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knee strengthening

Health, Knee pain

How to Prevent ITB syndrome: IT band exercises

July 28, 2014 • By

ITB syndrome can be painful and difficult to treat, BUT with the right pre-hab and IT band exercises, YOU don’t have to worry about any of that!

Prevention = Cure!

 

ITB syndrome is all too common, with up to 12% of long distance runners affected and a huge 22% of US marine recruits suffering from this, it is a very, very important problem to not only treat right but prevent. This leads to less time out from sport, training and work  – and more time doing what you love!(1,2)

So to prevent this, we need to sort out the risk factors – lessening the chances of you having to take time out.

The main risk factors are:

  • Downhill running(4)
  • Weak or inhibited lateral gluteal muscles (you hip stabilisers e.g.Gluteus medius)
  • Running around a track a lot in one direction
  • And greater than normal weekly mileage(3)

Now from that you can likely see that three of those points are easy to sort out. You can decrease downhill running and vary up your training more. you can run in both directions around a track, if you run n one. And you can make sure you don’t increase your training miles by more than 10% per week – No problem.

But having weak lateral hips – That’s something we really need to work at.

When your hip stabilisers don’t fire up or are weak, this leads to poor control of your pelvis ad hip abduction. Because of this, other muscles have to compensate for this deficit, leading to tight muscles and poor hip extension. This is a big problem, particularly in runners and studies have shown that runners with ITB syndrome do have weaker abductors in the affected leg.(5)

ITB syndromeOne of the muscles that takes over is your tensor fascia latae (TFL) – meaning it is working harder, often leading to spasm and tension. The clincher is that your TFL attaches into your ITB – That means if TFL tightens up, this tensions the band, making it tighter and tighter – causing compression at the knee and pain for you.

 

 

So here is the IT band exercises that we need to do:

  • Strengthen your lateral hip muscles
  • Improve glut activation
  • Loosen off and stretch compensatory muscles – e.g. TFL

 

The following exercises will do this and put you well on your way to being injury free!

1. Side plank

side plank for core strengthening

 

Level 1: Rise up into the position shown and hold for 30 seconds. Each time hold it for a little longer so that eventually you can hold it for two minutes.

Level 2: When you can easily hold it for two minutes, try doing side plank leg raises. This is where you rise into the side plank and then lift your top leg straight up and down. Begin this with 3 sets of 5 repetitions and build up, until you can do your goal of 30 in a row! (easily)

Note: If level one is too hard – bend your knees, so that you are lifting off your elbow and knee.

The side plank is great to getting your lateral gluts firing together with your obliques – just make sure you do not stick your bum out – bring it forward so that your body is straight.

2. Donkey kicks

Donkey kicks improve glut activation

Start on your hands and knee as shown and kick your leg out behind your slightly up towards the roof.

Perform 3 sets of 8 reps.

Note: to make this harder your can be on your toes instead of your knees on place your elbows on a gym ball.

 

 

3. TFL myofascial release

tensor fascia latae and itb myofascial releaseasis anterior super iliac spineThe TFL is, as you can see the image below a little muscle at the side of your hip. to find it, place your fingers on your ASIS which are the bones on either side of your pelvis at the front. From the side of these, drop down a couple of inches and you should be right on it!

I want you to lie on your side and place a ball under your TFL – you can use any ball you like, massage ball, lacrosse ball, tennis or golf ball. Then slowly roll the ball around that area, working out all the knots and tight spots – this can take 2-5 minutes but is well worth your time!

And remember, a bit of trigger point pain is expected here.

 

Interesting note for runners: Having a higher cadence (quicker strides) has been shown to lower the risk of ITB syndrome. This is because when you increase your cadence (which should ideally be 180 steps per minute) your land with your knee bent more and your foot below your knee – decreasing the force through the knee and making for more economical running.(5) This also links in with downhill running being a risk factor – when running downhill we land with our legs much straighter a position, placing a lot more force on our knees and hips.

 

And remember. You are much better off putting in a little bit of time now that spending a lot of time AND money when when you do get injured.

Invest in  yourself


Health, Knee pain

ACL Injury: Strengthening and Rehab Rules

May 10, 2014 • By

acl mechanismInjured your ACL?

Strengthening and rehabilitating the right way after ACL injury means less arthritis, faster return to sport and a more stable knee – So why wouldn’t you?

First and foremost an ACL injury needs to be confirmed and you need to ask yourself: Do you really need surgery?

Most likely, you wont need surgery unless you are a high level athlete or want to return to pivoting and high demand sports – the above post explains this in more detail and will help explain your options.

