THOUGHTS ON:
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New Year - New Goals: Setting & Achieving Your Goals This Year.
If you are like me, you love to set goals, spend hours on action plans to achieve those goals, and ponder on the impact and improvements you can make to yourself, your company, your family, your health, and everything else around you.
Fast forward from when we originally posted this blog, it is now 2020! Wow!
If you are like me, you love to set goals, spend hours on action plans to achieve those goals, and ponder on the impact and improvements you can make to yourself, your company, your family, your health, and everything else around you.
While you will not find a shortage of articles telling you how to set goals. Or how by February 1st, over 80% of people will have already abandoned their resolutions, let’s just keep this short and to the point in hopes that you are aiming to be part of the 20% who holds on, pushes through, and progresses not just your life, but your family’s, and everyone you interact with.
When gearing up for the new year, or getting back on track, set your aim high and work these 3 steps.
BE SMART
We have all heard of the ‘SMART’ acronym about goal setting.
Specific: Be as specific as possible with your goals, they are easier to break up and achieve if they are clearly defined.
Measurable: This is usually the easiest part. How will you know when you have achieved your goal? When you hit your mark. 1000 miles running - $100K in growth - 2 full weeks of vacation time with your family. Put a number to it!
Attainable: Don’t make your goals too easy. Set your goals just at the end of your reach. Goals that make you work and dig down deep create the best feelings of accomplishment when completed.
Relevant: Is this goal important to you? Does it help you become a better person? Can accomplishing this goal help and serve others?
Time-Based: Every goal must have a deadline, or it is just a thought; a dream; an everyday task.
Break down each goal you have set into smaller, workable, SMART pieces.
THE ONE THING - BUILD YOUR FOUNDATION
Studies have shown that we are incapable of multi-tasking! Don’t believe me, just try to do three things at once and see how well they are completed, if at all. The new year brings about much excitement about the possibilities and opportunities ahead, but if our focus shifts to too many things at once, it will all quickly fall apart. Start by reading ‘The One Thing’ by Gary Keller and focus all of your attention on one goal at a time. See it through to completion and then move on to the next.
When I sit down to plan out my year, quarter, or week, I review my One Thing, that big goal for the year. But, it has to be broken down further than that. Humans simply can’t focus on one thing for an entire year! You know the saying, ‘The way to eat an elephant is one bite at a time,’ it’s true. If you want to reach your BIG goal, break it down.
I have shifted my life, personal and professional, to ROCKS. This isn’t a fancy acronym, but I do like to think of these rock as the material needed to build the foundation of what I hope to achieve and provide to the world during my life. ROCKS are 2-3 small steps that can be taken each 90 days that move you a step closer to your ONE BIG THING. Science has shown us that the extent of our ability to focus on a task is 90 days, so this method works perfectly. Break your big goal down into 10-12 steps and put all your focus into 2 or 3 of them every quarter.
This works the same in business as it does running—every quarter, you have to change cycles. You may want to run a 3:30 marathon this year. You have four macrocycles of training to complete this year, each composed of 2-3 microcycles. Just going out and haphazardly running will not get you to your goal, you have to plan and focus.
10X EVERYTHING
Look at your goals. Look at the energy, time, commitment, and focus it will require, and 10 X it! In Grant Cardone’s ‘The 10X Rule’, he discusses that anything worth accomplishing will require ten times more time, energy, and resources than you initially thought. How do you attack this, with massive action.
In summary, take an hour this week, work through your goals and develop an action plan. Assure they are SMART, begin by focusing on just one, and TAKE MASSIVE ACTION!
- Happy New Year -
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management. If you have an injury that is preventing you from doing the things you enjoy, call or schedule now.
Youth Running: Benefits, Risks, & Considerations
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Shin splints can be an precursor to stress fractures in young runners. Check out our MTSS Blog Series to prevent and rehab this common injury.
It is estimated that 20-80% of runners will experience an injury in a given year. Random range, right? You try to find two studies that can agree on this! However, we do know that more than 50% of all pediatric sports injuries are due to overuse. We also know that overuse has is signs and symptoms and can be prevented.
What do we know about youth running? A lot actually. Let’s look at the facts and discuss how we can prevent future injuries so our young runners can enjoy a life-long relationship with this wonderful sport.
BENEFITS OF RUNNING FOR YOUTH ATHLETES
Great Cardiovascular Health.
Improved Cognitive Development.
Exercise increases metacognition, behavior regulation, and accelerates behavioral and emotional engagement.
Bone Health - Increased Bone Density
Positive Self Image & Emotional Wellbeing
Aids in Development of Total Athleticism.
Running injuries are common in youth-aged runners, but the benefits from frequent exercise, competition, and camaraderie far outweigh the risks. Learn more about beginning running for health and fitness here.
CURRENT TRENDS IN YOUTH RUNNING: INJURY RISKS
Accelerated Growth.
Peak height velocity (when children grow fastest, resulting in bones lengthen faster than muscles and tendons can keep up with) occurs around 12 for females and 14 for males.
Just before this rapid growth, bone mineral content is at its lowest, making bones and growth plates vulnerable to the load and stress of running.
Low Bone Mass For Age.
Affects 39% of female youth runners.
Might be the more likely cause of stress fractures than training load.
Low Energy Availability, Relative Energy Deficiency in Sports
Adolescence is a time of rapid growth with unmet energy demands…inadequate calorie intake with increased running demand can lead to abnormal menstrual function in females, bone mass depletion, and high risk of musculoskeletal injuries and stress fractures.
Males Commonly Suffer From Low Bone Mineral Density As Well.
Risk factors include being less than 85% weight for height, running over 30 miles per week, a history of stress fractures, and having a diet lacking in calcium-rich foods.
Answering ‘YES’ To The Following:
‘do you believe that being thinner leads to faster running performances?’
BIG RED FLAG
Increased Anxiety or Avoidant Coping Strategies Such As Denial.
Perfectionism-related thoughts are associated with higher rates of depression, anxiety disorders, obsessive-compulsive disorders, and eating disorders.
History Of Previous Running Injuries.
Strong indicators for in-season injuries are injuries during summer training (female) and history of previous running injury (males).
HOW CAN WE PREVENT INJURY IN YOUTH RUNNERS:
To prevent injury, cross training is necessary. Recent data suggest that shorter intense bouts of activity like sprinting, other sports, and neuromuscular training are better for developing motor skills compared with endurance running. Remember, though they grow, they are still kids and need time to play. Play outside, play other sports, rest from play. Don’t forget that.
Strength Training #1 - Improved Core And Pelvic Strength Led To Faster Race Times.
A 6 week strength program aimed at pelvic and core strength led to improved race times. Strength training also leads to better weight control, improved motor performance skills, improved cardiovascular health, and enhanced psychosocial well-being…oh, and less sports-related injuries.
Strength Training #2 - Spine & Hip Strengthening.
