Traumatic Knee Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. Multi time winners of best physiotherapists in Vancouver and Burnaby. And we're going to talk about traumatic knee pain. What do you mean by traumatic? I'm traumatized. Just hearing that already.

Wil: Yeah. So traumatic knee pain is when you have an injury to your knee because you know, there's been like an event or something happened where you fell and you hit or you know, something happened to it. Like there was a clear thing that happened. It may not even be from falling. Maybe you twisted it. But there's a clear event. 

Mark: So it could be a hit from someone like if you're in a contact sport, it could be from cutting really hard say, in soccer, football, whatever, basketball, hockey. It could be all those kinds of things where you've moved the knee joint in a way that it really shouldn't be moving. 

Wil: Shouldn't be moving. Or got hit in the knee in the way that it shouldn't got hit. Exactly. 

Mark: So the cause is pretty obvious something's happened that's, it could be a fall. It could be that twist, even just gardening, just the wrong with weight, you've twisted the wrong way and suddenly there's pain. So how do you go about diagnosing this, what's happened and what needs to be done?

Wil: Yeah. So I talk to my physio group all the time. It's interesting because the biggest thing that I hear, clients come back in to see our physios, is their worry is that they've done something really bad to their knee. And so when we assess it, we want to basically rule out or determine whether or not if it's one of these bigger injuries. Or if it's not. Like it could be a smaller injury or it could be a bigger injury. And so that's our job. 

So I'll give you an example, we had a client who came in to see one of our physios and they had this outside knee pain. And they had basically been playing, I think it was actually rock climbing or something like that. And they had done something and they twisted their knee and basically heard a pop or a clunk. And then got some swelling and pain immediately. And immediately the brains go into like the worst case scenario. And I think that's human nature. I think we think, oh my gosh, what did I do in my knee? And especially when it swells up. 

And so you know, you got a rule out all these big things. Fortunately for this person, it was just like a minor, it was interesting because of the way that they put the knee, the positioning of it, they twisted it and ended up spraining a ligament on the outside of their knee. That was totally healable. And it could have been a lot worse. Could've been like other structures in the knee that would take longer to heal. Or a bigger, more major ligament like the ACL. But in this case it was the LCL, which is the outside of the ligament. And so the typical timeframe for something like this, we can predict and project and then help the clients understand what to expect in terms of how long it's going to take the full heal. And how long it take it easy for kind of thing, because that's also another thing that you'll want to also respect. There's a healing timeframe for these kinds of things when it's traumatic. 

And so if it's a bigger ligament thing versus like maybe the spongy part of the knee called the meniscus versus the LCL, and depending on how serious that injury is as well, will determine the amount of time that you gotta to take it easier versus the amount of time that you can start to like then, okay I can actually start training harder now. They're going back to climbing harder now versus, okay you know what? Four to six weeks or six to eight or maybe within two weeks. So it all really depends. 

Mark: So when you've diagnosed it, you've determined exactly what the extent of the injury is and where it is. What's a typical course of treatment look like. I imagine getting the swelling down is probably the first layer. 

Wil: Yeah, that's the most important thing. If there's any swelling, you want to take that down. But at the same time, you know, if you want to be able to start to be able to put weight on the knee, retrain what's called your balance and your strength in your balance and sort of weighting it. And that's actually really important. And you need to do specific things to start to reactivate the muscles. That's super important. And so we want to look at the things that have been affected. You know, that's interesting, because we talked about in a previous podcast, about A-traumatic or non-traumatic knee pain.

So you can develop a lot of things that are kind then similar to things where you get tightnesses here and tightnesses there and weaknesses here. Because when you have a traumatic incident or a traumatic injury, then certain muscles will shut off and other muscles will just take over to protect. And now you develop this certain pattern of basically muscle activation. And a lot of that is just to keep you functioning. That's the miracle of the body. The amazing feature of the body is that it just will do that. 

So then what we want to try and do is we want to try and start to, you know, normalize the movement. You want to try and optimize the movement and be able to get you put weight on it. And it may not feel intuitive, or may not feel natural, or like you really want to do that. But the key is also, you don't want to do anything when you have that traumatic injury where you're getting that bad pain.

Mark: Yeah. Pain to be avoided. So if you could grade it, I guess, you know, a minor sort of thing is going to take two to three weeks. A major thing could be six months. 

