Iliotibial (IT) Band Syndrome in Runners

by Katherine Younes, DPT – Hampton Clinic

itbs-injury-hpt

As the fall approaches, many of you may be signing up for a 5k, 10k, or you may be an everyday runner. As many of you know, with running may come aches and pains. The most common overuse injury in runners is Iliotibial Band Syndrome.

What is Iliotibial Band Syndrome?

ITBS accounts for 12-14% of all overuse injuries in runners. The IT band consists of a thick, tight band of fascia located on the lateral aspect of the thigh. The IT band spans from the outside of the pelvis, runs over the lateral hip, and inserts into the lateral femoral condyle located just below the lateral knee. The continuous rubbing of the band over the boney prominences on the femur, combined with repetitive flexion and extension of the knee is believed to be the cause of ITBS. The good news? It is very treatable!

Signs and Symptoms of ITBS:

  • Stinging or sharp pain just above the knee joint on the lateral side of the knee

Swelling or thickness of the tissue just above the lateral aspect of the knee

Increased pain with activity: walking, running (downhill specifically)

Pain with bending and/or straightening of the knee, which can be made worse by pressing on the tissue on the lateral aspect of the knee

Causes of ITBS:

  • Poor footwear
  • Improper training: increase in mileage; change in type of training, change in training intensity
  • Running on cambered road surface
  • Running on an indoor track with tight turns
  • Muscle weakness: glute med, glute max, quads
  • Muscle tightness: IT band, quads, hamstrings

What can I do to treat my ITBS?

  • Ice – 15 minutes at a time, 1-2 times a day

IT band Stretch
it-band-stretch

  1. Use a rope or belt to wrap around your foot of the affected leg
  2. Cross the affected leg over the other and pull your foot up and out until a comfortable stretch is felt along your IT band.
  3. Hold for 10 seconds and return to starting position
  4. Repeat 10-15 times, 1-2 times a day

Foam Roll- massage
hip-roller

  1. Lay on foam roller on the affected side
  2. Start with the foam roller just above your knee and roll up to your hip. Repeat for 3-5 mins
  3. Can perform 1-2 times a day
  • Strengthen:

Hip Abduction Exercise
hip-abd

  1. Lay on your non-affected side with your bottom knee bent
  2. Keep top leg straight and raise leg up towards ceiling
  3. Return to starting position
  4. Perform 3 sets of 10 reps

Clamshell
hip-clamshell

  1. Lay on your non-affected side with both knees bent over one another
  2. Keep heels touching while opening and closing your knees
  3. Perform 3 sets of 10 reps

Bridges
hip-bridges

  1. Lay on our back with both knees bent up, feet on the floor
  2. Raise hips off the ground and return to starting position
  3. Perform 3 sets of 10 reps

Physical therapy is another option that can provide a wide variety of treatment techniques for this condition. Our team of physical therapists at Hampton Physical Therapy can provide strengthening exercises, stretches, Graston technique for soft tissue mobilization, Kinesiotaping, modalities and much more to provide you with a great outcome for your symptoms. Feel free to call our office or visit http://www.HamptonPT.com for more information.

  • Grau et al. The influence of matching populations on kinematic and kinetic variables in runners with Iliotibial band syndrome. Research Quarterly for Exercise and Sport. 2008; 79 (4): 450-457.
  • Shamus J, Shamus E. Case report: the management of iliotibial band syndrome with multifaceted approach: a double case report. International Journal of Sports Physical Therapy. 2015; 10 (3): 378-390.
  • Van Der Worp et al. Iliotibial band syndrome in runners, a systematic review. Sports Med. 2012; 42 (11): 969-992.

Plantar Fasciitis Are You at Risk?

by Kate Serodio, DPT, HamptonPT

flip-flops-hpt

 

Check all that Apply:

· Do you have high or low arches? ___

· Are you between 40-60 yrs. old? ____

· Do you run long distances, downhill or on uneven surfaces? ___

· Are you overweight or have you suddenly gained weight recently? ___

· Do you have a tight calf muscles? ___

· Do you Wear shoes with poor arch support or soft soles? Such as flip flops? Boat shoes? Or walk barefoot? ____

· Have you recently changed your activities? ____

· Do you like taking long walks on the beach? (no this is not the personal column!)___

· Recently suffered an injury on one side of your body and are now distributing all your weight on the other? ___

If you check YES to anyone of these then you are at risk!

