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Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Tag: IT Band Syndrome

Eliminating tightness in the TFL can reduce tension in the IT band as well as reduce knee pain associated with Runner’s knee or patellofemoral pain syndrome. Foam rolling prior to stretching is a good idea, but I think this stretch is a good one for all runners to add to their toolbox whether it be prior to or after a run. Check out the stretch from my online PFP column below:

 

I came across some very good reads on Twitter last week week that I wanted to pass along. The first is a blog post by Rich Willy, a PT, professor and researcher who specializes in running and running related injuries. If you or any of your friends have suffered from nagging IT Band pain, this is a must read. In this post, he discusses proper treatment strategies:

Treating ITB Syndrome

The second pearl involves long toss and force on the elbow. Ever wonder how advising a pitcher to reduce his throwing intensity actually impacts velocity and torque on the elbow? It seems that decreasing effort level by 25% and 50% does not equate to the same reduction in actual velocity with a study using the motus sleeve. Read more below:

Baseball Pitchers’ Long Toss Perceived Effort & Actual Velocity

Finally, there has been much discussion about return to sport assessment after ACL reconstruction. Lately, many have begun to question how effective hop testing really is when it cones to determining readiness to return to sport. I use several assessments (one of which is hop testing), but I also feel psychological readiness is crucial.

This article sheds light on the connection between proper single limb landing mechanics and psychological readiness.

Association of Psychological Readiness for RTS after ACLR and Hip and Knee Landing Mechanics

 

I work with lots of runners, both recreational and competitive, who are seeking to improve performance or overcome injuries. The most common issues I see are iliotibial band syndrome (ITBS) and patellofemoral knee pain (PFP).  With every runner, I routinely perform FMS and video analysis to get a better understanding of their movement patterns, gait mechanics and asymmetries.

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Without question, they tend to ask me if there is a better way to run.  Obviously, every accomplished runner has his/her own opinion on the matter.  Some prefer forefoot or midfoot strike, while other do just fine with a heel strike pattern.  In essence, we do not have any sound research or biomechanical evidence to declare one a winner.  Since I work with many injured runners, I am always seeking to find the most efficient ways to reduce injury risk and eliminate pain.

A paper just published in the September 2015 American Journal of Sports Medicine by Boyer and Derrick sought to answer the question of how shortening the stride length or altering foot strike pattern may impact certain variables.  Specifically, the authors sought to compare step width, free moment, ITB strain and strain rate, and select lower extremity frontal and transverse plane kinematics when stride length was shortened 5% and 10% in habitual rearfoot and habitual mid-/forefoot runners using both strike patterns while shod.


Continue reading…

I am pleased to announce that my new e-book on overcoming knee injuries and maximizing running performance is now available!  As someone who has run 4 half-marathons, a full marathon and several 5Ks, I know firsthand how frustrating an injury can be. Perhaps worse than the injury itself, is the fear of re-injury when every step brings trepidation in the back of your mind that the same pain could come back at any moment.

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Over the course of my fitness and therapy career, I have worked with hundreds of runners ranging from beginners to competitive runners.  Many have been sidetracked by anterior knee pain and IT Band Syndrome.  While there is no way to prevent all injuries, I have found that learning to assess the body and incorporate corrective strategies to eliminate asymmetries and imbalances along with proper conditioning allows individuals to run faster, longer and relatively injury free.

Up to 50% of all lower extremity injuries with runners involve the knee.  I have been working on a manual that summarizes my approach to injury prevention, rehab and training for runners.  You see, many people are not really fit to run when they start running. If more people knew how to detect potential issues and train adequately to prepare their bodies to run, injury rates would decrease and performance would subsequently increase.

As such, I wrote Fit For Running: Overcome Knee Injuries and Maximize Performance.  This 70 page e-book covers assessment, stretching, strengthening, soft tissue mobilization, plyometric training and injury recovery guidelines.  It focuses on preparing the human body for optimal performance – a manual for physical readiness if you will.  It is perfect for runners of all ages and abilities, running coaches and fitness trainers working with runners.

While my book aims to target knee pain, it really offers considerable knowledge and insight that would help a runner with any overuse injury. Given the proportion of knee injuries, I chose to focus the injury/rehab portion of the manual on this topic.

Click Here to download a free sample and learn more about this great new resource.

Every year I like to look back and reflect on things I have learned, things I have changed my mind about and of course clinical pearls that stand out.  Over the past year, I have been sharpening my IASTM skills, begun to practice dry needling techniques, and scrutinizing my hip and core exercises that I routinely use in rehab.

I look forward to sharing more about my clinical experiences with dry needling in 2014, but I feel the most critical and recurring theme of 2013 has been the overwhelming impact I have seen poor ankle dorsiflexion have on my patients.  I treat scores or runners, triathletes and clients with knee pain.  The most common issues in this group of clientele tends to be IT band friction syndrome or patellofemoral pain.

When I assess this group of patients, I routinely find the following:

  1. Poor dorsiflexion
  2. TFL dominance
  3. Glute weakness

Any time I evaluate a runner, I assess closed chain dorsiflexion (DF) mobility.  This can be assessed in half kneeling on the floor or standing at a wall.  I suggest removing the shoes during the assessment to eliminate any rise from the heel in the shoe that may bias the movement.  In addition, I hold the ankle in subtalar neutral to get a true assessment without allowing pronation.

The image below simply demonstrates the assessment position as well as the corrective exercise that can be used to facilitate better motion.

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Clients should be able to attain about 5 inches of clearance beyond the toes without lifting the heel or relying on pronation to get there. I routinely see limited mobility, and more importantly almost 100% of the time I find asymmetry on the side of the affected knee.

I recently evaluated a 29 y/o active female client who does Crossfit 3x/week and likes to run.  She has not been running much due to chronic right lateral knee pain and medial calf pain.  Her goal is to get back to running half-marathons.  Upon evaluation, her overhead squat assessment revealed pronation and external rotation bilaterally, right greater then left.  Her standing wall DF assessment revealed nearly a 1 inch deficit on the right side (about 3 inches), while her left side was 4 inches.

Below is how she looked on the treadmill video analysis I performed:

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You can see the highlighted areas in the photo above.  She has a marked amount of pronation in mid stance as well as left pelvic drop due to poor gluteal activation.  The poor hip stability and activation on the right side also plays directly into TFL dominance with the repetitive femoral internal rotation and adducted position of her right hip..

This poor biomechanical chain is set into motion by poor dorsiflexion mobility.  Runners can get away with this for shorter distances (3-4 miles) in many cases, but increased mileage leads to shin splints, calf strains, IT friction syndrome and patellofemroal pain.  You can see how this poor kinetic chain movement leads to ongoing microtrauma and eventually debilitating pain and dysfunction.  No matter how much one rests, going back to higher mileage will yield the same result.

In my client’s case, she also had a trigger point in her medial soleus – another issue connected with the ankle mobility problem. Her primary treatment plan will focus on soft tissue mobilization for the gastroc/soleus complex, TFL/ITB and glutes/piriformis, ankle dorsiflexion mobility exercises, IASTM to her gastroc/soleus/Achilles, single leg balance and strengthening and hip/core activation and stability work.

I am confident all of this will effectively resolve her pain.  However, it all begins with restoring ankle mobility.  They say a picture is worth a thousand words.  I strongly believe the picture I included of my client on the treadmill speaks volumes as to how poor ankle mobility can lead to unwanted compensatory motion, gluteal inhibition and overuse injuries.  The take home message here is be sure to assess ankle mobility in the presence of any lower extremity pain or dysfunction as it is often a critical piece of the puzzle in the face or recurring injury and chronic pain.