Wil: A minor thing you can take up to four to six weeks depending on what it is. So if it's like the spongy part of the knee and the meniscus, I mean, it's hard to say if it's a you know, minor thing could take longer than that. But if it's like the ligament on the outside called the lateral collateral ligament, then that could take, four to six weeks or it could take longer, depending on if there's other stuff involved too. 

So if it's very simple and it just really never is, you know, four to six weeks is the healing timeframe. So you have to respect that. And then sometimes it can be extended, it can go six to eight. And then if it's like looking at major ligaments in the knee, then there's other things that we want to look at where, potentially having other interventions involved like with the major ligaments of the knee. And then that can be a full several months, maybe up to a year long process. And then also, depending on the sports that you're doing, if you're just an amateur, trying to get back into doing things, it can take several months still. But if you're professional, then we can speed things up a little bit, but then also looking at what we need to help you actually regain, in terms of your functionality. 

Mark: If you want expert help with any kind of knee injuries that you might or might not have, hopefully none. Well, I wish you that never get a knee injury, but if you get one, the guys to see are Insync Physio. You can book online at insyncphysio.com or you can call the office in Vancouver, (604) 566-971 6 or in North Burnaby, (604) 298-4878. You have to call and book ahead. They're always busy. Insync Physio. If you want your knees strong, healthy and feeling really good, right until you're old and decrepit like me. Thanks Wil.

Wil: You're not old Mark. But thanks, take care.

Non-Traumatic Knee Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapists in Vancouver. And we're going to talk about knee pain. Specifically, non-traumatic knee pain. What's non-traumatic knee pain Wil?  

Wil: Hi Mark, thanks. Yeah so non-traumatic knee pain is basically the type of pain that you get in your knee when it's not something that you can recall. Like one incident happening. And sometimes you're a little bit fuzzy about it. And it may be like repetitive thing that happened, like maybe you started up running and cycling or you've increased your training load a little bit more. And so there isn't like a collision or direct contact or something specific that happened to it. And the onset of that pain can be gradual. 

Mark: So basically it started hurting and it wasn't so bad and you kept going and it got worse and worse and worse. Yeah. Is that accurate symptom? 

Wil: Yeah, that's a very common thing where, you know, someone comes in with you know, I just started getting some soreness after a training session. I just thought it was just regular soreness that, you know, from training a little harder, that you get after a hard work. 

Mark: And so what's the cause of this? What are the possible causes involved? 

Wil: So there's there's many different things, but you know, I'll talk briefly about some of the main things that we've seen as a physio group at our clinics. And when you look at non traumatic type of knee pain, you can have stuff where, you know, it's usually an imbalance issue. So an imbalance issue in the muscles, so you'll have certain muscle groups that are just tighter because you're always using them or maybe you're doing desk work where you're sitting down all day long and your hip flexors get really tight.

And then that pulls on certain structures called your IT band, which is basically a connective tissue all along the outside of your thigh that connects down to your knee. And that can start to get little tighter. And then when you take up running or get a little bit more mileage in and try to increase your training, then that starts to get irritated down in that area. Because it gets a little tighter. 

So these muscle imbalances are pretty prominent. And on the assessment of what's causing it and it's with everyone it can be different. So it could be like a different part of the hip flexor. It could be maybe the part of the hip flexor that's more around the front of the thigh. Which is part of the quad. Or maybe part of the hip flexor, that's kind of attached directly to this connective tissue that I was just talking about, the IT band. So those are the things that we do in terms of assessing to really determine what are the imbalances? So that's the big one. Is the muscle imbalances.

And so in addition to that, then you're looking at the weaknesses. So you're going to look at what is not activating to support the proper mechanics. To support the proper movement of that whole chain. So when I say the whole chain, I mean, like not just the knee movement but also what's going on in the hip. And then from the hip down in the knee to the ankle, is functioning properly or not. 

Mark: So once you've gone through the diagnosis and you've identified the possible causes, what's a typical course of treatment? 

Wil: Yeah, so depending on what we find. We have a physio group that basically, you know, we share our case histories to help each other to learn. And it's very typical. This one physio has a client that basically has this lateral knee pain and it's non traumatic knee pain. And as we went over it, your classic tightness into the hip flexors and weakness into the glutes that are not stabilizing the pelvis, which is causing all this non-optimal movement of the whole chain, as I was saying. And so the physio addressed those specific issues. So this person was a runner, and started increasing your training load. And then also the person, his work was getting busier and they're doing a lot of stuff in front of the computer. And so they're in a lot of sitting. And so things are getting tighter and tighter. And then their training load was getting a little bit heavier because they wanted to do a couple of races that had come up recently. 

