontal hip pain. Hip pain. This is really common. So what causes this kind of hip pain in the front of your joint? 

Simon: Hi, Mark, thanks for having me. Yeah. I'll just talk about hip pain sort of a little bit globally. And again, I might bring in a certain client that I saw recently as well, like a case study. But yeah, there's a couple of things that can cause hip pain to be honest Mark.

So this guy in particular, just came in and had pain in front of his hip. No real specific injury as such kind of came on more gradually. So we dug into the history of like how it came on and then he said he had it, I think mid November. So that would have been two months ago from when we recorded this video, he took a break.

He was actually doing a lot of Nordic cross skating, which I wasn't really aware of what that was, but it's almost like you're on the little wheels. Like you're kind of skating, but on ground as you maybe you know what that is Mark? But I never heard of it being from Ireland, but he explained it in good detail, but he was doing a lot more of that and he was in a lot more rowing he was telling me. 

And then he did feel the pain coming on, but he just kind of continued for awhile and he stopped and then the pain didn't go away and he landed in my office here, or in my clinic here. So, you know, the first thing, like, because it was more gradual in nature, you wouldn't be sort of thinking more like a groin strain. It might be overworked or chronic use of the groin, but we have  to kind of rule out the groin, which we kind of do in clinic where you squeeze the knees together. And if there's no pain on that, you kind of pretty sure it's not a groin, but even the mechanism of injury it's unlikely to be a groin. You know, you usually get that in lots of changing of direction.

He does have a bit of changing in your direction in that actually. He further made it more detailed in how this classical, where you just kind of go straight, these wheels are, there's kind of more lateral as he described. So the lateral movement was really making it worse according to him. So that was kind of interesting to see why that was worse for him.

So he came into clinic. We had a look at the front of the, he kind of pointed to the front of his hip, not to the side of his hip and it was more painful that at night time when he was laying on that side. So that's kind of how he presented. So we cleared the groin. Obviously we did the squeeze test where the knees were squeezing together. That was all clear. 

And then we kind of checked his hip flexors. So iliopsoas, that's the name of your hip flexor and then you have rectus femoris, which is actually one of your quads that also crosses the hip joint and it assists in hip flexion as well. So in the clinic here, he had a little bit of pain when he was completing that movement on hip flexion.

And when we started to palpate the front of the hip, you kind of have two bony nodules on the front of your hip. Just a little bit below that, he had a lot of pain in there. So he was also stiff in his hip as well. And he was a little bit older, he's 50 years old. So he has a bit of stiffness in his hip, but this is definitely, I think an overuse injury of the muscle called rectus femoris.

And just from lots and lots and lots of hip flexion. It was a lot of hip flexion. And then he was trying to alternate to something else which was rowing, which was also a lot of that hip flexion. It also was stretching the life out of his hip flexors as well.

So the muscle was really getting no time to kind of recover or heal, so I think he just needed a bit of education really.  I think he was concerned. It hadn't gone away in two months. So my job is to get out the aggravating factors. Just tell him, stop rowing, stop, stretching the life out of his hip. And just maybe cool down at Nordic cross skating just for a week til I settle it. So that's what we done just to start. 

And then we obviously just loaded up to the hip and a little bit more, but more gradually. And because it is chronic, it wasn't specific and some of the chronic stuff can take a little bit longer to heal, like it is a chronic tendinopathy. So you're probably looking at maybe, sometimes take two to three months. But if it's done right, we can introduce it a little bit earlier. So we load it up as hip flexors and we did a couple of exercises just to build up that muscle on the hip, we avoided sort of a lot of this aggravating factors for two or three weeks, and then we started to add it in gradually.

And he's actually after making a pretty good recovery now and he's happy that it's not hip osteoarthritis. So he's back doing his Nordic cross skating. Now I think he's back up to three or four times a week so with no pain. And so that was great. 

