Is it normal to have a tight IT band?

Everyone has a tight IT band, right?

Anyone who has had massage or soft tissue work done on a tight IT band will know exactly how tight and tender this area can get. It really is quite horrible.

For those of you that haven't heard of the IT band before it is simply a piece of connective tissue that runs down the outside of the thigh. The IT band is short for the iliotibial band (sometimes also known as the iliotibial tract). Along with a muscle called call the tensor fascia lata the IT band helps stabilise the knee, from the outside, in weight bearing activities such as running and hiking.

A tight IT band can cause a number of problems such as anterior knee pain and IT band syndrome. It can get tight for a number reasons, however poor bio-mechanics in walking and running as demonstrated in the video in this blog post are most often related to increased tension in the IT band.

The two major tests that we use in the clinic to assess the tension in the IT band are:

Obers test

Thomas test 

In a significant number of cases we will find these tests show 'positive' results, indicating that the IT band is overly tight. There are many reasons for this including poor bio-mechanics as mentioned above. However, one aspect that must not be missed is that many people simply put their body under huge load without taking the appropriate measures to offset this load. High training volume, with poor postural patterns (e.g. poor sitting position at work), can lead to imbalances, increased tension and specific weaknesses in the tissue. If your training volume is high, and you are not carrying out regular basic maintenance on yourself, then it is very likely you will end up with a tight IT band and consequently injuries can occur.

So, back to the original question, 'Is it normal to have a tight IT band?' My answer, NO, it is not normal however it IS very common. For this reason it is hugely important to carry out regular self maintenance e.g. Foam rolling, mobilising, self trigger point work, stretching, glute and core strengthening exercises, balance and proprioceptive work as well as regular massage will all help reduce your chances of developing a tight IT band. 

What exactly is a tendonitis injury?

In its most basic terms a tendonitis injury is where a tendon - usually at its insertion point - becomes inflamed. The suffix ‘itis’ in the term tendonitis simply means inflammation.

You will also see tendonitis being spelt tendinitis - this isn't a different term; simply a spelling variation.

There are many examples of tendonitis injuries, some common ones are:

• Patella tendonitis
• Achilles tendonitis
• Rotator cuff tendonitis
• Bicipital tendonitis
• Tennis elbow / golfer’s elbow (both types of tendonitis)

Tendonitis injuries generally come about through over-use or repeated overload of the tendon.

Symptoms include a gradual onset of pain, aching in the tissue and localised tenderness at the injury site. Occasionally there will be reddening of the tissue around the injury site. There may also be palpable nodules on the tendon.

One problem with tendonitis injuries is that they are often mis-diagnosed. Many of these injuries are NOT inflammatory based, in many cases the tissue has degenerated instead. If this is the case the injury is now called a tendinosis and will need to be treated in a different way. Imaging, such as an ultrasound scan, can confirm which type of process has occurred.

As a general rule longer term degenerative tendinosis occurs in the slightly older patient. Inflammatory based tendonitis will occur in the younger to middle aged patient, though there is no consensus on the exact incidence of these injuries.

To confuse matters even further the term tendinopathy can also be used. This describes the overall symptoms of the injury and is an umbrella term which describes both pathologies i.e. a tendonitis or a tendinosis.

As stated previously, treatment for these injuries will differ depending on the exact underlying issue. In both cases, however, there will need to be a period of rest - or relative rest - to allow the tissue to respond to treatment. Biomechanical / technique issues will have to be assessed as more often than not these are contributing heavily to the tendon problem.

These types of injuries can be complex and will require very specific treatment plans.

However the main thing to take away from this blog post is to not 'work through' a problem like this. You must take early rest from any activities that aggravate the problem and seek advice early. These injuries are MUCH easier to address in their early stages of development rather then when they have become chronic.

In summary:

Tendonitis = an inflammatory based issue.

Tendinosis = a degenerative process

Tendinopathy = a ‘catch all’ term that could be a tendonitis or a tendinosis.

6 Great Core Stability Exercises

Why is core stability so important and how can I improve it?

