Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto, he's the principal at Insync Physio, physiotherapists in Vancouver, BC, Canada. We're gonna talk about knee injuries from rock climbing. How you doing Wil? 

Wil: Hey, I'm doing great. Thanks, Mark. Yeah, rock climbing injuries related to the knee. It's a good topic.

Mark: So what's typically causing this? 

Wil: Well, there's one really main one, like in terms of rock climbing. It doesn't matter if you're looking at what kind of rock climbing that you're doing, cause there's different styles or types, I guess, categories. Like there's what's called bouldering, or you're not using a harness or a rope. And you're essentially climbing a boulders. And in the advent of gym's popping up with bouldering gyms you know, you you have a lot more of these sort of knee injuries related to the rock climbing.

And then also in sport climbing where you're climbing up with your rope and you're doing certain maneuvers that are more technical that can cause strains into the ligaments, especially in the knee or into sort of like that cushiony area that sits between the two bones and knee and the knee joint called the meniscus.

So yeah, I wanna talk a little bit about that today because that's something that I think is really important to really understand and also look at how that can be preventable. 

Mark: So what symptoms is someone gonna exhibit other than their knee hurts?

Wil: Sometimes they may actually swell up and so you might see some inflammation into there. And so there might be what we call the sharp, you know, principle where you have an injury. Sharp is an acronym. S stands for swelling. H stands for, there's heat, it feels hot. A is the altered function. R is for redness. So it's like discolouration in red from the swelling. And then the P is basically the pain. 

And so that's usually sort of a good little acronym to go by. And then, typically it will also hurt and feel like you don't really want to use that leg and that knee for specific maneuvers when you're climbing. And there's two real common ways of injuring it actually in technical aspects of climbing, where you're looking at what's called the heel hook, where you're basically using your heel and your foot like a lever. Kind of keep yourself up and it takes the weight off of your hands and arms a little bit more. And it also just helps with your body position. Sometimes body position and balance with a heel hook can really help you through the next move. So there's that part of it. 

And then the other part that can really contribute to an injury, is really just looking at when you're climbing that is, is when you're rotating excessively and you're dropping your knee to the point where it goes beyond the range and it can injure the meniscus. 

Mark: So when you're diagnosing it, does it make much difference, what the course of treatment is based on what you diagnose? 

Wil: Yeah, absolutely. So if it's an instance of you know, like a ligament strain or tear, then it's a typical four to six week timeframe, kind of thing, in terms of being a more of a mild to moderate injury. Where you're looking at it being from a full healing, full recovery, and fully rehabbed.

And so being fully rehabbed that final stage means that now you have the right things that you're doing to make it strong and feel like you can climb 100% and feel like you know what you're doing and then you're not gonna re-injure it.

And that's gonna be a process too, as you go through that recovery, the healing recovery and rehab phase. And for a mild injury it would take like four to six weeks and then get more moderate into more severe. So that would be definitely going beyond that timeframe a little bit more. And that's important to recognize.

Mark: What if it's a meniscus tear or some other thing like that, as opposed to a ligament?

Wil: Those can be a little trickier. And the reason why is because you're meniscus, it doesn't have the same blood supply or the nerve supply. So sometimes you might even hurt as much, but it's just locked. Sometimes the symptoms are a bit different, so they can really alter your function. So going back to that whole sharp acronym. So your altered movement and function is going to be more noticeable. 

So one of the other aspects I didn't actually talk about with bouldering is the falling part where you're falling right on the knee, you're not falling properly. So you wanna like do kind of like a fall and roll and really not fall on like extended knee and that's where you injure ligaments potentially, and then have more impact on the meniscus.

So that meniscus injury can be more complex. And then if it doesn't retain more normal functioning of the knee joint that's been injured, then we wanna look at more of a diagnostic next step. Because that way that'll help guide us towards management and then ultimately the rehab.

Mark: And how often does a knee injury require maybe surgical intervention? 

Wil: That all depends. I guess from my experience, it can be like, I would say outta the knee injuries like maybe 25% of the time. Depending like from even more serious major ligament ruptures into some more of the major ligaments that don't happen as often in rock climbing.

But I have seen it like the ACL which is one of the major ligaments of the knee to like meniscal injuries and very rarely do you get surgery done on like your collateral ligaments in the knee. So those are the side ligaments. And so the reason why it really depends is you wanna avoid going under and having it surgically operated if you can.

And so really the goal is to retain that function. Say you even have a meniscal tear, you want to just retain that function and get it rehabbed properly. Because the more that you can preserve that meniscus without having to snip it away and get into the knee and really surgically operate it, then the better it's gonna be in the long run. So that's key. Because if you're rehabbing and you're trying to really push through this and it's just not getting any better and you can't even walk, then getting in there and doing something about it, if we've had the proper diagnosis and have followed the proper channel of the medical path and looking at, you know, what's going on. That's when we wanna maybe look at more that surgical intervention that can help. 

Mark: How often is overtraining a component of knee pain in rock climbing? 

Wil: I think that with overtraining, it has a factor. More in the aspect where like if you're not using your core and you're doing like what's called a lazy type of heel hook and you're doing a lazy knee drop where you're over rotating and you're not engaging the core and you're not fully connected with that lower part of your body, with being on the wall or on the rock, then that can lead you to really cause your range to be over extended.

Or to get into that position of the knee where then it's more compromised. And then ultimately you add that with then you go to torque for some more difficult maneuver or move or using more power force. Or you have a fall on a rope or on the boulder and then you land, then that's a combination of it's been overused and you're not strong enough, and then you have the trauma on top of that.

So, it's kind of a tricky question because it's like sometimes people like say, yeah, it didn't start hurting until I had the fall. But then they've been doing things like they've been noticing that's been feeling tight doing that specific heal hook maneuver. Or that knee dropping maneuver. And so these are things that you need to look for, even just for those little things. And they should not last for more than like, you know, five or six days. Those little kind of things that you notice in your body and your knee, especially. 

Mark: How much is working someone through that so that they don't overtrain, they use their body properly, is incorporated into the rehab process?

