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Understanding the Causes of Recurring Musculoskeletal Pain and Injuries

Musculoskeletal injuries from trauma, repeated activities, or overused joints or muscles are very common — in fact, almost every one of us will get injured at some point in our lives. Most of the time, it will reoccur and become more serious when left unattended or untreated. When repeated injuries happen, it is very likely not due to a one-off fluke.

So why do we constantly get hurt at a specific joint or muscle? And why does the pain seem to travel elsewhere after?

The human body is complex and designed to move in countless movement patterns. When we move, kinetic energy travels from our feet to our neck and head. This concept is called the Human Body Kinetic Chain Movement. Our skeletal system consists of various joints linked in a chain, each with specific purpose and function.

Stability and Mobility at the Joints

When our joint is not functioning as it is intended to, our body will adopt a dysfunctional movement, which can lead to acute pain in our joints or muscles. If not corrected, chronic pain can happen. A sedentary lifestyle, past injuries, poor posture and misalignment, stress, health conditions, diseases, and other factors can lead to the development of dysfunctional movement.

Here’s an example of a common dysfunctional movement at the lower proximity. If your ankle (which is supposed to be mobile) is stiff, your body will seek mobility at the knee which is supposed to act as a stable hinge. A painful knee typically develops as a result. In another scenario, if you spend extended periods of time sitting and experience restricted mobility at your hips, your body may compensate by seeking mobility at your knee or lumbar spine. This reversal of joint roles can lead to injury or pain in the affected joint or muscle.

Continuing to compensate for the long term can cause a cascading effect such as muscle imbalances, poor neuromuscular function and muscle atrophy or hypertonicity.

One of the common mistakes we make is to only address the symptom (pain) with the use of NSAIDs, massage, chiropractic therapy and other non-invasive or invasive treatments, rather than addressing the underlying cause of the problem.

Another widespread misunderstanding is the idea that simply strengthening the muscle at a joint can solve the problem, without considering its kinetic chain relationship. For example, strengthening the quadriceps to alleviate knee pain, without taking into account the mobility of the ankles and hips or the stability of the lumbopelvic area.

That’s why it’s crucial to have a comprehensive understanding of how our bodies are designed to move, and to identify any weak links in our body’s kinetic chain to ensure optimal recovery through appropriate rehabilitation measures, and not view the problem in isolation.

Typically, it is advisable to conduct an assessment initially to pinpoint the root of the problem. However, when a patient presents to my clinic in pain, they often exhibit compensatory movement patterns that can yield false positives/negatives results. For this reason, my approach is to first identify the type of pain or injury they are experiencing and address their pain as a priority. To reduce their pain levels, I utilize methods such as soft tissue manipulation and other therapies that are appropriate for their condition.

Soft tissue manipulation and manual therapy, such as massage has been proven to:

  • alter pain signal at the central nervous system,
  • manage inflammation,
  • inhibit muscle spasm and reduce muscle tonicity,
  • improve blood circulation and oxygenation to the injured tissue,
  • and improve mobility and flexibility at the joint.

It is best to engage a practitioner who is trained or skilled in this field, or perform self myofascial massage by using a foam roller or trigger point massage ball under guidance.

Once the pain has been adequately managed, I will proceed with a thorough assessment to identify any potential weak links in the person’s kinetic chain. After that, they will begin an active treatment program that includes targeted stretches, mobility drills, and muscle reactivation exercises through a set of neuromuscular exercises. The rehabilitation program also emphasizes teaching the person to disassociate their movements and joints through specific exercise drills, which re-trains their brain to use their muscles and joints as it is supposed to. As soon as they are able to correct their dysfunctional movement, it is highly recommended to strengthen the entire structure based on function, rather than relying solely on brute strength.

Understanding the concept of our body’s biomechanics and how kinetic chain work can help you better manage or even resolve musculoskeletal injuries holistically, and not just detaching the problem to a specific joint or muscle.

Do take note that different types of musculoskeletal injuries may require different forms of therapy or approach. It is extremely important to seek a professional’s help to determine the appropriate care for your musculoskeletal pain or injury.

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.


Field, T. (2014). Massage therapy research review. Complementary Therapies in Clinical Practice.

Moyer, C. A., Rounds, J., & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological Bulletin.

Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine.

American Council of Exercise (ACE)

National Academy of Sports Medicine (NASM)


Minimize the Risk of Falling in Elderly with Simple Balance Exercises

The mortality rate of seniors after an unintentional fall increases significantly. 38-47% of the elderly who fall will eventually have a fatal outcome [3]. Furthermore, one-half of those who fall are likely to fall again [4]. To minimize falls, exercise and staying physically active is extremely important to ensure that the mind and body is constantly optimized. Unfortunately, not all exercises are created equally for fall prevention. Here are some simple but effective balance exercises that you, or an elder under your care, can do at home.