Mark: Well, hopefully he puts the skis on and gets out on the snow, which is really what that's training for. I've had this injury from cross country skiing. But it was from wax failing, going uphill, hard uphill and over stretching the rectus femoris. And so, did he have any crepitus in his hip? 

Simon: He didn't actually no, he had no crepitus in his hip. He was very tight in his hips now. And I'd imagine we all know you get a little bit of osteoarthritis as you get older, but certainly he wasn't symptomatic or had no clicking or popping or crepitus. That was good. I think that really eased his mind. I think he kind of thought it was the start of hip osteoarthritis. So he was kind of relieved that it was, I say, just that muscle it's important, but maybe it is better not to have hip osteoarthritis as well. 

But you're right, Mark, you can get more of the acute injuries. His was more chronic from lots of hip flexion, somewhat a more, acute injuries, you know, snowboarders, when they lean back, they can really over that muscle. Kind of like what you were saying when you're really doing a lot of uphill and stretching back, you injury it that way too, for sure.

Mark: Yeah. So what was the treatment protocol? What would be more of a typical thing if somebody had this kind of overuse injury to the rectus femoris or their front of their hip? 

Simon: Absolutely Mark, yeah. So what we do with him, actually, we, a lot of the time it can be just tightness in the quad muscle actually. So we just worked out that muscle with a lot of massage, some needling like IMS treatment or dry needling, it's called that because there's nothing in the needle obviously, but we just reset the muscle and make sure it's long enough. And really, again, it's all about education and just, you're overloading this muscle just too much in the amount that you're doing.

He really wanted an alternative, something alternative to do. He couldn't do it the Nordic cross skating because obviously he's probably training. Someone who does, this is usually really eager to get onto the snow and he didn't want to lose any sort of cardiovascular stuff as well. So I mentioned a little bit of biking to him and a bit of cross trainer if he could, but just really tried to limit, I avoided rowing as well, there's too much hip flexion in that.

I think he was just going to aggressive, a weekend warrior type character. So he was happy to just do a bit of bike for awhile but it was hard to reel him in to avoid the rowing and that cross skating. And then, yeah, we just loaded him up here in clinic as best he could. And yeah, he has no pain at nighttime now. And he's back doing his Nordic cross skating now. And he's looking forward to getting back into the slopes, he can do that now too.

Mark: Absolutely. So if you've got some hip pain, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver at the Cambie Street office. You can call to book your appointment (604) 566-9716. Or check out the website insyncphysio.com. Real easy to book right there online. 

If you're in Burnaby, they have a Burnaby office, (604) 298-4878. Same thing you can book online there. Pick from whichever physiotherapists you want. You can choose Simon, he's busy and he's good at what he does. Inphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thanks very much.

Frozen Shoulder

Mark: Hi, it's Mark from top local. I'm here with Wil Seto of Insync Physio in Vancouver. One of Vancouver's top rated physiotherapy clinics, many time winners of best physios in Vancouver. And today we're going to talk about frozen shoulder. How are you doing Wil? 

Wil: Yeah, I'm doing great. Thanks.

Mark: So frozen shoulder, what is it?  What the heck is this anyway? 

Wil:  So the technical term for frozen shoulder is adhesive capsulitis. So what it is is it's basically a progression of like a restricted movement in your shoulder joint. So what we call the glenohumeral joint in terms of its range of motion, that's primarily what it is.

And it's really tough to really determine what causes it, but essentially going back to what it is, you have this permanent scarring or this fibrotic scarring that actually occurs. And there's this sort of a neuralpathic and sort of a vasal motor or vascular process that occurs within the shoulder that just can't be really explained yet and what causes that. 

So there's that sort of neurological aspect that really still you know, causes a lot of questions as to where does it come from? And really the other aspect of this too, is that what we're looking at is the side effects of that. You know, so as you get all this fibrotic scarring and all this permanent scarring into the shoulder and the shoulder joint and the rotator cuff area, then you're getting a lot of those effects in terms of the function of that rotator cuff and what that means essentially.

