IT Band Inflammation

To follow up on the last blog post:

 

First, lets address the IT Band inflammation. This must be addressed initially as this could affect the way one moves during exercise and lead to further pain and muscular imbalance. The IT Band is a term which is short for Iliotibial Band. The ITB consists of the gluteus maximus, the tensor fascia lata (TFL), and the myofascial and or connective tissue which originates at each of these muscles in some fashion and inserts into the lateral aspect of the proximal tibia (larger lower leg bone). When one complains of ITB inflammation, or runners knee, they generally exhibit lateral knee pain. This is generally due to a lack of flexibility of the tensor fascia lata which can result in increased tension on the ITB during the stance phase (when your foot is on the ground) of running (Clark & Lucett, 2011). Issues with the ITB can also result from overuse of the and a weakness in the same side gluteus medius which could contribute to decreased time to fatigue for the TFL.

In order to decrease the pain being felt from the ITB inflammation a simple yet systematic process must be put in to place to release the tension or inhibit the over active TFL, stretch or lengthen it back to its optimal length, activate or strengthen the underactive or weak muscles, more than likely the same side gluteus medius, followed by an integrated movement involving a full body exercise while focusing on proper posture and form to hopefully make the the newly synergystic movement pattern a "habit".

 

One of the jobs of the TFL is stabilize the pelvis. This is however not its primary job. The gluteus medius is a much larger role player when it comes to pelvic stabilization in the frontal plane (from left to right or right to left). If the gluteus medius is weak, the TFL may become more dominant in pelvic stabilization causing it to be used more often than it should be. This is what can cause the "tightness" or shortened position within the muscle itself. When there is a muscular imbalance such as this, it can affect the major joints above and below the problematic area as most muscles in the body are connected through connective or myofascial tissue. Hense, the pain one feels down near the knee although the "tight" muscle is located roughly at the top of the hip. Without going too in depth, utilizing pressure from an object (a hand, foam roller, PVC pipe etc.) inhibits neurological activity to the tissue where the pressure is applied allowing the muscles and or myofascial tissue to relax. The picture above is a basic picture showing how to use a foam roller to release or relax an overactive ITB. While maintaining neutral alignment of the spine, place the roller beneath the affected side. This is the space between the hip and the knee. You can use your top leg to alleviate some of the pressure if it is too intense. When you find a triggerpoint or tight spot, hold there for 30 seconds. If the sensation is too intense, simply roll away until you can handle the pressure. The lighter the pressure, the longer you must hold the position for up to 90 seconds. You may follow this with slowly rolling back and forth. If you have significant shoulder or wrist dysfunction, this may not be the best method for you. There are some associated risks with using a foam roller. Therefore, it is contraindicated in those with osteoporosis, organ failure, or going through treatment for cancer. As always, consult with your physician if you have questions. You are also welcome to email me, and I will do my best to provide answers.

Once the ITB has been released, one may properly lengthen the tissue back to its normal state. We do this in order to promote balance around the joints which are affected by the tissue. This can be done through a simple static stretch for 30-60 seconds. One must not bounce when performing a static stretch. Maintain a solid "pull" throughout the area for the entire length of the stretch. The picture here is quite generic and is only one of many ways to lengthen the ITB. In this picture, the model would be stretching the left ITB by poking her hips to the left and leaning the upper body to the right.








Once one has effectivly inhibited and lengthened the over active area, it is time to activate or strengthen the underactive or weak muscles which lead to the syngergistic dominance of the overactive muscle. In this particular case, without meeting the person or performing a static and dynamic movement assessment, we will assume the underactive tissue is the gluteus medius. One method for strengthening the gluteus medius would be to lye on your side with the affected leg up, and your back against a wall. While maintaining your heel in contact with the wall, toes aimed forward, you raise the leg as high as you can without form being affected for 2 seconds, hold for 2 seconds, and lower for 4 seconds. Perform this exercise initially for 10-15 repetitions for 1-2 sets.


Now that we have created balance around the joints affected by the overactive/underactive muscles, we can integrate them back into the human movement system through a full body exercise which promotes coordination between the muscles. To do so we could utilize the ball wall squat into overhead shoulder press. Overhead movements place further stress on the core and upper body during a squat thus increasing inter musculature coordination during the exercise (Clark & Lucett, 2011). I apologize for the picture as it does not include the overhead shoulder press portion of the movement. To perform the movement begin with the stability ball supporting the lower to mid back in the standing position with the dumbells to be pressed placed at chest level with palms facing inward. Feet are shoulder to hip width apart with the toes aimed forward and the knees remaining in line with the second and third toes. Squat to roughly 90 degrees or as tolerated maintaining the original alignment of the knees and feet. As you rise to the standing position, externally rotate the shoulders allowing the palms to turn outward as you raise the dumbells overhead. Once the arms are overhead they should remain in line with the ears without jutting the head forward at all. If this can not be completed, begin with the squat portion of the movement with the hands on the hips as further corrective exercise may be required to address shoulder dysfunction. Perform this exercise 10-15 repetitions for 1-2 sets.

This entire process must be performed consistently at roughly 3 days per week to yield its benefit in some individuals. I do not have research to back this frequency but I have found this to be effective in most of the individuals I work with. Once the improper movement patterns are corrected, one can slowly be reintroduced back into more intense training methods. Continuing a regular foam rolling and flexibility routine may help to decrease the likely hood of this problem repeating itself down the line.

I must include that this routine may seem "easy" to some but I have to stress that it is necessary to correct an improper movement pattern. The isolated and integrated movements may be progressed to more difficult or intense movements throughout the program. Also, this is not the only method available for correcting improper movement patterns. There are other other methods which can be explored such as physical and massage therapy.

Please comment in the comments section below! I believe that in order to comment, you must have a google account or email.

Thanks,
Joe

Clark, A., M., & Lucett, C., S. (2011). NASM essentials of corrective exercise training. Philadelphia:Wolters Kluwer and Lippincott Williams & Wilkins.