Category Archives for "injury"

Injury Prevention with Wil Seto

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 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.

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, 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. 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.

Knee Ligament Injuries

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

Medial Collateral Ligament (MCL) Injuries

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. 


  • 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

Which is Better for an Injury: Ice or Heat?

Ever wondered whether to use ice or heat for your sore muscles, your healing fracture, or any injury? Both ice and heat have been commonly used to treat an array of injuries, but when to use either one is critical in preventing further damage and promoting faster recovery.

Acute irritation or inflammation of a muscle, ligament, or tendon is typically treated with ice. The cold application reduces inflammation and numbs the pain, especially when the superficial tissues are red, hot, and swollen. The inflammatory response associated with damage to tissues is a defence mechanism in the human body that lasts for the first several days to protect against infection. The response involves immediate changes to blood flow, increased permeability of blood vessels, and flow of white blood cells to the affected site.


Ice can be used for gout flare-ups, headaches, sprains, and strains. It is crucial to apply ice to the site of injury during the first 48 hours post-injury to minimize swelling. For soft tissue injuries such as muscle strains or ligament sprains, an ice massage involving elevation of the injured body part above the heart and circular movement of an ice pack around the affected area may promote faster recovery of these acute injuries. Apply for 10 minutes at a time, then take a break from icing for another 10 minutes. Repeat this process 3 to 5 times a day. Remember to wrap the ice pack in a dry cloth or towel.


Heat can also be used for headaches, sprains, and strains as well as arthritis or tendinosis. Heat causes blood vessels to dilate which increases blood flow and relaxes tight or stiff muscles and joints. Do not use heat during the initial inflammatory response as this will further aggravate the site of injury. For minor injuries, applying heat for 15 to 20 minutes at a time may be sufficient to relieve tension. However, longer periods of heat application such as 30 minutes to an hour may be required for major chronic injuries. Hot baths, steamed towels, or moist heating packs can be used as different heat options.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Prevent Elbow Injuries in Young Throwers

Recent research has shown that nearly 40% of 7 to 18 year old baseball players endure elbow and shoulder pain during their baseball season. Nearly half of these injured players report their ongoing participation despite having pain. A recent epidemiological study of ulnar collateral ligament (UCL) injuries in athletes 17 to 20 years old reported the number of UCL reconstructions has increased dramatically for this age group. Early education and detection of elbow injuries in throwing sports may help reduce the number of overuse injuries from developing.


“Little league elbow,” or known as medial epicondyle apophysitis, is most commonly found in young throwers. Sports such as baseball, softball, tennis, or golf, can result in this overuse injury to the growth plate on the inside of the elbow. Repeated stress to the growth plates may cause inflammation and lead to pain or swelling. Serious injury may even result in separation of the growth plate from the rest of the bone. Players may also experience a reduced range of motion and a decreased ability to throw hard or far. A child experiencing any symptoms involving their arm should cease activity and see a pediatric specialist or their family physician. X-rays may be required to determine the extent of damage.


Prevention begins with identifying causative factors early in the season and adhering to strict guidelines such as the pitch count for young players and the duration of participation in a given year. Total body conditioning that involves strengthening the hip, back, and legs may help reduce the strain on the athlete’s arms. See below for exercises on how to stretch and strengthen the forearm.

Playing in a variety of sports rather than engaging in one particular sport, known as early sports specialization, may promote athletic dexterity and minimize risk of overuse injury.


Partial UCL ruptures can be successfully treated with nonsurgical treatment. However, with or without surgery, players must cease any throwing activity prior to undergoing an organized throwing rehabilitation protocol to reduce the risk of further progressing the injury. Promoting mental health is also important in the young athlete’s recovery period. Preventing the athlete from participating in their sport may result in significant psychosocial trauma. Therefore, special attention to the athlete and feelings of sadness or depression should be addressed with coping strategies.
Watch the video below on how to perform “nerve flossing” for chronic neck, shoulder, elbow pain or stiffness:

Watch the video below on how to warm up properly before games or training to prevent injuries and perform better:


InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

4 Things Young, Active Guys Do That Ruin Their Joints

It used to be that joint problems were something only older guys had to worry about.

But today orthopedic surgeons are seeing people in their 40s or younger for joint replacements. In fact, data from the National Center for Health Statistics finds the number of hip replacements has more than doubled in a 10-year span, skyrocketing by 205 percent in people ages 45 to 54.

Surgeons attribute the rise to people wanting to stay active as they age.

Today’s implants also last longer than they once did, so joint replacements are now an option at a younger age, since physicians aren’t as worried about having to replace them.

But while the surgeries are effective, we’d all prefer to skip a trip to the hospital, right?