So this isn't something that necessarily appears from a fall or an injury necessarily. This could be just an over use thing. How does it present?

That's a really great question. So in the research and also just with my experience, you know, working with people and seeing this condition, it seems like 70%, first of all, like, you know, we're looking at prevalence, 70% of people that actually get frozen shoulder are usually females.

So when you're talking about what this whole condition is, then it sort of points to the whole. Is there a hormonal aspect of this. And then, you know, what's going on with that. And then also the found that you know, if you're between ages 35 to 65, then you're also at more increased risk of getting this as well.

And it seems like generally speaking, you know, like it's in 2 to 5% of the population. And so when you talking about how does this actually happen? Like, does it occur from overuse or is it a traumatic injury? Well I think when you talk about sort of the primary part of what frozen shoulder is, the onset of it is usually something that's without any known cause.

They call it idiopathic. Where there really isn't any reason. And they still don't even know, what it is exactly that causes this. And the jury is still out on that. Now, when do you start to look at, what we talked about secondary causes, you know, like where you're talking about, oh, is it an overuse thing? Is it like traumatic? 

Yeah. So it can actually occur alongside with things like trauma, so a surgical event. So you get an operation like for your shoulder for something else, and then you develop a frozen shoulder. And you can also have other things like overuse is another good example. Or falling on the shoulder you have an injury?  So those are definitely factors. 

And then there's also like within those sort of secondary factors, you have like other things too. There's systemic. So if you have diabetes, like diabetes mellitus, which is basically type two diabetes, then you can actually have an increased chance of getting this. So this sort of circles back to, is this a hormonal thing . Is this a neuroendocrine thing? 

 And then there's also extrinsic factors like is this like someone that has cardiopulmonary disease or you know, someone that has like a cervical disc issue, like post breast cancer, a meniscectomy and all that stuff. So that goes in line with the surgical. 

And then there's intrinsic factors, which we talked a little bit briefly about like rotator cuff pathologies. And then people that have had like you know, things around there too, or maybe like overuse and then maybe around that shoulder, not exactly in that shoulder joint, but like the AC joint, which is the acromioclavicular joint. So there's all these different things involved. 

Mark: In other words, to sum all that up, the shoulder is really complicated and it can go south in immense amount of ways, basically. Surprise. 

Wil: Yeah, it is. But the shoulder joint is just, is such a beautiful, like marvel of a joint, it's just amazing. 

Mark: So when you're going to treat this, what's your kind of first step? How do you diagnose it and how do you go about then doing a course of treatment? 

Wil: Yeah. That's a really good question too. And so actually funny enough, I was actually just In the process of treating someone that has frozen shoulder and there's specific assessment criteria that they fall in line with like being diagnosed as having frozen shoulder.

And so this particular patient of mine, she's an accountant and relatively fit, 41 year old accountant and she fell in that first primary category. Unknown reason. She didn't fall on it. Nothing really happened. Relatively fit. She fits in that age range and it was like classic range of motion limitation.

And so what I looked at was definitely wanting to improve that range of motion and also looking at how her actual, when we talked about intrinsic factors, how her rotator cuff has been affected by it. You know, and obviously, for someone like her who, you know has been really scared to use it.

Now starting to reactivate that part of the shoulder, the rotator cuff. So we actually started off you know, some simple stuff. Just working on her mobility and then an activation of that rotator cuff. And then we started doing some more specific stuff like neural muscular reactivation. Hands-on stuff with her that actually really started making a lot of progress. The other thing that we were also doing as well was a little bit of dry needling and IMS to kind of help that whole process of the muscles that are just sort of like this, which is essentially responding to a lot of stuff that's happening in the capsule of the shoulder.

Surprisingly so I've been seeing her since October. And surprisingly you know, within the first three sessions and she was seeing me once a week, her range of motion was like less than 25%. And her strength was so weak. She wasn't even using it. Within the first three sessions, three weeks of coming in to see me, we got her range of motion to over, definitely over 50% close to like 65-70% kind of thing.

