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In Part 1 of this series we talked about what Iliotibial (IT) Band pain is and the risk factors for developing it. In this blog post we will briefly discuss the common myths associated with this condition to further deepen the reader’s understanding.


Myth #1

Stretching the IT Band is important for recovery or prevention of IT Band pain -

We once thought that the IT Band could be stretched; however, this does not seem to be the case. A recent study showed no effect with stretching on short-term IT Band stiffness (2).



Even if we could change the length of the IT Band through stretching, it may not make sense to do so. Runners making a successful recovery from IT Band pain actually show increased stiffness in the IT Band, similar to individuals recovering from tendon injury. This increased stiffness is a favorable adaptation and something we are trying to achieve with the rehabilitation process.





Myth #2

Foam rolling will help my IT Band -

This is a similar discussion to the previous myth. The aforementioned study also looked at foam rolling the IT Band and found no difference in short-term stiffness. And again, a decrease in stiffness likely is not favorable.


IT Band pain also seems to be a compressive issue. Adding more compression is counterproductive.


Myth #3

Deep tissue massage or Instrument Assisted Soft tissue Mobilization (IASTM) will help with recovery -

A common thought is that deep tissue massage or IASTM will break up scar tissue or adhesions and loosen the IT Band. This makes sense in theory, but unfortunately does not play out in real life. And again, we want more stiffness in the IT Band during the recovery process so even if we could slacken the IT Band, why would we?



You may feel better initially with foam rolling, deep tissue massage, or IASTM; however, we are confident that this temporary decrease in pain is related to central desentization and is only transient, typically lasting for one hour or at most 24 hours. Let’s use this analogy as an example…The volume on your stereo is set to level 10. Your kid comes in and cranks it up to level 20! You request that he or she turn it back down to level 10 and now, level 10, seems quieter than before. Here’s a paper that describes this phenomenon.


Myth #4

I’ll just rest and it will get better -

As discussed in part I of this series, total rest is not the answer. This may be appropriate in the very short term as the sharp pain subsides, but by completely resting the runner is unknowingly causing the IT Band to lose even more load capacity.


Avoidance of loading the sensitive structure is also known as stress shielding, and is the incorrect way of going about rehabbing the IT Band.


Here’s how the cycle plays out – Injury occurs – runner offloads the IT Band, and unknowingly loses capacity – runner now has decreased or no pain – runner returns to running too quickly – re-injury/re-exacerbation occurs.










Figure 3: Cycle of loss of load capacity (taken from Dr. Rich Willy Etiology & Assessment)



Myth #5

LOCATION. LOCATION. LOCATION. IT Band is a hip and lateral thigh problem -

This is in fact, incorrect. Many think because the IT Band courses the length of the lateral glute and thigh, that pain in this region is associated with the IT Band. IT Band pain is characterized by localized pain at the lateral knee, hence the name, “Runner’s Knee.”



Myth #6

My IT Band is INFLAMED so I need ice and NSAIDs -

This is a logical thought, because something in that region is clearly irritated. However, we now know that inflammation is not the driving factor for IT Band pain. With inflammatory conditions, immune cells are always present, and with IT Band pain these immune cells are absent.




We hope this article was informative and helped clear up any misinformation you may have received in the past. Don’t forget to share this with a friend to help save time and money spent on ineffective treatment.

We successfully help runners and other athletes recover from IT Band pain all the time! If you need guidance in recovering from an injury, schedule an appointment, and we’ll help you get back to doing the things you love!



References:

  1. Aboodarda, S. J., Spence, A. J., & Button, D. C. (2015). Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage. BMC Musculoskeletal Disorders, 16(1). https://doi.org/10.1186/s12891-015-0729-5

  2. Pepper, T. M., Brismée, J.-M., Sizer Jr, P. S., Kapila, J., Seeber, G. H., Huggins, C. A., & Hooper, T. L. (2021). The immediate effects of foam rolling and stretching on iliotibial band stiffness: A randomized controlled trial. International Journal of Sports Physical Therapy, 16(3). https://doi.org/10.26603/001c.23606



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Part 1: understanding the condition


First off, there is very little quality evidence regarding the diagnosis and management of Iliotibial band pain, so much of this article is influenced from the work of Dr. Rich Willy and Tom Goom, Physiotherapist.


What is the Iliotibial Band Pain?


