Iliotibial Band Syndrome (ITBS): Why It Happens and How to Fix It

This episode breaks down Iliotibial Band Syndrome (ITBS), one of the most common causes of lateral knee pain in runners, cyclists, and endurance athletes.
Join us as we explore why it happens, how to prevent it, and the most effective, evidence-based strategies for treatment and rehabilitation. Featuring guest Neo Molefe, a 3rd year Physiotherapy student at Wits University, hybrid athlete, and community builder - bringing practical insights to help you train smarter, stay injury-free, and perform at your best.

Transcript

SPEAKER_02 0:02

Every day you face a choice to stay where you are or to step boldly into the stronger, healthier, and more resilient version of yourself. Welcome to Move and Thrive, the podcast for active people who want to move better, train smarter, and stay healthy for life without burnout and without avoidable injuries. I am Dr. Siabo Magunene, your sports physiotherapist, coach, and partner on this journey towards a thriving and high-performing life. So I invite you to move, to grow and thrive. Welcome back, friends. Today we are discussing one of the most common overuse injuries seen in endurance athletes, illiotibal pen syndrome or ITBS. If you are a runner, a cyclist or you are involved in repetitive lower limb activity, this episode is for you and this is something you need to understand. In this episode, we are going to talk about what is ITBS, why it happens, how to prevent it, and most importantly, how to manage and rehabilitate it properly using evidence-based principles. Today I'm joined by Mr. Neo Molefe, a third-year Vets physiotherapy student. He's also an athlete and a community builder. I know him as my student, very passionate young man about physiotherapy and about sports in general. Welcome, Mr. Molefe, to Move and Thrive Podcast. How are you?

SPEAKER_01 1:43

I'm good, thanks, Dr. How are you?

SPEAKER_02 1:45

I'm good, I'm good. Thanks for joining me. And uh how are things going? I know you are busy with your third-year program in physiotherapy here at VETS. How are things going?

SPEAKER_01 1:56

Things are going very well. I think I'm very excited to be in my third year of study. I think things it is still challenging, it's always been challenging for me, but um now we're at a point where everything just comes together and everything that you've been learning, um, it's starting to make a lot more sense because now you're doing it a lot more practically as well. Yeah, so it's it's really exciting, it's really nice.

SPEAKER_02 2:16

Wow, nice. I know you are very passionate about what you do, you love what you do, and I understand you have started a running club. Tell me about that.

SPEAKER_01 2:25

Yes, so I'm a leader at an organization called Aviato. It's basically a sports organization that is led by the mission to unite, develop, and inspire young black talent. And we do this through sports basically, and that's how we build community and we cultivate shared experiences.

SPEAKER_02 2:41

Okay, good. And what else do you do other than running? I know you are involved in running.

SPEAKER_01 2:46

Yes, um, I I do run, but I'm also um I'm I'm a hybrid athlete as well, which means I'm trying to grow in both disciplines of running and strength training. Um, but um over the years I've been pursuing sports a lot um because I only got the opportunity, not not the opportunity, but the confidence to start participating in sports when I was in first year of varsity. So when I started, you know, started to move, when I started doing the gym, um it opened me up to a lot more experiences. So I started playing a bit of touch rugby, I played a lot of indoor soccer, um, even now currently. And yeah, um I've also been a vets boxer actually. I was a vets boxer two years ago, and I was training boxing for the whole year, which was also really fun and challenging in a good way.

SPEAKER_02 3:30

And yeah, that's what I do. Wow, makes sense to be doing physiotherapy.

SPEAKER_01 3:35

Yes, uh yes, movement is uh currently movement is a huge part of my life.

SPEAKER_02 3:40

Sure, yeah. I'm sure your athletes are really benefiting. You are an athlete yourself and you do physiotherapy, it's a nice combination.

SPEAKER_01 3:48

Yes, and I think it's a nice bridge because um I'm able to bring the experience of an athlete whilst I'm you know I have a bit of knowledge as well from learning from professionals like you as well, and yeah, people who are very good at their research and you know, people at the highest level of the practice, sure, such as you, Dr. Gunene. And I'm very honored to be with you today.

SPEAKER_02 4:08

I'm very happy to have you here in this platform. Today we are discussing one of the most common overuse injuries seen in endurance sports. We're gonna look at iliotibial pen syndrome, and I'm sure you might have experienced this problem.