Here, the top mistakes we all make when it comes to our joints and how to stay out of harm’s way.

You’re Only a Runner

Many patients seeking joint replacement are in good cardiovascular health, but not necessarily good physical health.

If you only run, you might have imbalances when it comes to muscle strength and flexibility. And this, paired with repetitive trauma over time, could lead to arthritis, causing your joints to wear away. It’s important to cross-train.

Giving certain muscle groups (like the ones you use on long, slow jogs) a break once or twice a week while activating new muscles (like the ones you might use sprinting) can fend off injury.

You Let Your Weight Go

When you run, your knee joints carry 7 to 9 times your body weight. While your body can handle this, some research suggests that runners aren’t at an increased risk for issues like osteoarthritis, so it’s important to keep the scale in check.

From a biomechanical standpoint, increased weight is a lot of stress. Overweight people are at a 40 percent or higher increased risk of a knee replacement down the line compared to those at normal weights. The link was even stronger in younger people.

You Skip Stretching

The key to joint health is achieving a good balance between strength and flexibility. As you get older, you need to spend as much time, if not more time, stretching than strengthening. Why? Because the more candles on the birthday cake, the less flexible your muscles become, and flexible muscles help keep joints mobile.

You Push Your Flexibility Too Far

Intense workouts like mud runs aren’t the only way to injure your joints. While exercises like yoga are great ways to boost flexibility and strength, anything extreme when it comes to range of motion—like reaching for that pose your body’s not quite ready for—can put you at risk for a joint injury.

When you create range of motion extremes, you can create bony spurs (projections along a bone’s edges) that may predispose you to arthritis. Your best bet isn’t to skip yoga but rather to stick with the modifications that work for you. And give yourself time before trying anything you might not be ready for.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

The Great Ice vs. Heat Confusion Debacle

What ice and heat are for:

Ice is for injuries, and heat is for muscles. Roughly.

Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. The inflammatory process is a healthy, normal, natural process that also happens to be incredibly painful and more biologically stubborn than it needs to be. Icing is mostly just a mild, drugless way of dulling the pain of inflammation. Examples: a freshly pulled muscle or a new case of IT band syndrome (which is more likely to respond than the other kind of runner’s knee, patellofemoral pain, because ITBS is superficial and PFPS is often a problem with deeper tissues).

Heat is for muscles, chronic pain, and stress — taking the edge off the pain of whole muscle spasms and trigger points, or conditions that are often dominated by them, like back pain and neck pain), for soothing the nervous system and the mind (stress and fear are major factors in many chronic pain problems, of course).

What ice and heat are not for:

Heat can make inflammation worse, and ice can make muscle tension and spasms worse, so they have the potential to do some mild harm when mixed up.

Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat — and when brains think there’s a threat, they may also amp up the pain.

But heat and inflammation are a particularly bad combination. If you add heat to an fresh injury, watch out: it’s going to get worse! If you heat a freshly injured knee, it can swell up like a balloon, and three times more painful. (That is a rare example of a particularly severe negative reaction to heat. Most cases are not going to be that bad!)

The lesser known threat is from icing at the wrong time, or when it’s unwanted.

If you ice painful muscles, be careful: it might get worse! Ice can aggravate sensations of muscle pain and stiffness, which are often present in low back and neck pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very condition people often try to treat with ice.

What about injured muscle?

If you’re supposed to ice injuries, but not muscle pain, what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.

Which is better?

Ice packs and heating pads are not especially powerful medicine: some experiments have shown that both have only mild benefits, and those benefits are roughly equal in treating back pain.

The bottom line

The bottom line is: use whatever feels best to you! Your own preference is the tie-breaker and probably the most important consideration. For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!

If you start to use one and you don’t like the feel of it… just switch to the other.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Prevent Common Cycling Injuries

It’s not uncommon for cyclists to encounter nagging injuries. The good news is that most of the common cycling injuries are preventable. You’ll soon discover themes among preventing many of the injuries:
  • Make sure your bike fits you.
  • Train wisely.
  • Increase your strength off the bike.
  • Stretch.
Not only will these things make you a stronger cyclist, they will greatly reduce your risk of injury. 
Here we go with some of the more common cycling injuries:

How To Prevent Foot Pain

What may cause you to get foot pain:
  • Poor fitting shoes.
  • Worn down shoes.
Prevention tips:
  • Buy bike shoes that are the right fit.
  • Make sure your shoes are loose enough and aren’t too tight for your feet.
  • Do the insole test: Take the insole out from your shoe, and put it against the bottom of your foot. No part of your foot should be outside the insole frame. If it is, get a bigger or wider shoe.
  • Over time your shoes will lose their support. If you don’t feel the time is right to go out and buy new shoes, or you otherwise believe your shoes are in fine shape, you can add supportive insoles to alleviate the issue.
  • Switch to a wider pedal to distribute the pressure across more of your foot.