Before you begin, here are some important considerations:
1. Ensure that you do not have illness or on any medication that interferes with your balance.
2. You have a secure and steady support aid (table, bar, etc.) to hold on to, and there is no dangerous object surrounding you if you fall.
3. There is someone nearby who is able to help you.
4. Start easy and progress as you get better.
5. Try focusing on a non-moving object in front of you to help with your balance.


Hold on to a support aid (barre, table, etc.). Begin by placing one foot in front of the other in tandem, or semi-tandem. When you feel confident, let go of the support and try to balance for at least 30 seconds. Switch sides. To progress, cross your arms across your chest and hold the position. Aim to achieve at least 60 seconds on both feet.


Stand on one foot and make a star pose by shifting your weight to the side. Progress by extending both arms and legs. Hold the position for at least 30 seconds and switch sides.


Hold on to a support aid and stand on one foot. Once confident, slowly lower your chest towards the floor (like you’re bowing down) with a firm and braced back (don’t hunch), and push the other leg backwards. Stand tall and repeat this movement 6-10 times on each leg, and switch after.

There are many modifications you can include to make it more challenging, such as shifting your point of focus, shutting your eyes, introducing distractions and using different surfaces. When it comes to maintaining balance, frequency is key. It is recommended that you perform these exercises often enough until you see improvement. Take note of the duration you can stay balanced to measure your progress.

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.

Reprinted with permission from kewynnpt.com


Osteopenia: Beating Brittle Bones

I recall watching an advertisement on TV that was promoting a brand of milk that is enriched with calcium and vitamin D. The advertisement had a provoking animation of a woman, stooping gradually, as she gets visibly older. The message was that aging adults need higher intake of calcium and vitamin D to maintain strong and healthy bones – and their milk was the solution. Or is it? We know that our bones tend to become more fragile as we age. A proper name for this condition is called osteoporosis. But many of us are probably not aware that women are at a higher risk of developing osteoporosis, compared to men.


7 Reasons Why Exercise is Important for Chronic Pain

When it comes to managing chronic pain due to past injuries, most of us are familiar with common modalities like oral medication, topical analgesic gels, acupuncture, massage, pain therapy machines, meditation/mindfulness, or even surgery. However, did you know that exercising regularly is also an effective tool to manage chronic pain? 

Treating pain mainly falls into 2 categories:

  • Passive Treatment: Designed to address the pain (symptoms) 
  • Active Treatment: Designed to address the cause 

Passive treatment includes treatments that are performed on you such as ultrasound, infrared rays, needling, and manual therapy such as massage or chiropractic manipulation. The therapist is in control during this type of treatment and it mainly focuses on acute pain relief. It does not address or correct the cause of the pain. Brief pain-free periods may ensue, but passive treatment rarely increases the likelihood of complete recovery. For most, one of the main reasons is because people rely too much on passive treatment alone. Passive treatment is usually recommended during the early stage of rehab or for acute pain to help regain minimal functionality, to promote early stages of healing, and to break the vicious pain-cycle. 

Active treatment requires you to be physically involved in the process while working towards a cure to pain. Some active treatments include stretching, a corrective exercise program, and resistance training. However, it is extremely important that you are given the correct active treatment program that is relevant to your injury or condition as well as your goals. Correct exercises are able to address the root of the problem and may even prevent injuries. Active treatment is salient in the mid to late stages of rehab when one is nearly back to full functional capacity. The key is to strike a balance between passive and active therapies to best suit the type of chronic pain. 

In order to treat chronic pain, it is important to understand that pain is a complex and individualized experience. Moreover, physical exercise may seem counterintuitive when you’re already suffering from pain, but whether your pain is intermittent or constant, adopting exercise as part of your active treatment can play an important role in managing pain for the long run. 

Here are the 7 reasons why exercise is essential to manage chronic pain:

1. Exercise alters pain tolerance

Athletes tend to report higher resilience towards pain compared to people who are sedentary. Studies have shown that active individuals are also likely to perceive pain differently. People who perform aerobic exercise or resistance training regularly, may develop the ability to adapt and desensitize the sensation of pain, thereby altering their pain tolerance in the process. 