Iliotibial (IT) Band pain, also referred to as IT Band Pain Syndrome or IT Band Friction Syndrome, is common in runners and cyclists, and is the primary source of lateral knee pain in runners. Pain is localized over the lateral femoral epicondyle (see photo below) as the knee flexes and extends over an arc of roughly 25-35 degrees of knee flexion, classically known as the impingement zone (2). Knee pain is reproduced as the hip extends while the knee flexes as the tensor fascia latae musculature is loaded eccentrically, as with downhill running or stair descent. Runners with acute IT Band pain describe the pain as sharp and intense, often stopping them right in their tracks.


Quick Anatomy Review -


The gluteus maximus and tensor fascia lata muscles attach to the IT Band at its proximal end. The IT Band has extensive distal attachments, which include the patella, patellar

tendon, the lateral femoral condyle, the fibular head, and gerdy’s tubercle located on the anterolateral aspect of the tibia. It is also attached to the femur along its entire length. All of these attachments contribute to its quite robust structure.



So who gets IT Band Pain?


Novice male runners seem to have the highest propensity to develop IT Band pain. This is typically from being overzealous and doing too much too soon, which may also occur in experienced runners returning to sport after some time off. All running injuries are considered to be training load injuries.


Runners who rapidly increase running volume, particularly downhill, are at risk for IT Band

pain (2).

Figure 1.

Long and steep mountain descents while hiking may also lead to acute injury of the IT Band. Running with a narrow stance

width, as seen with single track trail running (see Fig. 1), increases the strain on the IT Band. This is known as a crossover gait pattern, which involves higher amounts of hip adduction.


Most importantly, a runner may participate in the aforementioned activities and possess relatively low tissue capacity, but the onset of symptoms will likely not occur without a rapid increase in training loads. Once the IT Band becomes acutely sensitive, relatively benign tasks such as descending stairs may be very painful. In most simple terms, the runner is no longer tolerating the load requirements at the lateral knee. The graph below (figure 2) does a great job of showing the relationship between the load demands of the task vs. the current load tolerated by the runner.




Should I just rest?


A common recommendation given by medical professionals is, “Well if it hurts to run, stop running.” This may be appropriate in the very short term as the sharp pain subsides, but by completely resting the runner is unknowingly causing the IT Band to lose even more load capacity.


Avoidance of loading the sensitive structure is also known as stress shielding, and is the incorrect way of going about rehabbing the IT Band.


Here’s how the cycle plays out – Injury occurs – runner offloads the IT Band, and unknowingly loses capacity – runner now has decreased or no pain – runner returns to running too quickly – re-injury/re-exacerbation occurs. (See Figure 3.)


Figure 3: Cycle of loss of load capacity


This cycle may repeat itself for a year or more, leaving the runner feeling very frustrated and defeated. IT Band pain is not a self limiting condition, meaning it typically does not resolve on its own over time if training loads remain unchanged. This is why early intervention is recommended from a qualified healthcare professional or running expert who has experience working with runners.


In part 2 of this blog series we will debunk some of the common myths around IT Band pain and in part 3 we will discuss rehab and return to sport recommendations.


References:

  1. Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport. 2007;10:74-76.

  2. Iliotibial Band Pain in the Runner Part 1: Etiology and Assessment. (2019, August 21). Physio Network. https://www.physio-network.com/blog/iliotibial-band-pain-in-the-runner-part-1-etiology-and-assessment/

  3. Orchard JW, Fricker PA, Abud AT, Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996;24:375-379.

  4. Van der Worp MP, van der Horst N, de Wijer A, Backx FJ, Nijhuis-van der Sanden MW. Iliotibial band syndrome in runners: a systematic review. Sports medicine. 2012;42:969-992.



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Updated: Apr 25, 2022


The Y Strap Adjustment has recently become popularized by a surge of Chiropractors filming and posting their treatment videos on YouTube. Due to the high volume of questions regarding this treatment, I will attempt to answer the most common questions I am asked in a Q&A format based on my personal experience.


Why do I use the Y Strap?

I have personally found the Y Strap to be the most relieving adjustment out of all adjustments for my patients and also, to have done on myself. With that being said, it is not for everyone. However, I would estimate that for 80% of my patients it is their absolute favorite adjustment they have ever had.

Is the Y Strap Adjustment Safe?

Do I need the Y Strap?

Does the Y Strap hurt?

How does the Y Strap work?

Can the Y Strap make you taller?

How often can the Y Strap be done?

Can I workout after the Y Strap adjustment?

What conditions does the Y Strap work best for?

What can I expect to feel with the Y Strap adjustment?

How is the Y Strap different from traditional spinal decompression?


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