And so they needed to address those imbalances that were actually causing this. Because the actual issue, like of the pain, yeah you look at it and you there's certain tests. He said, yeah, that's tight. So we want to work that out and we want to try and relieve that pain and that tightness in that area in the knee. But then you also got to figure out what's causing that. And so for this physio to really address that, this person actually had, it was really cool because she was saying that, this person that she was treating basically had almost 85% pain relief after the first session from doing releases. But then it came back because she wasn't really dedicated and doing her strengthening. And then when she realized that strengthening was really important. And then the physio also can do a lot of manual stuff to release, to help facilitate that cycle. 

Now that's a really good example of someone, you know, they come in the second time, they're like, oh, the pain came back. And then the physio did the manual stuff and released it. And then got them to progress with more strengthening. Came back a third time and the pain relief was gone and they increased the training load again. So it was like significantly better. And then they basically, I think was all healed in four or five sessions kind of thing. 

Mark: So when you say lateral knee pain, you're talking about pain that's either on the sides of the knee, not front or back, on the sides inside or outside?

Wil: Yeah. And there's other things that could possibly happen, but I'm just describing like the most common thing, which is just lateral knee pain on the outside of the knee. And it's not like on the knee cap. And it's not like inside the knee. So it's actually on the outside of the knee. And that's where your connective tissue attaches and you have all the muscles that can attach onto that that can pull on the knee structure and effect the movement of it right. 

Mark: If you've got some knee pain, you need to get it looked after, basically. If you want to increase your load, if you want to get back active, if you want something expert diagnosis to identify what needs to be fixed. What you could do to actually repair, allow your body to repair itself. The guys to see are Insync Physio. You can book online at insyncphysio.com, for either office. They have an office in North Burnaby and in Vancouver. You can call Vancouver 604-566-9716 to book or North Burnaby, 604-298-4878. You got to call and book ahead. They're always busy. Get yourself some help so that you feel better and get back moving well. Thanks Wil. 

Wil: Thank you, Mark.

Rotator Cuff Injury Horizontal Ball Catches

Start on your knees and lie with your belly on a balance ball while you engage your core stability muscles of your lower back to keep your posture in neutral.

Hold a lacrosse ball in your hand with your elbow up and knuckles pointing down. Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand without letting the ball fall to the ground. It’s important to only pivot through the elbow and not the entire arm and shoulder. Repeat this for 30 seconds doing 3 sets for each side daily.

This is a great dynamic strengthening exercise to rehab a shoulder or rotator cuff injury. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing. 

Low Back Rehab Front Plank Step Out

Begin in front plank position with your low back core muscles activated. Keep your shoulder blade muscles engaged and step your left foot out to the side and then bring it back to the start position.

Then step your right foot to the side and then bring it back to the start position. Repeat 10 repetitions for each direction for 3 sets daily. 

This will help build strength in your core stability muscles after a lower back injury.

Rotator Cuff Injury Sitting Ball Catches

You can sit on a balance ball to make this more challenging but a regular chair or seat will work ok too. Hold a lacrosse ball in your hand with your elbow up and forearm parallel to the ground, keeping your shoulder down.

Remember to engage your core stability muscles of your lower back to keep your posture in neutral. 

Open your palm releasing the ball and quickly rotate the forearm backwards and then quickly rotate it back to catch the ball with your hand. It’s important to only pivot through the elbow and not the entire arm and shoulder. Repeat this for 30 seconds doing 3 sets for each side daily.

This is a fantastic dynamic strengthening exercise to rehab a shoulder or rotator cuff injury. If you have any pain or difficulty doing this exercise, consult your local physiotherapist before continuing.

Growth Spurt Injuries Part2, with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. One of Vancouver's best physiotherapist clinics, multiple time winners of best physios in Vancouver. And we're going to talk about growth spurt injuries part two, we're talking about Sever's Syndrome. How are you doing Wil? 

Wil: I'm doing great. Thanks, Mark. 

Mark: What the heck is Sever's Syndrome? 

Wil: Well, Sever's Syndrome is basically a condition that causing heel pain and primarily in the athletic population of people who are immature muscle bone development. So basically, you know, people who are age as young as 8 up to like 15 to 16 years old. And it's specifically in the heel, like I was mentioning. 

Mark: So what kind of symptoms would show or lead one to start to investigate this? 

Wil: Yeah, so there would be sometimes painful inflammation that you would see and in more severe cases, a lot of inflammation in the heel. And in the insertion point to where your Achilles tendon is basically the tendon that attaches your calf muscle.