And then, so that was like back in October. And then now you know, she still comes in once a week and we're at like 90% range of motion and she wants to have that last little bit, like she's like we can do it. And typically with the prognosis of a frozen shoulder, they do consider it self limiting, it can last up to two years. Is sort of the prognosis on a medical indicator.  

Mark: So when people get this, this is the typical thing that doesn't, they don't want to use it. It hurts a lot. They don't want to move it and they can't really sleep on that shoulder too. Is that right?

Wil:  Yeah, definitely. That is another big symptom of it as well. And that's all coincided with the fact that as it gets stiffer and then things get in this chronic inflammatory process, that's producing more and more scar tissue. And what ends up happening is a part of their psychology is affected too, and they don't want to use it. And then as we go through the rehab with them and we help them with that, they build that confidence. And they start to realize that as the range is getting better, we also have to retrain the neural muscular activation patterns to be able to help reinforce that mobility gain as well.

So that's actually really, really important in this whole process. And I think this goes back in line with talking about, you know, the side effects of frozen shoulder, I guess, or the secondary effects, which is basically the rotator cuff stuff and the really stiff shoulder. 

Mark: So would you say that's a more typical response then at about three, four months of pretty steady work on it can get somebody back to 90% mobility and a lot less pain and issues with their shoulder?

Wil: Yeah, I would say like just recently with this particular individual and also a couple of others that have had worked with that, that seems to be what I'm finding and what we're finding in our group. Whereas you know, I've seen people that have suffered with frozen shoulder and didn't want to do anything about it because they've, you know, they've consulted Doctor Google, or even their family doctor even have said, yeah, you know, it'll be self-limiting within two or three years. But then, you know, they'll come in two years later and they're still right. You know, really super stiff and that's obviously a lot tougher to deal with because the other thing that I didn't actually mention was that she had been suffering with a frozen shoulder since last March at the start of the pandemic. And I think a lot of it was maybe she started to do more computer work at home and all those effects of what we've been experiencing with the pandemic. 

The other really interesting fact that we found, a group of clinicians and also sports medicine doctors and rehab specialists in Australia have found that if this is a true frozen shoulder and you catch it within the first three months of its onset, doing a specific type of injection has been really helpful to help with that. But that's actually very key to be able to diagnose it within the first three months because the effectiveness of that injection is no longer as effective. So it starts to get less and less. 

Mark: And you work a lot with sports medicine doctors. You guys co help each other basically. They refer patients to you. You refer patients back to them based on what their needs are. Is that right? 

Wil: Yeah, for sure, definitely my experience and our experience as a group, we have worked with a lot with sport medicine doctors. And currently right now we actually have sort of a specific sport medicine doctor that we can actually do direct referrals to without having to have a referral from a family physician. You know, and I know that with this time of the pandemic, it's really changed how things have been operating with the healthcare system. And this has been an example of being able to help our patients and our clients be able to get moving better the way that they want to again.

Mark:  Anything else you'd like to say about frozen shoulder? 

 Wil: Well I think it's a really tough thing to wrap your head around when you think you have it. I think honestly, like as much as you consult Dr. Google and family physicians like you know, they're great. I have some really good family physicians that we work with, like our group works with. But sometimes they're just not as knowledgeable cause it is like this orthopedic type of condition, but it's got a medical aspect to it as well. But they don't really know the rehab side of it as as much and we try to work with them and help family physicians. But I guess my biggest take home is like, if you're not really sure if this is what it is and you have stuff going on, get it checked out. You know, general rule of thumb is that if you have stuff going on and if it's like severe enough to even give you pain, like without using it, if it's not going away within like the first week or even two weeks, get it checked out. Get it checked out and at least figure out what's going on. Have a register physiotherapist take a look at it. And really you know, someone that has a little bit of a specialty in orthopedics and even in sports to be able to really ascertain, a little bit more and help you with your specific issue with that. 