Wil: Oh, it's super important because if it's not incorporated and it's not part of your rehab routine, then it can very well happen again. And then you can also get something worse happening or you can have something else happening.

A really good example, we had a client that came in that had this happen and rehabbed the knee properly. But then stopped doing the routine and the exercise of keeping it strong and then started to have back problems because they weren't engaging in the core. So it's kinda like you go in to see your dentist and you have cavities, and then now he's like, do you brush your teeth every day? No, I try to do it once a day. And then your dentist says, well, maybe it'd be good if you do it twice a day. I think that'd be really good. And then it's gonna help your cavity prevention even better. So you do that for the first little while, but then you stop that. It's the same thing. 

Mark: If you're having some knee pain from your rock climbing, if you've had a fall, if you've got some kind of trauma that you wanna get looked after, the guys to see in Vancouver are Insync Physio. You can reach them on their website. You can book for either location in North Burnaby or in Vancouver at insyncphysio.com. Or you can call the Vancouver office, (604) 566-9716. You have to call and book ahead. They're always busy. And they'll get you moving right and better. Better than ever. Thanks Wil. 

Wil: Yeah, you're welcome. Thank you, Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physiotherapy in Vancouver. We're gonna talk about knee injuries from running. How you doing Wil? 

Wil: I'm doing well, thanks. How about you? 

Mark: Good. So is it typical that your knee would swell up or is it just a pain thing from a knee injury from running?

Wil: Yeah. So if you get swelling in your knee and you run, like whether you're a recreational runner or someone who's a little more avid or competitive, that's not normal. So there is probably something going on and it could be like a few different things.

But primarily when we look at like the main things that could be happening in the knee, if like, say you've never had an injury before and you didn't like twist it or you didn't have any specific trauma, then it's most likely an overuse repetitive thing going on. And there's a few different kinds of things that could be happening.

Like number one, it could be an overuse IT band issue. So it's sort of like a connective tissue thing because there's a lot of imbalances in the muscles. And so typically going back to this whole like overuse and imbalance, that's usually what it is. So whether it's like an overuse imbalance where the IT band is pulling on the kneecap in a certain way, or it's like maybe a tight hip flexor that's pulling in on the kneecap, like with the quad muscle. Which is one of the quad muscles. There's four muscles that make up the quad. One of them is actually a hip flexer. And so that and then coupled with, okay, so how is the running gait? Like, how is your actual stride frequency?

Like what is your stride per minute kind of thing and what is your actual technique look like and how is your overall form. So we go from like your cadence to your vertical form and how much you're leaning into it and what that looks like when you're taking a step on each foot. So we can determine that. 

Because that's important to look at and then we assess you a little more closely with that muscle imbalance. Are you really weak, like say in your glute med? And is that glute med in your butt, that butt muscle not stabilizing your knee? Then you're not getting that stabilization where you're taking so many steps per minute, then you're just gonna have that sort of faulty mechanical problem happening over and over and over again. And you go for your training run and this can be something that starts to ensue. 

And it usually happens when you start to do a few things. Like you start to increase your training, so you start to increase the intensity, whether it's through more speed work or hill work or even more mileage. Say like you're training for something that's a little more intense, like a marathon or half marathon even. Or you're looking at off road training, where you're not looking at training for a trail race or something like that where you're getting on cambered surfaces and now that's a little bit more gnarly and harder and you gotta have more of that stability core strength.

Now obviously having a preexisting injury or where you've injured yourself before, that can play a factor. Because if you have something that you never fully rehabbed from, like say you sprained your ankle, then that can work its way up into stuff that's happening in your hip, hip flexer, and in your knee. And so I'm seeing somebody right now that has that exact problem. Where they've never had any problems, they're an avid runner and they ran a half marathon back in the 1st of February, the first half. And they sprained their ankles. It was an old sprain, but they never fully rehabbed it properly.

And they had been compensating and this person did a great job of compensating. Excellent job. They were able to get by and, and run the half marathon, but then started getting knee pain after. Obviously, you know, she pushed her pace and got bit of a personal best, but like, you know, she couldn't figure out why she was having knee pain.

Mark: So when you're diagnosing something like that, what do you see? Is it a gait issue? You sort of mentioned three things, so over training, a gait issue or an old injury, like what's the split between those? 

Wil: Yeah, that's a good question. So the gait allows us to see sort of the functional, bigger picture of what's happening and what they're doing. Now, if they have like a specific impairment already, then their gait's gonna be affected. Like if they're limping in, we're not gonna set your gait right away. We're gonna wait until that impairment part of things are healed up, whatever it is. So then when we look at the muscle imbalance part of it, then that's where we really wanna assess like, okay, so what is actually imbalanced.

So what's weak? What's tight? What's being overused? What's being over activated and what's being under activated? And then also the structure. So is there maybe something else going on in here? Is there like an old injury that they maybe don't remember? Like is there like a deficient ligament here that maybe got injured because it's deficient now? Or possibly a meniscus or a cartilage issue, maybe. Those are a little bit harder to ascertain in an actual assessment. But you can start to point towards those areas in that direction if you suspect a certain thing. 

Mark: So how much of the rehab processes, like maybe manual therapy or IMS, and how much of it is some weight training, load-bearing training that's strengthening, weakened parts in the chain of muscles. So your knee actually operates properly while you're running? 

Wil: Yeah, it depends. And so when we look at the manual therapy and the IMS and all the stuff that we do for you and on you, those are just things to facilitate and to reset what's going on and to facilitate a more optimal movement pattern. And same with the exercise prescriptions that we give that are tailored to address what's weak and address what's tight or not activated or under activated or what's over activated. Because we wanna essentially reinforce a more optimal movement pattern in that joint or joints, cuz it's usually more than just one part. So if you're getting knee pain, you know well what's going on in the hip?

Mark: And typical course of treatment? 

Wil: It depends. Like we had some people that got fixed in one shot. Like it's amazing. There was this one gal, that all I did was just change her gait pattern. And after one session we changed, I mean she had a tight IT band, so she had an IT band overuse injury. So we settled that down and then changed her gait pattern, night and day. Like, she couldn't even run past 5k after a 5k run, she was always having extreme and pain and it would swell up. After that first session, she was running like 10, 15 K, no problem. 

