Iliotibial Band Syndrome
Your iliotibial band is a fibrous band of tissue running from the crest of your hip, down to your knee. A muscle near the crest of your hip called the tensor fascia lata, attaches to this band to help control movements of your leg. Your iliotibial band passes over the point of your hip and over another bony bump on the outside of your knee called the lateral epicondyle. When the band is too tight,
it can become painfully inflamed as it repeatedly rubs over the top of either of these bony projections. Irritation at the bony bump near the knee is called iliotibial band friction syndrome.
The condition usually presents as pain on the outside of your knee that becomes worse with repetitive knee flexion or extension. This condition is the leading cause of lateral knee pain in runners, especially slower “joggers.” The pain usually develops 10-15 minutes into the workout. You may sometimes feel or hear a click during movement. Symptoms generally ease at rest. Running on slick “wintry” surfaces may aggravate the condition. Excessively worn running shoes may be a culprit.
This problem is commonly caused by weakness in your gluteal muscles. When these muscles are weak, the muscle that attaches to your iliotibial band must contract harder to stabilize your hip. Having one leg longer than another is a known aggravating factor.
Runners should minimize downhill running and avoid running on a banked surface like the crown of a road or indoor track, as well as wet or icy surfaces. Runners should reverse directions on a circular track at least each mile. Bicyclists may need to adjust seat height and avoid “toe in” pedal positions. Avoid using stair climbers or performing squats and dead lifts. Sports cream and home ice massage may provide some relief of symptoms.
Here is a brief description of the treatments we may use to help manage your problem.
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.
Your mattress and the position you sleep in may affect your condition.
✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:
✓ Maintain proper body position and alignment while sitting at your desk - Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
✓ Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
✓ Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
✓ Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
✓ Use a lumber roll for lower back support.
✓ Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
✓ Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
✓ Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
To avoid extra stress on your spine while standing:
✓ Avoid high-heeled shoes or boots
✓ Use a footrest measuring 10% of your height
✓ To decrease stress on your back and feet consider leaning on a tall chair.
✓ If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.
✓ When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
✓ Choose shoes with good arch support.
✓ Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
✓ Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
✓ “Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
✓ Patients with fallen arches should consider adding arch supports or orthotics.
✓ Repair or replace shoes with worn soles or heels.
Running shoes need to be replaced every 250 miles. There are three basic options:
✓ Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
✓ Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
✓ Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.
Exercise- Water Aerobics
“Water Aerobics” simply means that you are exercising in the pool. Water exercise adds resistance but reduces the effect of gravity, and is usually less stressful on your joints. Water Aerobics are better tolerated by people who have joint problems like arthritis.
✓ You do not need to be a swimmer to exercise in the water - most classes are held in chest-deep pools. Check with your gym or local YMCA to inquire about classes.
✓ Working out in a group class can help with motivation.
✓ As with all aerobic exercise, you should start gradually and don’t exceed the “talk test”- meaning you are still able to talk while exercising.
Sports creams come in a variety of styles that produce either a sensation of heat or cold. These creams do not speed healing, but may provide temporary relief. Their effect is to pleasantly irritate the skin by stimulating the highly sensitive surface nerves, so that your brain can temporarily "forget" about your underlying deeper pain.
✓ Sports creams have no known side-effects when applied in small amounts but do not apply more than a 2-3 of times per day unless otherwise directed.
Here are a few pointers for selecting your racquet:
✓ Improper grip size is a known contributor to elbow problems. When you grip the racquet, you should be able to snuggly slide the index finger of the other hand between the tips of your fingers in the base of your palm.
✓ A good grip overwrap can help prevent slipping and decrease the amount of force required to hold the racquet. (Factor the extra wrap into grip size, though)
✓ Players should quickly release their grip tightness after ball-to-racquet strike in order to reduce stress on the elbow.
✓ Increasing the size of your racquet head can help to reduce arm stress.
✓ Avoid choosing “longer” or “heavier” racquets that will increase the amount of stress on your elbow.
✓ Graphite is a light racquet but does not absorb vibration well. When possible, choose a more flexible frame that helps to absorb some of the shock of the ball’s impact.
✓ Avoid playing with old or wet tennis balls as the additional speed and mass of the ball increases stress on your elbow. “Softer” or “stage 2” tennis balls weigh less than standard tennis balls which will produce less stress on your elbow when you strike the ball. These balls can also slow down the game slightly.