2. Exercise increases the tissue’s tolerance threshold

Recurring injuries can happen when an excessive load surpasses the tissue tolerance level. Excessive load can come in many forms such as lifting up a pail of water, gardening, or from over-training. Gradually performing optimal exercises coupled with rest can stimulate and improve tissue tolerance margin. An increased threshold can help prevent an injury from reoccurring. 

Source: McGill, Stuart; (2017). Ultimate Back Fitness and Performance. Backfit Pro Inc.

3. Exercise improves blood circulation

Frequent exercise is associated with enhancement of the cardiovascular system. Aside from reducing risk of heart disease, increased blood flow raises the oxygen levels and helps deliver key nutrients within the body that are essential for cellular healing and reparation of injured tissues.

4. Exercise releases feel-good hormones

People living with chronic pain may experience severe disturbances in their psychological state. One can become anxious, depressed or stressed due to physical limitations. Therapeutic exercise can help elevate mood by releasing feel-good hormones such as endorphins and dopamine while at the same time reducing stress due to the release of hormones such as cortisol. 

5. Exercise may help address the root cause of the pain

Common injuries such as chronic lower back pain can be caused by many factors like continuous poor movement, muscle imbalances or past traumatic injuries. Exercise can help tackle the root of the problem by identifying compensating movements or muscle weakness through a series of assessments and resolve them with an exercise program. 

6. Exercise strengthens the body’s structure

Use it or lose it” is a popular phrase used by physical therapists and exercise professionals when it comes to exercise. The connective tissues that move our body and support the joints are muscles. When the muscle stop being challenged, they lose function and strength. Over time, this weakens muscles and exposes the musculoskeletal structure to potential harm. 

7. Exercise improves confidence

In addition to strengthening muscles and improving overall health, exercise can also enhance motor skills by stimulating the connection between the central nervous system and the muscles. Neuromuscular training helps improve balance, stability, proprioception and joint control. This can translate to pain-free movement and a decreased risk for falls. Practicing quality movements via routined exercise can boost functional capacity to perform various activities of daily living without fear of injuries. 

Regular exercise that encompasses both aerobics and strength training is strongly recommended because it is both healthy and effective to decrease chronic pain. However, be sure to seek the advice of a certified medical fitness professional to help you design an appropriate pain management strategy that is appropriate for your condition.

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist who currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.



  • Ageberg, Eva1; Roos, Ewa M.2 Neuromuscular Exercise as Treatment of Degenerative Knee Disease, Exercise and Sport Sciences Reviews: January 2015 – Volume 43 – Issue 1 – p 14-22 doi: 10.1249/JES.0000000000000030 
  • Järvinen TA, Järvinen TL, Kääriäinen M, Aärimaa V, Vaittinen S, Kalimo H, Järvinen M. Muscle injuries: optimising recovery. Best Pract Res Clin Rheumatol. 2007 Apr;21(2):317-31. doi: 10.1016/j.berh.2006.12.004. PMID: 17512485. 
  • Jones MD, Booth J, Taylor JL, Barry BK. Aerobic training increases pain tolerance in healthy individuals. Med Sci Sports Exerc. 2014 Aug;46(8):1640-7. Doi: 10.1249/MSS.0000000000000273. PMID: 24504426. 
  • F. Koltyn, R W Arbogast. Perception of pain after resistance exercise. (Br J Sports Med 1998;32:20–24)
  • McGill, Stuart; (2017). Ultimate Back Fitness and Performance. Backfit Pro Inc. 
  • Staying Healthy: Exercise to Relax. Harvard. December 2021. 
  • https://www.health.harvard.edu/staying-healthy/exercising-to-relax 
Young woman having knee pain

Women Are More Susceptible To ACL Injuries: 5 Essential Exercises To Minimize The Risk

Women have different biomechanics due to a slightly wider pelvis, which means their knees buckle more easily when landing from a jump. Women have looser joints, which is a risk factor for knee problems, and muscular, strength and hormonal issues also play a part.

The ACL provides the knee joint with stability and rotational control during movement. When an ACL tear happens, hearing or feeling a ‘pop’ at the time of injury is common. This is followed by localized swelling at the knee joint.

An ACL injury can occur in several ways:

  • Rapid change of direction
  • Sudden stop
  • Sudden deceleration while running
  • Landing incorrectly after a jump
  • Hyperextension of the knee
  • Direct contact or collision while playing a sport

If you experience any sharp or sudden pain at the knee, especially during sports or from a fall, follow the First Aid RICE protocol immediately — Rest, Ice, Compress, Elevate — and seek medical attention immediately.