The muscles in your core are very important to whole body function. During movement they keep your hips and spine in the correct alignment which in turn helps to prevent awkward and incorrect biomechanics. Poor biomechanics can lead to injury. For example if you are running and have poor core stability, your core muscles will weaken as you become fatigued and this usually lets your hips tilt forwards or side to side. This can put excessive strain on other muscles such as hamstrings/glutes and cause them to tighten and possibly tear.

So if you want to avoid injury I would strongly recommend adding a few of these exercises into your workout regime! Pick 2 or 3 to begin with and as you get better at them you can swap exercises or increase the number of sets and reps you are doing.

To start with try doing 3 sets of 10 reps or 30 seconds and progress from there.

These exercise videos were put together by a couple of friends and I at university and not only show you how to do the exercises but talk you through them as well.

1. Medicine Ball Twists

2. Sit Ups With Twist

3. Forward Plank

4. Side Plank

5. Superman

6. Trans Ab Heel Lowers

How to treat your own Knots and Trigger Points.

A tool to help trigger points - click picture

A knot is simply where a very localised section (or portion) of muscle has gone into a heavy spasm.

Everyone gets them and they tend to occur in very common areas.

One of the most common places that people get trigger points is the area just between the shoulder blades - running up to the base of the neck.

This blog post is going to teach you a very quick and practical way in which you can treat your own trigger points and knots - all you will need to do this is a tennis ball.

Before you read the rest of this post have a read of a previous post I wrote called - What is a trigger point (or Knot).

Trigger points respond very well to having direct pressure applied to them - this is something that you can do at home yourself. This can be supplemented with Sports Massage sessions at a sport's injury's or massage clinic.

This principle is very simple: you use a tennis ball (or 'back nobber' - pictured above) to apply pressure to your trigger points, in a kneading fashion.

How do I do it? The easiest way to apply the pressure is by trapping a tennis ball between a wall and your back (the area between the shoulder blades). You will need to make sure you have the ball positioned over a trigger point, though bear in mind you may have more than one trigger point in this area.

Once you have you have positioned the ball in the right place you should gently move side to side over the trigger point. This movement will be very small. If you have more than one trigger point, repeat the exercise where necessary.

How do I know I'm on a trigger point? This is simple. The areas that are tender will be the trigger points. As you move over them you might feel the tennis ball bump over the knot. You may have to move around a little to find the epicentre, but generally your instincts will tell you where to work.

How much pressure should I use? On a scale of 1-10 (1 = no pain / 10 = excruciating pain) aim for the mid numbers - 4, 5 or 6 - on that scale. You may feel like you want to go higher but avoid outright pain. A 'good discomfort' or a 'releasing discomfort is what you should be aiming for.

How long should I do this for? In the region of 1-5mins per trigger point. The main aim is to reduce your discomfort levels at the trigger point by about 50% before you move on to the next one. Ideally you will want to do this daily.

Finally, if your discomfort levels with the trigger points go up, it's likely you've used too much pressure initially. Leave the area for a couple of days to let it settle and try again with lighter pressure. If you are still having problems at that point then send us an email.

What to do with an Injury in the first 48hrs

Most people have heard of the principals of R.I.C.E when dealing with an acute injury...

• Rest
• Ice 
• Compression 
• Elevation

... However I have many people who'll come into the clinic after an acute injury and 9 times out of 10 I will have a conversation that will go along the lines of:

Me "Did you manage to ice the injury at all?"
Patient "No, I thought I'd leave it to see if it would settle down".
Me "Have you been able to put some light compression over the injury, since it happen?".
Patient "No, I didn't think of that".
Me "I take it you've been able to rest it and get it elevated in the evening then?".
Patient "Well I did a little bit on the first evening but...." 

And so the conversation goes on....

Avoid being the person in the scenario above - make sure you find time to look after you injury properly!

***

The point of this blog post is to stress that all the elements of the R.I.C.E protocol are simple to follow and combined they do make huge difference in improving the recovery rate of an injury.