SPEAKER_01 4:22

Yes, and I think ITB and other injuries involving the knee also are quite a highly relevant topic, especially in the running space, um, because I've seen some people struggle with knee pain on the inside and outside of their knee. Even personally, I felt it during runs as well, but I just don't think many of us understand actually what's going on there and why it keeps coming back, which is why, as athletes, we follow professionals and researchers like you so we can participate safely in our sports. Okay, you know.

SPEAKER_02 4:52

Okay, so I understand you have some questions for me.

SPEAKER_01 4:56

Yes, yes, I do have a lot of questions about this topic. Yeah, um, yeah, I'm here as an athlete and I'm here to give my two cents of what I know, but also a lot more questions um, you know, that can help us, you know, to further our our journeys as athletes. And I'm very keen to unpack that today because I also would like to understand a bit further, and I'd like to start by asking you what exactly ITP syndrome is.

SPEAKER_02 5:19

Okay, okay. Maybe before we get into that, I want to just mention that there's many overuse injuries that we see around the knee for endurance athletes, like runners, cyclists, and all of that. And ITB syndrome is one of those, and sometimes it's confused with many others, like your patellofemoral pain syndrome and your your patella tendonopathy. These are all types of injuries which are overuse injuries around the knee. Sometimes symptoms are similar. True. So today we're gonna look at just one. Maybe in other episodes we're gonna cover the other ones. But ITB syndrome is an overuse injuries which is characterized by pain on the lateral, meaning the outside part of the knee, on the side of the knee. Um, so many athletes feel like an aching pain. Sometimes it's a cutting pain around that area, which is basically an irritation of the structures around the knee, the outside part of the knee. So iliotibal band is basically a long band that starts from closer to the hip all the way from the side of the thigh all the way to the knee. So that thick band inserts around the outside of the knee by the tibia, just below the knee. So it inserts there, so it becomes a very um irritable area, especially when there's repetitive flexion and extension of the knee. So if you're doing a lot of activity that requires those movements around 20 to 30 degrees of repeated knee flexion and extension, so you find the friction happening around that area where that band is inserting there. And research, current research is talking about compression more than friction, that is really a cause of the problem.

SPEAKER_01 7:22

So, where does the pain typically occur? And how would an athlete know that this is ITB syndrome and nothing else?

SPEAKER_02 7:28

So basically, it's got to do with the tightening or tightness of the muscle as you do the activity, and that's where the compression occurs around that area outside the knee. So usually patients will the pain is localized just two or three centimeters above the joint line, the knee joint line. So if you look on the side of your knee, just palpate the joint line just above the joint line, two or three centimeters, that's where the actual pain is. In fact, when you also touch the band closer to the knee, that's when they will start to feel to feel pain. That's where it's localized, and it's usually caused by there are many factors that are contributing to the to the irritation of that area. As I said, it's the overuse, the repetitive movements of and the tightness of the whole structure, which comes all the way from the hip muscles. And there's a small muscle with six calls if you know it. You you do this in tensor fascia later. Okay, you are sharp with your anatomy. Ah, try. It's a small muscle by your uh pocket um area here when you if you're wearing a pants, just by the way you put your hand and in your in your pocket. That's that's where it's palpated. And if that muscle becomes tight, and also the glute muscles, the glute maximus, because both those muscles they extend to that thick band. So the tightening of those of those muscles can cause tension and irritation down there by the knee.

SPEAKER_01 9:05

So my understanding of ITB, firstly, is that it's an obvious injury, which means it's in the name. So you're you're using that specific structure so much that your body or that particular structure is around the joint or around the muscles, um, they can't handle it. And what are the specific main causes of ITB syndrome?

