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San Diego Marathon Running

Get Ready for the San Diego Rock ‘n’ Roll Marathon

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The San Diego Rock ‘n’ Roll marathon is coming up! You are likely finishing your build phases of training and are headed into a much needed taper to help rebuild your body before the big day. Now that training volume has decreased, you have more time to address your body to get it into tip top shape before race day. Beyond foam rolling, stretching, and mobility work, the following are services that can help decrease tightness, soreness, aches, and pains before your big day. Our office accepts most major insurances and offers affordable cash rates. Our San Diego Chiropractors treat runners and running injuries on a daily basis using the following techniques:

Active Release Technique– Our staff is trained in Active Release Technique which is a state of the art soft tissue injury management system. Our chiropractors utilize ART to help reduce tightness and soreness at isolated parts of the body. For example, many runners feel tight in their hips and quadriceps following long runs. One or two ART sessions before the Rock ‘n’ Roll Marathon can help rid the muscles of that tightness.

Active Release Technique Marathon Running San Diego

Graston Technique– While training for the Rock ‘n’ Roll Marathon, if any injury is long standing, particularly in a tendon, Graston is excellent to get ample blood supply to that area. Our San Diego Chiropractor will sometimes have runners perform movements while using the Graston tools to help facilitate movement between the fascia and muscles. Bascially, your muscles move better so you do not feel tight and sore before your race!

graston technique in san diego Marathon running

Spinal Manipulation– If your back is stiff and lacks proper range of motion, spinal adjustments may be the right treatment for you. Spinal manipulation is an excellent treatment to help restore proper joint mobility. Spine stiffness is a common complaint in runners especially when training for a marathon due to the long hours of training and consistent bouncing motion into the spine.

Massage Therapy– Our massage therapist is an avid runner and endurance athlete. If you have numerous areas of tightness and soreness, schedule a massage to have a nice once over to all of those complaints.

Head into your race feeling as healthy as you can and you will see great results. After the San Diego Rock ‘n’ Roll Marathon, we recommend our runners to receive treatment about once every 4 weeks to help reduce tightness in the common running muscles and joints. Our office is conveniently located in Mission Valley, San Diego near the Rock ‘n’ Roll Marathon course!

Good luck in the San Diego Rock ‘n’ Roll Marathon!

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.

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!

Do you Run with a Cross-Over Gait?

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Do you Run with a Cross-Over Gait?

A cross-over gait, also known as a “tightrope” gait, involves running with your feet crossing the midline of your body. As each foot crosses midline, it appears as if you a running along a tightrope. This running style decreases running efficiency and may set you up for future injury (or prolong your current injury!). The areas commonly injured are the inner shin/tendons, knee, outer hip/IT band, and lower back. Beginner runners, and runners with weak core/gluteal muscles tend to run with this type of gait. 

Do you run with a cross-over gait?

The absolute easiest way to diagnose a cross-over gait is by having a gait analysis performed. A professional gait analysis is recommended but a quick video recorded by a friend can be show if the feet cross midline. Setting up a camera behind a treadmill while running solo is another easy way check for cross-over gait (see runner below).  As you watch the stride, look for where the foot lands in relation to the body’s midline.

Other signs of a cross-over gait include: excessive wear on the outside bottom of shoes, scuff marks on the inner legs ( you actually hit yourself with your foot from running too narrow!), side to side head bob noticed visually when looking straight ahead, and inline foot prints when running on sand or dirt. The main symptom of a cross-over gait is recurring injury to the same area with running. Symptoms tend to lessen with treatment and rest but return with increased running volume, intensity, or both. 

 Why is a cross-over gait less efficient?

Simply put, you are wasting energy moving side to side; the more energy spent moving side to side, less energy spent moving forward. Cross-over gait puts a lot more demand on tissues which will cause the muscles of the core, hip, lower leg to work extra hard. The demand will create more fatigue which in turn will decrease efficiency further. 

How does a cross-over gait cause injury?