Who is most likely to get a Plantar fasciitis?

Plantar fasciitis is the most common cause of Heel pain and affects 10-15% percent of the U.S population. It is estimated that 1 in 10 people will experience PF at some point in their lifetime Plantar fasciitis is responsible for more than 600,000 outpatient visits annually! PF is most common in overweight, middle aged, active and sedentary adults that demonstrate limited ankle dorsiflexion (toes pointed towards your head), and spend long periods of time on their feet. However anyone may be at risk if they recently changed their footwear or increased or modified their activity level.

What exactly is PF?

Plantar fascia is a thick fibrous non contractile connective tissue that originates from the bottom of your calcaneus (heel) and attaches to the base of your toes and therefor supports the arch of your foot. Historically, plantar fasciitis has been erroneously thought to be an inflammatory condition of the plantar fascia. More recently, the literature suggests that the condition is actually due to a noninflammatory structural degeneration due to repetitive micro trauma of the PF secondary to chronic overuse. You will most likely see a shift in the name from PF to plantar fasciosis in the years to come.

How will I know if I might have a PF?

Your healthcare provider or your physical therapist could easily determine if you have a PF based on your clinical exam. The telltale signs that you can look for are:

-Pain with initial steps or after a period of inactivity but also worse following prolonged weight bearing

-pain to touch the medial heel or arch

-pain when pulling your toes into extension (towards your, creating stretch on your arch)

– Heel pain precipitated by a recent increase in weight-bearing activity

-decreased ankle dorsiflexion (tight calf)

Could it be something else? (Differential diagnosis)

Yes, there are always other conditions that could be responsible for your heel pain such as:

· -Lumbar radiculopathy – (possibly coming from your back)

· -Fat-pad atrophy,

· -proximal plantar fibroma

· – Heel pain of neurogenic origin (tarsal tunnel syndrome, calcaneal nerve entrapment) if you have some degree of numbness/tingliness/burning you most likely have a nerve involved

What can I do to prevent PF?

plantar-exerc2
Step #1: Immediately start stretching!

Plantar fascia stretch: Grab your toes and pull them towards your head 30sec 3x

Calf Stretch: dips on the step: place one heel off the edge of a step, toes onto a rolled up towel, and shift your weight to this leg, lower your body weight onto this leg and hold 30sec/3x (you can bend your knee to target the soleus muscle and you can keep your knee straight to target the gastrocnemius muscle.

plantar-exerc

Step #2:

· Avoid flip flops or unsupportive footwear. Many people that suffer from a PF often overly pronate (arch falls in while weight bearing), this repetitive motion puts too much strain on the PF. Arch supports will help prevent PF

Step #3:

· Gradually modify your activity levels and new recreational activities. Just because it’s finally nice out doesn’t mean you should decide to run a 10k when you haven’t been training outside all winter. Different terrain affects your body differently. The beach for example can be extremely problematic by increasing the stress while walking or running due the give of the sand. The motion of the foot is exaggerated.
Step #4

· Change your footwear every 300-500miles or at least every year. Footwear is less supportive with use and also time. The rubber material become less supportive over time because rubber breaks down over time regardless of use.

Step #5:

· If you start to feel heel pain, immediately stop doing what you’re doing and stretch. If you recently changed footwear, stop and throw out the shoes/sneakers. I often have patients think that they just need to break in the footwear and then they’ll be fine. This is not the case with this condition, your condition will only get worse if you continue to use them. Give them to someone you don’t like!

Step #6:

· If your pain continues for more than a week with these conservative measures you should immediately seek a physical therapist evaluation (Medicare patient’s and patients with PPO’s do not need a referral, you can simply schedule an appointment) or consult with your primary care to go to PT immediately. Research suggests the longer you wait the longer it will take to resolve the condition

What do I do if I have Plantar Fasciitis?

