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running with IT band syndrome San Diego

IT Band Syndrome: 5 Training Tips

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Trying to run with IT band syndrome is very frustrating. Often times, a runner can run with IT band syndrome for a certain amount of time until the pain comes back or becomes so unbearable that they have to limp home from their run. Our chiropractors treat runners who run with IT band syndrome as well as other running related injuries.

Top 5 training tips for IT Band Syndrome

Decrease volume– IT band syndrome is worse with a high number of repetitions. When you run with IT band syndrome, try reducing your volume by 50% to start off.

Avoid down hill running– Down hill running causes more force into the quadriceps and less activation from the glutes. The glutes play a very important role in knee stability. Without proper glute activation, a run with IT band syndrome through hills will make things worse. Stick to flat surfaces.

Increase intensity– Volume is the main issue when dealing with It band syndrome. With the decreased run volume, it is ok to get more out of those shorter workouts. Adding some intensity will help keep fitness levels high for training.

Run/Walk- This technique will help you keep the repetitions low. If you have tried to run with IT band syndrome for a long time without success, this option may be a good way to start back into running.

Uneven Surface running– Running on concrete or other flat surfaces hits the same muscles in the same direction over and over. If you run on a trail that has varying terrain (and limited ups and downs) this will cause the hip muscles to work more in different orientations. This will help build overall strength to support the hip and the knee.

These tips can help manage and allow you to run until the symptoms improve and you are pain free. These training modifications combined with manual therapy and exercise like our running chiropractors in San Diego perform, can help get you out of pain even faster. Our office is conveniently located in Mission Valley, San Diego.

Both Dr. Travis Rose, DC CCSP and Dr. Kevin Rose DC DACBSP are avid triathletes and runners. As experienced triathletes, Dr. Travis and Kevin Rose understand the frustrations of running injuries and try their absolute best to get you better, faster!

IT Band Syndrome treatment San Diego

New Methods in Treating IT Band Syndrome

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IT  band syndrome remains a stubborn condition that our chiropractors treat at our office in Mission Valley, San Diego. Runners, triathletes, and cyclists are the main groups of people who we treat for this condition. We previously posted treatment recommendations for IT band syndrome (found Iliotibial Band Syndrome) but wanted to update the information regarding treatment. The previous post still highlights relevant treatment advice in terms of research based treatment. Continue below to see the most recent types of treatment our San Diego chiropractors utilizes to best treat IT band syndrome.

Do you truly have IT band syndrome?

Many patients self diagnose their knee pain as IT band syndrome. They may be correct but true IT band syndrome is characterized by outside (lateral) knee pain right at the bony attachment of the IT band. It is often worse with repetitive movements such as running, walking, hiking, and cycling.

There are many cases that we have seen where the patient is experiencing general knee pain and were diagnosed with IT band syndrome. After our chiropractor evaluates the knee pain, it is often found that the person is experiencing knee pain due to muscle imbalances between the front of the thigh and back of the thigh. The pain and discomfort is often due to very tight and sore quadricep muscles. IT band syndrome is diagnosed because the IT band itself is found superficial to the outside quadricep muscle.

These patients are categorized as “quad dominant” and our San Diego Chiropractor works on the tight/sore quadricep muscles while strengthening the back thigh muscles, namely the gluteus maximus and hamstrings. Along with general strengthening and stretching, the patient must be taught how to use the glute muscles and hamstrings more during their activity.

New Treatment Approaches

We have had a lot of success using various types of myofascial release. Our San Diego Chiropractors have been trained in Active Release Technique and Graston Technique. Cupping is another therapy that has been used to help increase mobility between muscle fibers. Using motion with different types of myofascial techniques is especially helpful for treating IT band syndrome in runners, cyclists, and triathletes. The movement with myofascial work helps create mobility between layers of muscle/fascial tissue that often gets “bound up” with the constant repetitive stress from the sports mentioned previously. Take a look at the videos demonstrating IT band syndrome treatment:

Cupping used during athletic movements to decrease tissue compression and increase blood flow

Active Release Techique applied to the quadricep and IT Band

Strengthening the Hips for IT Band Syndrome

The previous article (found Here Iliotibial Band Syndrome) we wrote discussed several exercises that are still beneficial for IT band syndrome. We are finding even more success with more aggressive glute and hamstring exercises to help stabilize the hip and knee. Below is one of our favorite hip extension exercises. You can perform it one side at a time to make sure you are getting the most out of each hip. Our San Diego chiropractor treats many running injuries and will also assess different muscles groups to help establish proper running form. 