Exercises aimed at the spine and hip muscles helped injured youth runners rehab from injury faster and prevented future occurrences of common running injuries such as Achilles tendinosis, iliotibial band syndrome, runner’s knee, plantar fasciitis, and shin splints.
Strength Training #3 - Strength Training For Runners Program.
We have developed an instructional series around some of the best strength exercises for runners. You can check those out here.
Set Realistic Expectations - Know Age & Developmental Stage Capabilities.
Unrealistic expectations lead to athlete frustration, low self-esteem, burnout, and injury! This can lead to reclusiveness, depression, and loss of enjoyment.
Monitor Youth Runners For Signs Of Burnout.
Students athletes who withdraw from activities they previously enjoyed may be experiencing chronic stress and burnout from their sport. This leads to more complicated issues if unaddressed, like depression, obsessive-compulsiveness, and eating disorders.
If an athlete becomes more irritable, anxious, or struggles with perfectionism, they are demonstrating signs of burnout. They need time off or decreased self, coach, and or parental pressures related to their sports.
Coordination Of Care For An Athlete.
Extrinsic risk factors for injury include improper training volume, intensity, or progression, early sports specialization, poor footwear, and inefficient running form. These factors are better addressed when the athlete, parent, coach, and healthcare provider have open communication with the athletes BEST INTEREST at the forefront.
Modify Training Program To Allow Rest Periods
Injury can be reduced by developing a training plan that limits weekly and yearly participation time to reduce repetitive movements and increase scheduled rest periods within each week, season, and annual training cycle.
Suggested rest is at least 1 day per week, 1-2 weeks every 3 months, and participation limited to 9-10 months per year.
Avoid Early Sports Specialization (Bolded Based on IMPORTANCE)
Highly specialized youth athletes (those participating in one sport more than 8 months of the year) report more injuries than their peers, independent of age, sex, or training volume.
Early Sport Specialization is associated with unidimensional identity with the sport leading to the athlete feeling as like they lack control with their participation in that sport. This leads to burnout.
All Credit To The Authors & AJSM. No Copyright Violation Intended. Click Here To Access Full Article.
When To Seek Treatment
Now that we are aware of injury risks, YOU have to take preventive measures. For some, this means a little time off before training ramps up again. For others, it’s time to hit the gym, toss a ball around, shoot some hoops, and spend some time at the pool.
Early Care Is Crucial To Retruning To Running In a Resonable Time-Frame. Schedule Today.
Shin Splint Pain Relief -> CLICK HERE
IT Band Pain Relief -> CLICK HERE
Runner’s Knee Pain Relief -> CLICK HERE
When it comes to injuries, we know two things.
(1) Rest is rarely beneficial for sports injury recovery. Rehab needs to be active!
(2) The sooner you seek care with an injury, the sooner you will be back out and running.
If you or your child has been training for the upcoming cross country season but are continually being sidelined by injury and illness, it’s time to find help and get back on track. If you are a runner in the Salt Lake City area, Revive Sport & Spine is your go-to clinic to get you back up and running quickly, giving you the tools to help you run faster, farther, and more efficient than before.
Krabak et al. Youth Distance Running: Strategies for Training and Injury Reduction. American College of Sports Medicine. 2019. Current Sports Medicine Reports. www.acsm-csmr.org.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management for the great people and adventurers of the Salt Lake City Valley.
Medial Tibial Stress Syndrome Part 2 - Self-Care For Shin Splints
In PART 1 of our Shin Splints series, we took a look at the anatomy associated with medial tibial stress syndrome as well as the factors that make runners especially susceptible to them, namely the repetitive nature of running compounded by most cases typically doing too much too soon. Here in PART 2, we are going to look at self-care options as well as some considerations for preventing repeate episodes of shin splints so that you can keep running and training for your goal races.
In PART 1 of our Shin Splints series, we took a look at the anatomy associated with medial tibial stress syndrome as well as the factors that make runners especially susceptible to them, namely the repetitive nature of running compounded by most cases typically doing too much too soon.
Here in PART 2, we are going to look at self-care options as well as some considerations for preventing repeate episodes of shin splints so that you can keep running and training for your goal races.
SELF CARE OPTIONS FOR MTSS-SHIN SPLINTS
Self Myofacial Release - 4 Ways To Care For Your Shin Splint Pain
Pre-Running Warm-Up For Shin Splints
Training Modifications, Gear Suggestions, & Other Prevention Considerations
Form, Cadence, & Ground Contact Time:
This is a tricky subject, honestly I’m not sure why I even mentioned it. One can go miles down the form training rabbit hole and come out the other side worse they they were before. However, I do want to mention three things that must be considered and worked into your training plan to help prevent shin splints and make you a more efficient and faster runner.
The ground fights back! The more time we spend in contact with the ground, the harder this battle will be. I’m not here to talk about heel-striking, forefoot running, etc., but I will mention cadence. The higher your cadence, the less time your foot spends on the ground. Meaning, the less ground reactive forces you absorb and the less stress on your body.
Again, I’m not here to correct form. But I do believe we can all be more efficient. Strength training helps us become more efficient for those later stages of the race. Please add strength training to your program, it is extremely useful.
Alter your surfaces. Don’t always pound the pavement. The track and trails are your friend…and your feet will thank you for it.
Shoes:
Shoes are something I get asked about frequently. My honest answer is this, ‘We have more shoe technology and selection than ever…we also have more injuries than ever.’ Take that for what it is worth but I do believe shoes should be rotated and changed frequently. I suggest a 2-3 pair rotation, avoid running in the same pair two days in a row, and switching out for a new pair every 200-300 miles depending on the shoe.
Warm-Up & Cool-Down:
This is SO BIG. In every injury we encounter and talk about, how you warm-up (if at all) and cool-down has a direct impact on your injury risk, and recovery speed from injury. Warming up prepares your body for the task ahead, giving it the best chance to avoid injury. Colling down helps work out those tight spots after training while encouraging faster recovery.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Medial Tibial Stress Syndrome Part 1 - What Are Shin Splints and Why Runners?
Springtime is here! The weather is warming up, the sun is starting to shine on those early morning runs, and we can finally shed many of those heavy layers of clothes for our preferred running shorts and singlet top!
But…spring time also means something else for runners.
Springtime is here! The weather is warming up, the sun is starting to shine on those early morning runs, and we can finally shed many of those heavy layers of clothes for our preferred running shorts and singlet top!
But…spring time also means something else for runners.
For most runners, it means it is time to come out of the pain cave, get off the globogym cardio theater dreadmill, and start hitting the roads again. For some, it means it is time to come out of hibernation and begin training again. While this all seems well and good, the road can cause some aches and pains that the somewhat forgiving treadmill or cushy couch hid from you all winter long.