 

Why does a knee need to be strengthened following ACL injury?

acl anatomuThe ACL is right in the middle of the knee and prevents the tibia sliding forward on the femur and prevents excessive rotation. It is one of the four main  ligaments in the knee that give passive stability

So, simply, if you have an ACL injury – you have less passive stability in the knee and need to make up for this. This is done by improving the active stabilizers – Your muscles.

This is the same whether you have done a partial or full rupture – If partial, you need to unload the ACL and support the knee while it is healing. If you have ruptured it, then you need to replace this loss with increased muscle supports.

 

Why hamstrings are your savior:

hamstrings action in protecting the aclTo better understand a few of the below rules of rehab, it is important to know about the role of the hamstrings. The ACL works to prevent your tibia (the shin bone) sliding forward, when landing, kicking, twisting etc. Luckily the hamstring also does a similar job – they travel down the back of your thigh and attach into the back of your tibia as shown to the right.

So as I said above, if your passive structure (your ACL) is injured then lets improve the active structure that does the similar job (your hamstrings!).

 

Lets get to your Rehab Rules:

1. Closed chain before open chain

Why: First of all a quick explanation of open and closed chain exercises for those of you who don’t yet know:

open and closed chainOpen chain: Simply, your hand or foot is free to move in the air while doing open chain exercises – the chain is not continuous. Such as bench press, biceps curls and hamstring curls.

Closed chain: This is when your hands or feet and planted, in constant contact with a surface. Such as a push-up, squat or leg press.

A study investigating the tensile forces placed on the ACL during a range of exercises found that there is significantly less force through the ACL during weight-bearing (closed chain) exercises, when compared to open chain exercises – hence unloading the ACL and putting less forward pull on the tibia.

For example:

  • 0 Newtons of ACL loading during barbell squat, leg press, wall squat, front or side lunge (closed chain)
  • 59 Newtons of ACL loading during single leg squat (closed chain)
  • Seated knee extension (open chain): 396 newtons

The exception of this is seated knee flexion (hamstring curl) this is an open chain exercise but produces 0 ACL loading – this is because as discussed earlier, the hamstrings support the ACL by holding the tibia back in place.

It has also been shown that closed chain exercises recruit important stabilising muscle groups of the hip which play a big part in knee alignment and proprioception.

hamstirngs squat2. Lean forward at the hips

Why: Because the hamstrings originate from your sitting bones (ischial tuberosities) at the back of your pelvis – If you tilt forward at the pelvis more as shown here it acts to lengthen out the hamstrings. Thus increasing hamstring tension. As we now know that the hamstrings are important in stabilising a ACL deficient or injured knee – this is what we want! So don’t try to keep your body straight up and down (it is pretty hard to squat like that anyway). Actually the optimal forward trunk tilt was shown to be 30 degrees as this increases hamstring muscle activity and force – Ideal!

Don’t stretch your hammies

3. Balance it out: Don’t stretch your hamstrings or idolize your quads

Why: Your quadriceps and hamstrings play a tug-of-war on the knee – the quads pulling the tibia forward (increasing ACL tension) and the hamstrings pull the tibia backwards (decreasing ACL tension). You need to make sure there is a balance here by making sure your hamstrings stay tight and strong and when strengthening your quads – only do this in closed chain exercises in order to get co-activation of the hammys and hip stabilizers.

4. Keep your heels down

Squatting with your heels off the ground causes 3 times more ACL loading compared to squatting with your heels flat – so when possible (ie if you havent got incredibly tight calves) keep your heels flat on the ground. This is because having the heels raised up increases how far forward the knees go during a squat. As your knees go further forward the top of the tibia/ shin bone slopes down more – increasing the force on the ACL.

Note: This also applies to your shoes – If your wear shoes with big fat cushioned heels when working out – this can increase the shear force on your knee also.

5. Do not do knee extension

This is a pet hate of mine as it puts a huge amount of force through the the ACL and increases anterior tibial shear. The reason for this is because as an open chain exercise, it is working the quadriceps muscles in near-isolation, pulling the tibia forward and increasing ACL strain – Not what we want.

There are a lot of other exercises that would be far better to do such as leg presses, various forms of squats, lunges etc – these all have better co-contraction of knee stabilisers and importantly the hamstrings, leading to great ACL protection. When you are stronger and healing nicely it is important to do sports specific and functional rehab and so open chain exercises will be needed to have a strong knee – your Physio can progress you and guide you on to this as every knee is different.

 

For more specific information and data on ACL tensile forces during exercises, see this great paper by Escamilla et al.

Thanks for reading and good luck strengthening your knee!

Remember this is just a guideline to help your achieve your best and nothing is better than getting hands on input from your local Physio.