Ankle Sprains

Rolled Ankle

Many of us have experienced or will experience rolling our ankle inwards at some point in our lives. This is called a lateral ankle sprain and is a very common injury especially among younger athletes. In fact, there are approximately 2 million ankle sprains each year.1 Despite this occurring so frequently, only 50% of people who do sprain their ankles seek medical attention.2 Of those who do seek care, only 1 in 10 see a Physical Therapist within 30 days of the injury.3 There are many hypotheses for why people do not seek medical help for this issue. One reason is that many people believe the issue will just resolve on its own. But the truth is that a large percentage of people do not achieve full recovery after this injury. 

Within 3 years after an ankle sprain, 1 in 4 people continue to have issues of instability of the ankle and 1 in 5 will sprain their ankle again.4 Anywhere from 55-85% of people who sustain an ankle sprain consider themselves fully recovered 3 years after the initial ankle sprain.4 That’s a large amount of people who continue to have issues after spraining their ankle.

Why does it matter if I keep spraining my ankle?

Ankle sprains can be painful, can create swelling in the ankle, and can also cause concurrent injuries all of which can lead to abnormal mechanics impacting walking, running, and sports performance.4

Who gets ankle sprains?

Risk factors for acute ankle sprains include4

  • History of previous ankle sprain
  • Decreased ability to lift the foot upwards
  • Not warming up properly
  • Not wearing external support
  • Not participating in neuromuscular re-training
  • Hip strength (specifically hip abduction and extension weakness)
  • Poor performance on balance and hopping tests
  • Participating in court sports

How can Physical Therapy help?

Thankfully, physical therapy can help to address many of these issues. Your PT can provide you with the best ways to improve ankle motion, leg strength, balance training, and many other strategies that can be utilized to decrease your pain, improve your function, and reduce your risk of spraining your ankle again so that you can get back to your favorite sport or activity.

Disclaimer

Several injuries can be caused by rolling your ankle that may not benefit from the information above. A Physical Therapist is trained to determine the cause and how to resolve your symptoms. If you are dealing with this issue or other musculoskeletal-related problems, please feel free to contact our office, and we can schedule a visit. Why waste time when you can get back out on the track, back in the gym, or just be able to function through your everyday life without discomfort with the help of physical therapy?

References:

  1. Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of Ankle Sprains and Chronic Ankle Instability. J Athl Train. 2019;54(6):603-610. doi:10.4085/1062-6050-447-17
  2. Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British Journal of Sports Medicine 2018;52:956.
  3. Feger MA, Glaviano NR, Donovan L, Hart JM, Saliba SA, Park JS, Hertel J. Current Trends in the Management of Lateral Ankle Sprain in the United States. Clin J Sport Med. 2017 Mar;27(2):145-152. doi: 10.1097/JSM.0000000000000321. PMID: 27347860.
  4. Martin RL, Davenport TE, Fraser JJ, Sawdon-Bea J, Carcia CR, Carroll LA, Kivlan BR, Carreira D. Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021. J Orthop Sports Phys Ther. 2021 Apr;51(4):CPG1-CPG80. doi: 10.2519/jospt.2021.0302. PMID: 33789434.

Heel Pain

You might be excited to start a regimen of a daily run, bike ride, or walk. But then, over the first few weeks, you develop pain on the bottom of your heel. When motivation has finally gotten you off the couch and into your workout shoes, this small area at the bottom of your foot is now keeping you from reaching your fitness goals.

This pain on the bottom of your foot could be related to plantar fasciopathy (commonly referred to as plantar fasciitis). You may have heard of this condition before but do not know the details of how it develops or how it can be treated.

What is the plantar fascia?

Also called the plantar aponeurosis. This fascia helps to maintain the longitudinal arches of the foot. It consists of 3 bands that run from the front of the bone at the heel (calcaneus) to the bones that sit just before the toes (metatarsal heads).1 The fascia tense when the toes lift up and relax when the toes curl down.1 This process helps the foot conform to different surfaces.1 It provides shock absorption when the foot is flat and creates a stiffer surface to push off of when the toes are extended.