There isn’t much you can do once the injury happens, but there are ways to minimize the chance of it happening in the first place. Prevention is better than cure so focus on strengthening the kinetic chain and muscles around the knee. If you do lots of sport with plyometric movements, ensure your technique and form is correct, and include agility drills for neuromuscular control.

Here are 5 essential exercises to help stabilize and strengthen your knees, hips and glutes, which in turn will help prevent an ACL injury.

Single Leg Deadlift

Ensure that your knee doesn’t buckle and aim to keep your hips level. Keep your spine neutral and braced throughout the entire movement while maintaining balance.

Elevated Hip Raise

This exercise targets the hamstrings and calves. Maintain a neutral spine throughout the range of movements.

Walking Leg Lunges with Torso Rotation

Maintain an upright torso with your hips squared. If you feel a sharp pain in your knee at any time during this exercise, stop and seek advice from a qualified trainer.

Lateral Squats

Begin by placing your feet wide apart, then shift your weight from left to right while placing most of your body weight on the heels of your feet. If you feel a sharp pain in your knee at any time during this exercise, stop and seek advice from a qualified trainer.


Reprinted with permission from www.purelyb.com

Ke Wynn Lee is an author and an international award-winning corrective exercise specialist who currently owns and operates a private Medical Fitness Center in Penang. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.

Fitness parners in sportswear doing exercises at gym. Fitness sp

The Perils of Taking the Easy Way Out When It Comes to Fitness

We are by nature lazy creatures. We try to get by with as little effort as possible; we love to minimize work but maximize enjoyment. Sadly, this concept applied to exercise can have severe consequences to our bodies. 

Weak links, in essence, are parts of our bodies that are not as strong as the others. Logically, it would make sense for us to strengthen these weak links in order to build our bodies as a whole. 

However, our bodies usually choose to perform a movement with the least amount of effort and resistance. If one of our muscles is weak, instead of activating it, our body will compensate or cheat by making the other muscles around it work harder to complete the movement. 

This results in strong muscles growing stronger, and weak links growing weaker. The only way to overcome our cheating tendency is to consciously activate our weak links and establish proper movements. 

Once fundamental movements are established, only then can you add in other factors such as strength, endurance, speed, agility and athletic skills, which will help play a big role in improving performance and injury prevention.

A chain is only as strong as its weakest link

There’s no point building big muscles if your joints, tendons, and bones can’t stand the strain. Instead, it is wiser to first build your foundation — and for many people, that means revisiting the weakest parts of your body. 

Perhaps it came from a previous injury, or maybe it’s just a muscle you didn’t pay attention to previously. Whatever the case, tending to your weakest link will lay the necessary groundwork for true fitness. Skip this step, and you may end up doing yourself more harm than good. 

It’s not just limited to gym-goers who overload their muscles by lifting too much weight. In fact, women who are supposedly “flexible” and great at yoga can get into trouble too. On one hand, the gym-goers are building strength without flexibility; on the other hand, yoga enthusiasts are pushing the limits of their stretches without increasing their strength. This can result in joint laxity (looseness of joints) that makes them vulnerable to injury. 

Weak links due to injuries

Some of you reading this right now may have suffered injuries before, whether major or minor. And most of you would be able to relate to the fact that you never feel the same after an injury. The weak links caused by injury are often hard to repair and can lie dormant for a long time before resurfacing to cause discomfort and pain. 

That’s why it is important to identify your weak links. Even if you’ve never been injured, there are other factors that may cause weak links: 

  • old injuries that you were unaware of
  • surgery
  • poor movement
  • incomplete rehabilitation
  • alignment issues
  • muscle imbalances
  • aging
  • mindset
  • genetics 

As you may realize, weak links are not always caused by outward injuries, but may also develop due to intangible factors like age, mentality and physical habits. 

Nevertheless, many people suffer because they do not rehabilitate completely from an injury. A lot of people go through physio and recovery program, but stop once they reach 80% wellness. However, it’s at this stage where it’s the easiest to experience re-injury. Instead, it’s always better to achieve 110% fitness before you go back to your usual workout or sports routine. This ensures your weak link has been strengthened and prevents injury from occurring easily. 

Getting fit the right way

Ultimately, your body is unique. Although most of us want to go straight to training like Arnold, or run like Usain Bolt, our body has its own sets of strengths and weak links that need to be addressed individually first. And the best way to do that is through a personally tailored corrective exercise program, measured out specifically for you. 

The shortcut to fitness is doing it right in the first place.

Ke Wynn Lee, author and an international award-winning corrective exercise specialist, currently owns and operates a private Medical Fitness Center in Malaysia. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.