With a cross-over gait, the foot strikes at or across midline , forcing our joints to work in a non-stacked position. The lower extremity performs best with a stacked orientation to absorb shock/strain with muscles. With the joints working at a slight angle, several tissues now have to work harder to absorb shock and slow down joint movement. The following injuries are commonly associated with a cross over gait:

  1. Posterior shin splints/Posterior Tibialis tendinopathy– While running with a cross-over gait, the foot lands excessively on the outside part of the foot and as the body weight shifts forward, the foot quickly flattens. The slapping down of the foot is often viewed as “over pronation” when in reality, the foot and ankle are pronating too quickly. The posterior tibialis muscle (and other lower leg muscles) must contract powerfully to slow this motion down. This causes excessive strain of the muscle causing shin and tendon pain. Over pronation is not the issue and is a reason why changing footwear in these cases is not helpful. 
  2. Knee pain– As the leg moves toward middle, the inner knee structures get over stretched. The kneecap likes to move in a straight line over the knee. If the muscles are contracting around an angled joint, abnormal tracking of the knee cap occurs.  Patients often have pain at the front part of their knee. If chronic irritation occurs, it can cause swelling around the knee/knee cap.
  3. Outer hip/IT band pain– Again as the leg moves inward, the outer hip elongates, allowing the pelvis to “drop”. This over stretches the outer gluteal muscles. As the hip muscles become more strained, the less stability they are able to provide. Trochanteric bursitis, iliotibial band syndrome are two common conditions that arise from overused/weakened hip muscles. 
  4. Lower back pain– Keeping in mind with what occurs at the hip, the low back joints and muscles get stretched abnormally as the pelvis “drops” due to weak gluteal muscle stabilization. Local low back pain is common from this constant side to side joint irritation. Symptoms may be significantly worse if a runner  has disc degeneration and/or low back joint degeneration.
Cross-over gait injuries

Potential sites for injury with cross over gait

A runner with a cross over gait and a cadence of 180 steps per minute, will cross over 5,400 times during a 30 minute run! Running with a cross-over gait will only worsen as fatigue sets in, setting runners up for injury. It is important to identify this running pattern and address the deficiencies to avoid injury. If you have chronic injuries or recurrent injuries to the same body part, you may be running with a cross-over gait. In our upcoming blog posts, we will be discussing ways to fix a cross over gait and run more efficiently.  

If you are interested in being evaluated for running injuries, our office is conveniently located in Mission Valley, San Diego!

5 Ways to Strengthen Weak Ankles and Prevent Ankle Injuries

Prevent Ankle Injuries: 5 Ways to Prevent Ankle Injuries

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5 Ways to Prevent Ankle Injuries

Ankle injuries are one of the most common injuries among athletes. While it is impossible to completely prevent ankle injuries, taking precautionary measures before exercising can help limit the risks. Listed below are stretches to help strengthen and loosen up the muscles around the ankles. These exercises are great for both preventing injuries from happening and helping you recover from an existing injury:

  1. Peroneal Stretches

    One of the most important muscles to strengthen during any recovery or prevention of an ankle sprain is the peroneal muscle. These muscles extend from the top of the knee all the way down to where they attach at the bottom of the foot.

    The exercise is easy: Gently roll onto the outside of your feet and walk around for 60 seconds. This helps strengthen your ankle muscles and gives them additional flexibility.

  2. Ankle Circles

    This simple exercise will help strengthen the muscles in and around the ankle, improving the joints stability. You can either sit on a chair or stand for this conditioning.

    Extend your leg straight out, without bending the knee. Rotate your foot clockwise 10 to 20 times, rest leg for 5 seconds, and raise it again to rotate counterclockwise 10 to 20 times. Alternate legs and do 3 or 4 sets per side.

  3. Dorsiflexion Stretches

    The Dorsiflexion stretch is crucial amongst runners. This stretch is responsible for strengthening the muscles that run along the shin of the leg, called the Anterior Tibialis. This muscle is what controls the up and down movements of the toes. Therefore, strengthening this muscle will not only help prevent shin splints, but can also help protect the muscles and tendons in the ankle.

    First, sit on the floor with your right leg straight out and the left leg crossed, with the sole of your left foot resting against the inside of your right leg. Place a towel or band around the ball of the right foot and gently pull your toes back toward you. Hold for 15 seconds, repeat the stretch 4 times, and then switch legs.

  4. Write the Alphabet

    This exercise is as easy as reciting the alphabet! All you are doing is tracing every letter of the alphabet with your big toe. This exercise is best if you are seated in a chair.

    Hold your right leg straight out in front. Using your big toe as the “pen”, first write each letter of the alphabet in all capital letters. The same process again with lower case letters, then switch feet and repeat. Writing the alphabet is a challenging exercise that will help strengthen both of your ankles!

