Knee Injuries Running with Wil Seto

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 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.