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Health, Knee pain, running

IT Band Syndrome: Heal Fast and Strong

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Are you sick of trying to fix your IT Band Syndrome by stretching, strengthening or foam rolling your Iliotibial Band?

Good news!

You don’t need to waste your time with that any more. Here you will find a clear summary of what really causes IT Band Syndrome and what you can do to really help it. All based, as always, on current research and good old-fashioned experience from a runner and physiotherapist to help you heal strong and fast.

What is IT Band Syndrome really?

IT Band Syndrome is a common overuse injury in runners and cyclists and is commonly thought of as a friction syndrome.

First of all, the one myth that needs to be sorted out is this:

IT Band Syndrome is caused by friction, from the IT Band rubbing over the lateral knee

False: IT Band Syndrome IS NOT CAUSED BY FRICTION and the IT Band CAN’T SLIDE OVER THE LATERAL KNEE

Recent evidence shows that it is not due to friction and that there are some easy treatments and exercises that can effectively treat it.

In actual fact, IT Band Syndrome is caused by compression of the IT Band. Lets have a quick look at the anatomy so that you can see why this is:

How IT Band Syndrome happen then?

IT Band SyndromeThe IT Band is a thick tract of connective tissue which connects up your hip muscles to the knee and helps stabilize the knee in the process. It originates from the Gluteus Maximus and Tensor Fascia Latae muscle (see in the image to the right) and ends up attaching into the tibia (right up the top of your shin bone).

Before attaching into your tibia, the IT Band crosses over the lateral femoral epicondyle (where IT Band Syndrome pain is felt). For years it was thought that the IT band slid back and forth over this epicondyle as your moved your knee (and this is still far too popular theory: 1,2,3). Fortunately it has been proven through studying cadavers and use of MRI that the IT Band is actually anchored to the femur by fibrous strands and so cannot actually slide – so, no friction. The MRI’s also showed that at this point, underneath the IT Band is a layer of fat, full of little nerves and blood vessels, making it very sensitive, especially when compressed.

So from this, based on anatomical findings at least (which are hard to argue with) IT Band Syndrome is associated with compression of the sensitive layer of fat beneath the IT Band rather that friction.(4) This knowledge of the IT Band and it’s attachments isn’t all that new but has unfortunately been overlooked and ignored for too long. A big driver behind the myth of ITB friction syndrome is the perception that movement of the ITB across the epicondyle can be felt, but this is an illusion because of changing tension in its anterior and posterior fibres.(5)

Risk Factors for IT BAnd Syndrome

ITB syndrome is a repetitive strain injury caused by the IT Band compressing the layer of fat beneath it. The factors leading to this happening are thought to be:

  • Increased hip adduction (the leg moving inwards, towards the opposite leg)
  • Increased knee internal rotation (7)
  • Impaired function of the hip muscles
  • Poor running technique

The good thing is, if these biochemical issues are found and addressed, a resolution can be found.(6)

So, here is how you should go about treating your IT Band Syndrome the right way.

Treatment

1. Get a biomechanical assessment done by a sports physio or similarly qualified health professional. This should look at the strength, control and endurance of your hips, whether your have hip drop etc. They should also check out your technique.

Tip: As well as this, you can do a quick test at home to see where you are weak – See this post to find out how easy it is.

2. Start your rehab exercises that you can find detailed on a past blog post here

3. Make sure that your running technique is spot on – Your physio can help with this, or check out this post for some easy tips.

4. Shoes: Make sure that you shoes aren’t too old and worn and ensure that you do not drastically change shoe style. For example, don’t go from a cushioned, controlling runner to a minimal Nike or Vibram all of a sudden – it needs to be gradual.

 

Lastly, feel free to comment below and please share if this has helped you.

 


Health

Ankle Pain Running? Improve Your Ankle Range, FAST.

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Limited ankle range can cause you a lot of problems, and not just at the ankle.

Can you spare 5 minutes to improve your ankles and in turn, your running?