Wearing High Heels All Day? These 5 Moves Will Help Alleviate Lower Back Pain

Women love their high heels. They’re designed to symbolize feminine beauty by accentuating the butt and legs, and make us taller. But, there’s a trade-off — they hurt your feet, hips, lower back, and even your shoulders and neck!

The human body is designed to walk flat. High heels raise our heels and put our feet into a plantar flexion position where the weight is concentrated at the ball of your forefeet forcing your center of gravity to shift forward. To prevent you from falling, you have to lean back and this indirectly creates excessive curvature on your lower back (lordosis) resulting in stress being placed on the lumbar area. Over time your lower back muscles become overactive in order to maintain your balance when you wear heels. While your posture in heels looks great, it’s actually abnormal.

Photo: Erik Dalton

Apart from lower back pain, other side effects of wearing high heels include tight and stiff calves and soleus muscles, which run from below the knee to the heel. You may also increase your risk of spraining your ankle and having sore hips due to muscle imbalance.

5 Tips To Alleviate Lower Back Pain

1. Tennis balls to release tight and overactive lower back muscles

Lie on your back with both knees bent, lift your hips and place the 1 or 2 tennis balls under your lower back or the area that’s sore – avoid placing the ball directly on your spine. Gently lower your body onto the ball and place sufficient pressure until you feel a tolerable level of pain.

Maintain this pressure for at least 1 minute, or until the pain lessens. Increase the pressure and repeat the process for another 2-3 minutes. Repeat on the other side of your lower back.

2. Hip Raises to strengthen your butt

When your lower back muscles become overactive, your butt muscles weaken. This is referred to as lower cross syndrome. To strengthen your butt, lie down on your back with both knees bent, and raise your hips by pushing off from your heels. Contract your butt muscles by squeezing your cheeks together at the top. Hold for 2-3 seconds and return to the start position.

Maintain a neutral and braced spine throughout and perform 2-3 sets of 10-15 reps.

3. Strengthen abdominal muscles with the Dead Bug

Excessive curvature of your lower back causes abdominal muscles to lengthen and weaken. Unfortunately, exercises like sit-ups and crunches can harm your spine and don’t strengthen your abs effectively. Doing the Dead Bug targets your abs and improves endurance and function, while keeping your spine safe.

To begin, lie flat on your back with your arms held out in front of you pointing to the ceiling. Bring your legs up and keep your knees bent at a 90-degree angle. Slowly lower your right arm and left leg at the same time, and keep going until your arm and leg are hovering just above the floor. Engage your abs and keep your back as flat as possible. Hold the position for 2-3 seconds and slowly return to the starting position. Repeat on the opposite side.

Stop if you feel pain at your lower back as this could mean your abs aren’t properly engaged and you’re using your lower back instead of your abdominals. Opt for an easier variation or skip this exercise and consult a qualified trainer.

4. Stretch the calves and soleus muscles

Place your hands on a wall and stand with one foot behind. Keep your back leg straight and push your heel towards the ground to stretch the calves. After 30 seconds, bend your back knee slightly and try to keep your heel on the ground to target the soleus. Repeat with the other leg.

5. Stretch your hip flexor

Stretching the hip flexor for people with lower back pain is important. To do this effectively, get into a lunge position, contract your butt and tilt your hips upwards by tucking in your tailbone – you should feel the muscles above your quads stretch. Cushion your knees with a towel or exercise mat. Hold this stretch for at least 30-60 seconds, then repeat on the other side.

Lower back pain is unfortunately inevitable if you wear high heels over a period of time. Try wearing a lower heel to minimize muscle compensation or only wear heels if it’s absolutely necessary. If your lower back is acting up, wear cushioned flat sole shoes to alleviate the pain, and don’t forget to practice the exercises above!

Reprinted with permission by Ke Wynn Lee. Pictures courtesy of Ke Wynn Lee.

Ke Wynn Lee, author and an international award-winning corrective exercise specialist, currently owns and operates a private Medical Fitness Center in Malaysia. Apart from coaching, he also conducts workshops and actively contributes articles related to corrective exercise, fitness & health to online media and local magazines.




Older couple at the gym

Muscle Loss with Aging

We know how important it is to manage and control our body weight to remain at the recommended weight for our health. But did you know that if you’re a sedentary adult who weighed the same today compared to 10 years ago, could actually mean that you’ve gained fat mass? Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after the age 30. Even if you are active, you’ll still have some muscle loss. As a result, if your weight has remained the same for the past 10 years especially when you’re not physically active, you’ve probably lost muscle mass and gained fat mass instead. This progressive loss of muscle mass is called sarcopenia.