4 Muscles To Strengthen If You Have IT Band Syndrome ⎸ Ep 137

Use this episode as a guide if you have ITB syndrome. Dr Lisa reviews what ITB syndrome is, the mistakes made with ITB Syndrome rehab and what approach to take with your rehab so you can quickly return to run

Links and Resources:

• Watch this youtube for 4 exercises that address IT Band Syndrome
• Runners Complete Program: 12 week strength and mobility program that helps runners prevent injuries and run stronger. Receive 3 full body strength workouts that take 45 minutes and 3 post run mobility routines each week. Has helped over 2,000 runners take the guesswork out of what they should be doing outside of running
• Hip Program: At home rehab program for hip injuries including hip impingement, gluteal tendinopathy, low back soreness/pain, SIJ pain, psoas/hip flexor pain, piriformis syndrome and ITB syndrome
• Runners Knee Program: At home rehab program for pain around the kneecap, under the knee cap or around the joint line
• Foot and Ankle Program: At home rehab program for injuries including plantar fasciitis, shin splints, achilles tendinopathy, ankle sprains, posterior tibialis pain and big toe pain
• Toe Spacers (use discount code DRLISA10)
• Mobo Board (use discount code DRLISAMITRO10)

Transcript

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Welcome back to the Rehab for Runners podcast. I'm your host, Dr. Lisa. I took a couple weeks off because I had my baby and she came a week and a half early, which was a huge shock. My water broke, just like a little, just to give you a little background of how that went down. So I was about to get on a client call for running form analysis. And so I was like, okay, let me go to the bathroom because I was 38 weeks pregnant. So you know, you have to go to the bathroom all the time. So I was like, all right, let me go to the bathroom before this call. Like three minutes before the call, I stand up from the toilet after I go and my water broke. And it was insane. So that happened at around 3 p.m. on a Tuesday, March 10th. And she was born at 1120 p.m. that Tuesday. So things escalated very quickly. We are all both very healthy and we're doing amazing. And she's nine weeks now, which is crazy. She's 96 percentile for her length, which is also insane because my husband is tall, and I guess it's where you get the jeans for height. But I'm a little over 5'3, or actually a little under 5'3. So it's just funny to me that she's so tall. But she's like a spitting image of me as a baby, which is just kind of cool to see because I'm like, oh, I'm looking at like little Lisa. It's really cool. But today I'm gonna switch gears for a second. Um, today I want to talk to you about ITB syndrome because one, it's misunderstood. And two, as the temperature gets nicer and you know it's starting to get warmer where you live, people start to run more. And when people start to run more, these injuries, these overuse injuries tend to pop up. And usually there's there's patterns to when they pop up, and usually in the spring, that's when shin splendids and ITB syndrome are very popular, if you will. So today I really want to talk to you about the rehab with ITB syndrome, mistakes made with ITB syndrome, rehab, and four muscles you need to strengthen if you do have ITB syndrome. So let's break it down. First of all, when I was in PT school, way back when, which was like eight years ago, we used to think of it as a friction problem. And basically it was thought of that the IT band was rubbing against the bone where it connects, and this is what was causing the inflammation right where that spot is on the outside of the knee. Now, research has kind of turned and said it's more of a compression issue of the tissue under the IT band. So that changes a little bit of what we think about with rehab. I'm gonna go through what research really says, but basically the IT band, I remember this so specifically from when we dissected a cadaver in PC school, but the IT band is a very thick piece of connective tissue. It is thick. Like it is, you probably I mean, you can kind of feel how thick it is. It's not a contractile tissue, which means like a muscle is a contractile tissue because it can shorten and it can lengthen, it can contract. The IT band does not contract. The role of the IT band is to stabilize the hip and stabilize the knee. It doesn't do this by contracting, relaxing, it doesn't do this by lengthening and shortening like a muscle would. It does this because it's very, very thick and of where it attaches into the hip and into the knee. So, knowing this, one of the big mistakes made with ITB syndrome is that people feel like their IT band is tight, and therefore they've they're chasing that symptom of tightness by trying to stretch it, trying to lengthen it. And some PTs still do this, which is like kind of mind-blowing, but I guess they're not caught up with the research. But basically, you can't lengthen your IT band. It literally takes tons and tons of length or tons and tons of force to lengthen it. So you just doing like a stretch where you're in standing and you bring your leg over and you side bend, and it might feel good, it might feel tight on the outside of your hip or the outside of your leg, but that's because you're addressing the muscles that attach into the IT band. You're not actually stretching your IT band. So it's quite funny when I see like do these stretches for your IT