Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto. He's the owner of Insync Physio in Vancouver, one of the best physiotherapists clinics and physiotherapists in Vancouver. And we're gonna talk about injury prevention. How you doing Wil?

Wil: Hey, I'm doing good. Thanks for the shout out Mark. 

Mark: So I know we've talked about this before. People get a program of recovery and then they promptly after a week or two feel better and stop. That's not exactly a prescription to not get injured again, is it? 

Wil: No, it's not. I think it's also not looking even more long term. Where you know, you may have been on the program now for six to eight months and you feel great. And it's kind of like similar to, you know, you go to the dentist cuz you have a cavity, and you haven't really been brushing your teeth all that great. You mean miss a couple nights, three nights a week kind of thing. Well, you know, let me ask you what happens when you don't brush your teeth for four nights in a row.

Mark: I don't know anymore. I haven't done it for a long time. 

Wil: What do you think would happen? 

Mark: Well, you'd get gunk on your teeth and they feel kind of ucky and I would just feel too guilty. 

Wil: And it would probably smell a little bit. And your family and your friends would probably say something to you about it, right? Maybe, right. So that's the thing, like we brush your teeth and we prevent that from happening. And so when we look at rehab, we wanna think about it in the same way, in terms of preventing the lack of mobility, the lack of the way our muscles function and help support our body. Our muscle, bone, which we call muscle skeletal, muscle bone system.

And then you wanna add the nervous system and all that, which coordinates the muscle bone. So that's called the neuromuscular system. Or the neuromuscular muscular skeletal system. Now the biggest difference though, however, is that if you missed a week of not doing your rehab or your physio exercise or you're strengthening, whatever it is, then you're not gonna necessarily feel it, especially if you've been doing a program for like six to eight months or up to year.

The thing is that it sets you up though. It sets you up to now going back to certain patterns or if you're engaged in either a sporting activity. Definitely with sporting activity, our clinic and our physios see a lot of athletes, from weekend warriors to more the athletes. To your grandmother or your mom that wants to just lift up the baby, or your grandson.

It's the same model and the same process. You gotta work on mobility of the joints, mobility of the muscles, your core strength, or what I call the stabilizing strength and what we call also the mobility strength or the functional strength. And that starts to get altered. And you don't really feel the effects and symptoms of your issue.

And especially if you've had a colourful history with your body with previous injury or injuries. Then what ends up happening is that lack of exercise commitment will add up and then it will lead you more prone to having a relapse of your pre existing thing. It may not be as serious, but you'll have something going on and you start to feel pain and pain is when you cross that threshold when things go wrong. When you start to have pain in your teeth and you get it tooth ache, when you get cavities. 

Mark: So the short answer to this is if you've got a program, you want to keep doing it. But what about if I haven't been hurt? What can I do? Say, I don't have any knee problems, but I don't want to have knee problems. What would be the prescription to prevent? What do I need to be doing? 

Wil: That's a great question. So in sort of our day and age and how we like do things now and just this modern time of sitting a lot and the lifestyles that we live and lead and how active we are. We tend to have certain patterns that our body like to go through. Especially if you're sitting and certain muscles, like in your hip flexors will get tight and your posture will get really adaptive, maladaptive I should say.

And so what happens is that then your muscles start to remember, sort of okay, that's how I wanna be. This is where the resting position is. So your hip flexors normally, if they're nice and relaxed, resting position should be like this, your hip flex will then be in a resting position like this maybe, especially if you're sitting all day long. And then you add on the effect of like, you know, then you 're training. And you're now trying to like, push your body and now you're doing these things and you're sitting eight hours a day or you could even be like a painter and you're doing this eight hours a day or something like that.

They're all repetitive movements, whether it's sitting repetitively, standing repetitively or doing something where your body is adapting a certain neuromuscular skeletal pattern. And then you add some kind of activity, whether it's like a high performance activity, a sport, or even just like playing with your kid, I just wanna look forward to having that time off after my work shift of eight hours on the computer and just play with my son or my daughter, whatever.

Then what happens is then your muscles that have become more maladaptive and you have to work on opening it, getting it back to the normal before that. And this is part of that whole like preventative, this is the self-care that we need to really do. There's certain movements. You don't necessarily have to do physio per se, but there's a lot of like things that, let's say, oh, you know, I wanna start to run my first half marathon. I wanna run my first 10 K. And you start increasing. That's when you usually run into trouble. And especially if now you're approaching late twenties, early thirties and you may not have had an injury, but you decide to go on a goal, some kind of physical activity goal. That's where you could potentially maybe come in in bit of trouble with your body, cuz you start to push it. And especially with things that are repetitive and always the same kind of movements. 

Mark: So again, what would help me? What are some of the suggestions that you would have for somebody for injury prevention? What things could they do, since they might not wanna come into a physio? 

Wil: Yeah. So there's a lot of things actually. Like number one is looking at your posture. So posture for sitting and standing. So if you work at home a lot, or if you're working like on a desk or on a computer a lot, research has shown that you wanna basically mix up your stance. Like you don't wanna be sitting all day long. You don't wanna be standing all day long. So you wanna have a sit to stand workstation.

You wanna make sure that you have the optimal posture for sitting and the optimal posture for standing. So you could, you could hire somebody or you might have a kinesiology friend or maybe a son or a daughter that's studied kinesiology or something like that to give you some basic tips on posture. Or you could get a more professional approach towards hiring, like maybe an ergonomics team or something like that through an occupational therapy consultant. Come in for a physio assessment to look at your posture if you want to. 

But short of that, you really wanna be more aware of like your posture, but also how your body feels. You're like, yeah, I feel a little tight, but then, you know, like a massage, and then yeah, there's something there. Okay maybe pay a little more attention to that. Maybe look at addressing certain things like, oh yeah, there's this stretching thing that I used to do when I used to run and, and I wanna get back into running. Maybe I should address that a little bit.