If you are experiencing IT band syndrome, it is important to get evaluated by a sports chiropractor. Our San Diego Chiropractors work with all types of athletes. Each treatment is unique to the individual but likely includes some form of myofascial release, stretching, and strength training. Our office is conveniently located in Mission Valley, San Diego.

Big toe pain treatment San Diego

Functional Hallux Limitus

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Proper motion through the big toe is important for walking and running. When running, as the leg moves backwards, the hip, knee, ankle (dorsiflexion), and big toe extend to propel the body forward. Loss of range of motion at one or multiple of these areas will decrease efficiency and can lead to potential injury. Functional hallux limitus is a condition that limits the amount of big toe extension. When running with this condition, a runner will avoid pushing off the big toe or will not extend fully through the hip due to the poor range of motion at the big toe. Both cases lead to poor biomechanics and potential injury.

Identifying Functional Hallux Limitus

Many times patients report that they had imaging from their previous provider and we told their big toe joint is “normal”. Generally what that means is that there are no fracture and there is no arthritis but no diagnosis is made. Functional hallux limitus means that the big toe has limited extension during gait. In other words when that joint tries to function, range of motion is limited. If you do a test non-weight bearing, the toe will have great range of motion. So is a provider is not familiar with this condition, they will say everything seems normal, stop running until it calms down.

Let’s do a quick test to see if you may be dealing with functional hallux limitus. Sit down and cross one leg ,over the top of the other leg’s thigh. Now reach down and pull back the big toe. It should move back very easily (unless you have hallux rigidus). Now, repeat the process but this time, press your thumb firmly into the bottom of the big toe joint and hold. Try and pull the big toe back. If there is very little motion, you may be dealing with functional hallux limitus. The force from your hand pressing up into the joint mimics weight bearing. So if you have poor extension with just your hand, with full body weight through the joint, motion will be more poor.

functional hallux limitus running doctor

 

 

 

 

 

 

 

 

 

 

Evaluation

Assessing the big toe is relatively straight forward. The test found above is a “go to” test for our sports chiropractors and running doctors. Overall foot  and ankle range of motion will be assessed. Structural limitations will be evaluated as well, such as presence of:

  • Plantarflexed first ray
  • Forefoot valgus
  • Forefoot varus
  • Rearfoot valgus
  • Rearfoot varus
  • Pes Planus
  • Pes Cavus
  • Bunions

Treatment

Some cases respond well to aggressive soft tissue work to the restricted tissues. Active Release Technique and Graston technique with exercises can help breakdown tight tissues that may be causing functional hallux limitus. Other cases will need shoe insert modifications to allow for the proper range of motion at the big toe. General recommendations can’t be made as it is strictly a case by case basis; some patients need one modification while others need a different one.

Our running doctors and sports chiropractors will thoroughly evaluate your specific complaint. We are conveniently located in Mission Valley, San Diego!

Big toe pain treatment San Diego

Big Toe Pain and Conservative Treatment

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Many sports and activities of daily living require movement through the foot and big toe. When you are experiencing big toe pain, sports and certain activities can become quite difficult to perform. If your big toe pain is extreme, simple tasks such as standing, or walking can become very difficult. You may have heard of professional athletes missing months from their sport due to “turf toe” or other big toe conditions. The first thought (and I used to be guilty of this!) is, “It’s only your toe! Get out there and play!”. Well, if you are a 300 pound lineman in football and yue pressing through your big toe to try and stop an equally sized person, then there is tremendous load though a very small joint! When thinking of it from that perspective, it’s amazing that more athletes do not succumb to big toe pain and dysfunction.

Causes of Big Toe Pain

Acute Causes

Most commonly, a big toe joint can become sprained when it is bent backward or forward forcefully. This over stretches the joint and tendons in of the big toe. The following two acute conditions are commonly seen in our sports injury clinic:
Turf toe-Using a football lineman as an example again, when he is pressing forward and is met with equal or greater force by the opposing lineman, the big toe can get over stretched. Pain is generally felt on the bottom of the big toe and is difficult to walk due to the inability to push off.
Sand toe- A soccer player is playing barefoot on the beach and goes to kick the ball. She misreads the position of the ball on the sand and kicks the sand more than the ball. This forces the big toe joint downward, overstretching the top of the
joint and attached tendons.

