Friday, October 12, 2012

IT Band Syndrome

Fall is officially here and the holidays are approaching... what's this mean?  Well it means that we can all stop working out, grow beards, wear flannel shirts, watch football and drink beer all day... fantastic! Just kidding.  Or am I?  No I really am, we can have a football flannel shirt blog some other time.  What it really means is that everyone and their mother is trying to get the most out of the last few weeks of bearable weather by running more. Boston is filled with road races this fall, every weekend, and every holiday until it gets too cold outside to feel feelings anymore!  And like clockwork, every year, our office fills up with runners complaining of IT band pain and/or IT band Syndrome.  Now you may be saying... "what's an IT band?"  Lets find out.

If you look at the pictures above you'll see a long white "band" of fascia (which is kind of like a tougher skin that's underneath the skin... not a muscle and not a tendon).  The IT Band is a tight band that runs from the gluteal muscles up near the hips all the way down to the outside of the knee. The purpose of this band is hip and knee stability, especially during running or standing on one leg. If this area gets too tight or irritated it starts to pull on where it attaches to the knee and can cause pain, in most cases the pain is rather severe.   It's described as a stabbing pain that prevents runners from continuing their run.  But it's not only seen in runners, it can be seen in people who aren't very athletic at all... but we'll talk about runners because it's more prevalent in this demographic.

There are a few causes of IT band syndrome and IT band pain.  The first is simply a tight IT band which happens when we sit too much, don't stretch our gluteal muscles, don't exercise enough, etc.  These cases usually get better by stretching, rest and rolling.  Everyone has seen these people at the gym rolling up and down on a foam roller trying to loosen up their IT band.  It would be great if healing this problem was as simples as rolling up and down on a foam roller.

The second cause is the angle created from the hip, the knee, and the ankle. The picture below explains what we mean.  The example on the left is the problem, where the knees come close to connecting.
This natural posture causes abnormal stress on the hips and eventually the IT band.  And since women more often have this type of anatomy we see IT band problems popping up more frequently in woman.    People with this problem have a harder time healing and getting back to running because it's not as easy as rolling on a foam roller.  This problem has to be looked at from many angles. First we look at the feet, to see if flat feet or fallen arches are causing the knees to bend inwards.  If they are, sometimes inserts can help.  Or on the opposite end of the spectrum, bare foot running or minimal shoes may help.  Try the new balance minimus shoes or the vibram 5 finger shoes. These shoes seem to help a lot of people regain their arch stability, so you can also try those for a few months. And if you don't want to look ridiculous all the time I would go with the new balance ones :) Next we look at the hips for tight or spastic TFL muscles or gluteus medius muscles which may be tugging on the femur bone and increasing the angle at the knee.  If inserts, stretching, and/or deep tissue gluteal work doesn't fix the problem then we look at the 3rd cause of IT band syndrome which, believe it or not, is the spine.  

Now at this point you may be saying "oh here we go, of course the chiropractor thinks IT band syndrome is caused by the back... just like every other problem."  And you may even be saying this to yourself in a mocking tone!  Don't worry, I won't take offense :) Just try to stay with me on this one!  The reason some IT band issues are caused by the low back has to do with physics and how the body absorbs shock.  

Every runner understands shock and the transfer of force.  We've all had that run, when we're tired and achy and it feels like every step is painful.  Or you've literally heard someone running by you as their feet slam against the ground in what looks like a very painful running motion.  In an ideal world the force of hitting the pavement would be absorbed by your body.  Try to picture a runner.  Now think of the runner in black and white.  As the foot hits the ground think of an electric shock being formed down near the foot.  Now watch that shock wave travel up the foot, through the ankle, through the knee, through the hip, through the BACK, up the spine, into the head and then back down the body.  This is how force is absorbed by the body.  Anyone who's gotten a headache during running knows what it feels like if force is not properly absorbed.  

If the spine isn't moving correctly this force doesn't travel through it correctly, it basically gets blocked by an immobile spine.  What I mean by this is that the human spine should move like a slinky(I hope everyone remembers what a slinky is).  Each part of the spine should move independent of every other part, just like a slinky moves and glides.  If, due to injury, tightness or prolonged sitting, the spine becomes compressed, it's like the slinky gets a a few kinks in it.  Now instead of having a nice fluid spine where the force can easily be absorbed we've got a spine that is very rigid and unable to absorb force.

Now back to that image of the electricity running up from the foot into the body.  Visualize again that the force has made it up to the low back but now instead of being absorbed by the upper body it's deflected back to the leg.  This causes all the force to be absorbed in the lower body.  This in turn will stress out the muscles of the leg, the IT Band in particular, and eventually cause pain.  These cases of IT band syndrome don't respond well to simple stretches or ultrasound therapy.  

Many IT band issues can be avoided or cured rather quickly once the low back is adjusted and allowed to move like it's supposed to move.  If you're someone who is frustrated with the lack of improvement in your IT band issues you may just need a difference approach.  There's always a cause to the pain, and in turn, there's typically a cure.  Happy running.

Doctors Note:

1. IT Band Syndrome is caused by either tight muscles, fallen arches, poor leg mechanics or low back problems.

2. Most cases don't need months of treatment.  Make sure whoever is taking care of your pain looks at the low back as well.  Every part of the body effects the other, so don't just focus on one part.  Look at the body as a whole.

3. Rolling on a foam roller, ice and rest will help mild cases.  But many other cases need to add in low back work as well.

4. Try the new balance minumus shoes or the vibram 5 finger shoes for 3 months and see if it helps.

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