And then there's other individuals where it's more of a gradual process. So it's a little bit more involved. So it really depends on the individual. And then if you add other injuries that you've had on top of that and you're like compensating and you haven't really fully rehabbed. Like, here's the thing, you can feel good and you feel pretty decent, until you don't. But you don't know that you have deficiencies and you just think that you're doing okay, then that could be a problem. 

Mark: Is it fair to say that the sooner someone gets in, if they're starting to notice something, the easier and quicker it's gonna be to heal it up in most cases. And then as well, once they've got a prescription, don't stop, when you find what works. Don't immediately stop , keep going. 

Wil: Yeah, that's pretty accurate. But what I would say is a rule of thumb, like let's say you go on a run or a training run, and especially if it's a little bit harder and you're a little bit more sore and you're like, oh, a little bit swelling in the knee, and then you ice it. You do the things that you know that you shouldn't do to calm it down. If it doesn't calm down after a few days, that's when you should be getting looked at. 

But yeah, it's fair to say, you know, give it a couple days and then if it happens again, like say it calms down after two, three days and then you go, oh, it happens again. And then that's when you definitely wanna get looked at. Because you wanna assess what's going on. And especially if you know, oh yeah, like I did have that, I tried skiing like a year ago and I had a little minor tweak. Oh yeah, that's right. I remember that. Or, you know, like it could just be something as simple as like you fell on your knee and you had like a contusion, like swelling type of thing, where it went away and you don't think. 

Swelling in itself in your knee from whatever cause it could be like a ligament tear, but even, let's say you got whacked in the knee by like, you know, I don't know, whatever. Let's say your, hockey stick playing. Yeah, hockey stick and nothing has technically been torn, but the swelling, the mere fact of the swelling can actually shut down muscle activation patterns.

Mark: And that's where you can help with reestablishing the proper chain of events that need to happen that we take for granted, cuz it's all unconscious. But that can really be, we can overcompensate in a lot of mysterious and not good ways. 

Wil: Especially when you get into that part where you hit the threshold where now you have dysfunction and pain because that's now an indicator. Think of that point where you cross that threshold and you feel pain and definitely dysfunction, as now the indicator that something is wrong. No different than when you're driving and you look at your dashboard and you see the flashlight indicator, the check engine. You're gonna ignore it?

You put the tape on it. Yeah. Yeah. You can put the tape on it and ignore, or you can bring it into your mechanic and do something about it. 

Mark: If you want expert help for your aches and pains, especially knee injuries, knee swelling from running. The guys to see are Insync Physio in Vancouver. You can book online at insyncphysio.com. You can call the Vancouver office to book (604) 566-9716. Get in there, get running better. Set a new PB. Thanks, Wil. 

Wil: You bet. Thank you, Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, BC, Canada. We're gonna talk about an issue that's happens mostly with young gentlemen as they're growing. How you doing Iyad? 

Iyad: Good Mark. How are you? 

Mark: Good. Awesome. Fancy name for this one. 

Iyad: Osgood Schlatters Disease. And then we have a few other types of things that kind of fall in the same category of injuries. So the most common one, most people will know this as Osgood Disease or Osgood Schlatters Disease, and usually affects boys as they're going into the adolescent years, and tends to be from an issue of overactivity, like doing a bit too much, a bit more than they're able to handle.

And it comes in as like pain in the front of the knee and it'll affect you right under where the kneecap is. And we tend to see this a lot with people over a long period of time where they're just persisting through a bit of pain, and they're just kind of patching up and managing, and just kind of going along and playing a lot of soccer and maybe a high impact jumping sports.

So I've recently been seeing a couple of gymnasts who've had this cuz of all the tumbling that they're doing, and the way it kind of presents is just like localized knee pain. Really painful with impact weight bearing and sometimes also resisted exercise because you know, your quads pull right on that spot that hurts in the knee.

So yeah, usually when the bone's sore, you can't really do much with it. And you know, it's one of those things that most people will look online and read that it's self-limiting. And it typically is when, you know, most kids grow out of it. The annoying thing and the unfortunate thing is it can be really, really painful and it can like actually stop kids from being as active as they'd wanna be and maybe participating in the sports that they want to do.

And it's usually really funny cuz sometimes when we advise parents on like, well your kid's probably doing a bit too much and maybe we need to change some of the training routine a bit. And not necessarily just with rest, but also to modify a few activities, maybe do more of something and less of something else.

It's met with a bit of this kind of, oh, well, it's self limiting, so we'll just leave it be, but then, you know, it's not really a fun condition cuz it can really affect people's activity level. Especially a lot of young, active kids. They really love sports. Gives them a bit of identity, gives them something to explode their energy into. So that's one of the most common ones. 

We also have something similar to it that can affect the heel, which is called Sever's Disease. And it's the same idea as where you have pain just in the heel where the achilles tendon inserts and it happens from the same thing usually. Lot of activity, repetitive impact.

This one I see a lot in soccer and I guess also, because if you think about the cleats, they don't really give you lots of cushion support. And here in Vancouver we have a lot of turf fields, which are really nice, ripe for impact. And they don't give you as much cushion as grass does. And that could be one of the factors. 

Obviously it's a little more than that, but it tends to be also one of those volume related things. So if you are doing just a bit too much, not getting enough adequate recovery, maybe there's also some other risk factors that could predispose the kid to getting it sooner than later.

But there's so many factors in there. But it tends to be one of those things where we would see, and you know, then people usually come in when they're kids, like a lot of pain. 

Mark: So what, is there a root cause to this other than just over-training? 

Iyad: That's the most common one. Unless the kid has some form of like, let's say bone abnormality, it tends to be that. The other thing to keep in mind is like as kids are growing their bones, like we, stuff like good open growth plates. So the bones are a little softer than you would expect in let's say immature kid or somebody who's like, let's say in, in their teen years, and the tendon is not, let's say, a weak structure.