So your calf has made up of like three muscles, like your big ball muscles called the Gastroc. And then the one inside called the Soleus and they basically are attached by your Achilles, that attaches onto your heel bone, called your Calcaneus. And your Calcaneus basically for an immature, in terms of a physiological development, you know, ages 8 to 15, that's actually where it tends to happen with higher stress, higher loads tend to be more focused in that area. And also the other thing that you also have to consider is the fact that is there a big growth spurt because if there's a big growth spurt then that'll also be a contributing factor.

 And the other things too, is that you want to look at like how are they pounding? Because with Sever's, you know, if they're actually doing a lot of running and they also have bad footwear, you know, and they're poorly cushioned or worn down.

And depending on the surface that they're running and they're absorbing more of the forces. So there's a huge sort of biomechanical factor involved here.. 

Mark: So we kind of merged symptoms and diagnosis. So basically pain in the heel is the symptom that's going to show up. Is that right? 

Wil: That's correct, yeah. 

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

Wil: Yeah. So the biggest one is really, you know, you gotta rest. You really gotta let this settle down. Because like I was saying with these immature adults, you really gotta make sure that you give the growth plates and give the growth spurt that they experience to start to mature a little bit more. Because if you don't, then it can become a chronic problem and it can actually have all these other chronic compensations happen later in life. And it can come back and haunt you. 

Myself and our team we've been doing this for a very long time. We have so much experience, like decades of experience in treating athletes and working with young athletes and seeing them through from being young kids to adults and how a lot of them have had problems. Like with volleyball players, with runners, when they've developed conditions of this sort where, you know, whether it's Sever's or another growth spurt issue that they ended up having continued issues in their adult life, as they try to do avid sports.

And that's huge to really understand that you got to let it rest. And you don't want to be like, oh, it's like a tendonitis, but it's not. Because it's immature muscle, immature tendon development that you gotta just give time to really recover. And with younger folks and younger people, you just got to give them that chance. 

Mark: So if your kid's having a bit of knee pain, a bit of, in this case heel pain, the guys to see are Insync Physio. You can book online insyncphysio.com. Or you can call the Vancouver office at (604) 566-9716 to book or in North Burnaby, (604)298-4878.

Get your kids in there. Get them healed properly. Get expert advice to relieve their pain so they can get back to their favourite sport. Thanks Wil. 

Wil: You're welcome, Mark.

Growth Spurt Injuries, Part1 with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver. Multiple time winners of best physiotherapists in Vancouver. And we're talking about growth spurt injuries today. How are you doing Wil? 

Wil: I'm doing great. Thanks Mark. 

Mark: So you had given me some fancy names, Osgood-Schlatter syndrome. What the heck is this? 

Wil: Yeah, so, basically it happens in mostly the athletic population, in younger people. So these are the younger people who are basically going through growth spurts. And that's usually the important factor there, is that there's a larger amount of load. So with training, so in sports and being more repetitive and increasing that load, and then the growth spurt. 

So Osgood's what that is, is basically the attachment point of where your quadriceps muscle, the tendon, attaches down, like just below the kneecap. And so it's basically a pulling away of that attachment point because that bone and all that area is still immature.

And so the big, fancy name is Apophysitis. So basically it's the pulling away at that attachment point of the tendon on the bone.

Mark: So what kind of symptoms would someone, how would this show up for a kid? 

Wil: Yeah, so they would start to get some knee pain there right in that attachment point. And then the classic thing, especially if it's been going on for a little bit where they're still playing, they might start to get a little bit of a bony bump. And then essentially that's there for life because, you know, it's the protuberance or the attachment point of that tendon pulls away. And it essentially is a permanent bump. But in terms of long-term effects, if you manage this correctly and that's the key, is managing it correctly, and knowing what to do and knowing what not to do. And in terms of sport, gradual return to sport is really huge. 

Mark: So, how do you go about diagnosing this?

Wil: Yeah, so like I was saying that the biggest factor is you know, the load and also looking at the growth spurt because it happens in younger kids or kids between the ages of like, it could be as young as 8 to even like 14 or 15. And basically they get tenderness on palpation maybe swelling, you know, if it's really, really bad, just on that attachment point of that tendon, where the quads attaches just below the kneecap.

And so basically in really worst case scenarios, which I'm thinking about a kid that we saw, you know not too long ago in the clinic, one of our therapists, basically the kid had trouble walking. Woke up the next day, like had a hard training session, and it's obviously been developing for a while and he was pushing through the pain. But then it was just the last straw, that last training session.