band because it's just it's just like clickbaity. It's not, or it's just not a thing. You know, you're not stretching it. So, in order to reduce that feeling of tightness, we're not gonna foam roll it, we're not gonna do massage to it. Although you could, but really the reason that it feels tight is because the muscles connecting into it are tight. And they might be really, it's the muscles that connect into it have that sensation of tightness. Not saying that they are in a shortened position. We just need to address those muscles, usually by strengthening them, usually by stabilizing them. So we don't want to chase that symptom of tightness. We don't want to foam roll the IT band. Instead, we want to address the four muscles that connect into the IT band. So the thing with ITB syndrome, if you've had it, I've had it, it is awful. It truly is awful. And sometimes it can, I mean, what running injury is great, but sometimes it can present as stiffness in the knee, like when you're running, like very specifically when you're running or doing something high impact, it can feel like stiff in the in the knee joint. And it almost feels like it's hard to actually like bend your knee when you're running. This can evolve and turn into very sharp pain on the side of the knee, usually the outside of the knee. Um, more specifically, it's when you're bending your knee around that 30 degree mark. Uh, that's when you start to feel some of that pain. The other thing that is related to ITB syndrome is that it's very common to have weakness into hip abduction, abduction, bringing your leg away from midline. Therefore, you'll see the hip collapse into hip adduction, which is looks like the knee diving inward, that instability that's happening at the knee. And you'll also see hip drop, which is when you're standing on one leg and then the opposite pelvis, or what we call in the PT world, the contralateral side is dropping below the side that you're standing on. So if my right leg's on the ground, my left leg is swinging through when I'm running, and I have hip drop and I have ITB syndrome on the right side, the left hip and the left pelvis will look a lot lower compared to the right side. So that's that hip drop that's very common with ITB syndrome, and it just shows we need to keep addressing the glutes and single egg stability. Another mistake made with ITB syndrome is, and this is just common for any overuse injury, is that you're ignoring your training load. So a lot of running injuries, these overuse injuries that come on very gradually, even like Achilles tendonitis, shin splints, runner's knee, like all those common injuries, they are a lot of them happen because of training errors. And so ignoring your training load is part of that, you know, that umbrella term for training errors, where really you're not paying attention and you're not almost like tracking or, you know, really paying attention to how much are you running in low intensity, how much are you running in moderate intensity and high intensity? It's also related to your weekly mileage and the build that you're going week after week. It's also now related, research is showing us, to the longest run that you're doing week after week. And what does that build look like in terms of percentage? You know, how much of a jump are you making week after week with your long run? How much of a jump are you making week after week with your weekly mileage? What is the split of your entire week with low, moderate, and high intensity too? So if you're ignoring your training load, you're just going out there doing whatever you feel like. One day you're running 10 miles, the next week maybe you're running 15 miles, and then you drop back and you're doing random speed work, that is a good example of ignoring your training load. So if you are experiencing ITB syndrome, you want to, I mean, either way, if you're not experiencing ITB syndrome, you want to pay attention to what's happening with your training. But you really want to pay attention to those three things jump of weekly mileage, jump of long run mileage, and then what is the split of your low, moderate, and high intensity. So if you are, if you're having pain, that doesn't mean that you need to go two weeks' rest. You know, let's see how it feels after two weeks. I'm not gonna do anything. What it really means is let's modify your runs, let's do more low intensity runs, let's reduce your mileage so you can keep running while you rehab, and while and while you continue to run, it's not causing you to have that moderate to high intensity. So that would be a good example of you paying attention to your training load, making those modifications. Another mistake made with ITB syndrome, which I see all the time, and it's it's becoming one of my pet peeves, probably because I hear about it all the time, is when runners say, Well, and it's it's not your fault if you've said this. It's whoever has taught you this is it's their fault. It's usually like another um, you know, PT personal trainer, whoever it is, whoever you heard this from, but it's really saying, Well, I strengthen my glutes. And it's like, okay, amazing. Like you see, you know, I talk about it, do these exercises for glute strength, do these exercises for glute mead, glute max. What I try to say, or what I wish more people said, was that the glutes, the glut min, the glute mead, the glute max, has a ton of different movements, it goes