You know what I am talking about. That all too familiar pain down the inside of shin bone that can also sometimes radiate into the foot and seems to intensify with every run. Road running in the spring can be wonderful, but it can also be painful. The road is an unforgiving surface (part of the reason our treatment plans include running on a track or trail) that can bring even a veteran runner to their knees in frustrating agony with each run.
Yes, I’m talking about Shin Splints!
Today we are beginning our Shin Splint Relief & Prevention series by discussing what ‘shin splints’ are, how they occur, who is more likely to experience shin splints, as well as a few other complicating factors. We will follow this up with self-care in Part 2, and Treatment & Rehabilitation options in Part 3.
WHAT ARE SHIN SPLINTS: MEDIAL TIBIAL STRESS SYNDROME
From an anatomical perspective, shin splints are a condition where there is pain, tenderness, and sometimes swelling along the middle, inside of the tibia (shin) bone. While the cause is debated as to whether this pain comes from a muscle and tendon response to doing too much too soon, the tibia bones inability to handle the stress and pounding from running, or damage to the connective tissue that wraps and supports all of these structures in the lower leg and foot.
The hallmark sign of Shin Splints is the extreme tenderness along the inside of the shin that seems to improve as a runner warms up, but begins to worsen, last longer, and eventually prevent running as time passes without care. From this, this condition is more aptly named Medial Tibial Stress Syndrome.
Before we discuss why this condition plagues runners, and what we in the medical community think is actually happening, let’s look at the important anatomy involved.
WHY RUNNERS & WHAT FACTORS LEAD TO SHIN SPLINTS
Running injury statistics are horrifying, with studies estimating that anywhere from 40-80% of runners experience an injury EVERY YEAR. I am not going to bother trying to track down the actual number because it changes montlhy as new research comes out, but the fact is that as runners, we run a high risk of injury. From that, it is estimated that 1 in 5 are dealing with shin splints. Since this is such great news, let’s look at some reasons why this injury is so common and who could be at higher risk.
New Runners - If you are truly new to running, Shin Splints are almost a right of passage. In the process of your body adapting to this new stress, figuring out your form, and slowly increasing your mileage, your body will get to the point where it starts to scream…’why are you doing this to me’. As we progress through this series, you will find ways to build up your body, more specifically your legs, so that it can handle this new stress of running.
Running Biomechanics - The Tibia bone is believed to absorb 2-3x’s your body weight with each step. Take into account that the average runner has a cadence (steps per minute) of 140-180, it is no wonder we begin breaking down at the tibia.
Higher BMI/Body Weight - Looking at the last statement, if you have higher body weight, and you are new to running, forcing your tibia to withstand the pounding from running should be a slow process with ample recovery.
Training Volume - Just like new runners, if you are a veteran with a solid training base of 30-35 miles per week and you sharply bump up to 55-60 miles per week, you are essentially treating your body like a newbie with a very unfamiliar stress.
SIMILAR PROBLEM: Too Much Too Soon & Classic Overtraining
Form - Forefoot, Midfoot, or Heel Striker, you efficiency within that form and allowance for adaptation to stress is what either prevents or causes injury. I have seen all forms present with shin splints, and it is usually a combination of the above causes.
WHAT ACTUALLY CAUSES SHIN SPLINTS
While the cause of Medial Tibial Stress Syndrome is still debated, with research naming a different cause. It is likely a combination of the factors we are going to cover. This is why, if you have been suffering from shin splints for a month or so and are just trying to run through them, it is important to get an evaluation, a structured plan around your goals, and some treatment to get you over the hump.
Weak Ankle Dorsiflexion - Loss of eccentric control.
One issue that many believe to be a cause, or at least a contributor to shin splints is poor control of the anterior leg muscles, or weakness of the Tibialis Anterior muscle. This one stands out in newer runners because it is responsible for the slapping sound one makes when their foot hits the ground. This comes from weak eccentric control of the muscle, or the ability to slowly let it down to the ground. Our bodies are amazing, so when one area fails, another area takes the load…
Poor Pronation Control & Tight Posterior Tibialis Muscle
Lets first start by reminding everyone that pronation is a normal part of the gait cycle, but poor control of the speed of pronation can cause problems. If we have excessive tightness through the posterior tibialis muscles, either due to overuse or poor adaptation to load, it is unable to respond well enough when the foot hits the ground, causing the foot to crash in during pronation. If this is the case, we see each step pulling on this already tightened muscle, as well as the facia that wraps it and attached to the inside of the tibia bone (that spot where you are tender), inflaming the area, damaging the muscle, and leading to poor mechanics while running.
Bowing of the Tibia Bone
To further the case of this mid-shin bone pain where the posterior tibial muscle lies, we have data that shows the Tibia bone actually bowing during running. While our bodies are adaptive and resilient, we believe this bowing to be minimal, undetectable without fancy equipment, but a natural part of our body handling the forces the road gives back with each step. Where this comes in to play is with a young or new-to-running runner who decides to run through their pain. If this goes on long enough, and the runner overtrains, this can lead to a stress fracture injury.
Over Training - Too Much Too Soon
This is probably the most common reason runners experience shin splints, and most other injuries for that matter. Over-training is the common factor of the 3 potential causes we mentioned above. As a new runner or an experienced one looking to increase mileage, a plan that not only includes a structured running plan, but strength training, cross training, and rest must be considered.
SUMMARY
Shins Splints are most known to cause pain along the inner edge of the tibia bone that is tender to the touch. Swelling may or may not be present.
While many causes are debated, one thing holds true. Whether you are a new runner or a veteran. Doing too much too soon will likely lead injury.
Runners are most at risk due to the repetitive nature of running. Add in volume changes, the pounding of the road, lack of self-care and warming up before each run..it all adds up.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
New Year - New Goals: Running To Better Health
Improved health tops nearly every new year's resolution list ever made, 2019 will be no different. From this, running comes to the forefront of our ‘get in shape’ plan because of its ease (almost everyone can shuffle one foot in front of the other, not saying it is easy) and relatively low cost (a decent pair of shoes and some running gear is all you need). While this plan seems fool-proof, there is a reason 60%+ of the people we see in our clinic are runners, new and old.
Improved health tops nearly every new year's resolution list ever made, 2019 will be no different. From this, running comes to the forefront of our ‘get in shape’ plan because of its ease (almost everyone can shuffle one foot in front of the other, not saying it is easy) and relatively low cost (a decent pair of shoes and some running gear is all you need). While this plan seems fool-proof, there is a reason 60%+ of the people we see in our clinic are runners, new and old.
While running seems easy to do, there are many things to consider. Are you a runner? Have you ran since high school, or ever? Did you know your body type matters? Can you cover 1-2 miles and not be in misery the next day? Do you have good shoes? Do you have a partner to run with, accountability is essential for follow-through? You didn’t think about any of that, did you? While we will have more running and running-related injury articles to share with you in 2019, let’s start with some current research (Nerd-Alert).