And he was a competitive soccer player. And then woke up the next day and then just was limping. And normally in terms of the referral and the medical system, they would go see the family doctor, you know, like, oh, what's going on. And then they would probably refer over to what's called a pediatric specialist, which is basically a doctor that specializes in seeing kids.

And they may do some tests and scans, but usually when you look at it, you can see it. And a lot of it is proper physiotherapy management, and there's a lot of research that's showing, it's very dependent on where they are and their growth spurt. So if they're having a huge growth spurt in addition to that training load, then there's a certain amount of graduated return to sport that you want to take them in terms of intensity.

Mark: And what's the typical course of treatment? 

Wil: Yeah. So you really got to give them a chance to settle down and you really want to just take off the load. So if this was a mature, like adult, where the bones are all developed and the tendons are all developed now, then it present more as a tendonopathy or tendonitis. So then protocol would be much different. When you have something like this with an immature adult, with this kind of condition, you really got to take the load off.

And that's huge. It's not about, okay. Yeah, we've got to strengthen this and we got to stretch this. I mean, that's not the case. You don't really want to be doing too much of that. There are some things that you don't want to do because when they start to develop this and what we want to also look for is all the compensation patterns they might develop. Because then you don't want them to start that, because they're growing, not just in that, obviously in that area of their body, their whole body is growing. 

And you know, you look at some athletes that may have, you know, maybe oh, two inches in the year, or maybe a whole 12 inches in the last year. So depending on how big that growth spurt is, then you've got to look at, okay, let's see what's happening in the back. Let's see what's happening in the hip, you know, and in the compensation patterns that are going on there, because then they can start to have issues that can come back to haunt them.

Mark: So there you go. If your kid is having some issues with pains that are getting worse as the training load in their sport is going up, the guys to see are Insync Physio. You can reach them in Vancouver at 604-566-9716 or in Burnaby 604-298-4878. Or of course you can book online at insyncphysio.com. Get them in there, get this treated right so they don't have long-term injuries. Thanks. Wil. 

Wil: Thanks Mark.

Vancouver Physiotherapist Sports and Manual Therapy Rehab Clinics – Nancy Wang

Hi everyone. I'm Nancy. The reason why I got into physio is because when I was younger, my mom was in a car accident which left her at the hospital for about a month. And when she came home, she was unable to walk independently. So as a young child, being able to see my mom's rehab journey, was very inspiring for me.

And that's what sparked my initial interest in physiotherapy. Growing up had always been very active. So I love to rock climb and love a cycle and I love to do CrossFit. Those are my three favourite things to do. So as I was approaching going to university, I thought that physiotherapy would be the perfect profession for me because it involved bringing my active lifestyle and also my love for interacting with people into my job. So I find that I have such a great time, every time I go to work and it's basically like doing what I love for work. 

So the reason why I chose to work at Insync is because I feel that Insync is very involved in the community. We do a lot of events like going to a rock climbing or going to figure skating events. And I really like being able to engage with the community and engage with people that I am going to be treating in their natural environment. 

Another reason why I love Insync is because we have an awesome gym. Something that's really important to me as a therapist. Over the time that I've been a physio, I find is a squat rack and a pull up bar, and we have all of that here and I get to have a lot of fun in the gym, which I really appreciate.

And the third thing is that one of my best friends from physio school works here as well. So I get to see her in the clinic which is awesome, and I have this dream of high-fiving her every single time I pass by her at the clinic.

And I have a dog. He is my best friend. He's my furry best friend. I adopted him when I was in university and it kept me company ever since. He's three years old now. Our favourite things to do together are go to the beach, run in the trails, we often go to Pacific Spirit. I love to trail run with him and also hike, we go to Dog Mountain a lot. And snowshoeing a lot.

Muscle Retraining with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. And we're going to talk about getting your body better. How are you doing Wil? 

Wil: Hey, I'm doing great. Thanks Mark. 

Mark: So muscle retraining. What's muscle retraining?

Wil: Yeah, essentially, that's the core of what we consider exercise rehabilitation. So there's sort of like the more, very simple, basic aspect of that, you know, when you have an injury and you have to get the joint or the areas that have been injured, working and moving properly again. Which involves basically retraining the muscles around those areas that work properly.

