Preventing IT Band Syndrome

IT Band Syndrome is one of the most common causes of knee pain in runners. It is an overuse injury caused by repetitive friction of the iliotibial band across the Lateral Epicondyle (see image below). This syndrome presents as lateral (outside) knee pain due to tightness of the ITB and hip abductors. As a result of movement of the band during flexion and extension of the knee and hip, a tight band could be responsible for the inflammation at the knee or even the hip, or along the IT Band.

The main physical causes of this condition are:

• Tight IT Band.
• Altered foot function: Excessively flat feet cause the lower leg to internally rotate excessively, adding a stretch tension to the IT Band.
• Decreased Glute Medius/Maximus function.
• Overactive TFL muscle due to lack of Gluteus Medius function
• A weak or inactive Vastus Medials (VMO). This is the inside muscle group of the quadriceps and tends to become weak on people.
• Medial (inward) knee migration during walking/running.
• Leg length discrepancy.
• Tightness of hamstrings/Quads/Calves

Other non-biomechanical reasons for the condition can be improper running technique, worn-out or improper running shoes, hill running, canted running surfaces, and increasing mileage too fast. If you feel any of the non-biomechanical reasons may be an issue, please confer with your running store or coach.

1-Leg Stance Test for hip/foot/ankle instability      

Gluteus Medius Activation for hip stability

^{Hip instability causing knee inward migration This places excessive stretch on the IT Band}

^{Foam Rolling for IT Band}

From a physical standpoint, the best way to prevent IT Band Syndrome is to correct the causes by performing stretches and exercises to correct any of these above dysfunction. Stretching or foam rolling for the IT band, Hamstrings, Calves and Quads is necessary. Secondly, you need to be evaluated to determine if you have excessively flat arches or excessive pronation of the ankle. If you have flat feet, an orthotic may be beneficial. Lastly, strengthening of the hip stabilizers (glutes) and proprioception training of the ankle are recommended.

If you are, or in the future, suffer from IT Band Syndrome, conservative treatment usually does a great job of freeing you from your pain. In our practice we utilize Active Release Technique (www.activerelease.com), Graston Technique (www.grastontechnique.com) and Kinesio Taping along with other modalities to treat the pain and prevent it from coming back. I recommend you familiarize yourself with the above techniques if you are a runner; they are the top conservative treatment methods running related over-use injuries.

Preventing Low Back Pain

Low back pain is the most common pain syndrome in America today, and it is not limited to only the sedentary. Runners and many athletes suffer from this condition on a regular basis and there is usually a combination of physical causes and altered running or walking biomechanics that may be causing the condition.

The main physical causes of this condition are:

• Over-pronated or Supinated (high arch) feet
• Tight hip flexors
• Excessively flat or arched Lumbar Spine
• Joint restrictions in the thoracic spine or pelvic region
• Limited Hip range of motion/ Limited hip extension
• Weak Core Stability- Abdominals, Lumbar erectors and Deep Core
• Weak/Inactive Glutes
• Tight Hamstrings
• Altered Hip Extension Pattern- Discussed below

Hip Extension Firing Pattern

When extending the hip (leg pulling through and back) during running or walking, as in picture 3 below, the glutes should do most of the extension. The low back and hamstrings should be “helpers” during this movement. In many runners, this pattern gets altered due to weak glutes and overactive low back and hamstrings. When this happens, too much stress is placed on the low back and hamstrings. Tightness ensues in these two structures and this is two of the main reasons runners will suffer from low back pain.

Biomechanical Video Analysis

In the clinical setting we evaluate all runners walking and running for clues that may give us the understanding of how their injury is occurring. We don’t assess the video for running technique, but rather biomechanical faults that put excessive strain on certain structures that may be causing the runners pain. Below are a few examples of findings that can cause low back pain, amongst other injuries.

Unstable Foot/Ankle (pronated)

Hip Instability

Limited Hip Extension

Other non-physical reasons for the condition can be improper running technique, worn-out or improper running shoes, and increasing mileage too fast. If you feel any of the non-physical reasons may be an issue, please confer with your running store or coach to address them. Another huge problem in today’s society is sitting too much. Even as an active runner, sitting constitutes much of our day while at work and home. Research shows that sitting places 40% stress on the discs and muscles of our Lumbar spine and is the main cause of chronic low back pain.

From a physical standpoint, the best way to prevent low back pain is to obviously correct the causes by performing stretches and exercises to correct any of these above dysfunction. Strengthening for the Glute Max, Glute Medius, Foot/ankle and Core (See pictures below) is a must. Secondly, you need to be evaluated to determine if you have excessively tight hamstrings, flat or high arches and unstable ankles, altered curve to the lumbar spine (too flat or too arched), tight hip flexors and other muscular imbalances that places undue stress on the Lumbar spine.

Glute Bridges- Strengthens and activates the Glute Max, the main muscle group responsive for glute function and hip extension.

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Side Leg Lifts- Strengthens and activates the Glute Medius, the main muscle group in providing hip stability during one leg stance and running.

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Bird Dogs- Increases core stability and endurance to prevent weakness in the low back.

Bird Dogs

If you are, or in the future, suffer from Low Back Pain, conservative treatment usually does a great job of freeing you from your pain. In our practice we utilize Active Release Technique (www.activerelease.com), Graston Technique (www.grastontechnique.com) and KinesioTaping along with Chiropractic modalities to treat the pain and prevent it from coming back. I recommend you familiarize yourself with the above techniques if you are a runner; they are the top conservative treatment methods running related over-use injuries.

Preventing Plantar Fasciitis

Plantar Fasciitis is one of the most common causes of heel pain in runners. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs across the bottom of your foot — connecting your heel bone to your toes. 

Plantar fasciitis causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, getting up from a seated position, or running/waling. [1]

The main physical causes of this condition are:

• Tight calves will increase tension on the plantar fascia.
• Altered foot function: Excessively flat or high arches.
• Lack of big toe extension- Upward movement of the big toe.
• Tight hip flexors will reduce ability to use gluteals in ‘push off’ phase of stride, hence increasing the work load on the plantar fascia and calves. {2}
• Reduced gluteal and hamstring strength will again increase the demand on the calves and plantar fascia, predisposing to overload of these structures.{2}

Other non-biomechanical reasons for the condition can be improper running technique, worn-out or improper running shoes, and increasing mileage too fast. If you feel any of the non-biomechanical reasons may be an issue, please confer with your Friends In Training coaches to address them.

From a physical standpoint, the best way to prevent Plantar Fasciitis is to obviously correct the causes by performing stretches and exercises to correct any of these above dysfunction. Stretching for the Gastrocnemius (upper calf), Soleus (lower calf), hip flexors (See picture below), and the Plantar Fascia (See picture below). Secondly, you need to be evaluated to determine if you have excessively flat or excessively high arches. If you have flat feet, an orthotic may be beneficial. With high arches, manual therapy can help reduce the rigidity and tightness of the foot/arch. Lastly, strengthening of the glutes and hamstrings (along with hamstring flexibility) are vital to proper push-off mechanics during running.

If you are, or in the future, suffer from Plantar Fasciitis, conservative treatment usually does a great job of freeing you from your pain. In our practice we utilize Active Release Technique (www.activerelease.com), Graston Technique (www.grastontechnique.com) and KinesioTaping along with other modalities to treat the pain and prevent it from coming back. I recommend you familiarize yourself with the above techniques if you are a runner; they are the top conservative treatment methods running related over-use injuries.