SPEAKER_02 9:25

Alright, so causes, there's no one specific cause, right? Instead, there are many factors. It's multiple causes are multifactorial. So that's why we call it a syndrome. It's caused by many issues. But um, and these these causes are divided into intrinsic and extrinsic, internal and external factors. So mainly sudden increase in training volume and intensity. If you're talking of training volume, you're talking of mileage kilometers you accumulate in your sport. If you are a runner, so the amount of kilometers. So sudden increase in the kilometers, sudden increase in intensity meaning speed or yeah, speed. So that becomes the main cause. So if you're starting a sport and you suddenly increase intensity and volume, you are increasing the risk of ITB and many other overuse injuries that we mentioned earlier. So that's the main one. And the other one is that obviously it's got to do with the repetitive movements of flexion and extension of the knee, flexion and extension, especially between 20 to 30 degrees of movement. Another one is poor load management that talks to people increasing their mileage very drastically, and the rule of thumb usually don't increase your mileage or your load more than 10% weekly. So weekly increment. It's important to know how much of increments that you're gonna do when you are training. So poor load management, sudden increase in training and volume, those are the external factors that usually contribute. Shoes and other things also contribute, poor biomechanics, you know, contribute, but also internal factors which relate to the what is within the body, like muscle weakness, muscle tightness. We talked of tightness of the hip muscles like your tensor fascia lighter muscles, if they get tighter or in spasms, they can really cause the pain to be tighter and and and contributes to the pain. Yes. Weak lute muscles can contribute to the problem, especially uh abductor muscles, muscles that abduct the hip. If they are weak, they allow hip abduction during the allow the knee to go more inside. They allow the knees to go more inside. That happens a lot when you are fatigued at a certain that's why pain for this type of injury happens at a particular distance. Sometimes athletes will tell you at 20 kilometers, start to feel this. Why? Because muscles are fatigue at that point, and usually it's the hip control muscles that are fatigued, especially the abductor muscles and external rotator muscles, and also the whole glute region. If it gets weak, then it contributes to the problem. Yes. So there's many other issues, poor quadricep strength, especially when you're going downhill. There's a many athletes will complain of this pain when they're going downhill because of lots of eccentric control that is required when you're going downhill. So these are all factors that contribute. Doesn't mean if you have them identified, you will definitely have this problem. They just mean that chances of getting this injury are high if you have these factors.

SPEAKER_01 13:10

And that's why the proper diagnosis is important as well. But I think this speaks to the nature of the ITP syndrome as an overuse injury, um, because you just you you do a lot of repetitive movements or you overload your structures too much. And I think at the same time, this is why people who are starting out in in a lot of sports are very injury prone, um, because they they are highly susceptible to overuse injuries. So what athletes, because I see it a lot in running, okay. Um, a lot of people in running they they they get a lot of pain on the lateral aspect of the knee, even like in other parts of the knee. And what what other types of athletes are more um prone to getting an ITP injury?

SPEAKER_02 13:53

Okay, so we've mentioned long distance uh runners, marathoners, uh ultramarathon runners, they they are prone to this. Cyclists as well, distance cyclists, they get this because there's that repetitive knee flexion and a flexion extension around 20 to 30 degrees. So any any other athletes, those who are involved in triathlon, they get a lot because triathlon includes your running and cycling, and cycling, which is a problem, sometimes swimming as well, because you do have those small movements of knee flexion that happens, so anything that got to do with repetitive knee flexion and extension around those degrees, 20 to 30 degrees, then you will you will be prone to this problem.

SPEAKER_01 14:42

Makes sense. And are there any biomechanical or training areas that increase the risk?

SPEAKER_02 14:47

Oh yes, there's so many, and in fact ITB and many other near-related injuries relate to poor biomechanics. You know, we talked about rapid increases in mileage and intensity, that's that's a biomechanical issue. And weak hip, we talked about weak hip abductors, muscles that abduct the hip. And especially also the the the whole glute region. Um if if it's not strong enough, it will cause knees coming together. Yes. And most people get that when they are tired because of poor glute muscles and external rotten. Oh, yes, yes, yes, you are right. So all of those are things that relate to biomechanics and training errors, poor neuromuscular control as well, and running on surfaces that are steep on one side, combat surfaces. So so so in the nightshell, there's so many others that I've not mentioned as well, factors that could contribute to this, but overall it's to do with the actual activity or not.

SPEAKER_01 15:59

So basically, to put some some of what you said in simple terms, if you have a problem that can cause it to go into adduction, so for example, you start getting tired, your glutes get weaker. Um, that can is is is that what can cause an overload to your ITB, causing the pain specifically?

SPEAKER_02 16:15

Definitely, because that is really messing up your biomechanics. Biomechanics of running, which causes tension to the actual structures and to the joint itself.