Even if those muscles themselves were not injured. Or if a muscle was injured, say there was a strain or whatever, you know then obviously we need to retrain and rehabilitate that muscle fully. So there's sort of more of that simple aspect of that, where you sprain an ankle and then you have to retrain the muscles to basically help just the ankle joint to move properly.

And then as you look at more of a bigger picture and back farther to look at the bigger perspective than you're also looking at the overall motor control. That's a big word, the motor control, which is basically the way that the muscles function to make the body move in coordinated fashions or the biomechanics.

And so with the same ankle sprain, and this is actually backed up by research studies, where you may not have had an injury at all in your hip, but because of the cycle of pain and swelling, and then you're forced to use your other foot more initially, just even if you feel like you're walking, normally and you've sprained and there's swelling and pain.

You're gonna get compensation. You're gonna get a little bit more loading on your other leg and foot. And when you do that, you know and with a trained eye, we can see how you walk and you may be compensating more than you think. And so when that happens, then basically the whole circuitry of how the muscles work together, change.

And so you're undergoing a sort of a new programming of how your body works in relation to that sprained ankle. Now, the problem with that is you'll have to put more weight on it. Yes. You'll start to get some of that normalcy back, but it won't be a hundred percent unless we really focus and really address those deficits.

So the hip muscles will shut off, like in the gluteus medius, basically the muscles that help with walking and weight bearing on that side of the affected ankle. And you need to do specific things to retrain that. Sometimes the core muscles stability strength in your lower quadrant gets shot too. So you really needed to address those things as well.

Mark: So is this a function basically of you've been hurt in some way, and this can apply to I'm sure from top of your head to tip your toes, something's been hurt. And so your body's learned, in the meantime, while the healing is taking place to function and continue on. So other things are doing the job and now it's relearning, unlearning what the compensation has been in order to start functioning again properly. Is that a fair way to put it? 

Wil: Yeah. So what you're kind of leaning towards a sort of like the aspect of there's trauma. And there's like a clear injury. And for sure. So when there's a clear injury and trauma, then that process starts and sometimes you really do need to have a proper diagnosis and really look at, you know, well what's going on with this injury and why this is happening.

 And then address those deficits in relation to the actual injury and what's going on specifically at whatever's going on. Now the other aspect of this. The sort of the repetitive stuff where there's I mean, it's an injury as well, or may not be, where, for example, let's say I do a lot of sitting and my work is I'm sitting a lot and then I cycle to work, I commute, that's what I do, but then I don't stretch my hip flexors. 

And then what happens is I end up shortening my hip flexors, which is a problematic issue for getting that hip mobility. If I want to say, oh, Hey, you know what, I'm going to start up like ultimate frisbee or I'm going to play soccer. You know, I haven't played in a while and I'm going to join a league. I want to reconnect with that part of my physicalness again. 

And then what happens is that, well, your patterns that you developed with a tightness, you may not have pain or dysfunction, but the thing is you developed certain patterns that are non optimal for playing soccer, necessarily. Your hip flexors are really tight. And this is where you're more prone to getting some kind of issue happening as you start to play.

And especially if you're like for two different things, especially if you haven't played it in a while you start playing again and you start playing more avidly or competitively. Or if in the past, you've had some kind of pre-existing injury, that can be something that comes back to haunt you.

Mark: So how you diagnose this? 

Wil: Yeah. It's really looking at all this simple tests that we do. Sometimes people say certain things and people are very intuitive and say, oh yeah, I just feel like I'm doing this. And people get a sense of like, something is not right.

And so what we do is we get in there and we really assess and look at well, what is it about that, you know, that isn't moving right. And so we really test the parameters of whatever issue it is. If there's a trauma or pain or whatever disfunction that you're having, then we really address and assess and really examine things thoroughly.

If someone comes in, is I just want to prevent an injury from happening, or I just feel tight or I'm not really sure, I don't have an injury, but I'm not really sure what to do. So then we kind of look at, okay, well, what is it that you want to do?

So it's always goal specific. Well, I want to start a run program. Okay. Well, is it recreational or is it more competitive or what do you want to do? And then we base that on, okay so let's look at your running. Okay. And so where do you feel like you're tight maybe and then we also ask some questions about what they do.

Oh, I have a desk job. I sit like nine to five, five days a week. Oh. And I also commute to work. So then that points us in the direction of like what to look for more and also testing the core. Core strength. Does that activate properly? And do the muscles work in unison with each other properly?

Or is this muscle always on. And is this so tight that it doesn't actually allow the other muscles to turn on? So then there's this concept of what's called, reflex inhibition. So is there a lot of that kind of stuff going on, which is basically the non-optimal movement patterns that can start to develop when you have that kind of stuff happening. 