Mark: So bottom line don't suffer. If you've got a shore shoulder, sore shoulder, you want to give Insync Physio a call. If you're in Vancouver, in the Cambie, King Ed area, anywhere in that general vicinity, you can call them at (604) 566-9716 to book your appointment. Or if you're in North Burnaby, the North Burnaby office is at (604) 298-4878.

Get yourself looked after, get on the path to healing, and you're going to feel a heck of a lot better really fast. And you can check out the website insyncphysio.com. We've got dozens and dozens and dozens of videos on there on all kinds of exercises and stuff. If you want to try and play doctor yourself, you can, don't recommend it. The faster way is to get in and get a professional helping you. Diagnosing and giving you hands on treatment that will make you feel better. Thanks Wil. 

Wil: Thank you, Mark.

Hip Impingement

Mark: Hi, it's Mark from Top Local. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapist office in Vancouver. And we're talking hip impingement. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. Basically it's when the head of your femur or your femur bone basically pinches up against that part of the socket of your pelvis, which is called your acetabulum. So what they normally refer to it as FAI. Which is femoroacetabular impingement. And there's a few different causes to that. 

There's definitely, you know, like sort of structural genetic component where if you're pelvis and your hips are aligned in a certain way and the neck of your femur is not proportioned, or if it's shorter then you have an increased risk of having this type of impingement happening. 

So aside from looking at sort of the congenital factors, we're looking at more of the other secondary issues of like, imbalances that you develop from sport and activity, to specific injuries. Then you can run the gamut of like, you know, having issues that are caused by like the sacred iliac joint that shifts the alignment of the whole pelvis, which then causes a movement issue in the actual hip. So that's huge because I see that quite a bit too. To where you have like, in your hip, you have cartilage that's called your labral. And so you can sometimes experience sort of an injury into there. And then if you have sort of that kind of stuff going on and that can definitely give you changes in terms of the actual motion and movement of the whole hip. 

So when it comes down to the true FAI, there are a lot of different causes to this. And I think you really want to address what are the biomechanical factors.

So biomechanical factor being like, you know, what are the things that are affecting the way that this joint is moving. Assuming that you account for all the structural issues and that, all that stuff is normal. And you don't have that aspect with regards to that getting in the way. And then you're looking at muscle imbalances. So you have like your lower back joints maybe, your spinal joints maybe contributing to all that. 

Mark: So how would I know? How does this show up when somebody comes into your office, what are they complaining about? 

Wil: Yeah, it's like basically a pain in the front part of your hip. And it's primarily you know, you feel weak in there as well, weak and painful. And it's interesting because I had a fellow who was an avid rock climber recently who had been doing a bit more driving, I guess, just you know, driving around sort of getting to different rock climbing gyms now that there's the winter season and also he's a skier too. And he noticed that he was getting some more hip pain. And he was driving a standard, so he was using that left side. He was getting an impingement on that left side. And that was getting even more trouble as he was like sleeping. And then he was noticing that it was referring down to his knee.

That's when he finally thought he had to get checked out by me. It was when he started getting the increasing in symptoms and it just wasn't going away. So basically that's the biggest symptom right there. It's really that sort of like, you can put your palm of your hand or just your fist on the front part of your hip and that's the area of pain. And especially trying to bring your knee towards your chest and you start to elicit a sharp pain and then if you try and rotate it out, the knee coming outwards, and then that can also elicit a painful response into that interior part of your hip.

Mark: So that's how it shows up. You can't maybe put your socks on as easy without pain. So when you're diagnosing it, what are you looking at? You talked about muscle imbalances and all kinds of other things. How are you diagnosing it exactly to find what's going on? 

Wil: Yeah. So quite honestly, there's marked weakness in that hip. So weakness marked with pain. And then also just in terms of the movement of the joint. So when we get in there and looking at the joint, there's like the kinesiological movement or the anatomical movement of how it's supposed to move. And there's usually a restriction and extension, but then with that extension restriction, you have that accompanying weakness with the fluxion, which is bringing the knee to the chest. With pain. And there's always like, sort of this pinching sensation. And also coming out into the, what we call like an abduction fluxion motion, where you bringing the knee outwards and upwards kind of thing because that puts more sort of a closing in aspect of that hip joint. And then that brings in more of that impingement.