So the tendon even tensioning through the bone, puts a bit of a force. And if that happens, like let's say enough, you might ask, well, why does the tendon not get affected? Well, in those age groups, the tendon sometimes could be a little stronger and they're a little better at handling the loads than the bone. And then that's usually could present that way. 

Now with boys, if they develop this as they're into their teenage years, a little further in, they'll develop more likely things like lip patellar tendon problems, which is the pain just immediately under the kneecap, and they'll get a bit less of their bones getting involved.

Like the most common people I see in the clinic with Osgood Disease, and this is not based on any studies, is they tend to be between 9 and 13. Those are the most common ages I'll see them in. And it tends to be kids who are just, are incredibly active, which is a great thing but maybe doing a bit more than their bodies able to handle all at once.

Mark: And so is the diagnosis, is it fairly straightforward?

Iyad: Tends to be. I usually confirm with some form of imaging. Like if we need that, but it tends to be pretty easy to diagnose in the absence of a few things. Obviously if somebody comes in unable to weight bear, we wanna look at that. We wanna look at that pretty seriously, cuz kid not being able to weight bear, I would highly encourage everybody to go check with their physician right away. And this is like, cuz it doesn't tend to happen so much. And then it's one of those things where we just wanna remain vigilant for some of the things that could be a bit more serious than like, let's say just the early stages of Osgoods or Sever's. 

So that weight bearing thing can be really important. Sometimes kids with hip pain can also report knee pain. So they can actually come in with knee pain when it's actually just the hip. Well, that's also something we wanna consider. We wanna kind of keep an eye out for.

But yeah, for the most part most of us working in orthopedics get to identify that pretty well. And then sometimes a need confirmation with an x-ray and sometimes it's really just confirming kind of what you already know.

Mark: So the treatment generally is then a little bit more flexibility in the training program. A little bit lighter training program. What does that look like? 

Iyad: Potentially that, or sometimes we just get 'em training different things. So for example, if you're doing training for like cardiovascular fitness. You're just doing a lot of aerobic exercise. Well, there's some things that you could do that are probably a little less strenuous.

So that's one of the things we would do right away. We've gotta keep the kids active and keep 'em busy. And then if we're out of the very, very acute phases, we start some strengthening program, which can help with their ability to tolerate more impact. We could also change some, again, it depends on extensive it is and how bad it is and how necessary it is. 

Sometimes we could also look at running retraining and could look at strengthening up and down the chain. Because if you get somebody who's really sore, let's say with Osgood Schlatters Disease, and then you try to give them quad exercise, that might be really, really sore early on.

But later on it might be actually appropriate where you're trying to get them to do a bit more of that good load to the system to get them a bit more used to, let's say the good stressors that you would wanna put through their body and gets them a bit more adapted to the stresses.

Mark: If your child is having some issues with knee pain, heel pain, get into Insync Physio in North Burnaby. You can book online at insyncphysio.com. You can book for the Vancouver office there as well. You can call as well, Burnaby office is (604) 298-4878. You have to book ahead. They're always busy. Insync Physio in North Burnaby. Thanks Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver, Vancouver's best physiotherapy office, many time winners of best physiotherapists in Vancouver as voted by their customers. And we're gonna talk about Ultimate Frisbee knee pain. What's different about Ultimate Frisbee and knee pain Wil?

Wil: Well there's a couple of things I want to address with that. So there's the traumatic side of things, where you can have an impact injury or something happens where you maybe not have an impact from another player or contact injury, where you might have done something to it. So the traumatic injury. You might have strained something or torn something from another ligament or a tendon or something related inside of knee joint, like a meniscus. 

So basically that traumatic injury, you know, those ones they happen definitely a lot, but the other side of things are the non-traumatic type of knee injuries and non-traumatic knee pain that also happens quite a bit. A lot of players, when they're playing Ultimate, and I've worked with a lot of different Ultimate players from different national teams, from different world championships, world games where, you know, it happens at all levels. So it's not just the beginner is starting off.

It happens even with the intermediate, more advanced veteran to like, they're competitive, like world class type of player. And so I wanna talk a little bit more about that today, the non-traumatic type of injuries. And those are the ones that are like, well, I don't know really what's going on. I didn't really do anything. Or they may not necessarily feel the pain until later on after the game or later on that night after you take a shower or waking up the next day. And then it sort of gradually builds or it may feel more sore at the beginning of a practice or warmup or when they first start playing. But then it kind of goes away, but then it it sore again after.

So those are classic symptoms that we see quite often with Ultimate Frisbee players. And so we treat a lot of Ultimate Frisbee players at our clinic. You know, we've been working with the Vancouver Ultimate Frisbee League for quite some time now in partnership. And so with these type of non-traumatic injuries, what we see a lot of is this specific type of knee issue, it's called the iliotibial band syndrome.

And it's basically a movement dysfunction issue. And so you can build up a lot of imbalance where you have this thing called the IT band. It's a connective tissue that basically connects from the outer upper part of the hip, all the way down to the outer part of the thigh, lateral thigh, the knee, and its function is to really hold the thigh muscle and then part of that lateral hamstring and all those muscles on the side that tied together. 

But like when everything starts to get really tight, you gotta ask in the history, how are you recovering from your games? How are you recovering from your workout training sessions? And that usually says a lot too. And so they're probably not doing the proper things to recover those muscles and they start to pull onto that fascia or that connective tissue to the IT band, and causing that knee pain, which is usually more on the lateral or the outside of the knee. So that's your classic symptom presentation of this type of non-traumatic knee pain, most often. 

Mark: So the possible causes really are over training and not recovering properly. Could we sum it up that way? 

Wil: Yeah, pretty much. You kinda have to dig a little bit too, history wise because, you know, there's a few Ultimate players that we're treating now that they've had some injuries in the past.

So for example, you know, if you've had an injury on the other knee, okay, so now you're compensating a little bit more on your knee that is now affected. So that compensation, you know, is why you're getting the knee pain and so there may be stuff that's going on, right, where you never fully rehabbed, or it's not fully strong enough on that knee that you originally injured and you're compensating on that knee that's now affected, that you have that gradual pain. They're like, this isn't even my injured side. I don't know what's going on. We hear that a lot. 

