A Few Of My (LEAST) Favorite Things

A guest post from my friend and fellow Jersey Girls StayStrong Multisport Club member and a physical therapist, Laura Fucci.

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The Jersey Girls Facebook page is often studded with posts regarding injury issues and discussions.   The year since I joined you impressive, inspiring women I haves culled a few of the most frequently debated topics.  I have been a PT for 23 years, specializing in orthopedics and sports medicine  as well as a full body certified Master Active Release Technique practitioner.   I worked the Lake Placid Ironman the last 4 years where I treated countless Iron folk and met many of you Jersey Girls!  A mediocre runner and triathlete since 2003, I also competed in regional and national level powerlifting back in the 80s and 90s.

Moira asked if I would address some common injuries and hopefully dispel some misconceptions.

Let’s start with my least favorite thing: ITB Syndrome

ANATOMY:

The Iliotibial Band is a tough fibrous piece of connective tissue. It originates along the iliathc crest (the boney lip of the side of your hip)  It splits into a superficial and deep layer. The ITB encloses the Tensor fascia Latae and connects with tendons of the the gluteus maximus.

It then inserts laterally on the knee on the femoral epicondyle and crossing the knee joint onto the tibia.

FUNCTION:

Supplies lateral stability to the knee.

WHY DOES IT HURT?

The ITB gets the blame for causing pain in runners and cyclists as well as other athletes. The ITB is wrongfully accused.  It merely does the bidding of the muscles with which it attaches. Dysfunction in your gluteus, TFL hip flexors or even your foot can cause the ITB to be pulled such that it compresses on the richly innervated  and vascularized fat underneath the strands anchoring it to the end of the femur.  There is even debate in the research community that no “bursitis” exists in ITB syndrome as evidence shows lack of bursa in cadavers studys

This leads us to my LEAST FAVORITE THING about ITB Syndrome.

I have patients and athletes who are forever rolling ,grinding and in general punishing their ITB.  The ITB is not composed of contractile tissue, therefore IT CANNOT BE STRETCHED. Stop rolling your ITBs.  It wont help.  If you happen to get your TFL, gluteues maximus and vastus lateralis/ITB junction in there -then you’re achieving a stretch which trickles down to some relief.

HOW DID THIS HAPPEN AND HOW CAN I GET RID OF IT?

In PT we have a saying about the cause of pain: “It is where it ain’t”.  A good evaluation will uncover where the muscle dysfunction might be.  PTs and Chiros can go on for hours discussing  all the possible causes of ITB syndrome.  In the interest of time and space here are just a few:

Lateral muscle tightness of the TFL, gluteus medius or even the quadratus lumborum (along your side attaching to the top of the hip) can cause a pulling on the ITB which in turns pulls lower down the chain to the insertion on the knee. Think of a rope caught in between a tug of war. The losing side here is at the knee.

Hip lateral rotator weakness:   Gluteus Maximus as well as some shorter hip rotators.  PTs are big on getting patients to activate and strengthen their glutes to normalize functional movement and decrease pain.

Hip flexor tightness: In particular is a muscle called the rectus femoris that crosses the hip and inserts on the knee and can contribute to a painful dysfunction

Pes planus or flat foot: Be careful here as not to mistake a stable flat foot with one that really pronates.  This over pronation and pull the tibia into internal rotation and cause pressure on the lateral knee. A good assessment can judge if there is a need for a new running shoes or orthotic

kneeling-hip-flexor-stretch

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