Chronic Causes

We more commonly treat big toe pain due to chronic reasons. These conditions generally develop over time and are seen in middle aged and older patients (although these can affect younger populations in some cases). The following are common big toe conditions we treat:

  • Hallux valgus
  • Bunion deformity
  • Sesamoiditis
  • Functional hallux limitus
  • Hallux rigidus

Structural issues

In many cases, especially associated with chronic conditions, foot structure may cause pain and dysfunction at the big toe. Most commonly, we see the following:

  • Forefoot valgus
  • Forefoot varus
  • Plantarflexed first ray
  • Subtle cavus foot
  • Pes planus
  • Pes cavus

Inflammatory conditions

Some patients deal with recurring inflammation of the big toe joint. There are a few inflammatory arthritides that can affect the big toe. The most common cause of big toe joint pain and inflammation is Gout. A referral to a rheumatologist is warranted if an inflammatory arthritis is suspected.

Evaluation

Our Sports Doctor of Chiropractic will evaluate the big toe, foot, ankle, lower leg, and possibly continue up the body into the lower back. Some conditions can be affected by muscle/joint dysfunction above where the pain is actually occuring.

Treatment

When it comes to big toe pain, Active Release Technique and Graston technique can help restore normal tissue function around the big toe. Chiropractic adjustments to the ankle, and midfoot can help with proper foot function to de-load the painful big toe joint. Exercises are also prescribed to strengthen/stretch the small muscles of the foot to improve big toe mobility. If there are structural issues present and a patient has recurring symptoms or does not improve with care, orthotics may be prescribed to accommodate the structural issue.

Preventing Shoulder injuries

Shoulder Impingement and Shoulder Pain

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Shoulder impingement is a common condition that we treat at our sports injury clinic in Mission Valley, San Diego. Not only do we see shoulder impingement in the athletes we treat but we see it in many different professions that require repetitive use of the shoulder. Our conservative, non invasive shoulder treatments help provide pain relief quickly and prevent shoulder impingement from reoccurring in the future.

What is shoulder impingement

Shoulder impingement syndrome is a condition where the space between the head of the humerus (upper arm bone) and the acromion process (portion of the shoulder blade) narrows due to structural or functional causes. Structural narrowing of the space is due to arthritis, or bone spurring where the bone spur presses into the tissues in that space. Functional narrowing is due to poor shoulder stabilization from the rotator cuff, scapular dyskinesis (shoulder blade not moving well), and/or muscular imbalances between the front and back of the shoulder.When the space is narrowed, several structures are at risk to become irritated: rotator cuff, bursa, and biceps tendon.

Shoulder pain anatomy San Diego Sports Doctor

What are the symptoms of shoulder impingement? 

Classic signs and symptoms are pain in the shoulder while lifting the arm overhead, turning a steering wheel, pressing/reaching in front of body. Sport specific signs and symptoms include, pain with overhead activities (throwing baseball, volleyball spiking), swimming,Crossfit (thrusters, snatches), weightlifting, bodybuilding.

As impingement syndrome progresses and shoulder structures become more irritated, pain at night, pain and stiffness in the morning is a common complaint.

Evaluation

Our sports doctors will take a thorough history of the shoulder pain and perform an exam to the shoulder, upper back, and neck as there are many structures that overlap between those areas. The exam will help identify shoulder impingement and which structures are causing pain. The most common conditions that are diagnosed with impingement syndrome are:

  • Rotator cuff strain
  • Rotator cuff tear
  • Biceps tendonitis
  • Biceps tendinosis
  • Subacromial bursitis
  • Labral tear (SLAP tear, degenerative tear)

In certain cases, advanced imaging may be necessary to determine the extent of the impingement syndrome and subsequent injury to the und. An MRI can identify rotator cuff tears and Labral tears.

Noninvasive Shoulder Treatment in San Diego

At our Mission Valley office, we utilize the latest techniques to treat shoulder impingement including: Active Release Technique (ART), Graston Technique, joint mobilization/manipulation, and targeted rehabilitative exercise.

