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IT Band Syndrome: Why Foam Rolling and Stretching is not Enough
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Dear <<First Name>>,
CJPTWSpring is officially here!
 

A
lthough this may seem hard to believe (especially if you live in the Northeast like I do - with freezing temperatures and snow still on the ground), spring is here and I am ready to leave old-man-winter behind!!  Aside from the obvious things like tulips starting to pop up from the groundthe warmer, sunnier weather, and the bright colors that you start to see on people and in the nature around you, part of my excitement of ditching winter is getting into the full swing of running season!  If you are anything like me, you may have slacked off a bit this winter, so getting back into your running groove will require a little extra thought and preparation this season, that is, if you want to avoid getting injured and run pain-free!

What exactly is "IT Band Syndrome" and why am I telling you about it?

IT Band Syndrome (ITBS) stands for iliotibial band syndrome, and it is one of the most common injuries impacting runners.  Your iliotibial band is a tough, dense band of fascia (fibrous tissue) that forms from your tensor fascial lata (TFL) muscle in your hip, and goes all the way down the side of your thigh, inserting just below and into the side of your knee.  When your IT band gets irritated (more on that later), the common symptoms include sharp, stabbing pain or aching typically on the outside of your knee.  This is know as ITBS.  When I first started running, I suffered from ITBS and it was not fun.  My hip and thigh felt super tight all the time and I would get debilitating, stop-me-in-my-tracks kind of pain in my knee that prevented me from running more than a mile sometimes, and even walking or using stairs.  I occasionally still have problems if I am not careful, but after a lot of problem-solving and research, I have mastered my ideal management strategy and as long as I stick with it, I can run without knee pain!  I want to share some of this valuable information with you so that you can not only avoid having ITBS derail your running (or fitness) regimen, but also begin to have a real understanding of what is going on so that you can feel empowered to start doing something about the health of your knees NOW.

Ice, Foam Roll and Stretch... (or not?)

This is sadly the most common advice given to people suffering from ITBS.  While this may be adequate advice to ease the symptoms of pain and tightness associated with ITBS, it is not enough, and has a minimal, if any, effect on the root causes of ITBS.  Don't get me wrong, when your knee is throbbing and painful, regardless of the cause, ice is a good thing.  When the muscles in your legs feel so tight they could snap, foam rolling can be a good thing (if you know how to do it correctly).  Stretching... well... let's face it, stretching just feels really good, especially after a long run or a rigorous workout.  So why wouldn't it be a good thing?  It is a good thing.  The problem with stretching is that few people really know what to stretch and how to stretch in a way that is actually effective at lengthening a muscle and improving its function.  I could write a whole article (or three) on ways to effectively stretch but for the purposes of ITBS and this article, what you really need to know immediately about stretching is...

You can't really stretch your IT Band (gasp!)

I know.  This is really shocking and horrible news for some of you, but the IT band itself is a ridiculously tough piece of fascia.  While the properties of fascia are still somewhat mysterious and being understood, we do know that fascia is way stronger than muscle and requires carefully applied, and usually very strong forces to truly be stretched - forces that you are likely not using when you attempt to stretch (or roll) the IT band on your own.  In other words, the traditional IT band stretches that the physical therapist or trainer taught you, or that you found on google, really aren't doing much, if anything, for your knee problem.  In fact, they may be causing you more damage, especially if you are adding foam rolling to the mix.  The problem with ITBS, and why it is causing your knee to hurt, is that the IT band gets inflamed and irritated from being overworked.  You don't want to be stretching or foam rolling inflamed tissue.  It needs a chance to calm down, and then the reason behind it being overworked can be sorted out and addressed so that you can really fix the problem.

What to do instead...

While the causes of ITBS can be somewhat varied among people, the usual suspects (and the most common that I see) for the cause of this painful problem is a poorly functioning glut medius and an overly functioning TFL.  Let me explain...  

The main role of glut medius is to dynamically stabilize the pelvis and lower leg during movements such as walking and running.  When glut medius fails to do its job, some other muscle, or muscles, have to kick in to do the job instead.  Very commonly, TFL will come in for the rescue.  But the problem is TFL isn't strong enough, or positioned well enough, to stabilize the pelvis and lower leg without causing some (if not many) problems.  Since the IT band is sort of meshed in with TFL (check out the picture above), it can get irritated and inflamed as TFL continues to overwork itself, thus, leading to ITBS and very annoying, persistent knee pain.  This pattern will continue - and get worse - unless you do something about it.  