Mark: So you've diagnosed it, you've dug into the history, you're pretty clear on the direction, what's the course of treatment look like? 

Wil: So we wanna look at what the driving factors are to this knee pain. So what are the muscles that are really tight and pulling on it. Or is it the IT band just really super tight for whatever reason. And usually though it's a series or a few different areas pulling on it. So you gotta figure out what it is. And so once you figure that out and you start to work on increasing that mobility in those areas, then what's really important is to address the functional part of it.

So you gotta get things stronger, but then you have to help that person retrain the way they do their sprints again. The way they cut. The way they want to move on the field because if we just release it, it'll help for a little bit, but it'll most likely come back if you don't do other things to, you know, even strengthening, we can give you some strengthening release stuff. But likelihood of it coming back is pretty high, if you don't address that muscle activation pattern.

So could we sum that up even as saying like, when you've injured yourself or in the gradual process of injuring yourself, you've adopted unconsciously ways of moving that are not good. They're gonna cause the issue to come back up again. And that needs to be addressed. That needs to be, you need to relearn that basically somatically.

Yep, exactly. Yeah. You need to relearn that on a neuromuscular level. That's a big word, but it's basically trying to learn how to walk again for the first time like after you've been on crutches because you broke your leg and now you're like fresh out of the cast or whatever. But it's harder to actually relate with it because now, well I've been running and I'm playing, so I don't know what's wrong. Like why do I need to relearn that? But like, it's amazing how when we show people and we give people the exercises to do that are weak, they're like, oh my God, I can't believe how weak this is. Or, oh, I never realized. Like, I can actually play a full game, but I can't even do like one set of 10 of what you're giving me here because it's so difficult.

Mark: Expert diagnosis, expert exercise prescription so that you don't re-injure yourself. The people to see are Insync Physio. You can book online at insyncphysio.com. They have two offices in Vancouver and North Burnaby. You can call the Vancouver office, (604) 566-9716 to book your appointment. You gotta call and book ahead. They're always busy. Thanks Wil. 

Wil: Thanks Mark.

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

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

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

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

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

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

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

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

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

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

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

Thank you Mark.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wil: Thanks Mark.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wil: No problem.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physiotherapy in Vancouver. They're on Cambie Street and we're going to talk about knee injuries from rock climbing. How you doing Wil? 

Wil: I'm doing good. Thanks. 

Mark: So knee injuries, rock climbing. That doesn't make sense. How do you hurt your knees rock climbing? 

Wil: Yeah. So typically we injure our knees through like running sports mostly, and sports like Ultimate Frisbee, things that involve cutting. And quite commonly, you know, it's either a ligament or more specifically in what's called your meniscus. And so in rock climbing, the most common way to injure your knee and the structure that gets injured is the meniscus. And I'll explain to you what that is in a second. 

And so there are three ways of injuring it, really. Three main ways. So you're doing these maneuvers and essentially it's like now, when you look at the evolution of rock climbing, you have these moves that you make that are so much more dynamic, so much more involving the whole body.

And we're still used to training mostly just with our upper body. When you think of rock climbing, you think of just mostly upper body strength. And so when we don't have a strong, lower body and we're not tensioning through the lower extremity and through the knee in that way, then this is how we can injure the meniscus.

And so when we do things like what's called a heel hook where you bring you heel up high, and you're trying to use that as a lever to offload your upper extremities. Then basically what happens is that then you know, that can really injure meniscus and cause damage to there. 

Another maneuver is basically doing what's called a drop knee. And a drop me is basically when you're rotating, like you're, you're basically pivoting off of your toe, and you're internally rotating your hip in such a way where that rotation gets magnified in the knee. And if you don't have like a tension in that knee to hold it in, then it's a lot more wonky and wobbly, and then you tend to torsion it right at that meniscus. So if you can imagine that. 

And the third way is basically, as you imagine, when you're climbing, you're doing this maneuver called a high step. And so with high stepping, it's like bringing your, it's just basically exactly what it sounds. You're trying to bring your foot up high and then you're trying to reach and climb and you got your foot up high.

And at the same time, you're trying to push off that knee and balance yourself. But if you don't have the proper tension, once again, that that knee can get a little wobbly and cause some torsion on the outer edges of that meniscus. 

So what is a meniscus? So the meniscus is basically that spongy part that fits between the two bones between what's called your femur, your thighbone, and then your tibia, which is your lower leg bone. And it's provides protection in terms of a shock absorber. And it also provides stability in your knee. It's not like a cushion cushion, flat cushion per se, where it's like, you know, you absorb all the impact right in the middle. It's kind of more C shaped. So, what that means is that the outer edges and that's where it tends to get torsioned. So because of that sort of makeup of that meniscus, and when you don't have tension strength the knee holding it, then that's where you can really start to have that torsional strain on it.

Mark: So what kind of symptoms would someone have? What would lead them to, other than just it hurts? Are they going to have swelling? What's it going to look like?

Wil: Definitely. So swelling and obviously pain, but the loss of mobility, and one of the biggest ones would be like clicking and popping. Especially if you tear the meniscus and it gets caught in there. So the next step then is really looking, well, what do you do for it? So you always want to look at, you know, three main things really. Like you want to look at, okay, how do you regain your mobility? So there's things that you do for that. 

You know, and then strength, maybe number two. Okay. And then third thing is basically your functional movement. Now obviously proceeding all that, depending on how bad it is, if it's really swollen, the first thing that you do, you want to control that swelling. So there's things that you can do for that. 

But obviously you want to start to get the knee moving and that mobility is super, super important. And in terms of figuring out, okay, well, is this a meniscal injury or is this something else? Or is it like, you know, maybe like something else that that's not as sinister, like maybe just like an overuse sort of imbalanced thing.

So there's certain tests that we can actually perform on the knee. And usually you want to do a battery of them. So you don't want to just do one, you want to do a few of them to really test out whether or not it's a meniscal injury or even like, is it a really bad one, or if it's a minor. So you can sort of do that with some of these tests. 

Mark: So diagnosis, I imagine the history of how this happened becomes really important as a diagnosis tool to tell you okay, as an indicator of how bad it might be?