Who:
In this study, the authors gave 914 novice runners a GPS watch and tracked them over a year to study their habits and direction of their running habits. The group was divided into 3 groups based on their BMI (Normal, Overweight, & Obese) to help determine if there were any differences and similarities in their training selection.
What They Found:
The first interesting finding was that in this self-guided exercise program, all categories selected similar training doses. The authors suggest that this may explain the higher injury risk among overweight and obese runners compared with normal-weight runners.
Normal weight runners ran faster and farther than their overweight and obese counterparts. This is anticipated as these are all novice runners, but the perceived effort was not established and could be an interesting metric to develop.
Suggestions:
Starting a new exercise program is exciting, but one must also be willing to understand and see that they are at a starting point. Novice runners are at high risk of injury if they start too fast, or do too much too soon. An initial dose of high volume can lead to an injury that causes you to become inactive, losing any benefits you sought to gain in the first place.
BMI is important to consider. Have a higher BMI does not mean you can or should not run, it means that the programming must be different. Training has to do with ‘load,’ and by that, we mean that if you are 200 lbs, it is a bit more challenging and harder on your body to run 3 miles than for someone who is 150 lbs. This changes as we continue training and adapt, but at first, we must take things slow.
Any activity is better than a sedentary lifestyle! Remember to take things slowly. Your body will be sore, but that is to be expected. If you have pain, or your soreness lasts longer than a few days after exercise, seek professional guidance on preparing your body and running programming.
Who:
The authors of this study followed 447 runners over a 24-week running program. Their goal was to determine the risk associated with high-intensity running plans and high-volume running plans.
Before the study began, they hypothesized that runners on the high-intensity program would have higher rates of Achilles tendinopathy, calf injuries, and plantar fasciitis while runners on the high-volume program would experience more runners knee, iliotibial band syndrome, and patellar tendinopathy.
What they found:
Over the 24-week training program, 80 runners sustained an injury. However, the authors found no difference in the risk of injuries related to training volume or intensity.
Suggestions:
The others suggest this discrepancy between these results and other related studies and running-related injury beliefs are related to the periodization of the running schedules, the scheduled running intensities, and the categorizations of injuries.
Runners or all shape, sizes, and abilities will eventually run into injury. Prevention by adhering to a solid warm-up routine, frequent attention to weaknesses and immobilities, while also modifying a training plan to one's abilities can help prevent injury.
When beginning a new running plan, or increasing your volume or intensity, it is suggested to do one at a time. Listen to your body and take time off as needed.
If you are taking up running again, or for the first time, and you have questions, we are here to help. Running injuries are common. You often do not have to stop running, just a rework and refocus of your training plan. Train Hard & Train Smart.
Happy & Healthy 2019!
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Iliotibial Band Syndrome: Self-Care & Training Modification
As we work our way through this series, let not forget what we have learned so far.
Iliotibial band syndrome is a common overuse injury plaguing runners of all abilities. The most common offense is trying to increase your volume too soon while also increasing the intensity without cross-training or varying surfaces.
The Iliotibial band DOES NOT STRETCH! The tension we feel is caused by the muscles that support the IT band, Tensor Fascia Latae and Gluteus Maximus.
The stabbing pain we experiences as runners suffering from IT band syndrome is thought to be caused by the band itself shifting forward and backward as the knee flexes and extends. The research is out on that one…if we ever reach a consensus, I will let you all know!
Where are we now? Well…if you have made it this far, you are probably dealing with IT band syndrome and wondering if it will ever go away and let you get back to running the way you would like.
For this, we are going to discuss self-care. What you can do about the knee pain and tight hips at home while also mentioning a few stretches you can do at work or out on a run. Our goal is simple - Allow you to continue to train, modified while improving your IT band syndrome pain week-to-week.
What we are talking about today, where the real work takes place, the day in and day out self-care. And the big question….can you continue training?
As we work our way through this series, let not forget what we have learned so far.
Iliotibial band syndrome is a common overuse injury plaguing runners of all abilities. The most common offense is trying to increase your volume too soon while also increasing the intensity without cross-training or varying surfaces.
The Iliotibial band DOES NOT STRETCH! The tension we feel is caused by the muscles that support the IT band, Tensor Fascia Latae and Gluteus Maximus.
The stabbing pain we experiences as runners suffering from IT band syndrome is thought to be caused by the band itself shifting forward and backward as the knee flexes and extends. The research is out on that one…if we ever reach a consensus, I will let you all know!
Where are we now? Well…if you have made it this far, you are probably dealing with IT band syndrome and wondering if it will ever go away and let you get back to running the way you would like.
For this, we are going to discuss self-care. What you can do about the knee pain and tight hips at home while also mentioning a few stretches you can do at work or out on a run. Our goal is simple - Allow you to continue to train, modified while improving your IT band syndrome pain week-to-week.
What we are talking about today, where the real work takes place, the day in and day out self-care. And the big question….can you continue training?
SELF CARE PART 1 - START WITH A BETTER WARM-UP
I can not stress this enough! As you are working through an injury, maintaining some kind of load (training volume) is important, but you are better served spending time on a proper warm up, running just a few miles, then spending a good amount of time on the cool down. With just about every running injury we deal with, runners have a dismal warm-up if one at all. Most are so pressed for time, they lace up the shoes, run out the door, only to return and head straight to work. Most of us are not teenagers anymore, our bodies just can’t do this…not for long periods anyway. Start with a thorough warm-up - we will emphasize this again in our next article where we talk rehab and return to running so prepare yourself!
SELF CARE PART 2 - SELF MYOFASCIAL RELIEF
Understanding that foam rolling and stretching of the IT band itself is ineffective, where do we focus our attention? The hips…it is always the hips! But some attention at the knee can be beneficial while appropriate rest and recovery are always suggested after an acute flair-up or long run.
Rest & Recovery:
Traditional pain relievers for running related pain include ice, heat, topical creams like biofreeze, and some good old-fashioned rest. Today we have an array of tools that can aid in recovery, one we like to use frequently are compression boots from Rapid Reboot. We don’t expect everyone just to have these lying around, but they sure feel great after some dry needling, IASTM, and manipulation in the clinic.
Rolling & Stretching:
Now that we understand what anatomy we need to address, it is time to get your roll on! If we are able to continue to train, we suggest rolling and stretching 4-5 times each day. Before you lose it, these sessions are only 3-4 minutes each. If you are a frequent runner, or just starting out, here are the basics.
Rollers should be in your home, office, and car. You should have at least 3 lacrosse balls around, purse, cup holder in your car, in your desk, and your gym bag.
Roll in the morning, pre and post run, after your lunch break, when you get home, and then a good session before bed.