What is Plantar Fascitis/Fasciopathy?

The exact cause is still up for debate, but many theorize the condition is an overuse syndrome of the plantar fascia caused by repetitive loading, such as with a recent increase in running or walking distances, intensity, or frequency.2

Those who have an increased risk of developing this condition include:3

  • People with decreased motion when lifting the foot upwards
  • Jobs that require standing on hard surfaces for long periods of time
  • Running, especially on hard surfaces and/or with recent increase in running intensity and duration3,4
  • Increased body mass in those who are not athletic

Common symptoms include:3

  • Pain in the inner heel after the first step or after inactivity
  • Pain in the inner heel that worsens with prolonged activity

How do is Plantar Fascitis treated?

There is a widespread belief that this condition will resolve on its own, but treatment has been shown to decrease the severity and help people return to their daily activities faster than just taking a wait-and-see approach.5 Why wait to see how long it takes to go away, if at all when you could come to physical therapy and stop this issue once and for all?

What will your physical therapy sessions look like?

Your Physical Therapist will help reduce pain and improve your function using a combination of manual therapy techniques in conjunction with exercise. We will use various stretches to improve how your ankle and foot move and taping to provide short-term relief of symptoms.1 We will also take the time to educate and discuss the best ways to increase exercise intensity and duration so that your body can adapt to where you need to be to achieve your goals.

Disclaimer: Several conditions can cause heel pain other than plantar fasciitis. Other causes of this pain may not benefit from the advice shown above. However, you could still benefit from physical therapy to determine the cause and how to resolve your symptoms.

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References:

  1. Neumann, D. A. (2016). Kinesiology of the musculoskeletal system (3rd ed.). Mosby.
  2. Plantar Fasciitis. Rehabilitation Reference Center (RRC). March 2020. Accessed May 23, 2021. http://search.ebscohost.com/login.aspx?direct=true&db=rrc&AN=2009544221&site=eds-live
  3. Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, McDonough CM; American Physical Therapy Association. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014 Nov;44(11):A1-33. doi: 10.2519/jospt.2014.0303. PMID: 25361863.
  4. Di Caprio F, Buda R, Mosca M, Calabrò A, Giannini S. Foot and lower limb diseases in runners: assessment of risk factors. J Sports Sci Med. 2010;9:587-596.
  5. Plantar Fasciitis: Will Physical Therapy Help My Foot Pain? J Orthop Sports Phys Ther. 2017 Feb;47(2):56. doi: 10.2519/jospt.2017.0501. PMID: 28142369.

Physical Therapy for Headaches

Physical Therapy for Headaches

Headaches can be a painful condition for many individuals, impacting their everyday activities. There are many different types of headaches including migraines, tension-type headaches, cluster headaches, cervicogenic headaches, and many more. Determining the best treatment options for each of these can be a daunting task with options including medications, surgeries, modalities, etc.

Physical therapy could be an option for you if you are someone who suffers from headaches. Research has shown that the presence of neck pain in those with headaches is as high as 68.4%.1 There is also a higher chance of suffering from myofascial tenderness, which is a condition treatable by Physical Therapists.1

Headaches can be caused by many different issues some of which may need immediate medical attention. Physical Therapists are trained to determine when a headache can be managed by therapy or if it requires treatment from another healthcare provider.

Which headaches can we treat?

Cervicogenic Headaches (CGH)

Physical therapy has been shown to improve CGHs, which are classified as a condition where pain is referred to the head and/or face from the cervical spine.4 There are many areas of the neck that can create symptoms in the head and face, creating these headache sensations.4,5,6 These headaches often present on one side of the head traveling from the base of the skull to the eye and worsen with neck movements or being in one position for a long period of time.4,5 CGHs impact as high as 2.5% of the general population and can be as high as 20% in patients with chronic headache.6 Over half of people who have suffered from a previous neck injury also have a CGH.

How do we treat this?