Initial stages of care usually involve working on the flexibility and mobility of the tissues around the shoulder. This helps by improving functional limitations at the shoulder joint. After mobility has improved, targeted strength and control exercises for the shoulder are prescribed. This helps avoid re-injury to the shoulder in the future and can help improve performance.

In some cases, if the impingement is due to bone spurring or labral tear, an orthopedic referral may be warranted.

Shoulder pain treatment sports doctor

Schedule today to get a proper assessment and treatment for your shoulder pain. Our sports chiropractors are trained to treat your shoulder pain and other sports injuries effectively, and efficiently.

Cycling Knee pain San Diego Treatment

Cycling Knee Pain Treatment

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Most cyclists at one point or another experience knee pain when riding their bike. There are many types of cycling knee pain and many different causes. In majority of cases, knee pain from cycling is due to overuse of the muscles/tendons around the knee joint. The complicating factor is the bike itself and how you are fit on that bike. A dialed in bike fit will allow your body to absorb the forces that hard cycling produces. If your knee joint, is working in a strained position, the muscles and tendons will eventually fail once a certain volume and/or intensity is reached during training. Forced time off will occur, the cyclist will train pain free until that tissue threshold is hit, and then knee pain occurs again. Frustrating! Below you will find the most common causes of knee pain in cycling.

Knee Pain Running Doctor

Anterior knee pain

  • Patellar tendonitis most common
  • Chondromalacia
  • Fat pad impingement
  • Bike fit suggestion: increase saddle height
    • Advanced with evaluation of foot: shoe insert, cleat wedges

Medial knee pain

  • Pes anserine bursitis
  • MCL/knee capsule irritation
  • Bike fit suggestion: move cleats outward
    • Advanced with evaluation of foot: shoe insert, cleat wedges

Lateral knee pain

  • Iliotibial band syndrome it band syndrome
  • Hamstring strain (biceps femoris)
  • Bike fit suggestion: lower saddle height, move clears inward (toward bike)

Posterior knee pain

  • Hamstring tendonitis
  • Hamstring train
  • Calf strain
  • Bike fit suggestion: Lower saddle height

Evaluation of Cycling Knee Pain

Evaluation begins with a thorough history, including details on your personal history of cycling, and bike fit. Our sports chiropractor will take you through various range of motion, orthopedic, functional movement, and strength/endurance testing. After the evaluation, a working diagnosis is developed and treatment begins.

Treatment for Cycling Knee Pain

Most cases of knee pain from cycling improve with a combination of manual therapies including Active Release Technique, Graston Technique, and joint mobilization. A individual exercise routine will be prescribed as well to strengthen/stretch the affected tissues to reduce pain and dysfunction quickly. Our cycling doctor will help construct a cycling training plan to get back to riding pain free; some bike fit suggestions may be necessary.

Schedule today to get your knee pain properly diagnosed at our Mission Valley, San Diego office. Both Dr. Travis Rose, DC CCSP and Dr. Kevin Rose, DC DACBSP are trained to treat cycling injuries and are both avid cyclists and triathletes themselves. Dr. Travis Rose, DC CCSP has additional training in Bike Fit analysis for health care providers.

Knee pain san diego treatment

Patellar Tendonitis and Knee Pain

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The patellar tendon runs from the bottom point of the patella (knee cap) and runs down to the top of the tibia (shin bone). It acts as a pulley to lift the leg upward into extension when the quadricep muscles contract. Leg extension is important in many sports and day to day activities; squatting, walking up and down stairs, getting in and out of cars, etc.
When the quadriceps become overused, excessive amount of load occurs at the patellar tendon and patellar tendonitis begins to develop.

What are the Symptoms of Patellar Tendonitis?

Patellar tendonitis is characterized by pain and possibly inflammation along the patellar tendon. Early stages of patellar tendinitis tends to cause pain after exercise/aggravating activity, and then goes away hours after the activity; it may also be felt at the start exercise but feels better as exercise continues. As the condition progresses, pain may be felt before, during, and then is worse after exercise. If it gets ignored and an athlete tries to push through the pain, the tendon will actually start to deteriorate resulting in patellar tendinosis.

Patellar Tendonitis Treatment San Diego

Who are at risk?