Wil: Yeah, usually, and it can sometimes present like a little worse and you don't really know until you go through that rehab process and doing the right things to work on those three things that I was talking about. Well, I guess four, if you add decreasing the swelling, and then mobility, and then strength, and then the functional movement. 

So typically that should take about six weeks, four to six weeks. If there is very, very little progress. In that four to six weeks, then I'd be wondering, Hmm, maybe we need to actually look at this a little bit further. And I would recommend a referral for you know, see your doctor and get some scans done. And especially if you're wanting to get back climbing and it's just not getting any better, you know, and it's hampering your lifestyle.

Mark: Yeah, swollen, hurt knee is going to limit a lot of things. Couldn't I just stop doing what I do, how I hurt myself, let the swelling go down and have it heal up. Isn't that going to make it better? 

Wil: You do want to actually have a period of time where you don't climb or do any activity, but then after you know, it settles down. It could be a couple days or maybe a week or something like that. And then you do want to get it moving though. So there is a process. There is a process to this rehab where you want initiate, where we'll help it get better. So you do want to start to get it moving in that way and that way you know, you're working towards that recovery. Working towards that rehab process.

Mark: And what about, you mentioned movement retraining. Is that basically okay. This is, if you have to do heel hooks, knee drops, high stepping, et cetera for your climbing. Here's how to do it properly. So you don't hurt yourself again, or at least lessen the chance that you're going to hurt yourself in the future. Is that part of the training that you're going to provide? 

Wil: Yeah, for sure. And I think the other important thing to add to this too, is that there is definitely some research that's showing that when your knee stronger or when you have more strength and conditioning in the lower extremity, then you don't tend to actually have as many injuries. And they've looked at a sample of a bunch of climbers where, I think like climbers who weren't in very good shape, or weren't very strong in their lower body, tend to have these kind of injuries more in their knees. 

And so I'm alluding to more competition climbers. Competition climbers tend to have more strength in their lower extremity in their conditioning. And because of that, you know, they use tension strength, tension forces appropriately, to protect their knee versus, climbers that are not as strong and don't have the same strength in their knee and their lower body. And then as a result, it doesn't stabilize the knee. And then that's where the injuries tend to happen a lot more. So that's, that's another huge part of it too. 

Mark: And what would be an example of the kind of strength training that someone would do? Just maybe just one exercise as an example. I don't imagine it's just going to the gym and doing squats. It's probably a little more complicated than that given how your body is being used while you're climbing. 

Wil: Yeah, for sure. So if you're rehabbing it from an acute injury. Then it's really getting certain things activated and then progressing through that sort of activation muscle pattern, of say your hamstrings with your glutes and that core.

So doing two-legged bridges or, or one-legged bridges, as a very simple, basic exercise. To progressing to doing things like a bridge on a ball with a hamstring curl. Those are just some examples kind to you know, throw right off the bat here. But then there's some other complicated things that you can start doing.

And the other aspect of it is what do you do in your warmup? So when you're climbing and you're about to get on a climb, whether it's like a roped climb, a lead climb or a bouldering climb, how are you warming up, like even your hamstrings properly? How are you warming up like your knee? How are you warming up your hip? And how are you engaging things in your core? Because those are all important things because we quite often forget that we think, oh, you know, this is mostly upper body warmup stuff, finger warmup stuff. 

Mark: If you've had a climbing injury, the guys to see are Insync Physio. You can reach them on their website to book at either location in Vancouver or in North Burnaby at insyncphysio.com. Or you can call. The Cambie location is at (604) 566-9716 to book. Or North Burnaby, (604) 298-4878. Get expert climbing help from expert climbers who can help you be back out there and climbing well. Thanks Wil.

Wil: Thanks Mark.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto, he's the owner, the chief cook and bottle washer at Insync Physio in Vancouver and in North Burnaby. And today we're going to talk about running injuries, IT band knee pain. What's this all about Wil? 

Wil: Yeah, so the weather is getting really nice here and we're starting to see people running outside and and I'm seeing a lot of more running injuries coming into clinics. A lot of our physios are seeing a lot of runners coming in. So basically what it is, is the IT band is a strong connective tissue that basically connects a lot of the muscles on the outside of the thigh. It starts actually in the hip all the way down to the outside of the knee. And what it does, it actually adds extra stability to your knee. 

Now, the problem with running and especially as you start off, like you're running season, a lot of people were training for things like the Sun Run. That's just happening. It's just coming up here this coming weekend. And just as the running, season's starting to peak here, you know, they start to overload. And so what IT band injuries are usually a more of a repetitive type of injury.

Mark: So that's just overuse training, training too hard, too soon, basically? 

Wil: That's a part of it. Yeah. That's a huge part of it. I mean, it's certainly one of the biggest factors. There's a few other things that also can contribute to it as well. But like as you put on the mileage and if you don't get enough rest and let your body recover, that certainly can lead to the overstretching of the IT band because then the muscle that attaches on to them can really pull them and cause a lot of abnormal movement patterns kind around the knee. And so then you ended up getting this knee pain on the outside of your knee, which can also lead to like a clicking sound that can happen there as well. 

Well, you basically would do a bunch of different tests. You were on obviously, like I said, the IT band is part of the knee that provides stability to the knee. And what you want to do is you want to rule out all the other ligaments and see, you know, how that is. Now if you've had a pre-existing injury then you could have these imbalances happening in your knee too. So the IT band syndrome, there's specific tests for it, for looking at different muscle tightness and how that could be pulling on it abnormally. And so essentially if those tests are positive then you're looking at the pattern of how things are moving in the knee.

Then you can determine that it is IT band syndrome. And a lot of the times you have like a few factors involved. Like I said, if it's an overuse thing, but then you may have sort of inclination with like your body type, if your feet are a little bit more flatter, which is called pronation and if you're running in shoes that are worn out, that can basically provide less support for the running and mechanics of it.

And then the other thing is also you know, the really important aspect of this is, is looking at like, are you running on a lot of flat, versus like Cambridge Services or you're doing a lot of trail running and then it's causing your knee to really buckle. And if you're doing a lot of like hill training, then you're getting your hip flexors really tight. And so then what happens is that those muscles end up being really pulled and it causes pulling out of the IT band, which then can give you the pain that you can experience the knee.