How To Prevent Ankle Pain

Many times when cyclists feel a nagging pain around their ankle, it’s the Achilles tendon. The Achilles tendon attaches your calf to your heel.
What may cause you to get ankle pain:
  • Cleat position on your pedal.
  • Riding too much too soon, especially hills.
  • Tension in your lower leg muscles.
Prevention tips:
  • Try changing the cleat position on your pedal. Make sure your shoes aren’t too far forward. Cleats that are too far forward can strain the Achilles tendon as it forces it to pedal on your toes. You can reduce the tension on your Achilles tendon by having your toes pointed up during the bottom portion of the stroke, thereby taking care not to overwork it.
  • Build your mileage over time, especially when it comes to biking hills.
  • Stretch your calf muscles. When you are out riding, your calf muscles are in a near constant position so it’s important to counteract it.

How To Prevent Knee Pain

What may cause you to get knee pain:
  • Height of your bike seat.
  • Cleat position on your pedal.
  • Weakness or imbalance of your butt muscles.
  • Riding too much too soon, especially in a big gear.
Prevention tips:
  • Get a proper bike fit, including making sure you adjust your bike seat to the correct height. If the front of your knee hurts, try raising your seat height. If the back of your knee hurts, try lowering your seat height.
  • Include strength training as a part of your cycling routine. Focus on strengthening your outer gluteal muscles.
  • Reduce the amount of time you spend in big gears.
  • Ride at a higher cadence in an easier gear to reduce tension on your knees.
  • Increase your training gradually.

How To Prevent Hip Pain

What may cause you to get hip pain:
  • Riding too much too soon, especially in big gears.
  • Tight hip muscles.
Prevention tips:
  • Avoid riding too much in big gears.
  • Ride at a higher cadence in easier gears to reduce the pressure on your hips. A generally accepted cadence is 90+ rpm. If you’re unsure of what this feels like, and your odometer doesn’t tell you (or you don’t have an odometer!), try to find a stationary bike to test it out on. Stationary bikes generally provide the cadence at which you are pedaling.
  • Work on core strength so your core muscles can help your hip muscles when cycling to reduce the load off your hips.
  • Do stretches focusing on your hips.

How To Prevent Neck Pain

What may cause you to get neck pain:
  • Improper bike fit.
  • Riding in a tense position.
Prevention tips:
  • Keep your shoulders down and relaxed as you’re riding so you will avoid tension in your neck muscles.
  • Avoid over-reaching to your handlebars. If you find yourself doing this, some adjustments should be made to your bike fit.
  • Do gentle neck rolls and shoulder rolls. This is something you can do when you are stopped at an intersection or even while you are riding.

How To Prevent Wrist Pain And Numb Hands

What may cause you to get hand pain:
  • Too much pressure on the handlebars.
  • Improper positioning of your hands.
  • Poor positioning of handlebars.
Prevention tips:
  • Avoid putting too much pressure on the handlebars.
  • Hold the handlebars in neutral position, so your wrists are not angled at a position that is too high or too low.
  • Every now and then release a hand from the handlebar as you are riding and shake your hand out.
  • Wear padded gloves to minimize the direct pressure placed on the handlebars.
  • Adjust your handlebars to avoid putting unnecessary weight from your upper body on them.

Tips To Stay Healthy And Injury-free

You may have noticed some common themes among preventing these cycling injuries!
  • Have a bike that is properly fitted for you! This is one of the best ways to avoid many common cycling injuries.
  • Ramp up your mileage strategically. Record your rides so you can track your progress and you can tell whether you are riding too much too soon.
  • Increase your overall strength. Sure, riding a bike will build those leg muscles, but you also want to complement that, as well as work towards any problems with muscle imbalance. Also don’t forget about your core. Your core muscles are your foundation and assist your other muscles, including legs, in cycling. Your core also contributes to good posture on your bike, and you know good posture is also key in keeping injuries at bay!
  • When you’re riding, you can be in a sustained position for awhile, leading to tight muscles. It’s important to counteract that through working on your flexibility. There are some great yoga poses that can help in off-setting that tension.
InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.

How to Treat a Pulled Muscle in 7 Steps

Every time you exercise, you put microscopic tears in your muscles. That’s what’s behind that next-day hurts-so-good soreness. And after your body repairs these tears, you become stronger, faster, and fitter. But if you stretch a muscle too far, lift too much, or are working out with a muscle imbalance, you might not just have microscopic tears to deal with. You could literally tear your muscle into pieces. We have your solution.

