IT Band Syndrome

IT Band Syndrome 

By: Brooke Smith, DPT

Do you have knee pain or hip pain that occurs with walking or increased activity?  It could be caused by a tight Iliotibial (IT) Band.  The IT band is a thick band of fibrous tissue that begins at your hip and runs down the outer part of the leg, crossing the knee, and attaching to the top portion of your shin bone (tibia, figure 1).

http://www.aidyourhamstring.com/
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The IT band and the associated musculature act to stabilize and coordinate muscle function of the knee with running and walking.  It is a common overuse issue that occurs in “4.3-7.5% of long distance runners”.3   However, IT band syndrome can also occur in military recruits, cyclists, tennis players, adolescents undergoing rapid growth, weightlifting, people who perform a lot of squats, short distance or sprint-distance runners, rowing, and cross training.   IT band syndrome has been reported to occur equally in men and women and most frequently occurs between the ages of 15-50 years old.

Some common mechanisms of injury, creating pain, could be decreased strength, decreased flexibility, abnormal hip alignment (pelvic tilt), “bowlegs”, improper alignment or mechanics of the feet with walking/running, improper posture/mechanics with running or exercises, running on angled or uneven ground, leg length discrepancy, poor footwear, sudden increase in activity, returning from injury too soon, overuse, or over-training.   

Someone who has IT band syndrome will usually experience pain on the outside of the knee.  However, some people can present with pain over the hip joint (greater trochanter), or pain starting at the knee traveling up to the hip. Sometimes the pain can be described as stinging or needle-like pricks that can occur every time your heel strikes the ground with activities.  Pain will usually increase with activities such as running or cycling, especially when running hills, and with walking up/down stairs.  This is due to inflammation of the IT band causing it to snap over the hip bones (greater trochanter), leading to pain.  Other common symptoms may include repetitive popping sounds in the knee when performing activities, as well as tenderness with pressure over the outside of the leg just above the knee. Some tenderness might also be present at the hip joint (greater trochanter).  

However, there could be multiple reasons for pain at your hip or knee and these include: hamstring strains, MCL and LCL injuries, meniscus injuries, myofascial pain, osteoarthritis, overuse injuries, patellofemoral syndrome, and trochanteric bursitis.  Therefore, it is critical to have a professional MD or physical therapist assess your individual problems to determine if it is truly IT band syndrome.

Physical therapists will help diagnose IT band syndrome by taking into account the patient’s history of the present condition, performing special tests specific to IT band syndrome, alternative tests to rule out any other pathology, and assess strength and joint motion/mobility.  Some common treatments provided by physical therapists include strengthening of weak musculature, stretching of tight muscles that are contributing to the pain, manual therapy, soft tissue mobilization, assisting in custom orthotics, modalities such as ultrasound, TENS, and ice, and providing home exercise program to maintain results.   All treatments are specific to each individual patient and their specific biomechanical faults are taken into consideration to fix the cause of IT band syndrome.

If you think you might have IT band syndrome here are some simple tips, exercises, and stretches you can try: rest, ice, appropriate use of ibuprofen/NSAIDs, IT band stretching, and use of a foam roller to release the IT band, use proper footwear, stretch prior to and after running, get adequate rest between workouts, and gradually increase your training or exercises.  If you continue to experience pain, you should seek the advice of a licensed physical therapist to assist in diagnosis and treatment.  If you have any questions, concerns, or would like to schedule an appointment contact AZOPT at (623)-242-6908.

References:

http://www.medicinenet.com/iliotibial_band_syndrome/article.htm

http://sportsmedicine.about.com/od/kneepainandinjuries/a/IT_Band_Pain.htm

http://emedicine.medscape.com/article/307850-overview

http://www.emedicinehealth.com/iliotibial_band_syndrome/article_em.htm

http://www.runnersworld.com/injury-prevention-recovery/treating-and-preventing-iliotibial-band-syndrome?page=1

http://orthopedics.about.com/cs/sportsmedicine/a/itbs.htm

http://www.webmd.com/pain-management/knee-pain/tc/iliotibial-band-syndrome-topic-overview

What’s better For Pain - Heat or Cold?