SPEAKER_01 16:28

So then how can athletes prevent ITP syndrome? Because my understanding of the ITB is that it's a fibrous brand, which means it's it's very thick and very strong, which is part of its purpose. Yeah, but that also means that you can't really do um things like massage and and you know, straight um what's the foam rolling quite effectively because of how hard it is to stretch that band. So, how do you how do you treat um an ITBC, or rather, how do you prevent it?

SPEAKER_02 16:57

Okay. So, as you can see, prevention has got to do with addressing all the factors that you just mentioned now. Learning to gradually progress in training, don't do too much too soon. Yes, and when you are in serious training, just make sure that you prepare the body very well. Make sure that strength training is done properly and it aligns with the intensity of work that you are doing and the volume of work that you are doing. So most training programs will prepare the body with a lot of strength training beginning of the training season so that when you get to the hectic training, you are strong enough, your muscles are strong enough, your tendons are strong enough to cope with the load. So, gradual progression in training. We talked about 10% rule of thumb as a guide in terms of weekly increment. Don't go beyond 10% weekly increment. That will increase your chances of getting these types of injuries.

SPEAKER_01 18:02

I see. So that is that's part of the reason why athletes like rugby players, soccer players have a pre-season training that is very specific.

SPEAKER_02 18:09

To condition, to condition the body, prepare the body, strengthen, stretch those muscles, gradually get into volume and intensity, increasing your intensity of work.

SPEAKER_01 18:22

So that when they do get to that point where they like start participating at the highest level, their body has already been prepared for it. Yes. Which means for someone who's starting out as well, it's also quite important to be mindful of your load management and how you increase your running or whatever it is that you're doing.

SPEAKER_02 18:38

Yeah, yeah. So that's one, and then number two, in terms of how you can prevent this, incorporate rest and recovery in your training. That's very important. I know athletes who just want to keep training. Yes. No time to rest, no rest days, no time to sleep, don't sleep enough, all of those and nutrition as well, because recovery is not just resting, it's to take enough nutrition that will help muscle recover, like you're taking your proteins after each session, you know, fueling is important when you're resting and also when you are actually training. So incorporating rest and recover is important as a way of preventing these injuries and dealing with them when they happened. Yeah.

SPEAKER_01 19:22

I think you touch on a very important point, and that brings me to the question. How important is rest for recovery? Because a lot of us, a lot of us in in sports approach just being vigorous with the training and you know, doing as much as we can and training as much as we possibly can. Yeah, we see that as the optimal um optimal training. That's when we think that okay, I'm doing the best I can and I'm at the best um in terms of development and growing. So, how how important is it for those who neglect sleeping and rest in general? How important is it to incorporate rest?

SPEAKER_02 19:58

Yeah, so yeah, rest is very important whether you train or not. Um, in fact, rest is a way of healing the body, it facilitates healing. So, in fact, uh fitness is gain when you rest, not when you train. Because when you train, you break down those muscles. So that's not how you gain fit. Fitness is gain when you allow time for those muscles to heal. As they heal, they get stronger. So if you don't have rest days in between your sessions, then you kill yourself. You keep breaking those muscles, keep breaking them, you're not gonna get where you want to go in terms of fitness, and you might even find yourself injured because of that. So rest is very important. Have rest days, stop the activities and do less, or can do active recovery or rest completely. But there's also rest uh that relates to sleep. Sleep that's where it's almost similar to taking your car for service. No matter how fresh, how fast your car is, if it's not serviced, it's not gonna run properly. It won't run properly, at some point it will break down. So resting is a way of the body recovering because there's many repairing that's happening when you're sleeping, and you get to rest so that you are fresh for another session the next day.

SPEAKER_01 21:24

So, what types of exercises are important in order to prevent RTB syndrome?