Well then you are in the right place! As I discussed in last weeks post,  whether you’re an amateur, weekend warrior or a pro, good ankle range is a must for many basic movement patterns. If you don’t have it, you can’t squat right down, you can’t have a proper stride when walking or running AND it loads up other areas of your body causing pain and injury.

But luckily, there are three easy exercises that you can do to improve your ankle range.

wpid-wp-1411170423169.jpeg

 

First: Have a quick look at the post I mentioned above to take the ankle range test, so that you know your score (this way you can see how well you improve!)

 

 

 

 

These are the three things will improve your score in days:

calf stretch , soleus, gastroc - self treatment for shin splints1. Calf stretch

Lets get the basics right. The easiest way to do it is to, one foot at a time, drop a heel of a steps, as shown.

Hold this for 30 seconds

Swap over and do the other foot, and then you are done.

 

2. Self myofascial release – Plantar fascia and calf

For the second exercise, you need to work over some of your tight soft tissue (muscle and fascia etc)

  • First, get a nice firm ball (eg, tennis ball, lacrosse ball). While standing, place it under one foot and apply medium pressure. Now slowly roll it around the bottom of your foot, right through the arch for 30 seconds on each side.
  • MTSS shin splints self treatmentSecond, get your Foam Roller – if you don’t have one, either buy one (great investment) or use a ball. Get down on the ground and spend 1 minute on each side, nice and slowly really working in through  your calves.

I know that was really two exercise, but I’m sure you can handle it!

 

That’s four minutes so far, one to go…

3. Ankle mobilization exercise

Check out this video by Adam Kelly, that demonstrates this exercise well – All you need is a strong elastic band or a willing helper and do this for 30 seconds on each ankle.

 

Done. You have just decreased your chance of ankle pain running, walking and more.(1)

I challenge you to make this a daily routine for 10 days and re-test and see how much your score has improved!

 

Let me know how you get on and be sure to subscribe for more.

 

 


Knee pain, running

Patellofemoral Pain Syndrome: Home rehab and exercises

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patellofemoral pain knee cap pain exercisesCommon names for Patellofemoral Pain Syndrome (PFPS) are Chondromalacia patella, anterior knee pain, runners knee, patellofemoral tracking disorder.

*Now just a quick clarification: Chondromalacia Patella is not PFPS. Chondromalacia Patella is commonly over diagnosed and is when the articular cartilage on the undersurface of your knee cap is damaged. The prevalence of this is far less than Patellofemoral pain syndrome but generally occurs if PFPS is left too long as the cartilage gradually softens and degenerates. This can be confirmed with an MRI. The below rehab exercises and advice for Patellofemoral pain WILL HELP this also, it will just be a longer recovery period.

Patellofemoral pain syndrome. self treatment and rehab at home to decrease pain and get you back to it!What: Patellofemoral pain is felt at the front of the knee and typically comes on gradually typically comes on gradually. Normally the patella (your knee cap) glides in a groove in your femur when bending your knee. It is believed PFPS results from abnormal Patella tracking (not gliding smoothly in the groove) causing excessive compression on the under surface.

This mal-tracking can be caused by:

  • Quadriceps weakness (particularly poor activation of your VMO/inside quads) causing an imbalance.
  • Excessive knee soft tissue tightness
  • Tight Quads and Iliotibial band
  • An increased quadriceps angle (Q-angle)
  • Hip weakness (particularly Hip abductors and external rotators)
  • Altered foot biomechanics eg. over-pronation

Generally, there is always a combination of these factors causing a significant imbalance of forces on the knee cap, leading it to be pulled to one side (like a tug of war!). It is generally pulled laterally.

Symptoms and signs

  • Anterior knee pain
  • Knee stiffness with prolonged knee flexion eg. sitting in movie or driving.
  • Activity-related pain: Running, squatting, stair climbing (especially going down), kneeling, cycling, swimming breaststroke.
  • Tenderness/pain on compression if the knee cap
  • Crepitations or Grating sensation
  • Giving way
  • Swelling around the knee cap

Risk Factors:

  • Female gender
  • Iliotibial band syndrome (ITB syndrome)
  • Training: Long distance running, training on hard surfaces, hills, stairs

Note: it is important to remember that muscle dysfunction and repetitive loading of the Patellofemoral joint rather than fixed biomechanical factors and the major contributors to PFPS(Baker and Juhn 2000) and so there is a lot that can be done to help.