Evidence-based treatments that are shown to improve this condition include but are not limited to manual therapy for the neck and upper back, exercises geared towards strengthening the often neglected deep neck flexors, and progressive resistance exercise for the shoulder blade and upper back.4 Symptoms have been shown to resolve within 3 months after successful treatment of the involved area.7

Tension-Type Headaches (TTH)

Tension-Type Headaches often present with face and neck muscle tenderness when episodes occur.5 TTHs occur on both sides of the head and present with a pressing or tightening sensation around the head.5 They often are not aggravated by routine physical activity and do not present with nausea or vomiting. It is estimated that approximately 40% of the US population suffers from Tension Type Headaches, more commonly in women younger than 40 years of age.8

How do we treat this?

Physical Therapy has not been shown to completely cure tension headaches, but instead can reduce the intensity, frequency, and duration of the pain associated with these headaches.9 Individuals also report improved quality of life and neck motion with treatment.9 Soft tissue mobilization, cervical manual therapy, therapeutic exercise, and dry needling are just some of the evidence-based interventions we can use to help with this condition.9,10,11,12 Physical Therapy Plus is one of the few clinics locally that provides dry needling as an intervention choice with 3 of our clinicians certified in this area.

Disclaimer

Several conditions can cause headaches other than the conditions listed in this article. Other causes of this pain may not benefit from the advice shown above. Signs and symptoms that require immediate medical attention along with the headache include:

  • Fever, muscle pain, and weight loss
  • Changes in cognition, mental function, personality changes, and/or sensation or weakness in other parts of the body
  • Sudden and severe headache that may or may not occur with strenuous activity
  • Having new onset of headaches at an older age of greater than or equal to 50
  • If this new headache is different from previous headaches such as more severe, frequent, or presents with new symptoms

Please seek medical attention immediately if you fit any of the criteria listed above. These could indicate a more serious and potentially harmful issue causing your headaches that require immediate treatment.

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References

  1. Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia. 2015 Mar;35(3):211-9. doi: 10.1177/0333102414535110. Epub 2014 May 22. PMID: 24853166.
  2. Magarey ME, Rebbeck T, Coughlan B, et al. Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Man Ther. 2004;9:95–108.
  3. Childs JD, Flynn TW, Fritz JM, et al. Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty. J Orthop Sports Phys Ther. 2005;35:300–306.
  4. Neck Pain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther. 2017 Jul;47(7):511-512. doi: 10.2519/jospt.2017.0507. PMID: 28666402.
  5. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. PMID: 23771276.
  6. Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 Suppl 2):16S–22S.
  7. Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, Molina-Rueda F. Manual therapy in adults with tension-type headache: A systematic review. Neurologia. 2018 Mar 7:S0213-4853(18)30013-6. English, Spanish. doi: 10.1016/j.nrl.2017.12.004. Epub ahead of print. PMID: 29525399.
  8. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998 Feb 4;279(5):381-3. doi: 10.1001/jama.279.5.381. PMID: 9459472.
  9. Del Blanco Muñiz JA, Zaballos Laso A. Cefalea tensional. Revisión narrativa del tratamiento fisioterápico [Tension-type headache. Narrative review of physiotherapy treatment]. An Sist Sanit Navar. 2018 Dec 26;41(3):371-380. Spanish. doi: 10.23938/ASSN.0379. PMID: 30425380.
  10. Gildir S, Tüzün EH, Eroğlu G, Eker L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine (Baltimore). 2019 Feb;98(8):e14520.
  11. Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Effectiveness of dry needling for headache: A systematic review. Neurologia. 2020 Jan 13:S0213-4853(19)30144-6. English, Spanish. doi: 10.1016/j.nrl.2019.09.010.
  12. Van Suijlekom HA, Lame I, Stomp-van den Berg SG, et al. Quality of life of patients with cervicogenic headache: a comparision with control subjects and patients with migraine or tension-type headache. Headache. 2003;43:1034–1041.

Shoulder Injuries

What is the shoulder composed of?