SPEAKER_02 21:30

Okay, so we did talk about um the weak control muscles, yes, your clutes. Clutes are important with running, uh, in fact, with any type of sporting activity. So you you need you need to strengthen glutes, especially those that are responsible for abduction. So lying on your side is one of the exercises you can do. Lying on your side and just lift your leg up and down. You can do it against gravity, just the weight. Uh of the leg up and down. If that gets easier, then you introduce therapy or weights as you do that. So the more you do of that, you are strengthening that muscle. You're making it when you run, avoiding the knee collapsing or going inside or inwards. So having strong abductor muscles is important. And having strong hip extensor muscles is also important. Doing your your your hip thrusts or your bridges is important. You have to incorporate bridges in your exercises. You have to incorporate abductor exercises as I mentioned, including external rotation of the hip muscle. All of that is cluther responsible for all of those movements. You can do things like clamshells, which where you lie on your side, bend your knee and your your hips, and just keep abducting your upper leg, whether against resistance, using terabends, or just body weight or against gravity. So we call those clamshells. You also can also do lateral bend walks. You just put a terabend around your knees and just move sideways. That can strengthen your glute muscle. So key muscles to strengthen is glutes. Basically are very important and also quadriceps. Especially the eccentric control part of it. Yes. Especially when we're talking of ITB Bent syndrome, it's always happened most of the time when you're running downhill. So running downhill, you need a lot of eccentric control of your of your quadriceps. So as you strengthen quads, focus on the eccentric component of it more so that you are stronger when you're going downhill and avoid long strides as well. Because long stride downhill is a factor to causing the problem.

SPEAKER_01 24:04

So having shorter strides helps you with have have more control over the movement itself.

SPEAKER_02 24:09

Yeah. And it reduces the tightness of this band as you do that. And also avoiding too much of knee flexion as you go downhill. So there's a lot of biomechanical factors that you must control. So running form is one thing that a physio or a coach will assist you with to say you need to correct your running form so that you can correct your biomechanics and avoid these injuries. Because these injuries relate to poor biomechanics, especially when you get tired along the way.

SPEAKER_01 24:41

And I see that's the role that strength and conditioning plays with prevention of such injuries. Because if you strengthen your glutes, which we have highlighted to be a very important muscle group to train, then you have stronger control over your you know your adduction and abduction, which means your your form remains proper and your biomechanics is also such that you don't you're not prone to sustain those injuries because you're not your form is not um it's not becoming poor the more you run. What are the most effective treatment approaches with um ITB syndrome specifically?

SPEAKER_02 25:17

Okay, we we we talked about um addressing all the factors that becomes a rehabilitation part if you are now having somebody with ITB. So this also is included. As much as we said it can be used as a way of preventing, we also use in the rehabilitation, but later phase of rehabilitation. Let's take somebody who's already having ITB and is coming for physiotherapy. We usually divide rehabilitation in four or five phases. So phase one is basically we want to attend to anything that relates to inflammation, pain, swelling around the area, uh, mobility, all of those to ensure that we deal with that.

SPEAKER_01 26:00

So that's during what we call the acute phase of healing.

SPEAKER_02 26:08

You can do other activities that do not involve the repetitive movements of the knee, flexion and extension. So rest is important, icing is important during that phase of rehab. And um also issues of dealing with swelling. You can apply some strapping or bandaging to control swelling around the area, elevate above the level of the heart. As you are sitting, just elevate or sleeping, elevate it, will assist control swelling. If you have swelling around the area, so that phase you need to deal with pain. There are many pain modalities that you can use. Eyes can help as well, it's got analgesic effects. Applying eyes reduces some pain. You can also, if it's pain is too strong, you can just take normal painkillers to reduce the pain levels. So that phase is really a phase where you have to really deal with inflammation-related issues. Then after that, maybe after a week or two, then you start getting into strength development because you can't just say because there's no pain anymore, I've recovered from the inflammation phase of healing. You know, then I must go back to training. No, you it's not you're not ready yet for full training. You have to now rehabilitate. And rehabilitation now includes all of the addressing of the factors that we mentioned. Yes, getting into strengthening the relevant muscles, especially hip control muscles. All of those exercises, you do them during the rehabilitation phase.

SPEAKER_01 27:42

Strengthening those glute muscles.

SPEAKER_02 27:44

So that becomes your phase two, and then phase three. Now you're moving into more functional related things, sport-specific training, where you're gradually getting back. You're not going full force into the actual full program like you were doing before. You now gradually, together with the help of the physio and the coach, helps you to in terms start with jogging, uh, do a bit of short distances, maybe not so much of speed, just work on your distance more than speed, gradually increase intensity, which is increasing your speed. So it's gradually returning to training that becomes um the last phase now.

SPEAKER_01 28:24

And that's a that's an important one because um what we do a lot as athletes is that we, especially when we're not being managed by like physiotherapists or maybe coaches, we get to a point during our rehabilitation where we start to feel that the pain is gone, and then we immediately go into the same volume of training as we used to. So, how important is it that we emphasize that you need to transition into your normal level of function and not just decide that okay, I'm good now, so I'm gonna go back to running as as much as I used to.