So example, tight hip flexors can cause reflex inhibition of your gluteus medius muscle, which is your butt muscle. And why that's a problem is that, you start to participate in sports again and do a lot more things where you need to have that control in your back and your pelvis. Then you might start to get issues in your and your hip and your pelvis and have all these non-optimal patterns, basically emerge. 

Mark: So what's the typical course of treatment to reprogram this? 

Wil: Well in terms of treatment. So this is a really good question because there's treatment in terms of coming into the clinic and we can do things to reset stuff.

So resetting being other, oh, it's a manual therapy issue. We do something where we use our hands to kind of move the joint or muscle or whatever, or maybe some IMS needles or whatever it is. And then maybe prescribed the right exercise to move you in that right direction. Because we also don't want to prescribe the wrong exercise.

So what I mean by that is that we don't want to be giving you something to soon. Because if we start giving you a strengthening program without mobilizing that joint, it's going to be a tug of war, trying to get that muscle activated, if you know what I mean?

So there's that aspect of it, where you're coming to the clinic. And it may be something as simple as, okay. Yeah, come in. You come in, we assess you and then it's not that bad, you're not having any pain. And then we do something manually to reset you or whatever.

And then we give you some exercises to follow up that you need to do on your own. And it could be follow up in two weeks, fallow up in four weeks, depending on the issue. Or someone comes in more acutely, come back in about one week and we want to see how this changes. We want to keep resetting things and re-influencing it.

And basically, it's that notion of being able to make sure that we get everything back into its optimal alignment or moving pattern. And then reinforcing those movement patterns. And so what we do in the clinic is we reset them and we get it at an optimal potential for the movement pattern and we teach you strategies or rehab exercises. And then the reinforcement of those movement patterns, whether it's a mobility issue and a strength issue, usually both. And that's what you need to do to follow up on your own. That's the most effective. 

Mark: If you've been feeling a little bit out of sorts, like you haven't healed properly, or you've got some long-term issues that you need to get reprogrammed perhaps. Get some expert advice in the dark arts of getting your body working properly, insyncphysio.com. You can use that address to book your appointment. Either for the Vancouver, Cambie and King Edward office or in North Burnaby, near Willingdon on Hastings Street. Insyncphysio.com or you can call them. The Vancouver office is 604-566-9716 to book your appointment. North Burnaby 604-298-4878. Thanks Wil. 

Wil: Thanks Mark.

High Ankle Sprains

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. And we're going to talk about ankle sprains. How are you doing Wil? 

Wil: Hey, I'm doing well, thanks. 

Mark: So high ankle sprains or unique ankle sprains. What's that all about? 

Wil: Yeah. So this is a kind of ankle sprains that we usually see at the clinic from sport injuries usually. And the reason why it's more of a high ankle sprain, like someone in a ski boot you know, it's not your typical type of like just rollover obviously. Or someone that's playing football where they're in a scrum and they end up lying in a position where the ankle does this position of like a dorsiflexion where it's flexed towards your nose basically. And then it gets rolled over kind of thing. 

And so that kind of impact can sprain an area, so there's the distal being sort of closer to the ground and approximately closer to my head. So the distal portion of your what's called your tibia fibula or your ankle. So in your ankle, you have your two lower leg bones, your tibia, and your fibula. And that actually creates the roof, the dome of your ankle. 

Now that tib fib actually has ligaments that can actually get sprained when you get into that range or that mechanism of injury. 

Mark: So the ligaments in between the two bones, basically. 

Wil: Yeah, exactly. And it can be like something that's you know, I'll say mild for this kind of injury, to like something even more severe where it's like possible fractures to even tearing higher up into that area. It can go beyond just those ligaments to the connective tissue. 

Mark: So this is where the ankle has been flexed like you said, up towards your nose and typical causes. Why is it more with hockey and skiers and football players? 

Wil: Yeah. Basically when you put it into that range of motion, it actually causes more stress into that joint. And also there's nowhere else for it to go. So now it's basically, that's where it's got to go, that's where the force ends up.

Mark: So they're there in a boot on the side. So the sides are really well supported, but the front and back has to be moving because that's how, if you're going to ski or skate, you have to have that flexion. 

Wil: Or if you're say, playing football and you're a scrum or whatever, American football, I guess, or whatever kind of sport, and you end up in that position, like on your stomach or whatever, and then you get forced more, you know, and that can cause that to happen.