The shoulder (shoulder girdle complex) is commonly thought to be made up of just one joint, but in fact there are 4 different joints that help the shoulder function. All 4 of these joints must be working properly to attain full motion of the shoulder. These 4 joints include:1

  • Glenohumeral- head of the shoulder in the socket
  • Sternoclavicular- collar bone connecting to your sternum
  • Coracoclavicular- shoulder blade to the collar bone
  • Scapulothoracic- shoulder blade to the middle of your back

The majority of your motion (2/3rds) comes from the glenohumeral joint and a 3rd comes from the scapulothoracic.1 Conditions such as arthritis, causes the individual to use more shoulder blade motion than from the shoulder itself. The body is smart in that we try to avoid motions in areas that are painful, but then we start to rely on different areas to pick up the slack. This can lead to faulty movement mechanics that may lead to pain and discomfort.

The importance of the shoulder blade (scapula)

The scapula is an often-overlooked area for many healthcare practitioners. It helps to connect the shoulder to the skeleton. The scapula’s role is to1

  • Help stabilize the shoulder within the joint
  • Allows for greater motion of the shoulder
  • Serve as an area of attachment for 17 different muscles in the body!

In order for the scapula to work properly, a balance between different muscles in the front and back of the body are needed. Imbalances can also lead to faulty movement patterns that may lead to pain, discomfort, and/or poor performance.2

The role of the rotator cuff

This is the most well recognized area of the shoulder but is often not well understood and can place a lot of fear in the everyday person. The rotator cuff is a group of 4 different muscles that attach from the shoulder blade to the head of the shoulder (humeral head).2 They each have an important role in stabilizing the shoulder at rest or with activity and help to move the shoulder in different directions.2,3

These 4 muscles include:2

  1. Supraspinatus- raises the arm such as with reaching overhead
  2. Infraspinatus- turns the shoulder outward as in starting a lawnmower
  3. Teres Minor- also turns the arm outward but more so with the arm overhead such as combing your hair
  4. Subscapularis- turns the arm inward such as reaching behind your back to fasten a bra or throwing a baseball

Shoulder injuries

There are a lot of different shoulder injuries out there that can impact your everyday function. Here are just a few.

1. Rotator Cuff Injury

As described above, the rotator cuff is very important for daily shoulder motion and stability. Injuries to this group of muscles comes in all shapes and sizes and can occur from a fall or from overuse.3 Tears can range in a variety of different sizes and can be treated most commonly with Physical Therapy or surgery depending on the patient’s history and extent of the tear.3 One thing to note is that after a certain age, most of us will have some sort of tear in our rotator cuff muscles. This can be a normal part of aging and does not necessarily mean you will need surgery.

Overuse can occur in those who do repetitive overhead motions of the shoulder or recently participated in a more strenuous job or recreational activity (ex. starting tennis 7 days a week without playing before).3 Often times our best remedy for treating this is taking a step back from the activity and then slowly building back up.

2. Shoulder impingement (Subacromial Pain Syndrome)

There are several different types of shoulder impingement. The most commonly recognized hypothesis is that impingement occurs when the rotator cuff, shoulder bursa, or tissue in the shoulder is compressed between the humeral head and shoulder blade/collarbone.4 This can be due to many reasons including the shape of our shoulder blade, weakness of the shoulder muscles causing increased movement of the humeral head, and bony changes within the shoulder complex.4 Although the cause is still up for debate, the condition is defined as a non-traumatic, shoulder problem that causes pain localized to the front of the shoulder (acromion) that often worsens with lifting of the arm.4

3. Frozen Shoulder (Adhesive Capsulitis)

To this day there is still no definitive consensus for why this occurs. Some people are more at risk including those with a history of thyroid issues and diabetes.5 The condition is characterized by the development of adhesions and thickening, of the shoulder capsule.5 People often complain of a loss of motion and increased pain without any specific event they can associate with this issue.

4. A neck issue (cervical referral/radiculopathy)

Many issues related to the neck can be felt in the shoulder. This can include many different structures in the cervical spine that are perceived in the shoulder or below.6 One tell-tale sign for if an issue in the shoulder is in fact coming from somewhere else such as the neck, is if symptoms are felt past the elbow. Most often, issues perceived below the elbow are in fact caused by somewhere other than the shoulder.