SPEAKER_02 28:56

It's unfortunate people don't listen to us physiotherapists. We give them a good program when they think they are fine, they go to their but they still come back to us. So we we are still nice and still treat them after, even if they don't listen to us. So it's important that we follow the instructions of whoever is assisting you, whether a physio, a biokinessist, or a coach. And the important thing is gradually returning. There are principles that guide you. We talked about the 10% rule of not more than 10% weekly increment of mileage or speed, whatever you are uh doing. So monitor symptoms. It's important to monitor symptoms. You can't run through pain and think things will be fine. Yes, being mindful. If pain increases more than three out of ten, then it's a sign that you are not, it's it things are not going well. But if pain is less than three, you can still do something but reduce your volume, reduce your intensity. So monitor pain and be structured in your training, don't be haphazard because you will run into getting the same injury again or other type of injuries.

SPEAKER_01 30:07

Yes, and I think that's uh that's another thing to emphasize as well. And that brings us to the question of if an athlete starts feeling symptoms of ITB, say during a run I start feeling this pain on the outside of my knee, what should I do immediately during that specific run? Is pushing through the pain okay or is it not? Because I know a lot of us would have the mentality to just want to push through the pain and you know, just finish what you started.

SPEAKER_02 30:30

Let me tell you, pushing through pain will not make things worse. In fact, pain is telling us something is wrong. Yes. So you can't hope that it's telling you to change something. Yeah, it's telling you to either stop or do something because if you're not doing something, there's further damage that's happening. So running through pain is never a solution. So that's why you must monitor symptoms. If pain moves beyond three out of ten and keeps increasing, it's a sign to stop what you're doing or reduce and get help. Attend to what is causing the pain. We already talked about the causes of pain. So it's important that you seek professional help. Don't sit at home and just think things will just, you know, be resolved because the cause you must deal with the cause. It's not about just treating pain, it's about dealing with the cause. You treat pain today, tomorrow you go back, you get the same problem. So seek professional help, physiotherapists will assist you to rehabilitate fully and help you with strategies to prevent the injury from happening again.

SPEAKER_01 31:35

Yes. So then in terms of seeing professionals, at what point should you see a physio and at what point should you see a doctor? Who do people go to when they have sports injuries specifically? Because I think a lot of people usually never know. Like I'll hear a lot of people say, Oh, I want to see a doctor, oh, I need to see a so how who do you go to when you start feeling like that?

SPEAKER_02 31:57

Obviously, sports-related injuries will need to be seen by a sports-specific professional.

SPEAKER_01 32:05

Yes.

SPEAKER_02 32:06

It's physiotherapists who are dealing with that. You can see a doctor to do a full evaluation and give you other pain management uh modalities, but a doctor will always refer you to a physiotherapist. So physiotherapists are first-line practitioners, which means you can go to a physio first-time. And you don't need a referral. You don't need a referral. So you you will end up with a physio anyway. So rather go to a physio. If a physio thinks you need a doctor, then he will refer you to a doctor. If a doctor sees you, you will refer to a physio. But it's important to go to a sports-specific therapist or health professional to get specific treatment and rehabilitation.

SPEAKER_01 32:50

I think you I thought that to be a very important question because usually we don't know who to see when we have injuries. Um, but now let's address some myths because there's a lot of information that we found in the internet as athletes, especially um athletes that are trying to grow within their specific disciplines. And often some of it is not very accurate because um we live in a space where everyone is sharing their opinion. So you're not really getting the right opinions in every video that you go through, every reel that you go through. Um, hence we follow professionals such as yourself who are practicing in the highest level of um the practice itself. So then with that, I have the question of what is the best way to actually the question is foam rolling, does it actually fix ITB? Because I've seen videos of it and I've seen people say that foam rolling um is good for ITB syndrome. What's your take on that?

SPEAKER_02 33:42

Yeah, there's a big debate around foam rolling when it comes to managing ITB. Old literature will say do foam rolling as a way to fix the problem, but foam rolling has got a way of just giving you temporal relief in terms of pain, uh, but it doesn't really deal with the cause of the problem. It doesn't fix the problem. It doesn't fix the problem. Yeah. So, and again, the ITB is a very thick and very firm structure, it's difficult to really alter the length of it. You can try with your hands as a therapist to to massage that part or to form roll that, especially the actual band itself.