What’s better For Pain - Heat or Cold?

By Doug Lehman, PT

Often times, patients will ask me if they should use heating pads or ice to treat pain.  My answer varies depending on the type of pain.  There are two basic types of pain that we treat: acute and chronic.  Acute pain is pain that occurred recently, usually within the past 24 or 48 hours.  Chronic pain is pain that extends beyond the expected period of healing.

Acute injuries are usually treated with cold therapy.  The general rule with cold therapy is if an area is red, swollen, or inflamed, or the injury just happened, we want to cool the area down and prevent further or reduce any inflammation.  Cold therapy will reduce swelling and pain by constricting blood vessels.  It will also limit any bleeding that may occur.  Cold therapy is generally used after exercise, again to cool the inflamed areas.  Cold should not be used to treat chronic injuries before exercise. 

Some choices for treatment can range from a bag of ice (or snow for cold weather climates), a gel cold pack purchased from a store, or a large bag of frozen peas (yes, this does work, just don't eat the peas!).  Cold treatment can be applied for 20 to 30 minutes before allowing your skin temperature to return to normal before reapplying the cold therapy.

Heat will generally be used for chronic injuries.  It can help sore, stiff, nagging muscles and joint pain.  Heat should not be used with acute injuries or any injury exhibiting signs of swelling or inflammation.  Heat can help relax tight muscles or muscle spasms. Heat used before exercise will increase the elasticity of joint connective tissues and stimulate blood flow. 

Choices for heat treatment include an electric heating pad, a microwavable hot pack, or uncooked rice in a tube sock heated in the microwave (yes, this works too!).  Heat should be used for 15 to 20 minutes at a time with enough layers between the heat source and skin to prevent burning. 

Heat or cold therapy works by stimulating your body's own healing force.  Many arthritis doctors recommend both heat and cold treatments to help reduce inflammation and ease the pain and stiffness that comes with arthritis. It may take a little "trial and error" to learn which therapy works best for your pain, but you can use this blog as a starting point.  For chronic pain, feel comfortable utilizing the method that works best for you.

When a Home Exercise Program is Not Enough

When a Home Exercise Program is Not Enough
By Ryann Roberts, DPT
Owner and Physical Therapist, AZOPT

Ever had an injury or nagging pain that just won’t go away?  During the course of exercise, sports, and sometimes normal daily activities, these injuries occur frequently.  Some people will turn to word of mouth, YouTube, or a medical professional for assistance.  They will receive an abundance of information, exercise, and movements that may help alleviate or reduce the pain.  Many of these stretches and activities loosen tight muscles, strengthen weak muscles, alleviate the pain, and help you achieve full return to activity.  But what do you do when the home exercise program (HEP) does not resolve your injuries fully?

I see many people in the gym or who come into my office at AZOPT and tell me despite finding a good HEP and performing the exercises correctly and frequently, the pain still will not go away.  My response is always the same – you need the skilled hands of a physical therapist to manually release the restricted tissue.  A skilled physical therapist uses techniques and stretches you will not receive any other way.  A physical therapist will push your limits safely and effectively in a way you cannot on your own.

You can only foam roll or lacrosse ball out a tissue so much and so deep compared to what manual therapy from a physical therapist can perform with their hands.  Physical therapists can ‘feel’ the restriction and use several deep tissue methods to release the restriction deeper than a foam roll or a lacrosse ball.  A physical therapist’s hands can get pin point to the exact restriction and effect positive change. 

I talk with athletes daily about aches and pains they are having and how they should best attack the pain or restriction.  I am happy to give general stretches and advice to best resolve their problem, but nothing compares to the time spent on the table manually working through the pain.  On the table, I am able to feel the restriction and range of motion loss, and trace it to a certain area that is causing the limitation, thus the pain.  Through repeated sessions, I am able to address every factor contributing to the problem. 