Cupping & Flossing:
These may not be tools accessible to all, but they help you achieve stretching in ways that are difficult to do on your own. One of my personal approaches to provide relief to the knee pain we experience with IT Band syndrome is to place a few cups (I have a few sets of these) around the lateral knee and lateral quadricep muscle, walk about for a few minutes, perform a few squats, rinse and repeat 2-3 times per week.
SELF CARE PART 3 - TRAINING MODIFICATION
Training modification is the hardest part to address. For most, the ability to continue training toward your race is almost as important as fixing the injury. While maintaining some load is ideal, there are instances where a total shut-down is necessary for a few weeks. If you are a typical runner, meaning that you are going to run through the injury, we must modify. Here are the basics. Remember that Iliotibial band syndrome is the result of too much mileage or intensity, too soon in your training plan. Not having a proper base as you head into a 20-week marathon training plan is a recipe for disaster.
Our first suggestion is to cut your volume by 50% and decrease your intensity for the next 2-4 weeks. Our goal is to maintain some running, but the speed work and downhill bombs need to take a backseat for a while.
Please, cross-train! As runners, we think that running is it, period. When we are injured, and more so when we are not so that we can prevent injury, we must cross train. If you have been battling IT band syndrome for more than a few weeks, it is time to work in some biking, swimming and weightlifting. This allows you to maintain most of your cardiovascular capacity while taking out the pounding associated with running.
Lastly, look at your running form. Can it be cleaned up a bit? For most of us, that is a very strong, Yes! I’m not saying to go out and get an extensive running evaluation to change the subtle nuances of your stride, most of us just are not at that level, but shortening your stride, increasing your cadence, and working on your running drills can provide a needed boost in your running efficiency.
Cadence should be upwards of 170-180 steps per minute.
Perform drills on a soft surface (track or field) 2-3 times per week.
More on this in the rehab portion next week.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in the Greater Salt Lake City Area of Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Runner's Knee Part 4: Treatment, Rehabilitation, & Return To Running
After three exhilarating weeks of discussing Runner’s Knee, we have covered the anatomy, mechanism of injury, hip and ankle mobility, training modifications when injured, and self-care options. This week, we culminate with what happens when self-care is not enough, when you need to seek help, and what that looks like.
After three exhilarating weeks of discussing Runner’s Knee, we have covered the anatomy, the mechanism of injury, hip and ankle mobility, training modifications during injury, and self-care options. This week, we culminate with what happens when self-care is not enough, when you need to seek help, and what that looks like.
SEEKING HELP
When to seek care while dealing with patellofemoral pain is a common question we encounter. In all honesty, as runners, our natural tendency is to ‘wait & see’ and try to run the problem away. Furthermore, some will try to rest a week or two, putting training on hold, only to start running again and find the knee pain is still present.
Not to be all high and mighty, but in my professional opinion, the earlier you seek care, the less likely you are to lose precious training time, and the quicker we can get you over Runner’s Knee. To help simplify this, here are three rules to adhere to when debating care for your knee pain.
Knee pain is worsening with each run, earlier in the run, and lasting longer after each run causing your training to suffering.
Knee pain is not responding with consistent self-care and proper warm-up and cool-down routines.
Knee pain starts to be present during regular daily activities such as walking, taking the stairs, and rising from a chair.
WHAT DOES TREATMENT LOOK LIKE
So, you have decided to seek help with Runner’s Knee.
Step one: find a doctor who runs!
Now that step one is out of the way, let's talk about the basics of what actually happens and what you can expect from care in a sports medicine/chiropractic office.
To get us started, let's look at the hardest question first...How long will it take? That is a hard question to answer because every case is different. Each person presents with a different level of pain, unique exacerbations, varying training volume, intensity, and running age, as well as racing expectations and outlook on their condition. From all of that, nailing down an exact timeframe for peak performance is elusive. However, typical treatment plans range from 2 weeks to 2 months, again depending on goals and the time the condition has been present.
Once this is understood, the next step is to understand that this is a team effort. For most clinics, you will only be actively receiving care for 1-2 hours per week. What happens during the other 166 hours of the week is up to you, and we discussed that in our last article regarding self-care.
When an athlete presents to a clinic like ours, treatment should be a 3-tiered approach.
Soft Tissue: As we have reviewed the anatomy, we know that there is significant muscle ‘issues’ involved in runner’s knee. For this reason, this is where we start. How to decrease the tension and abnormal pull from muscles so that the patella tracks correctly and decreases joint wear is one part of the puzzle. There are numerous ways to achieve this and in our clinic, we find Dry Needling, Shockwave Therapy, IASTM - instrument-assisted soft tissue mobilization, and cupping therapies to provide the best, and quickest, results.
Joint Mobility & Stability: After the soft tissue is addressed, we look at the structure. As discussed in our second article, the mobility of the hip and ankle are vital to correcting and relieving runner’s knee pain. Manipulation is designed to restore normal motion to a joint that is currently not moving properly. Over time, restored joint motion can improve running mechanics and decrease strain and stress placed on the surrounding muscles.
Rehabilitation Exercise: Lastly, once we have the muscles and joints under control, a building back up must occur in two ways. One, we must create stability and control of the joint through muscle strength. Two, training volume must begin to ramp up, slowly and controlled, which we discussed in the third article of this series. To further address part one, rehabilitation exercises need to be explained and directed.
Below is a basic 3-phase rehabilitation program aimed at relieving patellofemoral pain while helping to rebuild strength and prevent future occurrences.
Phase 1: During the first phase of care, our exercise prescription is aimed at pain relief and improved mobility. These exercises should be performed 3-5 times per week, preferably as part of your running warm-up if we are able to continue training through care. We start with 1 set of 10 reps for each exercise and 30 seconds for the wall sit, working up to 2 sets over the course of this phase of care, which is typically 2-4 weeks.
Phase 2: The second phase of care focuses on returning to your full running volume while building strength and stability. We expect to perform these exercises 3-5 times per week again, preferably before running, but we will start with 1 set of 15 for each exercise and a 45-second hold for the wall sit. Over the 2-4 weeks of this phase, we will work up to 2 sets of each exercise.
Phase 3: The third phase focuses on strength and injury prevention. At this time, we move to self-care as the patient is released from active care. Our goal is to perform 2-3 sets of 10-15 reps for each exercise as a warm-up before each and every run.
RETURN TO RUNNING
Once we work through care and training is gradually ramping back up, or you have been consistent with home care, how do you know you are ready to return to full, unrestricted running? To help determine whether you can get back out there and get after it, we use our return-to-running assessment. Our goal here is to complete all five exercises without pain. In this assessment, each exercise must be completed for 60 seconds, with as many repetitions as possible.
Finally, we have covered more information than you could ever want to know about runner’s knee - patellofemoral pain syndrome. Hopefully this has been enough information to keep you out of our office, but... runners have many other issues and injuries to face, and Runner's Knee is but one of them. Until next time...
Train Smart, Recover Well, Race Great!