into a ton of different hip actions. So when you say, Oh, I've been, I've done everything, I've tried strengthening my glutes, which I hear all the time, and I say, Well, what have you done? Okay, I've done sidesteps and I've done clamshells, and I do them before every single run, and it's helped a little, but not a lot. I still have pain when I run. If that sounds like you, it's because you're working into hip abduction, which is okay. You're working into hip external rotation, but what about hip internal rotation? What about hip extension? What about single leg stability? The all of those things happen at the glutes as well. And we need to get you to a point where we're identifying what areas are you weak in at the hip and are you actually strengthening into those actions? Because just because you're doing a couple exercises for your glutes doesn't mean you're covering what needs to be strengthened, even if those exercises feel difficult. So we need to work into more glute-dominant movement patterns. We need to work into strengthening, you know, all parts of the glutes. And the other mistake made with ITB syndrome is that you're not doing running specific exercises like clamshells. That exercise, you know, there's nothing wrong with that exercise in terms of the exercise itself. It's like every PT that doesn't know anything about helping runners will give them that exercise. But if you're running, doing so you're running, you're able to continue to run and you're not progressing from doing table exercises, that's a problem because we need to get you to the point where we're working on stabilizing into single egg. We're working on weight-bearing exercises because when you run, you know, obviously you're in weight bearing and obviously it's single egg. So let's now get into the four muscles that you need to work on and strengthen and stabilize if you do have ITB syndrome. And these are, you know, I already told you, I've had ITB syndrome. It popped up during my first marathon, and I was like, why does it feel like it truly the one thing I thought of when this happened, which I don't know, maybe this is just my PT brain, but I used to treat a lot of post-stop knee replacements. And if you've ever seen a knee replacement, you know it's so swollen and they can barely bend it. And that's literally what it felt like when I had ITB syndrome during the race because it felt so stiff that it it truly just felt like I couldn't bend my knee that much at all. Um, so I don't know, that was just random. But I've had ITB syndrome, I've had to rehab it, I've had to go, I've had to drop down into a run walk. But the thing, you know, I'll get into the four extra the four muscles in a second, but the thing that I did, which, you know, I obviously it's easier for me to do it, but it just is like a little side bit, is that once I felt the pain, you know, and really I will say I did not have any ITB syndrome pain throughout my entire training of my first marathon block. It literally popped up during the marathon itself. And then after the marathon, I really had to rehab it. I couldn't, I could barely run a mile and a half, even after I took, you know, two weeks off because I was doing that anyways, because of the marathon itself, just to recover. But I had to modify my runs. I had to go into walk run. I had to rehab. But the thing is, I didn't wait months and months and months hoping it would just go away, doing the same exercises, hoping that maybe this time it will work. I had to really address the source of the pain, modify my runs. And once I did that, I want to say it took maybe two months, so like eight weeks of rehab, which is pretty typical for ITB syndrome. Maybe sometimes it's a little bit longer, but I didn't delay my rehab. I didn't, you know, I started it as soon as I felt the pain, which was really two weeks after I was done with my marathon and I recovered. That's when I started rehabbing. So just as a side note, make sure if you are feeling the pain, you're jumping on the rehab exercises quickly and you're modifying your runs. Okay, so four muscles. These are the muscles that connect into the IT band. So that's that's why this is important because we're we're not chasing symptoms here. We don't chase symptoms. We are going after the source of the pain. So if we're addressing the source of the pain, a lot of the this is happening at the hip. Some of it's happening at the knee because of where the muscles are located. But let's start with muscle number one, which is the quadricep muscle. This muscle crosses the knee and it crosses the hip. Now, if we're getting really specific, we're looking at the vastus lateralis, which is a probably Latin, I'm sure it's Latin, for a later, the lateral quad muscle. And as you can probably imagine, it runs right with the ITB or the IT band. The ITB. So you have the quad muscle, and like I said, it does cross the hip as well and works into hip flexion. Um, so this muscle is usually pretty tight. So when you're actually foam rolling your IT band and you're like, oh man, it feels so tight, a lot of what you're feeling is the lateral quad that's tight. So, just as like a quick correction, if you do like to foam roll your IT band, just rotate your foot just a little bit to get a little bit more of the front side, like the front half of the quad versus being straight along the side of your thigh. So now you're getting more of the quad, and that will make