Or maybe I should roll out that part of that hip muscle a little more with a ball and then stretch it. Like there's all these proactive things that you can do. You can look up a lot of things online, but just be really careful with that too.

You wanna listen to your body? You wanna really like look at the alignment and not be in one prolonged stance or posture, especially if it's not optimal.

Mark: So, if we could encapsulate this a little bit, it's keep active. If you're gonna ramp things up, ramp it up slowly, so your body can adjust, but also your core is gonna be really important. So you talk a lot about activating your inner core and all those kinds of things. But also say something like Pilates or any other stretching type of exercise, yoga. I'm sure that, you know, in moderation, like always cause you can hurt yourself doing anything, I guess. 

Wil: Yeah, for sure. And you made really good point about you wanna keep active, and if you ramp up your activity level, then you wanna do these things. But most importantly, though, if you ramp up your activity level, you want to be more aware and self-aware about what's going on in your own body. And if you don't have a history of any kind of injury, you still want to be aware, you want to be like, okay, after a workout or a training session or a run or whatever it is that you engaging in, just pay attention to what your body's feeling cause is telling you something. 

And then these things like yoga and I'm not trying to endorse like yeah everyone to do one thing, you have to figure out what it is for you. And we have physiotherapists that are trained and basically able to assess looking at, oh, what's tight, what's weak, you know, and that's what we do.

And we can, we can do a functional assessment. So you're gonna do your first half marathon and you're just engaging in training. Great. So then we're gonna take everything into account. We're gonna look at what you do for work and your sitting position. And then we're gonna assess everything related to what you need to train successfully.

And so for you, you need to be able to, as someone that's partaking in your activity, be sort of looking at your activity, well, what am I doing? Okay. I'm gonna be playing volleyball. I'm gonna be jumping a lot. Okay. So right, hips, knees, ankles. And I'm gonna be hitting the ball, shoulder. So just be more aware of those parts the body that you're using. And take an inventory of it. And if it gets tight, maybe do some of these sketches that maybe some friends or coaches or whatever are suggesting, or that you may know from your repertoire.

If you start getting pain, monitor that, is it more than just, oh, I had a hard workout pain. And if it lasts for more than three to five days, that's when you definitely need to get it looked at.

Mark: So if you're in Vancouver and you have an injury, the guys to see are Insync Physio. You can book online at insyncphysio.com for the Vancouver office. They also have an office in North Burnaby or you can call them (604) 298-4878. Thanks for watching. Thanks Wil. 

Wil: You bet.

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.

Background: The knee and the injuries that are involved in this joint are proved to be common and difficult to rehabilitate. In this blog, we will focus on injuries specifically to one of the four ligaments of the knee as shown above. Ligament sprains/strains/tears are most commonly acquired through sport related activities. The most common by far is the ACL tear which usually requires surgery to fix and can force an athlete to miss entire seasons before training again. 

The best way to prevent a ligament sprain and especially a tear, is to maintain stability and strength in the muscles of the legs, glutes and core, ensuring you are warmed up before a workout/practice, and consulting a physiotherapist if you experience any sudden pain. Also, for prevention of any injury, be sure to stretch, ease into new exercises, and ensure you have a proper form with a stable base of support before and during an exercise (even in sports, think about how kicking a soccer ball for example affects your joints).

If you have injured your knee in the past, are currently rehabilitating, or would like to work at strengthening the ligaments of the knee for your personal athletic ventures, check out our latest series on the INSYNC youtube channel such as the ones here below!

Anterior Cruciate Ligament Knee Injury: Roller Bridges

Knee Ligament Injuries: Looped Band Bridges

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

pTHealth Canada. (2018). Ligaments of the Knee [Photo]. Retrieved from https://www.pthealth.ca/app/uploads/2018/10/knee-ligaments.jpg

What is a medial collateral ligament (MCL) sprain? 

The medial collateral ligament (MCL) is the knee ligament on the inner part of your knee. It is one of the four major knee ligaments that help stabilize the knee joint. An injury is caused when the a force is too great for the ligament to resist, thus causing an overstretch of the MCL. This can be caused by sudden movements such as a sharp change in direction, twisting the knee while the foot is planted on the ground, or a blunt force to the knee. 

Injury severity?
Grade I

The knee ligament has a slight stretch, but it doesn’t actually tear. Although the knee joint may not hurt or swell very much, a grade I sprain can increase the risk of a repeat injury. Resting from painful activity and icing the injury can be useful to subside the pain.  

Grade II

The knee ligament tears partially. Swelling and bruising around the injury site are common, and use of the knee joint is usually painful and difficult. Use of a weight-bearing brace, or supportive taping are common treatments of this sprain. A physiotherapist may also help by providing strengthening and joint exercises to guide the healing process. 

Grade III

The knee ligament fully tears. Swelling and bleeding can sometimes be present under the skin. The joint is unstable and it can be difficult to bear weight. You can also feel the knee giving way. With a grade III sprain, surrounding structures, such as the meniscus and/or ACL also become at risk of injury. A grade III sprain should be rehabilitated under the guidance of a physiotherapist and/or knee specialist. 

Prevention?

• Improve patellofemoral alignment 
• Improve your proprioception, agility and balance
• Improve your walking, running, and squatting techniques 
• Strengthen your knee, especially quadriceps and hamstrings

If you have any pain during exercises, or are unsure about what you are doing, please consult your local physiotherapist before continuing.

Healthwise Staff (2017). Medial collateral ligament injury.
Retrieved from https://www.healthlinkbc.ca/health-topics/abn2411