  5. Achilles Stretches

    Rupturing the Achilles tendon can set you back for quite a while. By doing regular Achilles stretches, you can help limit the risk of rupturing the tendon and help improve flexibility.

    From a standing position, bend the knee of your left leg at a 45 degree angle. Step the right leg back and keep it straight. Ground the heel of your right foot and push the hips forward. Hold this position for 15 to 30 seconds and then switch legs, repeating 2 to 4 sets on each leg.

Athletes at Risk

At our Mission Valley Office, we see many athletes with injured ankles including: ballet dancers, MMA fighters, soccer players, baseball players, and foot ball players. It is important to perform the above mentioned exercises to help prevent ankle injuries. If you are currently experiencing an injury to the ankle, please schedule with our certified sports chiropractors today!

rock climbing injury

Rock Climbing and Pulley Injuries

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Finger pulley tears are one of the most common injuries in rock climbing, but many climbers may not know how to identify or treat this type of injury. What is a pulley, anyways? A pulley could best be described as a group of fibers that help secure tendons to the bone. For those who may be experiencing a finger pulley injury, be on the lookout for the following:

  • Grade I (sprain):

    Symptoms may include some pain when squeezing or climbing. Treatment may include taping the injured finger to relieve stress and massaging the finger at the injury site. Squeezing a putty such as TheraPutty a few times each day is also a very good tool to aid in recovery. Climbing is okay, but should be done at a reduced level of difficulty. Soft tissue treatment such as Graston and Active Release Technique (ART) can be effective for in the initial phases for Grade I.

  • Grade II (partial rupture of pulley tendon):

    Symptoms include pain with squeezing or climbing and possibly when extending the finger. Treatment can include massage and putty, as with Grade I, but no climbing should be done for the first 1-2 weeks. When it is time to return to climbing, start back slowly and tape the fingers.

  • Grade III (complete rupture of pulley):

    Symptoms can include sharp pain at the pulley, you may hear a “pop” sound, possible bruising and swelling, pain when squeezing/climbing. Treatment may include taking ibuprofen and the regular use of a cold compress for the first couple of days. No climbing! A splint may be used to immobilize the injured tendons. After 4-8 weeks, putty can start to be used to help strengthening, along with the Grade II treatment.

As with any injury, your first step should be to seek care from a medical professional to determine the correct treatment plan, but these descriptions are intended to serve as a general guideline of what to expect from a pulley injury. If you’re in pain, make sure you don’t ignore it!

IT Band Syndrome treatment San Diego

Iliotibial Band Syndrome

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Check out our updated post on IT band treatment found here: New Methods in Treating IT Band Syndrome!

Iliotibial band syndrome (ITBS) is a painful, frustrating condition that affects the outside part of the knee. The IT band is a thickening of inelastic connective tissue which arises from the Tensor Fascia Latae and the Gluteal muscles and inserts into the outside of the tibia and Tibialis Anterior.1 During movement, the IT band approximates the lateral aspect of the knee, creating an “impingement zone” and irritates the tissues found there, primarily a highly innervated fat pad.2,5 With repetitive flexion and extension of the knee, particularly during excessive running, ITBS can develop and cause moderate to severe pain on the outside of the knee.

Who is at risk?

Active individuals are prone to iliotibial band syndrome due to chronic “overuse” type of trauma to the IT band and muscles of the thigh/buttock. A number of risk factors put a person at a greater risk for developing ITBS which include: training intensity/duration, running down hills, wearing shoes with poor arch support, biomechanical factors such as flat feet, gluteus medius weakness, etc.4  Runners who run while fatigued, may be at more of a risk for developing ITBS due to increased flexion at foot-strike; this results in greater impingement at the “impingement zone” of the knee leading to greater tissue irritation.2

Examination

Sports chiropractors will carefully evaluate the knee including: ROM, various orthopedic tests, and a specific palpatory assessment, which allows the practitioner to identify muscles that have developed myofascial adhesions, causing muscle tension and pain.

The knee is caught between two other main joints of the lower extremity: the ankle, and the hip. The IT band connects to the hip musculature and also has fascial connections to the tibialis anterior, the bulky muscle in the front of the lower leg.1 Examination of the hip, lower leg, and ankle may also be assessed in an attempt to determine dysfunctional muscles, joints, and structures which may be causing excessive stress at the outside of the knee.