Athletes who perform repetitive jumping and leg bending are at risk to develop patellar tendonitis. Basketball players, CrossFit athletes, volleyball players, runners, cyclists, backpackers/hikers, triathletes, are all at a higher risk due to the potential overuse of the quadricep muscles. Specifically for running and hiking, performing lots of down hill routes will increase the likelihood of developing patellar tendonitis.

Evaluation

In most cases, patellar tendinitis can be diagnosed with a thorough history of the injury and brief physical exam. In some cases, imaging such as a X-ray or MRI may be necessary to rule out other conditions such as meniscus injury, patella alta, chondromalacia, arthritis, etc. Check out our blog here for other causes of anterior knee pain.

Treatment for Patellar Tendonitis in San Diego

For acute pain relief, Active Release Technique, Graston Technique, stretching, foam rolling, and training modification are essential. As the patient improves, eccentric exercises are prescribed to repair the patellar tendon. This helps strengthen tendon fibers to resist future load from activity. Eccentric loading for patellar tendinosis is even more important as this restarts the inflammatory process at the tendon so the tendon can heal.

Stop dealing with patellar tendinitis on your own. Schedule today to get evaluated by our sports chiropractors located in Mission Valley, San Diego. We have helped countless athletes overcome knee pain with our targeted approach.

Outer hip pain running clinic San Diego

Outer Hip Pain in Runners

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Outer hip pain is a very common complaint we see with out runners at our Mission Valley office. The outer hip musculature is designed to provide hip, and lower back stabilization during running. When there is pain or tightness at the outer hip, the stability at the hip and lower back is compromised. This in turn can create abnormal stress into the hip, outer hip muscles, lower back, the knee, and even the lower leg/foot. The following conditions cause outer hip pain and dysfunction:

Causes of Outer Hip Pain

  • Glute Medius Muscle Strain
  • Tensor Fascia Latae Strain
  • Gluteus Medius Tendinopathy
  • Trochanteric Bursitis
  • Iliotibial Tract Syndrome (IT Band Syndrome)
  • Sciatic Nerve Entrapment

As mentioned above, the out hip plays a role in lower back and hip stability. If the outer hip is painful or dysfunctional the following conditions may also be present:

  • Low Back Pain
  • Facet Joint (Lower Back Joint) Irritation
  • Hip Impingement
  • Knee Tracking Issues
  • Outer Knee Pain (IT Band Syndrome)
  • Shin Splints
  • Plantar Fasciitis

Evaluation

It is important to be evaluated by a running doctor and sports chiropractor. We will help diagnose your outer hip pain and any potential compensatory injuries that may be occurring simultaneously.  A combination of range of motion, orthopedic, functional movements, and strength/endurance tests will be used to pinpoint the exact cause of your pain.

Gait Analysis

We currently offer at home gait analysis for current patients. After being evaluated in our office, if it is deemed necessary, we have our patients video tape themselves running on a treadmill and send it back to us for evaluation. For outer hip pain, many runners with outer hip pain run with what is known as a cross over gait. Check out our previous blog posts here on what a cross-over gait consists of.

Hip pain Running San Diego

Potential sites for injury with cross over gait

Treatment for Outer Hip Pain

Active Release Technique is an excellent tool for helping runners with outer hip pain get out of pain quickly. A targeted home rehab approach is then prescribed b our running doctor as a way to prevent the injury from coming back again. Schedule with us today at our Mission Valley, San Diego running injury clinic today!

The Running Clinic Certification

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Congratulations to Dr. Travis Rose, DC CCSP for successfully completing the course in “New Trends in the Prevention of Running Injuries”! This course, taught by The Running Clinic, teaches health care providers about the latest methods to treat and manage running injuries. Dr. Rose is currently the only healthcare provider with this certification in Mission Valley, San Diego.

Running Clinic Running Doctor San Diego

The following is a quick Q and A with Doctor Rose regarding running injuries.

Q: Having taken this latest course, put on by The Running Clinic, what were the main takeaways to prevent running injuries?

Dr. Rose: The main takeaways for injury prevention and increasing running efficiency were the following: 1. Run with a cadence between 170-180 steps per minute, 2. Limit the up and down motion while running (decrease vertical loading associated with injury), and 3) Use as little of a shoe as possible as this allows you to run more naturally.

Q:  Was there information that surprised you or went against conventional running information?