So I think the other aspect to looking at IT band injuries and knee injuries with running is how do you treat it? So one of the big things for treatment is really looking at rebalancing everything around the knee. And so part of that rebalancing is in doing things that are basically going to take the load off of it in terms of mechanics.

First thing you want to do, though, is definitely unload what's causing it to give it pain. And so if it hurts with running, then you want to basically take down your training a little bit more and let it settle down because when it's really bad, you can actually have quite a lot swelling and then you can't even walk. So you want to look at the training load and really decreasing that. And the things we talked about footwear. And then looking at recovery, are you recovering enough?

And then are you getting too much training at a high intensity and then not letting your body recover. And so the other aspect too, is we talked a little bit about if you had a preexisting injury, then you can start to compensate with like your hip flexors and some other muscles.

So then you might want to start to look at, okay, so do I have other deficits or do I have other issues that I want to address. Like, so maybe I have a weak core and I'm compensating with my hip flexors to basically stride and really push through. And that's the other issue is my stride. Am I always overstriding? So then maybe I want to look at that in terms of my running mechanics. 

So we would actually do a running mechanics. We have a treadmill that we can actually look at a bunch of different factors involved in terms of your posture and how you run. And also you know, part of that posture is like making sure that your cadence. So your cadence is like how many steps are you taking per minute? And then they've done research studies and they showed that if you're under a certain amount of steps per minute, you're actually more prone to the injuries. And so that's another factor.

Mark: If you need help with any kind of running injury, knee, or anything related to your running program, see the expert trained sports physios at Insync Physiotherapy. You can book your appointment at insyncphysio.com. Or you can call the Vancouver office. They're on Cambie and King Edward. You can reach them at (604) 566-9716. Or the North Burnaby office they're on Hastings near Willingdon, at (604) 298-4878. Insync Physio. Get feeling better. Get moving right and running. Enjoy this beautiful summer we've got coming.

Mark: Hi, it's Mark from TLR. I'm here with Iyad Salloum. He's the clinical director of Insync Physio in Burnaby, British Columbia, Canada. And today we're going to talk about running gait analysis. What's this all about Iyad? 

Iyad: Yeah, we see a lot of runners and some who are very into it and some who are just the weekend warriors and some people kind of want to take it to the next level. We have some very keen people who want to know how they're doing, how their form looks. So we would put them on a treadmill and take them through an assessment to see what things they could improve on from a form point of view and running economy point of view. Things like that.

And then you get also the people who are repetitively injured. Despite doing tons and tons of rehab. And they're like, well, what's going on here? And even when you try to manage how much running they're doing and the whole load management piece, they can still kind of keep cropping up with these random injuries. Like shin splint, hip pain, knee pain. And those are people who would also benefit probably from having their gait looked at or their running analyzed I guess. 

Mark: So what would be, what are some of the causes I guess of, before we get into actually talking about how you do this, what are some of the causes of somebody having kind of a not pure running style?

Iyad: I guess it's good to say that nobody, very few people have a very perfect, where we consider perfect running style. And I guess that's really important to normalize it because if you've adapted to your running form, there's really no need to change it. Now it's the people who, for example, the people I've seen mostly, have read something on a magazine, for example, that says you have to switch your running style from a hind foot strike, do a forefoot strike, where you kind of hit more with your toe than with your heel.

And that's a shock to the system, because imagine if you're running, like I think of a marathon training program and they're running between 40 to 50 kilometres a week. That's kind of on average. And then it kind of sometimes can go a bit more closer to competition time. They're trying to run up their volume. So imagine if you suddenly switch your running form. 

Well, that could change the demands on your body quite significantly. It'll change a lot of things. For example, like the length of your stride, which muscles are kind of going to hit the ground first and absorb more. Even stresses on our bones and ligaments. The average kind of like person never thinks about like, oh, I'm loading my bones when I run. And kind of also putting forces through these structures, but they are things that need to also adapt to tension and pressure. And this is kind of where having things done in a graded way is usually the best way to do it.

But then most people who like you're talking about with what happens is it tends to either be people who do too much too soon, and then they start running differently to avoid their pain, or you get the person who thinks they should run a certain way and tries to force their body to do something that maybe it hasn't been used to for 20 years plus of running.

You know, it's like since we're kids, we're just used to running a certain way and those people, if they just continue doing what they're doing, they were probably would have been okay. But now that they've kind of changed this, they got an injury and they can't seem to figure out what's the best way for them to run. So those are the people who would really benefit from kind of having that piece looked at. 

Mark: So this, if I'm to maybe, shortcut and jump through this, like the root, what we're looking at here is really the root cause of how to make your running form more efficient or less stressful and it's going to be possibly, or probably more effective than changing your running shoes or, you know, the stylish shorts you wear.

Iyad: Yeah, absolutely. So like, you know, the people we're talking about, we're not talking that like, the Eliud Kipchoge level, you know, or trying to shave off a millisecond off their marathon time. We're talking about, just you know, like recreational runners or even like serious runners who are not at the elite level.

Yeah like, definitely if you have old shoes, you should probably have that looked at. But most people do that first. Most people assume, oh my knees hurt, the shoes. Or maybe I should change something, maybe my socks are slipping. They literally change all of these things before they start to consider some of the things like, maybe it's just the way they're running.

And we tend to see these things where, it's really interesting, some people were like, well, I've been doing this all my life. How come? Well, things change depending on the stresses we put our bodies. So maybe people used to be more regularly active. And now they're going into periods where they're working all week and then trying to hit it hard on the weekend.

And those are kind of people who might benefit from having their running form maybe addressed better. Because now they're getting all of that training volume in a short period of time, and it's not leaving them with enough time to kind of cope or adjust to that. So for the most part, those are the people who would really benefit from having that looked at. But again, not every imperfect run needs to be changed because if you've adapted to it over time, you're good. 