Step #1:

Immediately start stretching as indicated above!

Have numbness or tingliness? Perform the exercise for only 3 seconds and repeat only30x, 3x/day. Nerves do not like to be put on stretch for long periods of time! This will help bring blood flow to the nerve and reduce intraneural swelling

Step #2:

Modify your footwear. Stop wearing nonsupportive footwear, yes that includes your new flip flops. I recommend keen sandals, they are extremely comfortable, supportive and essentially no break in period

Step #3:

Roll your arch with a tennis ball to stretch the PF

Step #4

Consult with PT or PCP to initiate therapy treatment. Physical Therapy is extremely beneficial and effective. Again, you are best to start therapy sooner than later. The longer you have the condition the longer the rehabilitation. In general, most patients will require 6wks of PT 2x/wk. in order to return to their prior level of function.

tapingWhat will Physical Therapy consist of?

Graston Technique: Graston Technique incorporates an instrument assisted soft tissue mobilization that allows the therapists to effectively detect and treat scar tissue and restrictions that affect normal function. Essentially, the technique aims to make a chronic condition acute again. Your body will then start to help and heal itself. For more information visit: HamptonPT.com

Manual mobilization: Your therapists will aim to increase your dorsiflexion by manual joint mobilization techniques and manual stretching.

Neural mobilization: The tibial nerve can often be involved. It’s important to add neural mobilizations if it is suspected that the nerve has become inflamed. This will help desensitize the nerve.

Footwear modifications: Your therapist will examine your gait and foot biomechanics and determine the best footwear for you. You may also be advised to utilize over the counter inserts or heel pads. Your physical therapist could also make you custom orthotics if deemed necessary. Most often over the counter inserts are sufficient.

A rocker bottom sneaker has also been found in the research to aid in some pain relief and decreased plantar fascia pain.

You may also benefit from changing footwear throughout the day if you must stand long periods of time. This will change the pressure distribution.
Exercises/Stretches: There are a series of exercises to help increase the mobility/flexibility of your ankle which will help decrease stress on your heel. You will also be advised in a progressive series of strength exercises to help build/support your arch.
Taping: Low dye taping is very beneficial in immediately eliminating a true plantar fasciitis. This may also be used to determine the need for inserts

Night Splint: A night splint may be advised however if you have nerve symptoms this may exacerbate your pain. A good rule of thumb, if it feels better in the morning then it’s helping. If it feels worse then don’t do that!

Do I need an injection? Injections can weaken the plantar fascia and put you at a risk of rupturing the PF. More conservative measures should be performed first and then determined once other measures have failed.

We at Hampton Physical Therapy treat this condition regularly and have great outcomes. If you have questions/concerns regarding your condition, please don’t hesitate to call and speak with one of our Doctors of Physical Therapy.

J Res Med Sci. 2012 Aug; 17(8): 799–804. Plantar fasciitis Mohammad Ali Tahririan, Mehdi Motififard, Mohammad Naghi Tahmasebi,1 and Babak Siavashi2

Journal of Orthopaedic & Sports Physical Therapy ,Volume 44, Issue 11 Heel Pain—Plantar Fasciitis: Revision 2014 Robroy L. Martin, PT, PhD, Todd E. Davenport, DPT, Stephen F. Reischl, DPT, Thomas G. McPoil, PT, PhD, James W. Matheson, DPT, Dane K. Wukich, MD, Christine M. McDonough, PT, PhD

Abduction in the plane of the shoulder blades

Rowing and Lat Pull Downs

General Tips and Advice:
Simple stretching routine to warm up your muscles before beginning your round

Hit a few balls on the driving range/warm-up area prior to hitting the course

Wear sunscreen, a visor/hat, and sunglasses to protect you and your eyes from the harmful UVA rays

Stay well hydrated during and after your game

When riding in the cart keep yourself, including your feet, inside the cart

Be aware of your environment and other players to avoid accidental soft tissue injuries…Fore!