So that's sort of the primary part of it, like, Oh yeah, that's the hip impingement. And then we really look for well what's causing that. And aside from like, you know, the structural and the congenital parts of what I talked about before, you know, then you're really starting to look at, okay, so is this now really like an issue with the sacroiliac joint that's driving this. And then also quite often, in addition to that, you know, we talked about the weakness. You also want to just really work on strengthening specific muscles in that hip flexor area. 

Because strengthening that area helps to support the normal moving patterns in that hip again. Because when it's really weak, then it basically, you know, all the other muscles that are really tight started to take over and then you get all this imbalance and it basically spits it to the front. Spits that joint to the front. And then you can imagine as it does that, then you go to like, bring the need of the chest. If you've got to bend over and you have that motion of fluxion pinching even more when you're having all that imbalance happening. So those are the things that we're looking at addressing is those imbalances, but then primarily, you know, what's driving it. Is it, you know, the sacroiliac joint.

So with this specific client who actually had a sacroiliac joint injury, it was definitely driving that hip impingement. And then now we're also in the process of looking at helping them strengthen his core. Now it's hard to tell, was his core already weak, and then it caused the sacroiliac joint to shift. It's hard to say, but we definitely know that he had this issue with his mobility and his SI joint or a sacroiliac joint. So now we're in the process of trying to help him with his core strengthening and also his hip flexor strength. And I've only really seen him three times. He comes in like he's still really active, still climbs.

And in those three sessions, you know, the first time he came in, he was getting constant pain. You know, it was like nine to 10 on the pain. And it went from nine to 10 out of the pain to like a three to four out of pain out of the second session. And that was like a month later. And, you know, we gave him some exercises, reinforced the stuff that I did manually and doing the releases that we did and all the things that we worked on to try and really restore a more normal movement pattern in that hip.

And then I saw him for the third time, like a month after that. So this has been a span of like almost three months. And he's like at times where he's pain free almost, and he feels it mostly with climbing. And then when he's still driving a little bit, when he's clutching with that left foot.

Mark: Anything else you wanted to say about hip impingement? 

Wil: Well, I think you know, the big thing is that if you're trying to stretch it out, it's not just about trying to stretch things out in there. Like it's, I think the biggest misconception is that I got this really sharp hip pain, you think, Oh, I just stretch it and it's okay.

Sometimes it may be, sometimes it might help, but like if you're stretching and you're noticing very little returns and gains in that, then you want to get it checked out because then you want to get at the root cause of what's actually driving that. And you know, something as simple as like, you know, figuring out that alignment issue and what's causing that and addressing that, you know, can really make the difference of like, like you know, from experiencing a constant nine to 10 out of the pain to making life a little bit more enjoyable. Making your sports and activities a little more enjoyable. And finally being able to pursue the things that you really want to be able to do again. 

Mark: Bottom line. If you want to feel better, if you're tired of being in pain, the guys to call in Vancouver are Insync Physio. If you're in the King Ed, Cambie area, Mount Pleasant, et cetera, et cetera, they get people coming from all over the place actually. They're that good. The Vancouver office is (604) 566-9716 to book your appointment, you got to call and book ahead. They're busy. Or in North Burnaby, there's another office (604) 298-4878. Give Insync Physio a call they will help you out. 

If you want to check out the website, Insyncphysio.com. You can book online there as well. And you'll see there's lots of videos on there for all kinds of types of exercises and stuff that will help. Whatever, if you've got a minor issue that you need to work on, maybe that'll help, but if you want expert help and getting better and moving freer, give them a call. Thanks Wil. 

Wil: Thanks Mark.

