Non-Traumatic Knee Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver, many time winners of best physiotherapists in Vancouver. And we're going to talk about knee pain. Specifically, non-traumatic knee pain. What's non-traumatic knee pain Wil?  

Wil: Hi Mark, thanks. Yeah so non-traumatic knee pain is basically the type of pain that you get in your knee when it's not something that you can recall. Like one incident happening. And sometimes you're a little bit fuzzy about it. And it may be like repetitive thing that happened, like maybe you started up running and cycling or you've increased your training load a little bit more. And so there isn't like a collision or direct contact or something specific that happened to it. And the onset of that pain can be gradual. 

Mark: So basically it started hurting and it wasn't so bad and you kept going and it got worse and worse and worse. Yeah. Is that accurate symptom? 

Wil: Yeah, that's a very common thing where, you know, someone comes in with you know, I just started getting some soreness after a training session. I just thought it was just regular soreness that, you know, from training a little harder, that you get after a hard work. 

Mark: And so what's the cause of this? What are the possible causes involved? 

Wil: So there's there's many different things, but you know, I'll talk briefly about some of the main things that we've seen as a physio group at our clinics. And when you look at non traumatic type of knee pain, you can have stuff where, you know, it's usually an imbalance issue. So an imbalance issue in the muscles, so you'll have certain muscle groups that are just tighter because you're always using them or maybe you're doing desk work where you're sitting down all day long and your hip flexors get really tight.

And then that pulls on certain structures called your IT band, which is basically a connective tissue all along the outside of your thigh that connects down to your knee. And that can start to get little tighter. And then when you take up running or get a little bit more mileage in and try to increase your training, then that starts to get irritated down in that area. Because it gets a little tighter. 

So these muscle imbalances are pretty prominent. And on the assessment of what's causing it and it's with everyone it can be different. So it could be like a different part of the hip flexor. It could be maybe the part of the hip flexor that's more around the front of the thigh. Which is part of the quad. Or maybe part of the hip flexor, that's kind of attached directly to this connective tissue that I was just talking about, the IT band. So those are the things that we do in terms of assessing to really determine what are the imbalances? So that's the big one. Is the muscle imbalances.

And so in addition to that, then you're looking at the weaknesses. So you're going to look at what is not activating to support the proper mechanics. To support the proper movement of that whole chain. So when I say the whole chain, I mean, like not just the knee movement but also what's going on in the hip. And then from the hip down in the knee to the ankle, is functioning properly or not. 

Mark: So once you've gone through the diagnosis and you've identified the possible causes, what's a typical course of treatment? 

Wil: Yeah, so depending on what we find. We have a physio group that basically, you know, we share our case histories to help each other to learn. And it's very typical. This one physio has a client that basically has this lateral knee pain and it's non traumatic knee pain. And as we went over it, your classic tightness into the hip flexors and weakness into the glutes that are not stabilizing the pelvis, which is causing all this non-optimal movement of the whole chain, as I was saying. And so the physio addressed those specific issues. So this person was a runner, and started increasing your training load. And then also the person, his work was getting busier and they're doing a lot of stuff in front of the computer. And so they're in a lot of sitting. And so things are getting tighter and tighter. And then their training load was getting a little bit heavier because they wanted to do a couple of races that had come up recently. 

And so they needed to address those imbalances that were actually causing this. Because the actual issue, like of the pain, yeah you look at it and you there's certain tests. He said, yeah, that's tight. So we want to work that out and we want to try and relieve that pain and that tightness in that area in the knee. But then you also got to figure out what's causing that. And so for this physio to really address that, this person actually had, it was really cool because she was saying that, this person that she was treating basically had almost 85% pain relief after the first session from doing releases. But then it came back because she wasn't really dedicated and doing her strengthening. And then when she realized that strengthening was really important. And then the physio also can do a lot of manual stuff to release, to help facilitate that cycle. 

Now that's a really good example of someone, you know, they come in the second time, they're like, oh, the pain came back. And then the physio did the manual stuff and released it. And then got them to progress with more strengthening. Came back a third time and the pain relief was gone and they increased the training load again. So it was like significantly better. And then they basically, I think was all healed in four or five sessions kind of thing. 

Mark: So when you say lateral knee pain, you're talking about pain that's either on the sides of the knee, not front or back, on the sides inside or outside?

Wil: Yeah. And there's other things that could possibly happen, but I'm just describing like the most common thing, which is just lateral knee pain on the outside of the knee. And it's not like on the knee cap. And it's not like inside the knee. So it's actually on the outside of the knee. And that's where your connective tissue attaches and you have all the muscles that can attach onto that that can pull on the knee structure and effect the movement of it right. 

Mark: If you've got some knee pain, you need to get it looked after, basically. If you want to increase your load, if you want to get back active, if you want something expert diagnosis to identify what needs to be fixed. What you could do to actually repair, allow your body to repair itself. The guys to see are Insync Physio. You can book online at, for either office. They have an office in North Burnaby and in Vancouver. You can call Vancouver 604-566-9716 to book or North Burnaby, 604-298-4878. You got to call and book ahead. They're always busy. Get yourself some help so that you feel better and get back moving well. Thanks Wil. 

Wil: Thank you, Mark.