Get sound advice from a professional regarding proper form, warm-up/stretching routines, and training techniques

Enjoy your golf season more by taking these tips and including them as part of your routine. Your game will likely improve and your body will thank you later. It is always good to have your golf swing checked by a professional to avoid poor swing mechanics, which can lead to compensation and overstressing your joints and muscles. Go get out there and have a great season! Most importantly be safe and have fun! For questions or consultation contact Hampton Physical Therapy http://www.HamptonPT.com/

Is Your Child’s Backpack an Injury Risk?

By: Jessica Villerot DPT – Hampton Physical Therapy (Hampton & Seabrook, NH)

backpack-hptIt’s that time of year again when your child will be returning to school. But before you head out for that infamous back-to-school shopping, it is important to make sure your child’s backpack is making the grade. Although backpacks are still the best way for your child to carry their homework and school supplies, if worn or fit incorrectly, or overloaded in weight, it could be doing more harm than good. A child’s growing muscles and joints are more susceptible to injury when heavy loads are repeatedly placed and not properly supported on their backs.

A recent study, led by American Physical Therapy Association member, Shelley Goodgold PT, associate professor of Physical Therapy at Simmons College in Boston, found that 55 percent of children surveyed carried backpack loads heavier than 15 percent of their bodyweight, the maximum safe weight recommended by most experts. These heavy loads can cause harmful postures (i.e. forward lean, leaning to one side, arching the back) that could result in compression of the vertebral discs, muscle strain/sprains of the back and neck, or strain on the shoulder joints and nerves. The spinal and abdominal muscles are some of the strongest muscles of the body, and if backpacks are worn correctly, these muscle groups can work together to stabilize the spine and protect the body from injury.

So what can you do, as a parent, to help your child avoid injury? Follow these simple steps:

· Supply your child with a proper fitting backpack. The size of the backpack should fit the size of the child, NOT the amount of books/supplies the child needs to carry. The shoulder straps should fit comfortably on the shoulders and under the arms, so that the arms can move freely. The bottom of the pack should rest in the contour of the lower back, NOT sag down toward the buttocks.
· Use a backpack that has a padded back and shoulder straps to reduce pressure on your child’s back/shoulders.
· A waist belt helps distribute some of the load to the pelvis.
· Compression straps on the sides or bottom of the backpack that, when tightened, compress the contents of the backpack and stabilize the articles.
· Wear BOTH straps. Using only one strap, or a backpack with a strap that runs across the body and over only one shoulder, forces one shoulder to support the weight of the bag. Wearing both straps allows the body to support the weight of the backpack in a neutral spinal posture.
· Use caution when using backpacks with wheels. If the handle does not extend far enough, your child will be forced to bend forward or twist when pulling their backpack, both actions that can cause serious back injury. Also, remember that wheeled backpacks may present problems when trying to carry them up/down stairs or onto the bus.
· Try to monitor how much weight your child is carrying in their backpacks. It is recommended that children not carry more than 15 percent of their bodyweight in their bags.

back-to-school-backpack1Finally, look out for signs that your child may be negatively affected by an improper fitting/wearing backpack.

· Pain when wearing or shortly after wearing the backpack.
· Red marks on the shoulders.
· Numbness or tingling into the arms or fingers.

If your child is complaining of any of these symptoms, or if you feel your child would benefit from an evaluation of a medical professional, please don’t hesitate to call and speak with one of our Doctors of Physical Therapy at Hampton Physical Therapy with clinics in Hampton and Seabrook, NH.

We would be glad to help in any way we can! www.HamptonPT.com 603-929-2880
RESOURCES: Pediatric Physical Therapy: Fall 2002-Volume 14, Issue 3: 122-131. Backpack Use in Children. Goodgold, Shelley ScD, PT; Corcoran, Moira DPT, MSPT; Gamache, Diana MSPT; Gillis, Jennifer MSPT; Guerin, Jennifer MSPT; Coyle, Jennifer Quinn MSPT.

Grimmer KA, Williams MT, Gill TK. The associations between adolescent head-on-neck posture, backpack weight, and anthropometric features. Spine. 1999; 24: 2262–2267.