-Dr. Reheisse
Dr. Reheisse is a Board-Certified Chiropractic Sports Physician practicing in Murray, Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Runner's Knee Part 3: Training Modification & Self-Care
Over the last two weeks, we have discussed the ins and outs of what Patellofemoral Pain Syndrome is, the anatomy involved, how adjacent joints (hip and ankle) can lead to maltracking issues, and why runner’s are specifically susceptible to this common overuse injury. You can read Part 1 & Part 2 here.
Now it’s time to talk self-treatment and training modification. Our goal is to maintain training (load) if possible when you find Runner’s Knee settling in, but more times than not, rest and self-care is needed while also modifying our training volume and intensity until symptoms recede.
Over the last two weeks, we have discussed the ins and outs of Runner’s Knee - Patellofemoral Pain Syndrome, the anatomy involved, how adjacent joints (hip and ankle) can contribute to maltracking, and why runners are particularly susceptible to this common overuse injury. You can read Part 1 & Part 2 here.
Now it’s time to talk about self-treatment and training modification. Our goal is to maintain training (load) if possible when you find Runner’s Knee settling in, but more often than not, rest and self-care are needed while also modifying our training volume and intensity until symptoms recede.
TRAINING MODIFICATION FOR RUNNER'S KNEE
Let's get the big one out of the way first! One of the reasons many runners try to avoid visits to a doctor’s office about one pain or another is the fear that the physician will tell them to stop running. Depending on the injury, how long it has been ongoing, current severity, and other factors, some runners are able to continue training during treatment and rehab, albeit in modified form.
Without getting too technical, we first need to understand the concept of 'load' and how it changes when we are injured. As runners, we have a specific language, so I am going to explain it in those terms. When our training is on and we are injury-free and fit, long runs, speed work, tempo runs, and intervals go well and help us improve. The load on the knee (and other joints) is well managed, and there is ample time to recover. Now, let's say you decide to sign up for a race that is in 6 weeks, and your training base is less than optimal. In hopes of having a good race, you ramp up quickly, doing hard days back-to-back, pushing it to your goal race pace for a good portion of your long run, etc., and now...BOOM, knee pain! What has happened here is that you exceeded the load threshold your body can handle and recover from.
For an interesting read, look into Scott Dyes work. This is what is commonly referred to the ‘envelope of function’ in the coaching and physician world.
Jumping back in...now that we are injured, our load threshold is lower. This is why a 5-mile run is painful halfway through when just 2 weeks ago, you were cruising through 10 miles with a few pickups. If you continue down this path, patellofemoral pain can become so severe that just getting out of bed and navigating stairs is difficult. When we encounter a runner in this position, we need to sit down and talk about a training plan, race expectations, and our long-term goals.
While it is never our goal to shut a runner down in the middle of a training cycle, the athlete's long-term health and ability are top of mind. Because of this, when discussing training, we tend to cover three things.
Can we gradually ramp up training while continuing to respond to treatment?
When we begin treatment, we have to start with a baseline. That may be 2 miles, 5 miles, or No miles before the pain sets in. That is our starting spot. As we follow-through with the suggested treatment plan, this load threshold must also go up. Rarely does pain go from 100 to 0, meaning, the pain goes from beginning at mile 2, then mile 4, then we find ourselves back up to 8-10 miles with no pain. This is the progress we look for.
Initial volume should decrease by 50% for the first 2 weeks.
If you are coming to us for knee pain, make a conscious effort to dial it back for a few weeks. This allows you to keep training, but also a little more rest than normal while we get through the first few treatment session.
Intensity, or pain-provoking runs, need to take a full break until volume can increase without pain.
With runner’s knee, we find that the harder, hillier efforts cause the most problems. While we want to maintain load on the knee while we treat, easy runs are the plan for the first few weeks. Looking at what we just talked about with gradually ramping up, we need to make sure you can handle a good distance without pain before we start pounding out the speed-work and hill repeats. And this goes for downhill too!
SELF TREATMENT OPTIONS FOR RUNNER'S KNEE
Now that we have discussed training modification, what can you start doing at home to help with Runner’s Knee? Honestly, you should be doing all of this already, but pain is a much better reminder to break out the foam roller than a good run. Your relationship with your foam roller needs to be strong. Your diet needs to be on point. Your bedtime needs to be early. Lastly, you need to realize that weight training is your friend.
Let's discuss a few of the easiest and most common self-treatment options.
Foam Rolling:
I don’t need to further detail my love for foam rolling over stretch or the benefits that regular foam rolling can provide for a runner. As we address runner’s knee, rolling needs to be frequent, short bursts throughout the day. Meaning, roll the quadriceps, hamstrings, and posterior hip muscles 3-5 times per day. Again, these are short 2-3 minute sessions. 10-15 rolls up and down over each area. Check the video!
Hip Mobility Drills:
As runner’s, our knee functions is highly influenced and controlled by what is happening at the hip. If your hip range of motion is limited, this will eventually show up at the knee. Check the video!
Ankle Mobility Exercises:
As a practitioner, I’m typically a ‘ground-up’ person when it comes to runners. While the hip controls the show, if the ankle does not move properly, it can not react properly or efficiently when the foot hits the ground causing problems up the chain. Studies show that just a few degrees difference between ankles is a good indicator of future injury. Work on your ankle mobility - Check the video!
This is a bit controversial. As you will hear me say in the demonstration below, the effect of taping is hard to prove. Don’t get me wrong, I love taping, in the short-term. It is by no means a long term fix for any injury! With that, you can also find 500 runners at the upcoming Big Cottonwood Marathon or the St. George Marathon that have their knees, shins, hips, and ankles taped that will absolutely swear by it. With all of that, I just don’t have solid evidence that proves any of that...but placebo is a powerful tool and I do appreciate taping as a means to help someone recovery and cue good movement patterns. If anything, the tape is a visible reminder to roll, stretch, and rest more. Check the video!
Body-Mass Index:
BMI has to be briefly discussed her because whatever weight we are carrying around affects our knees! Remember from the part of this series we mentioned that during running, the knee takes on 5-6 x’s your body weight during each step. While many people us running for weight loss, and other avoid it due to weight, the fact is, those with knee pain will benefit from weight loss if they are in the higher BMI category. I am not a dietician, we do not push weight-loss in our office, and I can’t tell you how many ‘Clydesdales’ category runners that can kick my tail in a race. Health is more than just pounds, but Runner’s Knee can be helped by a better BMI.
Psychosocial Influences:
Lastly, psychosocial factors. Runner’s are among the worst when it comes to injuries and the doom and gloom that comes with it. Some are severe enough that I have referred out to a professional for guidance. This is not something to be ashamed of and can actually help your recovery and performance. We now understand pain a bit better than we did 20 years ago, we still have a long way to go, but we know one thing to be true, if you do not think you will get better, you won’t. You have to buy into the plan, think positive, take the little wins, and know that this will not last forever. Any injury will last longer than we want it to, but you have to realize that by pure running statistics, you will get hurt at some time if you are training consistently, but it will also pass.