If you see a premiership footballer or rugby player go over on their ankle their Physio / Sports Therapist / Club Doctor will follow all four of the R.I.C.E principals in the initial stages - so make sure you do the same for yourself.

Rest - For a lower limb (foot, ankle, knee, hip) injury try avoid walking or weight-bearing through the joint. Use crutches if you can get hold of them. In addition, do all that's possible to limit actions that are painful or that increase swelling. Having said that do not avoid movement of the injured joint or tissue 100%. Gentle PAIN FREE movements should be encouraged as early as possible, even if these movements are only very small at first.

Ice - This past blog post explains the use of ice in more detail - Click the link here for more info.

Compression - From my experience this is the most over looked principal of R.I.C.E - however it is arguably the most important aspect in managing the swelling brought about by your injury. Compressing the area will prevent the swelling pooling too heavily at the injury site. Tubigrip (available at Boots etc) or a bandage will work perfectly for getting some light compression over the injury site in most cases. Make sure you check the capillary refill (see video) in your fingers or toes to help make sure you haven't over tighten the compression.  

Elevation - as with compression, the aim of elevation is to prevent (or reduce) the amount of inflammation pooling at the injury site. By elevating the injury gravity can assist in draining the area. Make use of all the chances you have to get the injured area elevated.

So there is a basic outline of R.I.C.E and why it's important to follow. Just make sure you do it!

Hip, knee or ankle problems with running? (take the test)

Take the 30 second test below:

Step 1 - Stand on one foot and perform a single leg squat, go as deep as you can (or as far as your mobility will allow).

Step 2 - Watch yourself in a mirror and note what your movement looks like.

Step 3 - Now compare your movements to the video below.

Do your mechanics look more like the video on the RIGHT or the video on the LEFT?

The video above shows 2 different sets of mechanics. The left side shows 'good' mechanics, the right side is 'poor'.

You might need to watch the video several times but you will see in the right video the biomechanics are not as efficient as the video on the left.

In the video in the right you will see:

1. The knee drops in heavily (adducts and internally rotates).
2. The left hip drops and loses alignment (trendelenburg sign)
3. The general balance and proprioception is poor.

The single leg squat is a great way to assess for this type of poor mechanics. However you will generally find that if an individual presents with these mechanics in the test it will carry over into their walking or running pattern (or gait).

These type of poor mechanics (video on the right) are often linked to knee, shin, ankle and foot pain of various type. The reason for this is that the mechanics in this type of movement are poorly aligned and inefficient. The knock on from this is that tissues - muscles, tendons, ligaments, fascia and cartilage - are put under increased stress and are subjected to increased 'shear' forces.

The good news is that in most cases these poor mechanics can be corrected and are often linked to imbalanced or weak muscles (core / gluteals etc). However with simple rehabilitation exercises these problems can largely be corrected.

Now before I finish I have to say that what is written above is a very simplified version of what can occur,  but the purpose of this post was to present the basics of what poor running mechanics can look like.

If you need a more in-depth analysis it's best to book an appointment with one of us.

Stretching Your Hamstrings - 9 different variations for you.

We often get asked at the clinic about how best to stretch the hamstrings. 

The truth is there is not a single method that is 'best' for all people and all injuries. 

Some stretches work better for certain problems. This is largely due to the fact that different stretches will bias (or target) different aspects of the muscle and different methods change the 'type' of stretch you get. 

In addition any experienced therapist will know that some individuals 'feel' a better stretch with one method when compared to another. This can vary from person to person. For that reason it's often best to try a few different methods of stretching, before deciding on which one to stick with.

Below are 9 different ways to stretch your hamstrings, try a few of them a 'feel' what works best for you:

For a full size printable copy of the stretches click here.

P.s. There are many more methods for stretching the hamstrings that are not included above, however this should be a good starting point.

P.p.s I have a couple of stretches that are my personal favourites. For example, the No1 stretch that I use is the second one from the bottom. There are a few reasons I prefer this stretch, but the reasons are a bit lengthy to go into on this blog post. Again this one doesn't work well for all people but it's one I use often.