Mark: So how do you diagnose this? 

Wil: Yeah, so the presentation of how it happened is actually really important. And 10 out of 10 times, that's the mechanism of an injury. So I'll give you an example of a fellow who came in. He was a Triple A hockey referee, a junior hockey ref. And he was reffing a playoff match and he got his ankle in that exact same position, but he doesn't remember exactly how he went down. He went down, but he told me the position that his ankle was in. Which is exactly that same position and he's in a skate. 

And then basically he got hit, went down and then came in as an emergency assessment, a couple of days later and like all swollen up. So it was really hard to really determine exactly what was going on. But like, given that presentation that was very highly likely, and also like, you know, in a skate, you know. So that was sort of our number one. Yep. This is what we think it might be. And it could be this maybe.

And then as the swelling came down a few days later, we were able to actually apply specific clinical tests that actually can determine whether it is this or not really show, yep it is that. And we were able to know that this is probably more affected. And that's important because then that also guides with that more clinical diagnosis. We're able to now guide that treatment and know the healing and recovery timeline for this individual. 

Mark: So what's the typical course of treatment. I'm assuming that a high ankle sprain is a little bit longer recovery period than a regular. 

Wil: Yeah, for sure. At least twice as long, actually. So if you think of it like a mild ankle sprain, and usually if it's mild, you can pretty much start walking. You can even run on it. But for those ligaments and the swelling, when it's been torn, for that to settle down, it takes about four weeks. But it doesn't mean you can't do stuff.

Well with the high ankle sprain, with involving the distal tib fib ligaments and possibly even more, it's double that. So with a simple ankle sprain, you know, a simple tip fib ligament sprain, you double that, and then they may not be able to walk properly. That's the other important thing, like when you sprain it, because it's such an important aspect, weight bearing stability.

So when you injure it, there's usually limping immediately. And there's difficulty to walk on it, especially going on your toes. So we want to restore the range of motion. We want to make sure that we get the swelling down. It's very, very important to actually address the swelling and the mobility issues within the first two weeks.

So studies have shown that if you address that and you add a bit of manual therapy, so you're asking, what are the things that you typically do? You add manual therapy to, the RICE principle, which is rest ice compress and elevate, and then you also make sure that you get them moving on their own and basic strengthening for that range of motion that they have.

That actually has been shown to improve the mobility and get things going faster. And then the other thing now that we want to start to do, is that after we got that going for the first two weeks, then you can start to introduce a little bit more motion with typically like strengthening. You know, like with we talked about in an earlier segment about the motor retraining or muscle retraining. So we now need this stuff to retrain the muscle system related that whole ankle all the way up to the hip and the core. Not just specifically at that ankle joint. 

Mark: Is there anything that an athlete in any of these of higher risks sports to get this kind of injury can do to prevent it or minimize it, if an accident happens? 

Wil: Yeah, well, the research is really, really scant on this, but I would say that you need to really look at what your deficits are. So what I mean by that is like, okay, so first of all, if you have a preexisting injury and especially if it's like a lower body injury, pre-existing injury, then you might have some deficits that you're not really super aware of. So try to suss that out a little bit more. 

Like are you more inflexible like in your hip and then maybe your core isn't turning on properly. And that might actually influence, you know, if you're getting back into soccer. That might actually influence your ability to actually be more stable when you're running. 

Take this hockey referee, for example, if he wasn't really strong in his core, and he actually had been an existing client with us for other injuries. He had worked his way up to now at a high level of reffing. He had to really work on maybe his core strengthening, and these other issues, these pre-existing injuries. 

And that's the key. Is really looking at where, maybe I'm tight here, any tightnesses in any areas in the body, where it feels just a bit tighter, you know, not fully mobile like before. And it's not just, oh, I'm getting old kind of thing. There is a thing that you want to look at that. You want to pay attention to that. You don't want to be like, oh yeah, I'll be fine. Like it's not out of sight out of mind and you think, oh yeah, I'm going to get away with it. So you need to address that. And you need to look at that. 

Mark: If you want to get some treatment for a high ankle sprain, or you want some prevention treatment which is always a great idea, insyncphysio.com to book. You can book either the Vancouver, Cambie and King Edward office or the North Burnaby office on Hastings near Willingdon. You can call of course, to book as well. Vancouver 604-566-9716 or North Burnaby, 604-298-4878. Insync Physio will get you feeling better and moving better. Thanks Wil. 

Wil: Thank you, Mark.

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