Prognosis: Depends on co-existing conditions, but poor if causative/aggravating factors and not addressed. If symptoms have been there for over 12 months you will have a poorer prognosis but do lose heart, it can get a lot better, you just need to persevere and stick at it 🙂

Test yourself! To see how stable your hips are.

Self Treatment:

Exercises:



Bridge - increase leg strength, glute activation and decrease back pain.Bridge - increase leg strength, glute activation and decrease back pain. improve your athletic and sporting performance with stronger posterior muscle strength and activation1. Single leg bridges: 

Action: 10 x 3-5 second holds on each leg.

Tip: alternate legs and switch your core on.

 

 

Heel raised squat for VMO and glute activation for knee pain

2. Decline mini squats:

This squat is great for VMO (your inner quad) activation but it also increase glute activation. I have used a phone book here just to show that you can use anything at all that is 1-2 inches.

Action: Do not push into pain (if it is sore, don’t go as low), you do not need to go below parallel. Squat like you are going to sit down in a chair and do not let your knees go past your toes.

Perform 3 sets of 12, nice, slow and controlled.

Tip: look up to the top of the wall to help your balance.

 

 

Foam roller for ITB syndrome, knee pain

3. Foam roller: These are great. If you haven’t got one, get one! (A reasonably dense Foam Roller preferably)

Roll all the way from the knee to the hip, making sure you do it slowly.

Spend 2 minutes on the side as shown and then 2 minutes on the front/quads.

Tip: try to keep your feet off the ground and DO NOT LET PAIN PUT YOU OFF, it will get easier.

 

 

Clam exercise plus - gluteus medius strengthening, pelvic stability, leg strength4. Clams:

Lying on your side as shown. keeping your ankles together, lift your top knee 20cm, then lower down again (don’t drop it!)

Goal = 1 set of 50, if you are doing them right, you will need to build up to this.

Tip: Keep your top elbow down on the ground and hips rolled forward.

 

 

Hip flexor and quads stretch to decrease back pain, improve posture. great exercise from a trained Physiotherapist5. Quads stretch:

Hold this stretch for 1 minute.

You may need to put a cushion or towel under the planted knee!

Tip: you do not need to lunge forward, to add more stretch, tuck your bum in under you or put back foot up on something (eg. wall or foam roller).

Note: if this hurts the knee (even with padding) then stop doing it and wait a couple of weeks before building it in.

 

Do these exercises two times daily.

 

 

Other things that may help:

  • Brace: while rehabbing your knee, a brace can help keep you moving, such as a Patella Tracker
  • Orthotics: the use of Orthotics reduces PFPS in the short to medium term and addresses bio-mechanic deficiencies on the foot.
  • Ice: after exercise, after a long day or when there is any pain ice minutes for 10 -15 at a time (no longer).
  • Rest, give it a couple of weeks rest. this gives you a great time to get a head start on the exercises and really start the rehab off well.
  • Altering training: shorter distance, get off hard surfaces, cross-train.
  • footwear: throw out old shoes, stay away from shoes with poor support eg: Flip-Flops, jandals, sandals, slippers.

Often it is not the knees fault all this pain and discomfort happens, so to treat this condition it is important to look above (quads, ITB, hip) and below (foot, calf).

Follow this advice for at least 12 weeks (yes three months, you NEED to be serious about this to decrease the risk of early knee arthritis and ongoing pain.)

If you have any questions feel free to comment below.

Please share, comment, follow and let me know how you get on!

 

You may also like:

Lower Limb rehab

Glute activation, the missing link

Quick stability and balance test

A good research paper if you want more info on PFPS research


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