Dr. Rose: The biggest “eye opener” was the fact that there is zero research to support prescription of specific shoes for specific types of feet. Many people put their trust in companies to tell them which shoe to buy based on treadmill analysis. Unfortunately there is research that shows that shoes don’t limit pronation like they claim to do. So why give somebody a big bulky shoe when it doesn’t do what it is designed to do? Instead, work on the items listed above and become a better runner!

Q: What is the biggest cause of injury in runners?

Dr. Rose: It is when a runner changes something. For example, a runner runs 25 miles per week, same distances for each run. But then decides to run an extra 10 miles one week. That change in volume is what will likely cause an injury to pop up. Another example is always running on concrete or hard trails, then deciding to run 10 miles on soft sand. The body was not ready to support a long soft sand run and an injury occurs.

Q: There is a lot of information for exercises online to help improve running technique, can a runner do home exercises and fix their running flaws?

Dr. Rose: Unfortunately no. I used to be under that assumption when I was an injured runner. I would get frustrated when I would do a ton of strength exercises and core work to then run 2 miles and have that all too familiar pain come back. Running gait needs to be corrected to take strain off the injured area. Using myself as an example, I suffered from repeated shin splints due to cross over gait. It did not matter how much glute or calf strengthening I did because once I ran incorrectly again, the tendon would get overloaded and I would be back to square one. Once I learned to run with a wider step width and have a faster turn over (faster cadence), my injury went away almost immediately and I was able to slowly build back up.

Q: Any other advice on running injuries that you learned?

Dr. Rose: When in doubt, get it checked out. Running should be fun and injury free. I hear too many stories from patients about how tight and sore they are after every run. Or that pain is something “you deal with as a runner”. Not true! Get evaluated by a running doctor who can get your gait back on track. If there is not a running doctor in your area, there are a few pieces of wearable technology that can help. One being Lumo Run which gives feedback on cadence, vertical bounce, hip drop, hip rotation, and braking force. If you already run with a running watch, usually they have features that you can use (like cadence) to start really emphasizing proper technique.

Dr. Travis Rose DC CCSP and Dr. Kevin Rose DC DACBSP are Chiropractors trained to treat a wide variety of sport related injuries. Schedule a visit at our Mission Valley, San Diego office!

Hip pain running doctor San Diego

Types of Hip Pain and Running

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The hips play an important role during running. Running is essentially a single legged sport once you break down the movement.  The hip not only helps propel the body forward but also is a stabilizer of the lower back and the leg during the gait cycle. Due to the demands placed on the hip, it is susceptible to overuse, and acute running injuries. A running doctor can help by diagnosing the problem correctly and developing a treatment plan to get you back to running pain free.

Common types of hip injuries found in runners

There are many types of running injuries that can occur at the hip. Pain may be felt in the front, outside,inside, or back of the hip. Certain cases runner’s will describe the pain as deep in the hip joint. We will categorize the most common types of injuries we see based on location of the injury:

Front hip pain in runners

  • Hip flexor strain
  • Rectus Femoris/quadricep strain
  • Iliopsoas bursitis
  • Iliopsoas tendinitis/tendinosis
  • Rectus femoris tendinitis/tendinosis
  • Hip impingement
  • Hip labral tear
  • Stress reaction/stress fracture
  • Hernia

Outside hip pain in runners

  • Gluteus Medius tendinopathy
  • Iliotibial band syndrome
  • TFL strain
  • Trochanteric bursitis

Inside hip pain in runners

  • Adductor strain
  • Adductor tendinopathy
  • Iliopsoas tendinopathy
  • Hip impingement
  • Hernia

Back hip pain in runners

  • Hip osteoarthritis
  • Hip labral tear
  • Gluteal muscle strain
  • High Hamstring injury
  • Piriformis syndrome
  • Low back pain referral
  • Sciatica

To complicate the injury spectrum, there are cases where runners feel pain in the hip but is a referral from joint/nerve impingement from the lower back. Also if the hip is weak and injured, other injuries to the lower back, knee, shin, and foot may become prominent. Receiving a diagnosis from a running doctor trained in diagnosing and treating runners is very important.

Hip pain treatment

Our sports chiropractors at our Mission Valley office are trained to treat a wide variety of running injuries. We specialize in Active Release Technique, Graston technique, running form analysis, and rehabilitative/performance exercise. Schedule today to get evaluated by a running doctor who knows how to get your training back on track!