Muscle Retraining with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. And we're going to talk about getting your body better. How are you doing Wil? 

Wil: Hey, I'm doing great. Thanks Mark. 

Mark: So muscle retraining. What's muscle retraining?

Wil: Yeah, essentially, that's the core of what we consider exercise rehabilitation. So there's sort of like the more, very simple, basic aspect of that, you know, when you have an injury and you have to get the joint or the areas that have been injured, working and moving properly again. Which involves basically retraining the muscles around those areas that work properly.

Even if those muscles themselves were not injured. Or if a muscle was injured, say there was a strain or whatever, you know then obviously we need to retrain and rehabilitate that muscle fully. So there's sort of more of that simple aspect of that, where you sprain an ankle and then you have to retrain the muscles to basically help just the ankle joint to move properly.

And then as you look at more of a bigger picture and back farther to look at the bigger perspective than you're also looking at the overall motor control. That's a big word, the motor control, which is basically the way that the muscles function to make the body move in coordinated fashions or the biomechanics.

And so with the same ankle sprain, and this is actually backed up by research studies, where you may not have had an injury at all in your hip, but because of the cycle of pain and swelling, and then you're forced to use your other foot more initially, just even if you feel like you're walking, normally and you've sprained and there's swelling and pain.

You're gonna get compensation. You're gonna get a little bit more loading on your other leg and foot. And when you do that, you know and with a trained eye, we can see how you walk and you may be compensating more than you think. And so when that happens, then basically the whole circuitry of how the muscles work together, change.

And so you're undergoing a sort of a new programming of how your body works in relation to that sprained ankle. Now, the problem with that is you'll have to put more weight on it. Yes. You'll start to get some of that normalcy back, but it won't be a hundred percent unless we really focus and really address those deficits.

So the hip muscles will shut off, like in the gluteus medius, basically the muscles that help with walking and weight bearing on that side of the affected ankle. And you need to do specific things to retrain that. Sometimes the core muscles stability strength in your lower quadrant gets shot too. So you really needed to address those things as well.

Mark: So is this a function basically of you've been hurt in some way, and this can apply to I'm sure from top of your head to tip your toes, something's been hurt. And so your body's learned, in the meantime, while the healing is taking place to function and continue on. So other things are doing the job and now it's relearning, unlearning what the compensation has been in order to start functioning again properly. Is that a fair way to put it? 

Wil: Yeah. So what you're kind of leaning towards a sort of like the aspect of there's trauma. And there's like a clear injury. And for sure. So when there's a clear injury and trauma, then that process starts and sometimes you really do need to have a proper diagnosis and really look at, you know, well what's going on with this injury and why this is happening.

 And then address those deficits in relation to the actual injury and what's going on specifically at whatever's going on. Now the other aspect of this. The sort of the repetitive stuff where there's I mean, it's an injury as well, or may not be, where, for example, let's say I do a lot of sitting and my work is I'm sitting a lot and then I cycle to work, I commute, that's what I do, but then I don't stretch my hip flexors. 

And then what happens is I end up shortening my hip flexors, which is a problematic issue for getting that hip mobility. If I want to say, oh, Hey, you know what, I'm going to start up like ultimate frisbee or I'm going to play soccer. You know, I haven't played in a while and I'm going to join a league. I want to reconnect with that part of my physicalness again. 

And then what happens is that, well, your patterns that you developed with a tightness, you may not have pain or dysfunction, but the thing is you developed certain patterns that are non optimal for playing soccer, necessarily. Your hip flexors are really tight. And this is where you're more prone to getting some kind of issue happening as you start to play.

And especially if you're like for two different things, especially if you haven't played it in a while you start playing again and you start playing more avidly or competitively. Or if in the past, you've had some kind of pre-existing injury, that can be something that comes back to haunt you.

Mark: So how you diagnose this? 

Wil: Yeah. It's really looking at all this simple tests that we do. Sometimes people say certain things and people are very intuitive and say, oh yeah, I just feel like I'm doing this. And people get a sense of like, something is not right.

And so what we do is we get in there and we really assess and look at well, what is it about that, you know, that isn't moving right. And so we really test the parameters of whatever issue it is. If there's a trauma or pain or whatever disfunction that you're having, then we really address and assess and really examine things thoroughly.

If someone comes in, is I just want to prevent an injury from happening, or I just feel tight or I'm not really sure, I don't have an injury, but I'm not really sure what to do. So then we kind of look at, okay, well, what is it that you want to do?

So it's always goal specific. Well, I want to start a run program. Okay. Well, is it recreational or is it more competitive or what do you want to do? And then we base that on, okay so let's look at your running. Okay. And so where do you feel like you're tight maybe and then we also ask some questions about what they do.

Oh, I have a desk job. I sit like nine to five, five days a week. Oh. And I also commute to work. So then that points us in the direction of like what to look for more and also testing the core. Core strength. Does that activate properly? And do the muscles work in unison with each other properly?

Or is this muscle always on. And is this so tight that it doesn't actually allow the other muscles to turn on? So then there's this concept of what's called, reflex inhibition. So is there a lot of that kind of stuff going on, which is basically the non-optimal movement patterns that can start to develop when you have that kind of stuff happening. 

So example, tight hip flexors can cause reflex inhibition of your gluteus medius muscle, which is your butt muscle. And why that's a problem is that, you start to participate in sports again and do a lot more things where you need to have that control in your back and your pelvis. Then you might start to get issues in your and your hip and your pelvis and have all these non-optimal patterns, basically emerge. 

Mark: So what's the typical course of treatment to reprogram this? 

Wil: Well in terms of treatment. So this is a really good question because there's treatment in terms of coming into the clinic and we can do things to reset stuff.

So resetting being other, oh, it's a manual therapy issue. We do something where we use our hands to kind of move the joint or muscle or whatever, or maybe some IMS needles or whatever it is. And then maybe prescribed the right exercise to move you in that right direction. Because we also don't want to prescribe the wrong exercise.

So what I mean by that is that we don't want to be giving you something to soon. Because if we start giving you a strengthening program without mobilizing that joint, it's going to be a tug of war, trying to get that muscle activated, if you know what I mean?

So there's that aspect of it, where you're coming to the clinic. And it may be something as simple as, okay. Yeah, come in. You come in, we assess you and then it's not that bad, you're not having any pain. And then we do something manually to reset you or whatever.

And then we give you some exercises to follow up that you need to do on your own. And it could be follow up in two weeks, fallow up in four weeks, depending on the issue. Or someone comes in more acutely, come back in about one week and we want to see how this changes. We want to keep resetting things and re-influencing it.

And basically, it's that notion of being able to make sure that we get everything back into its optimal alignment or moving pattern. And then reinforcing those movement patterns. And so what we do in the clinic is we reset them and we get it at an optimal potential for the movement pattern and we teach you strategies or rehab exercises. And then the reinforcement of those movement patterns, whether it's a mobility issue and a strength issue, usually both. And that's what you need to do to follow up on your own. That's the most effective. 

Mark: If you've been feeling a little bit out of sorts, like you haven't healed properly, or you've got some long-term issues that you need to get reprogrammed perhaps. Get some expert advice in the dark arts of getting your body working properly, insyncphysio.com. You can use that address to book your appointment. Either for the Vancouver, Cambie and King Edward office or in North Burnaby, near Willingdon on Hastings Street. Insyncphysio.com or you can call them. The Vancouver office is 604-566-9716 to book your appointment. North Burnaby 604-298-4878. Thanks Wil. 

Wil: Thanks Mark.