Pulls, sprains, and tears (all the same thing) range in severity. Grade 1 means the injury hurts but you can still move the muscle without too much trouble and it could heal in less than a week. Grade 3 means the muscle has ripped clean off of your tendon or bone and you’ll probably need surgery to reattach it. Ouch.

Think of your muscles like a piece of fabric that you’re holding in front of you, between your two hands, If you were to pull that fabric in opposite directions, it would stretch up to a certain point. If you continued to pull, some of those fibers would start to break. Then, given enough force, the entire thing would eventually rip right in half. Yeahhh, your muscles can do the same thing. Fun times.

Despite the gnarly description, exercisers rarely know how to treat a pulled muscle or do anything to treat their muscle sprains. They just try to tough it out. Bad idea. When not treated properly, even seemingly minor pulls can contribute to more severe ones later on. And those can send you to surgery and take you out of commission of several months.

Plus, if you do have a serious strain, you only have a window of a few weeks before your doctor really can’t do anything for you.

So how do you know if your post-workout pain is a strain? Typically, the pain will be sharp, intense, and localized to one specific spot along your muscle, Beckstrand says. Massaging the area will likely hurt, and you may even feel a knot. While it generally hurts less when you’re resting the muscle, it may still feel uncomfortable and spasm. Usually, the pain comes on all at once.

Sound all too familiar? Here’s how to treat a pulled muscle and feel better STAT:

1. Elevate, compress, and ice it.

The sooner you can get the pulled muscle above your heart, apply compression, and ice it, the better. All will help reduce inflammation and keep blood from pooling in your muscle—because, yes, torn muscles can bleed. Ice it for 15 minutes every hour or two for at least 24 hours following the pull, and continue elevating the area for an entire week whenever possible. As far as compression goes, it is recommended to wear a neoprene sleeve, ACE wrap, or compression garment to squeeze excess blood out of the area, support the muscle, and speed recovery. Wait at least a week to wean yourself off of compression gear.

2. Avoid pain medications.

Granted, of course, you can bear it. Pain medications like over-the-counter anti-inflammatory drugs may not be your friend here. By interfering with the normal inflammatory process—an important part of healing—pain medications may interfere with the cascade of events needed to jump-start tissue regeneration and repair. If you do take pain meds, make sure to follow the bottle’s directions. If they say to take two, don’t go ahead and take three.

3. Watch for bruising.

If a bruise pops up around the pain site, your pulled muscle is likely serious. Bruising occurs when the muscle is torn so badly that it bleeds into your body. That’s a surefire sign you need to go to the doctor. But keep in mind, if the tear is deep in your muscle, it could take a few days for any blood to rise to your skin’s surface and cause bruising, she says.

4. Don’t stretch or roll it out.

At least don’t do it immediately after pulling it. After all, stretching a sprained muscle will only pull the torn ends farther apart, potentially making things a whole lot worse. The same goes for foam rolling. Give it a chance to try to knit back together before you get too aggressive with the foam roller. There’s a time and place for that but it’s not in the acute phase. If the strain is minor—and most are—you can try gently rolling the muscle a few days after pulling it. If foam rolling hurts, back off and try again in a couple days.

5. See a doctor.

The biggest issue I see with muscle strains is that people wait way too long before they come in to get help. After a few weeks, your body has already tried to heal itself, which often results in permanent scarring and tissue damage. Rehab for a muscle strain becomes much more difficult with time. It is recommended that if you’re experiencing symptoms of a muscle strain injury, don’t let symptoms go on for longer than two weeks without consulting your medical provider. The ideal expert is a physical therapist. Before scheduling an appointment, call your insurance company and find out if you have to see a primary care first to get a referral. Some insurance companies insist on a referral, and you want to make sure all visits are covered.

6. Take it easy.

Depending on the severity of your strain, you may need to take anywhere from a few days to a few months off of exercise so that the muscle can heal itself. When you do head back to the gym, start with gentle bodyweight exercises (no plyometrics). Progressively add more sets, reps, and eventually weight. All the while, remember that the muscle should never hurt. If it does, stop the exercise and either try a different variation or back off entirely.

7. Consider what went wrong.

As long as your pulled muscle isn’t a case of “I tripped and fell,” you need to address the cause of your muscle pull. You may have a muscle imbalance that, if left untreated, will continue to contribute muscle strain. (For instance, runners often suffer hamstring tears because their glutes are too weak, she says.) Consider how you’re training all of the muscles in your injured body part. And don’t hesitate to talk to a physical therapist or exercise physiologist about how you can correct any muscle imbalances.

InSync Physiotherapy is a multi-award winning health clinic helping you in Sports Injuries, Physiotherapy, Exercise Rehabilitation, Massage Therapy, Acupuncture & IMS.