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References

  1. Neumann, D. A. (2016). Kinesiology of the musculoskeletal system (3rd ed.). Mosby.
  2. Reinold MM, Escamilla RF, Wilk KE. Current concepts in the scientific and clinical rationale behind exercises for glenohumeral and scapulothoracic musculature. J Orthop Sports Phys Ther. 2009;39(2):105-117. doi:10.2519/jospt.2009.2835
  3. Weber S, Chahal J. Management of Rotator Cuff Injuries. J Am Acad Orthop Surg. 2020;28(5):e193-e201. doi:10.5435/JAAOS-D-19-00463
  4. Diercks R, Bron C, Dorrestijn O, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314-322. doi:10.3109/17453674.2014.920991
  5. Kelley MJ, Shaffer MA, Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther. 2013;43(5):A1-A31. doi:10.2519/jospt.2013.0302
  6. Neck Pain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther. 2017 Jul;47(7):511-512. doi: 10.2519/jospt.2017.0507. PMID: 28666402.

Cubital Tunnel Syndrome

Most people are familiar with Carpal Tunnel Syndrome, but did you know the second most common nerve entrapment in the arm occurs at the elbow?1 This condition is known as Cubital Tunnel Syndrome and occurs when inflammation of the Ulnar Nerve occurs as it passes through the shallow inner tunnel of the elbow.1

Who is affected by Cubital Tunnel Syndrome?

This injury often occurs in throwers due to the large amounts of stress placed on the elbow or with activities that cause long periods of the elbow in a bent position such as long-range bicycling.2

What are the symptoms of Cubital Tunnel Syndrome?

Cubital Tunnel Syndrome can present with:1,3

  • Numbness and tingling along the ring and little finger
  • Inner elbow pain
  • Loss of coordination or clumsiness in the hand and fingers
  • May have non-painful snapping or popping in the elbow with active and passive motion at the elbow

How is Cubital Tunnel Syndrome diagnosed?

Your Physical Therapist will take you through a series of tests to make sure your symptoms are in fact coming from the elbow. Many of the symptoms listed above could be related to issues of the neck, nerves in the shoulder, as well as referred pain from different organs, so ruling out these other issues is paramount.1,3

How can Your Physical Therapy help?

We will use a series of treatment techniques, exercises, and education to help improve your symptoms. These can include but are not limited to:4,5

  • Figuring out which lifestyle and behavioral changes will reduce pressure on this nerve
  • Provide stretches and manual therapy to improve flexibility at sites of compression
  • Strengthen surrounding structures to reduce stress on the area
  • Nerve gliding exercises to reduce symptoms

What if I had surgery for this, can I still benefit from physical therapy?

Absolutely! Despite the surgical technique used, those who have had surgery for this condition can benefit from physical therapy. After the typical 1-3 weeks of being immobilized, it is important to help alleviate the effects of not moving with strengthening and mobility exercises within the safety of your post-surgical precautions.5

Disclaimer: There are many conditions that can present as Cubital Tunnel Syndrome. Other causes of this pain may not benefit from the advice shown above. However, you could still benefit from physical therapy to determine the cause and how to resolve your symptoms.

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References

  1. Assmus H, Antoniadis G, Bischoff C, Hoffmann R, Martini AK, Preissler P, Scheglmann K, Schwerdtfeger K, Wessels KD, Wüstner-Hofmann M. Cubital tunnel syndrome – a review and management guidelines. Cent Eur Neurosurg. 2011 May;72(2):90-8. doi: 10.1055/s-0031-1271800. Epub 2011 May 4. 
  2. Aldridge JW, Bruno RJ, Strauch RJ, Rosenwasser MP. Nerve entrapment in athletes. Clin Sports Med. 2001 Jan;20(1):95-122. doi: 10.1016/s0278-5919(05)70249-0. PMID: 11227711.
  3. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther. 2005 Jun;28(5):345.
  4. Caliandro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2016 Nov 15;11(11):CD006839. doi: 10.1002/14651858.CD006839.pub4. PMID: 27845501; PMCID: PMC6734129.
  5. Mazurek MT, Shin AY. Upper extremity peripheral nerve anatomy: current concepts and applications. Clin Orthop Relat Res. 2001 Feb;(383):7-20. doi: 10.1097/00003086-200102000-00004.