SPEAKER_01 34:25

It's not gonna have much effect.

SPEAKER_02 34:26

Yeah, you may just cause pain unnecessarily to yourself, trying to make a difference there. Maybe if you form roll, try to aim to go closer to the hip and attend to the muscles we just spoke about, the tensor facial later muscle. Yes, because that's a muscle that gets into spasm that gets shortened and it causes tension all the way down there. So if you work on it, even with the physical as a physiotherapist, we usually work on that specific muscle, mobilize it, stretch it, and strengthen it later. It will help with the whole problem. So when you form roll, you must be smart which structure form rolling. If you form rolling muscle, it will help. Because the muscle is easier to manipulate than uh a band of and then in a muscle has got lots of blood vessels around it, so there's it when you after massaging, after form rolling, blood circulation improves in the area, which provides lots of healing properties. So it depends what structure. But if you're just gonna form roll the actual band, you're not gonna have much effect. Yeah, and I I know some uh even dry needling that the the dry needling. Yeah, forming dry needling works if you know what structure you are working on, but mostly on muscles, it's very effective in relieving tension around the muscles. It's another science um that we use as physiotherapists training, but it's only professionals who can use that kind of form of treatment.

SPEAKER_01 36:01

True, true. And how should how should athletes safely return to running or sports after an RTB syndrome?

SPEAKER_02 36:09

Okay, we we've been covering that uh uh for a while now. So gradually returning. Remember, we talked of the four or five phases of the rehabilitation program. The last one, last phase is focusing on returning to running. Returning to specific sports. Yes, it's got to do with gradually returning, meaning the program must gradually increase in terms of volume and intensity while monitoring symptoms. Yes. So you must work closely with your physiotherapist or sports-specific professional to guide that process of returning. Because if you suddenly move into your full training, suddenly increase your mileage, you will increase your risk. So it's a matter of monitoring how you are responding to increase in volume, to increase in intensity as you continue strengthening. Because strength exercises are important, not just during rehab, but as part of the training program. Yes. Two to three strength sessions a week are very important to manage.

SPEAKER_01 37:16

Does that apply to runners as well?

SPEAKER_02 37:18

To yeah, specifically to runners and also every particular sport, you have to do some strength and conditioning work to support your sport, to support the body, cope with the increase in volume, increase in intensity. So gradually increasing or returning to sport is important. Pain monitoring is important. Have a structured program, science-based program that will lead you to where you want to go, not suddenly and just do it haphazardly. So those are the ways of returning to sport that are safe. And a common guide is I've mentioned pain that increases above three out of ten. It's a sign that you must reduce or stop what you are doing. Anything that's worsening the activity, the symptoms, it's a sign you must adjust your program or stop the activity that you are doing. So those are safe ways of returning to training or competition.

SPEAKER_01 38:18

And while we're on the safety, what are the common mistakes that athletes make during recovery?

SPEAKER_02 38:23

Oh, so many. The first one is just going back too soon after an injury. So returning too quickly will increase chances, and in fact, it can even compromise your future in the sport because you might just come up with a very worse injury because you're already at risk, you've just recovered. Then going back too quickly is a problem. Ignoring pain signals is a is a is a mistake. Focusing only on stretching, maybe when you learn strength. Yes. Yeah, it's a I know I know endurance athletes don't want to do strength training. Yeah, that is so they feel it's delaying their progress and it's not fun, it's painful, it's necessary.

SPEAKER_01 39:09

So, how important is it to strengthen your muscles? Because I know um it's especially among the running community as well. I I know a lot of runners are not interested in in strength training. And just how important is it to strengthen to actually strengthen those structures through strength training?

SPEAKER_02 39:25

Very important. Every program, in fact, should include strength training, especially when you are starting the season. Usually you want to focus on preparing the body for the actual work. So, as part of preparing the body is to strengthen those muscles, those tendons, those ligaments, so that they cope with the activity. So it's very critical in every program. Face phase of training includes a lot of strength training. And even when you are in the hectic training program, you still incorporate strength training to maintain what you've gained so that it supports what you do. In fact, it can even help you improve performance if you keep um incorporating strength training.