Hopefully, this article cleared up a few things regarding your training and the ability to continue through treatment, as well as a few ways to care for Runner’s Knee yourself. Ideally, you can manage this yourself, learn from it, and prevent it from recurring. As runners, we are prone to injury; that is just the way it is. But, we want to make sure you have the necessary knowledge and tools to help yourself before you give up, stop running, and then drag yourself into a sports physician's office.
LET'S REVIEW TODAY’S INFORMATION
When faced with Runner's Knee, training modifications are a must. We typically cut the training volume by 50% and avoid intense workouts (intervals, hills, tempo) for the first 2 weeks.
Self-care is a must. It not only helps speed your recovery over your treatment plan, but it can also help prevent future injury.
Self-care can be as simple as foam rolling a few times per day or running specific mobility, stability, and strength exercises.
Stay tuned for part 4 of our runner’s knee series, where we will discuss when to seek treatment and how we treat Runner’s Knee in our office, as well as a few examples of our suggested rehabilitation exercises.
Train smart, recover well, race great!
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Murray, Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Injury Prevention For Runners: Tips To Support Your Training
As runners, we really only have 2 goals...
Run faster/farther than we ever have before.
Remain injury free.
For the last 4 years, it has been our goal at Revive Sport & Spine to be the leading sports chiropractic clinic serving the greater Salt Lake City area when it comes to running-related injuries and prevention. Having aimed for the same goals mentioned above through my own running the last 20+ years, there are few endurance sport related injuries that I have not encountered either personally or clinically.
While we field questions about running form, injury prevention, running shoes, pre-race meals, training plans, strength training, etc., some questions are better answered by those who work in that arena day in and day out.
Over that last few months, we were able to sit down with a few local specialists in sports nutrition, mental skills training, strength training, and running shoes. Our goal was to find out how each component can aid runners with injury prevention.
As runners, we really only have 2 goals...
Run faster/farther than we ever have before.
Remain injury-free.
For the last 4 years, our goal at Revive Sport & Spine has been to be the leading sports chiropractic clinic serving the greater Salt Lake City area for running-related injuries and prevention. Having pursued the same goals mentioned above through my own running for the last 20+ years, I have not encountered many endurance-sport-related injuries, either personally or clinically.
While we field questions about running form, injury prevention, running shoes, pre-race meals, training plans, strength training, etc., some questions are better answered by those who work in that arena day in and day out.
Over the last few months, we were able to sit down with a few local specialists in sports nutrition, mental skills training, strength training, and running shoes. Our goal was to find out how each component can aid runners with injury prevention.
INTERVIEW 1: Nutrition Tips For Runners with Dietitian Tayla Russell.
INTERVIEW HIGHLIGHTS:
Runners and other endurance athletes are different from athletes who play soccer, football, baseball, etc., and therefore have higher specific nutritional needs that fluctuate depending on the distance and type of race. One must is that we need more carbs during our training cycles. Choose good carbs like grains, fresh fruit, and fresh vegetables.
As runners, injuries are inevitable. Know what foods can help during the healing cycles can speed up your recovery and get you back out on the road or trails quickly. Great Anti-Inflammatory foods include healthy fats like avocados, nuts, and seeds, high anti-inflammatory fruits like pineapple, and spices such as ginger and turmeric.
Myth: All runners must carb load before a race? False, while long-distance runners do need some extra for energy stores later in the race, most people just over-eat the night before a race. So if you are waking early the next morning for a 5k or 10k race, you are better served to have a light dinner of fresh veggies, lean protein, and a small amount of carbohydrates.
Contact: Tayla Russell - dietitiantayla@gmail.com - 435.553.5698 - Max Muscle Cottonwood
INTERVIEW 2: Mental Skills Training with Nate Last, M.S. from Mental Grit Consulting
INTERVIEW HIGHLIGHTS:
Negative Self Talk: Negative talk puts us in our own way on our path to our goals. Everyone does it and it is a major contributor to not performing at our best.
Ideal Mindset: We have an ideal mindset, we have to practice it just like everything else we are working on. Understand you can accomplish your goals, we can and will fail at things in the process, but use it as a building tool to strengthen your mindset.
Process Before Outcome: When training and racing, focus on the basics, focus on doing everything you can do RIGHT NOW, in the moment that will help you perform better in the future. It is okay to think ahead and dream about the future, but don't stay there! Bring yourself back to the process.
When Injured: Stay on track through an injury. Believe your body is capable of healing and training again. When you believe this, it will happen, and it will likely happen faster.
Contact: Nate Last - Mental Grit Consulting - 801.368.7564
INTERVIEW 3: Strength Training For Runners with Ryan Carver, CSCS from Leverage Fitness Solutions.
INTERVIEW HIGHLIGHTS:
Should Runners Weight Train: YES! Weight training can help prevent injury by building the strength of not just your muscle, but ligaments, tendons, and joints. Weight training can also make you faster by improving your overall economy and efficiency.
Increase The Weight Or Volume: As runners, we spend most of our time doing high volume training. So when it comes to weightlifting, increasing the weight and shift toward lower reps is ideal to obtain the most benefit. Also, just because we run or cycle, we still need to lift with our legs, don't shy away from the squats, lunges, and deadlifts.
Top Exercises For Runners: (1) Weighted Step-Ups (2) Nordic Curls - Hamstring (3) Hip-Hike (4) Shin Strength - Toes To Shin w/ Resistance (5) Stir-The-Pot Core Exercise.
Contact: Ryan Carver - Leverage Fitness Solutions - 385.985.3603
INTERVIEW 4: Running Shoes & Injury Prevention with Darrell Phippen from Wasatch Running Center.
INTERVIEW HIGHLIGHTS
New Technology: All name brands have great technology, but which one is best for you and your running style and goals? Shoes are lighter, have better and more comfortable uppers, and have more fits than ever before. Getting a correct fit, and finding the best shoe for YOU, is almost as important as your training plan.
Shoe Fitting: Trying a shoe on is not enough to make a decision. How does it feel with movement, walking and running? Working with the professionals who have been trained in shoe fitting can make all the difference in finding the right shoe to help you remain injury free.
How Many Shoes Do You Need: As runners, more shoes is always better. But when you look at the average mileage of shoes, 250-350, and how often you run, having multiple shoes has its advantages. Our suggestion is to have a minimum of 2 shoes if you are primarily a one surface runner, 3 if you mix trails with road running. This allows them to last longer, continually challenge your feet and allow them to adapt to a variety of surfaces, and help prevent injury.
Contact: Darrell Phippen - Wasatch Running Center - 801.566.8786
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Murray, Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Iliotibial Band Syndrome Pain - What You Need To Know & What You Can Do About It.