Sacro Iliac Joint Injuries – Monster Band Walks

Start with a resistance band wrapped above your knees with the slack taken up. Be in neutral spine posture with your inner core engaged and your lower back flat.

Then assume an athletic stance with your hips and knees bent with your butt sticking backwards and your upper body leaning forward and hands in front. Take a side step and straighten out your knees, hips and body as you land your weight onto the stepping foot.

Return to the athletic stance and repeat. Perform 2 reps on one side and then 2 reps on the other side doing this 5 of them on each side for 3 sets.

If you are doing this exercise in a gym or space that has more room then you can perform 10 side steps in a row and then switch to the opposite side doing 3 sets in total. This exercise is great for strengthening your gluteus medius muscles to help with the rehab of your weak and dysfunctional sacro iliac joint.

If you have any pain and problems with this exercise or are unsure about what you’re doing consult your local Physiotherapist before continuing. 

Neck Strain Injuries – Core Neck Strength Moderate Rows

This rowing progression exercise is a great way to build more core stability strength to help you rehab your neck strain injury. Using a looped band, make sure it’s anchored to a sturdy object. Wrap the first band around yourself & it should be around your shoulder blades and in line with the back of your shoulder and armpit.

Then have a second band anchored & hold that second band in your hands. Ensure you have your arms on the inside of the first band. Press the tip of your tongue up against the roof of your mouth to engage the deep neck core stability muscles.

With your knees slightly bent, begin to row or pull your shoulders and elbows back. Focus on pulling your shoulders and shoulder blades back against the resistance of the band.

Repeat this for 10 repetitions doing 3 sets daily. 

Neck Strain Injuries – Core Neck Strength Basic Rows

A successful rehab regime for your neck injury means being able to get stronger in your upper quadrant and scapular muscles with your core neck stability strength. This is a good exercise to help with that.

Using a looped band, make sure it’s anchored to a sturdy object. Then wrap the band around yourself, the band should be around your shoulder blades and in line with the back of your shoulder and armpit. Ensure you have your arms on the inside of the band.

Press the tip of your tongue up against the roof of your mouth to engage the deep neck core stability muscles. With your knees slightly bent, begin to row or pull your shoulders and elbows back.

Focus on pulling your shoulders and the shoulder blades back against the resistance of the band. Repeat this for 10 repetitions doing 3 sets daily. 

Ankle Sprain Injuries – One Leg Squats – Gluteus Medius Muscle Strengthening

This is a great exercise to rehab & strengthen your ankle injury after you have sprained it. It works the muscles of the lower quadrant to help provide more dynamic stability.

Keep both sides of the pelvis level and squat down on one leg pushing your butt back like in a chair. Keep the knee over the ankle and aligned with your hip and second toe and prevent it from moving past the toes as you squat.

You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward. Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10 repetitions doing 3 sets on each side.

Ankle sprains affect the optimal activation of what’s called proprioceptive strengthening, or rather the balancing muscles of the leg and hip. The gluteus medius is a muscle that is important in this function.

If you have any pain or problems doing this exercise consult a local physiotherapist before continuing. 

Knee Ligament Injuries – One-Legged Squats

This is a great exercise to rehab & strengthen your knee injury after you have sprained it. It works the muscles of the lower quadrant to help provide more dynamic stability.

Keep both sides of the pelvis level and squat down on one leg pushing your butt back like in a chair. Keep the knee over the ankle and aligned with your hip and second toe and prevent it from moving past the toes as you squat. You also want to reach both arms out in front of you to keep balanced and bend your hips so your chest comes forward. Your weight is on your entire foot as you come straight back up. Place the emphasis on pushing through the heel while squeezing your butt all the way back up. Repeat this for 10 repetitions doing 3 sets on each side.

Knee Ligament sprain injuries affect the optimal activation of what’s called proprioceptive strengthening, or rather the balancing muscles of the leg and hip. The gluteus medius is a muscle that is important in this function.

If you have any pain or problems doing this exercise consult a local physiotherapist before continuing.