a bigger difference versus just doing the IT band. Okay, the next muscle that you have is the hamstring. So we looked at the front of the quad or the front of the thigh. Now we're going to the back of the thigh. So you have that lateral hamstring muscle connects right into the IT band. We're looking at knee flexion, bending your knee, and we're also looking at hip extension. Usually what I have found is that when someone has IT IT band syndrome, I know I have this. One, it was really hard to do a single egg squat. And two, I was not loading my glutes that much at all. Like getting my hips back in a single egg squat, getting my butt back in a single leg deadlift was hard for me. And it's hard for a lot of people that are dealing with IT band syndrome because it's that movement is forcing you to load your glutes and your hamstrings, which tend to be a little bit weaker with this type of injury. So being able to really strengthen into that hamstring, into hip extension, and that leads us into the glutes, glute mead, glute max. They are more of like the top part of the hip, obviously, in the back part of the pelvis, connecting into the IT band. So they're also working, you know, the glute max is working into hip extension and then external rotation, and then part of the glute mead is doing, you know, the glute mead does it all. It does internal rotation in the front, external rotation, hip abduction, single leg stability, and pelvic stability. So we want to work into those areas and not just one or two motions of the hip, but now we're we're really working through these different muscle actions that make up the entire gluteus medius, not just one part of the gluteus medius or one part of the gluteus maximus. And our last muscle we want to strengthen. I said four muscles because glutes that kind of group them together, but the fourth muscle is the TFL. Tensor fascia lata. Tensor fascia lata, something like that. I'm sure it's Latin again. Um, TFL. It's like when you say an acronym so much and you say the entire thing, and you're like, tensor fascia lata. You're just like, you're like, all right, postpartum brain, let's let's turn on. Um, but this muscle is a hip flexor muscle that runs on the front part of the hip. So front, lateral, front, outside part of the hip. It's usually pretty tender when you touch it, especially if you have ITB syndrome. So that is another muscle that we really want to address. It is, you know, I read a research article that says the TFL is usually very weak when someone has ITB syndrome. So hip flexion, working into hit the hip internal, external rotation, because the TFL does control rotation of the hip as well. And being able to basically progress all of these muscles, you know, a lot of them work together, but being able to progress the exercises that address these muscles into controlling single leg. That is the goal. The goal is, you know, I wouldn't recommend for every single person. And you'll see in like my rehab programs that I don't just start with single leg exercises because you have to progress. We want to build the foundation first and then go into, you know, weight bearing, double leg, and then weight bearing single leg with some assistance and weight bearing single leg with uh without assistance, and then single leg with some more load, and then going into jumping. Like there is a progression that we want to go through. So we're not just jumping straight into a single leg squat and it looks sloppy and it doesn't look good, and we're not working through those specific movement patterns that we want to master, because then you're not gonna get that bang for your buck out of that exercise if it's sloppy and you're not, you know, you don't have that foundation built. So we want to progress the load, allow your body to have time to adapt to this load, and then you continue to progress. And that's that's exactly what we do in the hip program. So if you do have ITB syndrome, like I've said, the source of the pain is at the hip. So I do recommend going through that exercise, that going through that rehab program. I will link it below. That's the exact program I've gone through with ITB syndrome. Thousands of other runners have gone through it with ITB syndrome. And the one thing I will say too, that a lot of other PTs and rehab programs forget to add with ITB syndrome is really focusing on single-leg rotational control. And that is like, you know, a fancy way of saying, can you control the hip as you rotate left and right or internal, external rotation in single leg? Because the hip is rotating all the time as you're running. It's not just like an isolated hip flexion and hip extension. It's, you know, we're we're working with a lot of co-contractions and these synergies, and we're lurk, we're working through actions where, you know, when you work on it outside of running, you want to be able to have that exercise of work, what you're working on display into running. You know, that's the whole idea. So we have to work into hip internal, external rotation as you're going into hip flexion and you're going into hip extension. Um, if you have questions, feel free to message me because I know ITB syndrome can hurt so bad and can really restrict how much you are able to run. But I hope you enjoyed this episode. And like I said, I'll link that hip rehab program below if you want to check. it out and it's good to be back. I hope you have a great run. Bye.