Runners in Utah and all over the country have expereinced that stabbing knee pain, during and after a run, that seems to come out of no where, leaving you sidelined and unsure what caused it or how to deal with it. Iliotibial Band Syndrome, or ITBS, is one of the most common injuries experienced by new and veteran runners alike. We discuss some of the basics and a few simple tools to help deal with it.
I can remember like it was yesterday. I was nearly halfway through Chiropractic school and roughly 1.5 years returned to frequent running. It was a cold morning race, cold enough to earn its race title of ‘Frostbite’ series. As I ran down a slight decline, 3 miles into a 10k jaunt, I felt this sudden STABBING on the side of my right knee. Unsure of what was happening, I was able to run another 400 meters before having to stop and walk...I had never done that before, stopping in a road race was absurd...but to my surprise, outside of a little tightness, the knee pain subsided, that is until I started running again. Within 100 meters, the stabbing pain was back. From there, I journeyed on my longest 10k race to date!
Of all the running injuries that come through the clinic, Iliotibial (IT) Band complaints take the cake. While few runners escape the stabbing grip that is an IT Band Syndrome injury, there is much confusion as to what is actually causing the pain, and even more about how to treat it. Nowadays, I encounter a handful of people every week who complain of this exact same thing, so let's take a simple look at what is going on as well as a few proven ways to take care of it.
5 THINGS YOU NEED TO KNOW ABOUT IT BAND SYNDROME
1. It is one of the most frustrating running injuries known to wo/man!
ITBS is a common overuse running injury. The IT band (who wrongly gets most of the attention) is a dense band, made of fibrous connective tissue, that connects the hip to the lower leg, while also crossing the lateral (outside) of the knee, providing stability in the process. The band is a continuation of the Tensor Fasciae Latae (TFL) muscle, acted on by the glute max, and assists in hip extension, abduction, and external rotation.
2. If you succeed in 'stretching' the band...it's called tearing! You Can't Stretch It!
Yes, you read that right, you can’t actually stretch the IT Band. Why? It’s a tendon! It’s Thick! Connective tissue is very strong….the band is like a truck tire! A few studies have attempted to measure some sort of stretch of the band itself, one going as far to harvest the band from cadavers, try to break it down by freezing and thawing the tendon and then put it under mechanical stretch to find that...NOPE, didn’t gain much more than a millimeter. If this is the case, how can you expect it to stretch by rolling the outside of your leg with a piece of foam, or by crossing one leg over the other and leaning into a wall?
3. Running causes this pain, how? Good question...It Depends!
The IT Band is tightest at 30-40 degrees of knee flexion, an angle many runners pass through multiple times in the gait cycle. In addition to this, it can help absorb ground reactive forces from each foot strike while also being required to provide more and more support of the lateral knee as the hip fatigues in the later stages of a run. This allows the hip to drop during the stance phase, causing a valgus knee, excessive foot pronation, pronation speed control, and rotation and friction at the lateral knee. Now, this is all just mechanical mumbo-jumbo. Running irritates it because it is a high-compression (no longer believed to be a friction issue), high-load spot of the lower extremity, and with movement and need for stability and function comes the opportunity for dysfunction. If you combine this with the capacity every runner has to overtrain, or that most new runners take up the sport with no coaching, we have created the perfect storm!
4. But it hurts RIGHT HERE! You mean that is NOT the cause?
We now know that the IT band courses from the outside of the hip/thigh region to the outside of the leg just below the knee, therefore the pain in on the outside of the knee. We bring this up as it is often confused with Runner’s Knee. While both interrupt our ability to enjoy running and racing, they have very different causes and presentations.
5. Treatment is relatively simple, sometimes aggressive, but simple. The commitment, on the other hand... runners don't do well with commitment.
So where do we focus our attention as we work to decrease the pain and get back to running? THE HIPS! Have you been listening? With runners, there is always a hip component of the problem; in the instance of IT Band complaints, it is a 95% hip problem. As we address how you can begin tackling this irritation on your own, remember that the sight of pain is not always...more like ‘rarely’....the site of the problem.
3 THINGS YOU CAN DO TO TREAT IT BAND SYNDROME A STARTING POINT
Self Treatment Phase 1: Foam Roll and Stretch The Cause
This should be expected, I love the foam roller. Mostly because it is simple to use and travels well, but when used correctly, it is honestly the best $20 you can spend. You are more than welcome to roll over the IT band itself, under 3 circumstances - 1. Know that it will hurt! 2. You admit you are not lengthening the IT band itself and are more addressing trigger points and just smashing the lateral quad into the femur. 3. As with any area, you do not to do it excessively.
With that being said, we DO want to use the foam roller on the posterior hip to address the glutes and external rotators of the hip as well as the TFL muscle itself. Work through these videos, they are no more difficult than sitting on the roller and moving back and forth but I do suggest 3-5 sessions per day, no more than 10-25 rolls up and down on each area of the hip and leg
Self Treatment Phase 2: Strengthen The Hips
Once you have addressed the mobility of the hips and the flexibility of the associated muscles, it’s time to build strength. As we fatigue during running, our hips begin to dip and get sloppy. This not only causes us to be extremely inefficient, but it leads to mechanical breakdown and resulting IT band syndrome related lateral knee pain.
We have worked hard over the last few years to develop a warm-up routine that addresses many of the most common running injuries, and this particular injury is the one that started it all. Our suggestions here is to utilize strength bands in your warm up to ignite the posterior hip, as seen in our BANDS warm-up video. Start with 1 set of 10 for each exercise, PRIOR to running! Exercises: Clams, Bridges, Band Walks.
Self Treatment Phase 3: Increase Cadence/Change the Terrain/Work The Hills
Lastly, while we have little data on how ground reactive forces contribute to IT band complaints, clinically, it is a big enough factor for us to consider a few modifications while you run back to health. From personal experience and talking with 1000s of runners who have worked through their IT band problems in our office, the two things your IT band does not like are hard pavement and downhill running. If you are a runner in Utah, this just set off a huge signal in your brain, recalling every race you have run in the last 2 years and realizing they were ALL downhill road races!
Rarely do we shut runners down while we are working through an IT band issue, but I will suggest 3 ways to change up your running.
Increase your cadence by 10-20 steps per minute. While difficult at first, it helps relieve many common running complaints.
Check out some alternate terrain. In my book, it goes trails first, track is a close second, and lastly, the road. I get that it is easiest to run out the door and do a road run, but the track (rubber) and especially the trails are much more forgiving to your legs.
Work the hills - YES, UP! Not only is there less pounding going up a hill, but it also builds some great strength in the legs and hips!
Work on adding these simple steps to your running warm-up and cool-down. One thing I can attest to as a past ITBS sufferer, if you think that once the pain is gone, you can slack on your flexibility, your warm-up, strength training, post-run rolling session...you will be sorely mistaken
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Murray, Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