SPEAKER_01 40:14

Because I'm sure there's a lot of literature that speaks to how better you perform when you do actually strength train. And I think that's one thing I wish more people understood, especially with their in running, because I see it a lot in running as well. Yeah, um, that when you it starts with the form, and when you strength train, that helps supplement your form as well, and it helps you to maintain it in such a way that you don't start sustaining injuries.

SPEAKER_00 40:36

Yeah.

SPEAKER_01 40:38

And then when when when should someone seek professional help instead of self-managing? Because when we sustain injuries, I think usually people have an idea of what they have to do. Um, they just ice it and you know, and then they you try getting back after two days. So at what point should someone start thinking of seeking professional help from a physiotherapist or a biokineticist?

SPEAKER_02 41:03

As soon as you're having pain that is stopping you from doing an activity and you are not able to perform the way you want to perform because there is pain, you need to see someone. Not just for treatment, but for also advice to know what to do. Yes. But obviously, if you are familiar with what we are talking about, then you can do a lot on your own and then just go once in a while to consult a therapist. But there are things that you may not be able to do yourself, like manual therapy, things that we do using um other modalities. You may not you may be limited to go topedic manipulation, like we talked of uh dry needling as well. There are many things that as professional will use, methods of treatment that we will use that you'll be limited to use. But when it comes to re exercise rehab, you can do a lot on your own with the guidance and advice of a professional. So, professional, you don't just go for treatment, you also go for advice, education to know what to do and for diagnosis as well, to know what you are dealing with. Most of the time, athletes assume they have something when they don't have.

SPEAKER_01 42:15

Yes. So and it's very easy to misdiagnose as well.

SPEAKER_02 42:18

So diagnosis is important and it can be done by a professional. Treatment, some treatments must be done by a professional, and but there's a lot that you do yourself as part of rehabilitation. So it's important to seek help as soon as possible. And sometimes physio, we think we only need a physio when you have a problem. Yes. You need physio to maintain and to prevent injuries. True. So it's important to professionals have physio once a week or every second week, just for maintenance, sports massage, and many other things that we do to prevent and assist you recover.

SPEAKER_01 43:01

So that's very true. Because in a lot of things I do as well, I always tell people that if at some point if I have a lot of money, I I'd like to have my own personal sports physio. Because you know, it's something that you need a lot, especially when you're an athlete that is very consistent and you know, because you want to stay healthy and you want to stay strong. So I see the importance as well, and I'd like for people to know that a lot more as well.

SPEAKER_02 43:24

Sure, yeah. Yeah, my friend, thank you. I think we've covered most of it. Um, ITB uh it's a serious issue. ITB syndrome, it's a serious issue. And just to remind listeners, it's a load related condition. It relates to the actual activity that you do. It's not just a structural problem. It comes because you started running, it comes because you are involved in cycling. So it's got to do with being smart in managing the load of running, the load of cycling. And successful management. Will depend on the understanding of the cause and it will depend on addressing relevant biomechanics and applying progressive loading. We've been talking about progressive loading. And I want to remind everyone rehabilitation is active, not passive. You don't say I'm on recovery, I'm recovering from an injury when you're just sitting at home and doing nothing. So it's about doing something to treat the problem, do something to prevent it from happening again. So rehab is very important. So thank you for joining me. I hope I will see you often here. And we have started a series of discussing injuries. So I hope the next one, which one are we tackling next?

SPEAKER_01 44:47

Um, I don't know. Um patelephemeral pain, maybe, but whatever it is, I'm excited. I'd love to join you on another episode.

SPEAKER_00 44:53

Yeah.

SPEAKER_01 44:53

Um, I think I'm falling in love with generally evidence-based practice, sure. You know, understanding that some research has been done to understand these conditions, and um, yeah, I I love discussing them as well because it helps reinforce that clinical knowledge.

SPEAKER_02 45:06

One friend of mine just asked me if we could talk about plantar fasciitis. It's another interesting one.

SPEAKER_01 45:15

It is, it is.

SPEAKER_02 45:16

Yeah, we may we may also come back to the other knee-related overuse injuries. Maybe next one, let's do plantar fasciitis.

SPEAKER_01 45:24

No problem. Yeah. See you in the next episode. Thank you very much, sir.

SPEAKER_02 45:29

Thank you for joining us again on Move and Thrive. If this episode supported you in any way, do pass it forward and inspire someone else.