Traumatic Knee Pain with Wil Seto

Mark: Hi, it's Mark from TLR. I'm here with Wil Seto of Insync Physio in Vancouver and North Burnaby. Multi time winners of best physiotherapists in Vancouver and Burnaby. And we're going to talk about traumatic knee pain. What do you mean by traumatic? I'm traumatized. Just hearing that already.

Wil: Yeah. So traumatic knee pain is when you have an injury to your knee because you know, there's been like an event or something happened where you fell and you hit or you know, something happened to it. Like there was a clear thing that happened. It may not even be from falling. Maybe you twisted it. But there's a clear event. 

Mark: So it could be a hit from someone like if you're in a contact sport, it could be from cutting really hard say, in soccer, football, whatever, basketball, hockey. It could be all those kinds of things where you've moved the knee joint in a way that it really shouldn't be moving. 

Wil: Shouldn't be moving. Or got hit in the knee in the way that it shouldn't got hit. Exactly. 

Mark: So the cause is pretty obvious something's happened that's, it could be a fall. It could be that twist, even just gardening, just the wrong with weight, you've twisted the wrong way and suddenly there's pain. So how do you go about diagnosing this, what's happened and what needs to be done?

Wil: Yeah. So I talk to my physio group all the time. It's interesting because the biggest thing that I hear, clients come back in to see our physios, is their worry is that they've done something really bad to their knee. And so when we assess it, we want to basically rule out or determine whether or not if it's one of these bigger injuries. Or if it's not. Like it could be a smaller injury or it could be a bigger injury. And so that's our job. 

So I'll give you an example, we had a client who came in to see one of our physios and they had this outside knee pain. And they had basically been playing, I think it was actually rock climbing or something like that. And they had done something and they twisted their knee and basically heard a pop or a clunk. And then got some swelling and pain immediately. And immediately the brains go into like the worst case scenario. And I think that's human nature. I think we think, oh my gosh, what did I do in my knee? And especially when it swells up. 

And so you know, you got a rule out all these big things. Fortunately for this person, it was just like a minor, it was interesting because of the way that they put the knee, the positioning of it, they twisted it and ended up spraining a ligament on the outside of their knee. That was totally healable. And it could have been a lot worse. Could've been like other structures in the knee that would take longer to heal. Or a bigger, more major ligament like the ACL. But in this case it was the LCL, which is the outside of the ligament. And so the typical timeframe for something like this, we can predict and project and then help the clients understand what to expect in terms of how long it's going to take the full heal. And how long it take it easy for kind of thing, because that's also another thing that you'll want to also respect. There's a healing timeframe for these kinds of things when it's traumatic. 

And so if it's a bigger ligament thing versus like maybe the spongy part of the knee called the meniscus versus the LCL, and depending on how serious that injury is as well, will determine the amount of time that you gotta to take it easier versus the amount of time that you can start to like then, okay I can actually start training harder now. They're going back to climbing harder now versus, okay you know what? Four to six weeks or six to eight or maybe within two weeks. So it all really depends. 

Mark: So when you've diagnosed it, you've determined exactly what the extent of the injury is and where it is. What's a typical course of treatment look like. I imagine getting the swelling down is probably the first layer. 

Wil: Yeah, that's the most important thing. If there's any swelling, you want to take that down. But at the same time, you know, if you want to be able to start to be able to put weight on the knee, retrain what's called your balance and your strength in your balance and sort of weighting it. And that's actually really important. And you need to do specific things to start to reactivate the muscles. That's super important. And so we want to look at the things that have been affected. You know, that's interesting, because we talked about in a previous podcast, about A-traumatic or non-traumatic knee pain.

So you can develop a lot of things that are kind then similar to things where you get tightnesses here and tightnesses there and weaknesses here. Because when you have a traumatic incident or a traumatic injury, then certain muscles will shut off and other muscles will just take over to protect. And now you develop this certain pattern of basically muscle activation. And a lot of that is just to keep you functioning. That's the miracle of the body. The amazing feature of the body is that it just will do that. 

So then what we want to try and do is we want to try and start to, you know, normalize the movement. You want to try and optimize the movement and be able to get you put weight on it. And it may not feel intuitive, or may not feel natural, or like you really want to do that. But the key is also, you don't want to do anything when you have that traumatic injury where you're getting that bad pain.

Mark: Yeah. Pain to be avoided. So if you could grade it, I guess, you know, a minor sort of thing is going to take two to three weeks. A major thing could be six months. 

Wil: A minor thing you can take up to four to six weeks depending on what it is. So if it's like the spongy part of the knee and the meniscus, I mean, it's hard to say if it's a you know, minor thing could take longer than that. But if it's like the ligament on the outside called the lateral collateral ligament, then that could take, four to six weeks or it could take longer, depending on if there's other stuff involved too. 

So if it's very simple and it just really never is, you know, four to six weeks is the healing timeframe. So you have to respect that. And then sometimes it can be extended, it can go six to eight. And then if it's like looking at major ligaments in the knee, then there's other things that we want to look at where, potentially having other interventions involved like with the major ligaments of the knee. And then that can be a full several months, maybe up to a year long process. And then also, depending on the sports that you're doing, if you're just an amateur, trying to get back into doing things, it can take several months still. But if you're professional, then we can speed things up a little bit, but then also looking at what we need to help you actually regain, in terms of your functionality. 

Mark: If you want expert help with any kind of knee injuries that you might or might not have, hopefully none. Well, I wish you that never get a knee injury, but if you get one, the guys to see are Insync Physio. You can book online at insyncphysio.com or you can call the office in Vancouver, (604) 566-971 6 or in North Burnaby, (604) 298-4878. You have to call and book ahead. They're always busy. Insync Physio. If you want your knees strong, healthy and feeling really good, right until you're old and decrepit like me. Thanks Wil.

Wil: You're not old Mark. But thanks, take care.