You have to strengthen glut medius and give TFL a break.  
Now there are lots of different ways to do this, but one of my favorite (and simple) exercises for strengthening glut medius is the one shown here.  When done correctly, this exercise is really hard and should make the side of your hip BURN.  The key in making this exercise effective (and why it doesn't work for most people) is to make sure you have the correct form.  Your hips need to be completely stacked and stable, and your leg needs to stay completely parallel (knee and toe pointing forward).  The biggest correction I give to people is to not let their top hip fall back as they are doing the exercise and to not let their top leg turn up (rotate) towards the ceiling.  One helpful cue I give that makes this exercise really effective is to "lengthen" your leg.  You want to imagine that you have tight pants on and as you lift your leg, you don't want to see any wrinkles in your pants.  This helps to work the tiny intrinsic hip muscles that work to stabilize your hip in its joint (kind of like the rotator cuff of the hip).  The last cue I give is to tighten your belly!  People LOVE to let their belly hang out on this exercise and arch their back.  Make sure you are keeping your belly pulled in toward your spine and that your back stays nice and straight.  You want to aim for about 30 reps in a row (you may need to build up to this) and you can add some resistance by securing a thera-band between your two ankles.  Throw this exercise in on your cross training days as it is a valuable core and hip strengthening move.

Another great exercise to strengthen your glut medius and improve your balance (good balance is so important and almost always overlooked) is the single leg squat.  Just stand on one leg as shown in the picture and squat as low as you can while keeping good form and balance.  You want to keep your belly pulled in like I explained in the previous exercise, and also try to keep your foot as "quiet" as possible.  As you continue to practice, both your intrinsic foot strength and your balance will improve and your foot will become more stable on the ground (i.e. more "quiet").  The most important thing during this exercise is to keep your pelvis level and stable.  Basically, if you had two headlights attached to the front of your hips they would be pointing straight ahead and be at the same height at all times.  I would recommend doing this one in front of a mirror and maybe even holding onto the wall for balance until you get better at it.  Again, aim for 30 in a row on each leg and do it 1-2 times per week on your cross training days for maintenance.  This exercise also works your inner quad and glut max!

So what about foam rolling and stretching?

If you love to foam roll (like I do) then go for it!  I teach my clients how to foam roll properly all the time and I use one myself for rolling out my legs, working on pelvic stability, and stretching out my back pretty regularly.  Rolling out your gluts, piriformis and quads can be particularly helpful for ITBS - just stop foam rolling directly over your ITBS!  As far as stretching goes, dynamic stretching is a great way (the best way in my opinion) to warm-up before a run.  If you google dynamic stretching, you will find all sorts of crazy routines out there.  Some are good but some are a little scary to me.  My advice is to find a relatively simple routine that you like, that is easy for you to perform (i.e. doesn't hurt), and that hits all of your major muscle groups - and then be persistent about it.  Stretching only works when you do it consistently and on a regular basis.

Problem-solving...

Now keep in mind this is just a general overview of ITBS.  My intention here is to clear up some of the confusion around ITBS so that you have a better idea of what it really is and what you can start to do about it now on your own.  This is not a prescription for treatment.  If these exercises and my advice prove to be successful then this is excellent news!  I may have just saved you from full-blown ITBS a few weeks or months from now.  But if you are really suffering, then please find a licensed and highly-trained physical therapist in your area right away (hint: if they tell you just to foam roll and stretch then you will need to find another therapist).   When I work with my clients on any problem or performance-related issue, the first thing I start with is a head-to-toe assessment and detailed movement analysis.  This is the only way to truly find the root cause of not only ITBS, but of any movement dysfunction or mechanical problem you might be having.  If your ITBS is chronic, or impacting your daily life beyond running, then you may need expert help.  There are several hands-on treatment options, like dry needling for example, that will help to kick-start the healing and recovery so that you can get to the phase of strengthening and stretching on your own.  I used dry needling on myself when my ITBS was really bad and it was a life-saver!

If you found this information valuable and know someone who would benefit from reading this, please pass this newsletter along!  I am still in the process of growing my online community so sharing is appreciated.

Wishing you full and pain-free movement!
Carrie


 
Attention Portsmouth and Seacoast residents!!

I'll be speaking in more detail about this topic on Thur April 2nd at 7pm at Runner's Alley in downtown Portsmouth.  It takes place in the community room upstairs right after the runners group meets.  There will be opportunities for Q&A, personal demonstration, and a special offer if you attend in person.  

Call or email now for more information!
Ph: 617-545-7505
Email: cjphysicaltherapy@gmail.com
Attention DC-metro Residents!!

Did you know that I travel to DC once per month and treat clients?

Many of my DC-area clients have enjoyed taking advantage of my services on a monthly basis.  Prevention is key to keeping nagging pain and discomfort from becoming a full-blown, unmanageable problem.  And maintenance therapy is essential for the management of many chronic conditions.  

I will be there next month from Fri April 2nd - Mon April 5th and still have a few openings.  I would love to see you and guide you with your physical therapy and wellness needs!

Call or email now to inquire about openings!
Call: 202-573-8305
Email: carriept@yahoo.com

Dr. Carrie Jose is a physical therapist, Pilates instructor, movement expert, trained dancer, and natural-born motivator.  She provides private physical therapy, Pilates and wellness services and consulting in Portsmouth, NH and Washington DC.

Want to work or consult with Carrie?
Email her at cjphysicaltherapy@gmail.com or call 617-545-7505
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