HEPs are very good; I give them to my patients all the time, but as a part of a larger program.  I give instruction and advice all the time.  Without actually spending time with the person on the table, my advice is limited.  If your routine is working for you and you are able to function or compete on a daily basis with this program, then keep going!  If you find you are constantly searching for that next great stretch on the Internet to fix your problem, have a physical therapist perform an evaluation.

I treat the CrossFit Fury Games athletes consistently.  I know what their tissues feel like.  I know each individual’s range of motion.  Therefore, I also know their medical ailments and when their bodies are tight.  I can prepare them for competition in a couple sessions because they see me regularly.  I know their bodies.  They know that self-stretching and foam rolling will only take them so far.  At AZOPT, we understand all athletes because we are athletes.  We understand the physical demand of exercise from the everyday person trying to get fit to the competitive athlete we all admire. 

I decided to write this blog because I see too many people looking for the easy answer to their pain.  I do not mind giving advice to anyone who asks, but if you truly want the answer, you need to come see us.  Treating pain without the use of medication takes time and effort.  The easy answer is “take 2 of these and call me in the morning”.  The hard answer is “make an appointment and let’s get to work”.  You spend so much time, money, and energy to get healthy; do not fail yourself at the point of pain.  Put in that extra rep and call to make an appointment; we can only help you if you allow us to.  It was not easy getting to the point where you need help, and it will be work getting beyond the pain.  Physical therapy is the natural cure for the ailing athlete. 

If you are having nagging pain or an injury that just will not go away, give us a call at (623) 242-6908 and make an appointment.  We are here to help you get Stronger, Faster, Safer.  

Attention Baby Boomers: Stay Healthy While Staying Fit

Attention Baby Boomers: Stay Healthy While Staying Fit

Mitch Kaye, PT,

PTPN Director of Quality Assurance

“Sixty is the new 40,” say many early baby boomers celebrating their 60th birthday this year.

This generation of 76 million people born between 1946 and 1964, determined to ward off aging, has focused more on exercise and wellness than did their parents. They were at the forefront of the aerobics and fitness movement that began in the 1970s and are now flocking to health clubs in even greater numbers.

But, as a result, increasing numbers are suffering from “Boomeritis” — the phenomenon of boomers becoming injured while exercising and playing sports at a level often too intense for their aging bodies.

Sound familiar?

It’s not just about soreness or stiffness. As boomers refuse to let injuries get in the way of their exercise routines, they’re undergoing complex knee and hip replacements and surgical repairs to the shoulder, ankle and elbow. Orthopedic surgeons say they are performing such surgeries more often on patients in their 40s and 50s than in the past.

Physical therapists are also treating more boomer patients than ever, not only for rehab after injuries and surgeries, but also for customized fitness training geared to their musculoskeletal limitations.

Staying healthy and avoiding injuries

If you’re a boomer, regular exercise is key to preventing or improving chronic conditions that come with increasing age. But you may need to make some modifications to avoid injuries.

Here are some tips for staying healthy and avoiding injury — at any age.

• Moderate cardiovascular exercise will improve the quality of your life, but be sure to get screened by a physician first.
• Exercise at a pace appropriate for your age. Adjust your activities and know that you have limitations: You may only be able to get your heart rate up so high, you may have joints that are not as flexible, or you may have arthritis.
• Seek the advice of physical therapists to work on your flexibility, strength, endurance and posture. You need to know what posture to have while sitting at a computer, as well as how to set your computer station ergonomically to reduce the risk of neck, shoulder and hand injuries.
• Stretch on a daily basis. Try to incorporate gentle stretches for your neck, back, arms and legs. Hold each stretch 15-30 seconds and do 3 repetitions each.
• Perform gradual strengthening exercises. Begin with light weights, 10 repetitions with 2-3 sets, and gradually increase the resistance.
• Eat well-balanced meals with protein at each meal, including plenty of fruits and vegetables. Drink eight glasses of water daily.
• A loss of mobility following injury, hospitalization, or even sustained sitting positions at work can speed the deterioration of muscles, joints and bone. A physical therapist can help you regain mobility and improve quality of movement.
• Exercise mentally, not just physically, by doing crossword puzzles, jigsaw puzzles, sudoku, Scrabble and other mind games.