October 31


Hip Pain Running Injuries with Wil Seto

By Wil Seto

October 31, 2022

hip pain

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. He's the clinical director. He's the big cheese, the chief cook and bottle washer. He's the chief joint manipulator. Maybe that's even better, at Insync Physio. And we're gonna talk about something that's a little tricky. Hip pain running injuries. How you doing Wil? 

Wil: Hey I'm doing really good, thanks, Mark. Yeah. Actually, funny enough, I used to be a chief bottle washer at a restaurant when I was growing up, and in some ways I still am at home with the young babies. Yeah. Yeah. So this is actually a really good topic to talk about because you know it, this is definitely peak running season with the weather that we're having.

You know, it's cooler, which is perfect. And it's prime running season too, cuz it's not rainy. And so people are getting out and what I'm seeing is a lot of people coming in with hip pain from running. And one in particular is a woman, a client who came in to see her physio team.

And you know, we do share the caseload here. And this one patient had a pain going on her hip and she started up running in the fall and then did a couple races and I think she ended up doing Turkey trot or whatnot just as a sort of like a training race. And she was having trouble just like even like sitting for more than 15, 20 minutes and the pain was going down basically right into the outside of her bum cheek area and then referring a third of the way down her thigh, on the backside.

So, a lot of the times when you kind of start having that stuff coming on and if it's like after a run or during a run, you know, can be a little bit troublesome or a little bit worrisome. And then after the run, it doesn't go away, then you should try and do something about it. I mean with this particular client, she was trying to do exercises to relieve it that she found online and she was just trying to do some self massaging on it and nothing really worked. 

So we ended up assessing her and it turned out that she had, what's called a thicker iliac joint or SI joint dysfunction happening. On further questioning, it turned out that she has had a couple kids and because of that, she's got some hypermobility in that whole SI joint and pelvis. And then when we looked at things a little bit more, there's a lot of imbalance going on. And this is someone that's also quite an avid runner.

And at one point she has done quite a handful of half marathons, a few marathons. So she's not like new in the game. And she was having this kind of ongoing hip issue, and it was getting worse and worse. And then I think she ended up going on a trip and she was away with her family for a couple weeks and then it got really bad and then she came back, sat on the plane and, you know, and she was like, Oh, I could barely move the next day. 

So that's usually, you know, the presentation that we see people finally like, this is sort of the cherry on top, I can't take anymore, and you know, the straw that breaks the camel's back.

When we looked a little bit more closely at what was going on, there was a lot of imbalances. And in addition to looking at what's going on with SI joint, there was some ligament instability. She could walk and all that stuff okay, relatively easily, but the main issue was running hurt it. She started in the first like five minutes was kind of okay, then it started getting worse. And then sitting for more than 15 minutes was bad. So she was quite rotated out of alignment. 

And so we were looking at why she was like that. It turns out that it was because she had this instability in through there, all these ligaments that were really loose, probably from her pregnancies before in the past. Her kids are like 10 and 7 or something like that. And then she has these imbalances where a lot of things are just so tight. And then that tightness was just not allowing other things to actually activate and turn on. 

So these imbalances were affecting her actual running pattern or what we call her running gait. And so when we looked at it, we were like, Oh, you're totally not activating this. And then when we actually went in there specifically, look at how strong she was, it was astonishing for her where her one side where she was getting the pain, it was like she was failing. It was like 40%. Like she could barely hold that up.

And then on the other side, she didn't have any problem. They were like, Oh, wow, that's crazy. So we looked at why that was going on and we had to like do some adjustments to kinda get things aligned and it was affecting our whole back, all the way up into her lower back. And so we assessed that obviously, and it wasn't coming from her lower back or upper back in terms of the main cause.

So we think that that unstable SI joint had been trickling up and everything's just been seizing and everything was sort of like, I guess lack for better word, stuck, in the thoracic segment of the mid back area. So we essentially did a bunch of adjustments first and kind of realigned things that in itself kind of helped her, but that wouldn't sustain it, and I'll tell you why in a second.

So we did all these adjustments and then her strength where she was failing went from like 40%, to like 70%. And she was like astonished at how much of a difference that made. But then that bringing it up from 70 and keeping it even at 70 to bringing it up to 90 and potentially up to 95, maybe a hundred, possible, is only possible if we actually prescribe the right exercises.

So we assessed her and looked at, this is totally like this. It's not actually opening up. The mobility is actually not great when it goes into an extension and as a result you're not able to activate certain things. So what we ended up doing was reinforcing certain things. We had to do a lot of soft tissue releasing as well, and then suggesting certain other modalities to release that soft tissue.

So whether it being massage therapy or other forms of deeper releases like IMF or just working on some more active relief stuff with other therapists, that was important. Make sure we gained that mobility and then reinforcing it by working on opening up those areas that are tight and strengthening. So we call that up training. The areas that are not actually turning on that are down trained. And then those areas that are up trained that are just on too much, we gotta settle those down. 

So we sent her on her way with a bunch of prescribed exercises specifically for her, and she was doing great. I said, You know, like you can check in with me if you want. And she was pretty functional, but I said, You can check in with me in about a week, or you know, a couple weeks or something like that. And she was doing really great. But then she stopped her exercises and she ended up having to go away somewhere and she didn't do her exercise for a week and then came back and she was frustrated.

Because she didn't have enough time, she was only able to do them for like four or five days, and then because she didn't have time to do exercises, it came back, same thing. And then that physio basically treated her and got everything going again, and she's good again now. She's really on top of her stuff. That's the homework, so to speak. 

And she's looking at running another half marathon as sort of a training run before she does the the BMO next summer. And that's her goal. She hasn't really been running in a while and she wants to get back into that running routine. So that's been two weeks since we last saw and we haven't heard from her. And we said check in with us in about two, three weeks. So I think the physio is seeing her next week. 

Mark: So it's an important part, and we've mentioned this before, an important part of your healing process is to, I don't know, I keep thinking repattern or retrain the proper firing of muscles. Once they've loosened up, once you've rebalanced and readjusted everything so that things are firing in the right order, the right way they should be doing. And that takes practice, basically. You gotta have some reps in so that you rewire your neurology to work right. Is that a fair assessment? 

Wil: Yeah, absolutely. And I think the other key factor here is knowing what ones to do. Of course. Because I mean, she was trying to do all this stuff before she saw us on her own and she didn't know what to do and she was just like, Oh yeah, I'm tight here. And then trying to do stuff that was almost there, but just little tweaks that maybe she wasn't getting right.

And then also when you're so stuck, and use this quotations, stuck and out of alignment, that it doesn't matter how much you're even doing the exercise correctly, you gotta give yourself a fighting chance. What I mean by that is that you're gonna be on good neutral ground where everything's all on alignment now. Then we can actually have a fair fight.

Mark: Yeah. Let the healing grow from a place where the soil has been tilled a little bit and is ready to take that seed of the exercises. If you're having some running issues, if you've got some hip pain or even back pain, from ramping things up cuz suddenly it's running season. The guys to see are Insync Physio. You can reach them on their website, insyncphysio.com. They have a North Burnaby office as well. And to call the Vancouver office, (604) 566-9716 to book your appointment. You have to call and book. They're always busy. Thanks Wil. 

Wil: Thanks, Mark.

Wil Seto

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