Mark: Yeah. So before we get into the actual mechanics of what you're analyzing, you're also looking at what kind of volume they're doing? You're investigating what's their typical pattern. What's their history. How are their shoes? All of that is kind of the starting place before you get into, okay here's how the biomechanics are working. Is that right? 

Iyad: Absolutely. It's a great question Mark. The gait analysis is only a piece of this whole thing. So ultimately, even if you have the perfect running form, if I start throwing a hundred kilometres more out of you per week than you're used to, your body's going to react one way or another.

So we'd look at, we would do usually in the clinic, a good history. We'll do a training history. A specific injury history. We'll scan them, let's do a bed type exam. Or if their knees hurt, we'll check that out obviously. We'll check out how they move in like easy planes and movements like front, back and side.

And then we would want to look at them running too. Because you'll have a lot of people who have specific pains at certain distances of running. So even when that happens, we'll get people for example, to come into the clinic after they've run their 10 K and they're starting to feel soreness.

So we get to really see what they look like when they're kind of in that zone of fatigue. Maybe that's where things are starting to go poorly for them. And it really helps us identify deficits. So sometimes it's a purely strength issue. Your muscles are just not coping with with that kind of level of impact or volume. So we would kind of help them shore up up, I guess, wherever they need to strengthen. But yes, it's a total picture. It's never just a standalone piece. It has to be part of a more comprehensive exam. 

Mark: So what's involved in the actual gate analysis. Let's have a look at that. 

Iyad: Yeah, so I'll just do a quick screen share here so we can have a look. This is one of our colleagues here in the clinic when we were kind of playing around with this. So we would just kind of get somebody on the treadmill. We'd get them to run for a few minutes to kind of get used to the feel of the treadmill. And then we'd just look at basic things. 

We don't need to quantify angles and degrees to such an extent that's used in research studies primarily, but it's not going to change our clinical outcome. Because there's so much variation between people. So we look at things like how they're striking, how level they can maintain during a run.

We look at, for example, like if they're crossing over too much we tend to look at it from multiple views. So we'll do a side view. We want to see how far forward are they. For example, relative to their centre of mass. And then what we'll do from there is we will come up with a running program to kind of help supplement that and maybe help them retrain that. Sometimes it's just this small, simple cues of changing their step rate.

Sometimes it's getting their arms swinging more. And sometimes we just look at that and we're like, that looks good. It's just the volume issue. We're going to have to address that because if it ain't broke, don't fix it. 

Mark: On this idea of strengthening, how often is that a component of the analysis or the prescription that you provide?

Iyad: Prescription, almost always. And it tends to be the one area that runners don't like to really focus on. Runners love to run. We know that and they're really good at that. The way we think about this is it helps keep them running versus make them stop. Because that's the last thing I'd ever want to do is to tell them to the rest, for example.

That tends to be a bit of a last resort for us, if there's a serious issue, like a stress fracture or something like that. But yeah, strengthening tends to be a big component of this because it allows us to build capacity in some of these areas that are going to be effected or maybe need to be absorbing more of that force.

So a common example would be for example, the person who just switched their running style. Well they probably should have addressed also that maybe if I switched to my forefoot strike my calfs are going to be loaded more and my achilles tendon might need a bit more. And then their hips and quads might also need to work differently.

So those are kind of things that we want to address too. And it's always important to look at the overall picture. It doesn't need to just look pretty. It also has to be gradual. Because that's a fundamental piece where all of us get into trouble, on the non elite level at least. 

Mark: And the kind of strength training we're talking about, it's not, let's go do some curls. It's more of endurance strength training. How would you describe that? 

Iyad: It would be actually sometimes a mix of that, like where we're just getting them to just go heavy. Because sometimes they just need to get the muscles tolerant. And sometimes we will need to work on like, you know, maybe a smaller, finer movements. But there's no such thing as bad strength training. This is kind of one of the biggest myths that people think we have to do, plyometric only to get running better, actually like barbell training can be very helpful. Dumbbell training could be helpful. 

We use whatever resistance tool we think is going to help them address the deficit. So if the barbell is the best way to do it, we do a barbell. If it's the dumbbells, and it also depends on what they have access to. We get creative sometimes the equipment that they have access to.

If somebody doesn't live near a gym and doesn't want to go, especially nowadays with COVID and all that stuff. We'll try to kind of work within whatever they have at home to allow them to kind of build up that capacity that we need them to be able to run. If that's their goals around run, we kind of work with them with whatever way they have to kind of build up that program for them.

Mark: So the typical course of treatment or length of treatment to get changes so people feel a little bit better about their running. What would that be? 

Iyad: Yeah, that's a good question. So there's lots of research on this and it varies between person to person, but the average is between six to nine training sessions that they'd have to do. We give them some certain cues. Sometimes it's auditory cues. They follow a metronome with the step rate that we find works best for them. And sometimes it's to focus for a few minutes at a time on, for example, swinging their arms a bit more, being chest up a bit more. Some people's knees cave in too much when they run.

So we kind of try to give them some cues to do that. So we'll try to get them to practice that over a while. And this happens in a mix between home treatment and also in clinic treatment because we can't see them every day here. So we're aware of that and we try to give them as much to work with at home.

And yeah, it can take anywhere from six to nine training sessions for people to kind of get used to this new style of running, but it doesn't really affect their efficiency from any point of view, like in the long-term. It's a short-term dip as they get used to this new style, but as they going to work through it, people just kind of pick it up again, and it becomes a new norm for a short period of time sometimes. And yeah, most of the time it's a good way just to kind of keep people running despite the injury. That's also another use for it. So it doesn't have to be, this is going to be your new, permanent thing for life. It could just be a nice tool for us to play with their symptoms and keep them active while they're rehabbing their injuries.

Mark: If you want some expert analysis of your running gait, if you're having issues with your knees. If you're having issues with whatever you want to try something new, get expert analysis at Insync Physio. You can reach them and book at insyncphysio.com on their website. Or you can call them in Vancouver 604-566-9716 or in North Burnaby 604-298-4878. Willingdon and Hastings. Lots of parking, especially in North Burnaby. They will look after you and they're experts in this stuff. Thanks Iyad. 

Iyad: Thanks Mark.