A functional evaluation will also be performed to determine movement patterns that may cause excessive stress on the knee/IT band. A gait assessment both walking and running may reveal over pronation at the foot, or hip dropping during the stance phase of the gait cycle. Squats and lunges may reveal deviation of the knee towards midline, which may indicate glute medius weakness on the same side.

Treatment

Iliotibial Band Syndrome Treatment Graston San Diego

Graston® Technique applied to IT band/Quadricep.

Treatment depends on the stage at which the ITBS is found at the time of examination. To combat swelling and pain associated with ITBS, treatment primarily involves ice and modification of activity.3,4 Patients can ice the knee at home using ice massage for 3-8 minutes, two times per day to combat the inflammatory process.

Sports chiropractic care primarily involves addressing the soft tissue structures that affect the IT band. Active Release Technique (ART®) is used to remove myofascial adhesions (scar tissue) that have developed in the muscles that surround or connect into the IT band: gluteus maximus/medius, TFL, vastus lateralis (outside quadriceps muscle), biceps femoris (outside hamstring), and in some cases the tibialis anterior. The practitioner will have you perform specific movements for each structure involved, while deep pressure is applied to the structure to help stretch the myofascial adhesions to help restore proper function to the muscles and remove excessive tension that may be exacerbating the ITBS.

Some ART® protocols are designed to break down adhesions within the muscles, while other protocols are designed to restore relative motion between myofascial structures. The latter is important for IT band syndrome as the band itself lies over the large vastus lateralis and biceps femoris. Improving the movement between these structures will help remove tension at the outside of the knee.

Chiropractic adjustments may be used to improve the joint function of the low back, pelvis, hip, knee, and ankle to help improve the symptoms at the knee.

Rehabilitation

Once pain has significantly decreased, specific exercise protocols will be given to help prevent recurrence of symptoms and strengthen weak muscles such as the gluteus medius muscle. Gluteus medius weakness results in greater adduction angle at the knee (knee moves inward) during gait which results in over stabilization of the IT band leading to ITBS, trigger points, and contracted muscles.6,7 Proper strengthening of the glute medius will result in greater hip stabilization and keep the knee from deviating towards midline during dynamic movements (running, squatting, jumping).The IT band is an inflexible structure, however, IT band stretching can help relieve tension in the muscles that insert into the IT band. In addition to static stretching, the use of ischemic compression through the use of a foam roller can be used to successfully decrease the sensitivity and intensity of trigger points.8

IT band syndrome exercises san diego

It band syndrome exercises

Iliotibial band syndrome exercises San Diego

Raise knee as high as possible without losing positioning.

For runners, once pain has been minimal for 2 weeks and strengthening exercises are performed, a running routine can resume.3,4 Running should take place every other day on a flat surface with easy sprints and no hills.3,4 Gradual increases in frequency and duration of running should occur over a period for 3 to 4 weeks.4

Other Treatment Options

Other treatment options for ITBS include NSAIDs for pain and swelling.4 In chronic cases that have not responded to conservative care, corticosteroid injections may be warranted.10 In rare cases surgery may be performed to release the tension of the IT band over the lateral knee.11

Conclusion

If you are experiencing knee pain, it is important to get evaluated by a sports chiropractor to determine the exact cause. ITBS is a very common condition affecting approximately 8.4% of injured runners.9There are a number of conservative options for patients who are affected with this condition, particularly Active Release Technique (ART®) to help relieve pain associated with ITBS. ART®, chiropractic adjustments, stretching of the TFL/IT band, followed by gluteus medius strengthening and a gradual return to activity will result in most patients recovering from ITBS in 6 weeks.4

References

Meyers, T. W. (2009) Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. New York, NY: Elsevier.

Fredericson, M., and Weir, A. (2006). Practical management of iliotibial band friction syndrome in runners. Clinical Journal of Sports Medicine, 16 (3), 261-268.

Ellis, R., Hing, W., and Reid, D. (2007). Iliotibial band friction syndrome- a systematic review.  Manual Therapy, 12, 200-208.

Fredericson, M., Wolf, C. (2005). Iliotibial band syndrome in runners innovations in treatment. Sports Medicine, 35 (5), 451-459.

Fairclough, J. et al. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Jounral of Anatomy, 208, 309-316.

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