Tendonitis vs Tendonosis

When someone is experiencing an issue with their tendons, many may assume it is tendonitis such as Achilles tendonitis, patellar tendonitis, tennis elbow (lateral epicondylitis), or rotator cuff tendonitis. A tendonitis is inflammation of the tendon caused by too much load often associated with an episode of lifting too heavy or a sudden strenuous event.1 For many people with tendon injuries, there is no specific event that can contribute to their symptoms and in fact occur gradually over a long period of time. There also may not be the presence of inflammation and swelling.1,2 This is why symptoms can continue to persist despite doing things like icing the area and/or taking anti-inflammatory medications. If there is no inflammation and swelling, then these will be ineffective treatment options.

If it is not tendonitis, then what is it?

Tendinopathy is the term used to describe all issues pertaining to tendons such as tendonitis and tendinosis.2 Tendinosis is the term used to describe issues with the tendon as a result of overuse, usually occurring over longer periods of time.2 A number of different activities can fit this description, but the main contributor is the repetitive nature of the activity. Examples can include running, repeated use of a screwdriver, typing, swinging a tennis racket, etc. The main driver is that the level of activity exceeds our ability to recover from the task.

Why is it important to know the difference?

The treatment for tendonitis vs tendinosis varies greatly. For example, tendonitis includes swelling and inflammation and may benefit from treatments focused on reducing this swelling.2 This includes anti-inflammatory medications or the well-known treatment option of RICE (rest, ice, compression, elevation). But if the issue is tendinosis, then inflammation is not the major driving contributor to pain, and these treatments will not resolve symptoms. Tendinosis will benefit more from gradual strengthening to improve the tendon’s ability to handle the demands placed upon it.3,4,5

How will your Physical Therapist treat tendinosis?

This depends on a number of different factors. For instance, the early stages of the condition can heal in just a few weeks or months while more chronic issues can take up to a year or more in duration.1,2,3 Also, the location of symptoms may play an important role where the treatment approach to Achilles tendinosis could look different from Patellar tendinosis.4,5 It is our job, to determine the best treatment route, work strategies, and progression in order to resolve your issue.

Some potential interventions Your Physical Therapy may use include:2,4,5

  • Work and daily activity modifications
  • Manual therapy
  • Gradual strengthening

Disclaimer: There are a number of different causes of symptoms that may present as tendon-related issues. A Physical Therapist is trained to determine the cause and how to resolve your symptoms.

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References:

  1. Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res. 2015;33(6):832-839. doi:10.1002/jor.22806
  2. Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork. 2012;5(1):14-17. doi:10.3822/ijtmb.v5i1.153
  3. Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?. Br J Sports Med. 2016;50(19):1187-1191. doi:10.1136/bjsports-2015-095422
  4. Figueroa D, Figueroa F, Calvo R. Patellar Tendinopathy: Diagnosis and Treatment. J Am Acad Orthop Surg. 2016;24(12):e184-e192. doi:10.5435/JAAOS-D-15-00703
  5. Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020;55(5):438-447. doi:10.4085/1062-6050-356-19
  6. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies.

IT Band Syndrome

When the days become longer and the weather gets nicer, you might find yourself itching to get outside and enjoy your favorite outdoor activities, like riding your bicycle or going for a run. After resuming your favorite outdoor activities, you might quickly start to notice pain and discomfort on the outside of the lower thigh and knee. This pain on the outside of the knee could be related to Iliotibial Band/Friction Syndrome (ITBS).

What is the Iliotibial band?

It’s actually not a muscle! The IT band (ITB) is a dense fibrous band of tissue that covers the outer side of the thigh and connects primarily to a muscle at the hip (Tensor Fascia Latae) and partially to the gluteus maximus.1 It then travels down the outside of the thigh to the outside of the shin bone.1

The IT band does not create the motion but creates movement through tension created by the hip muscle. The role of this muscle at the hip (Tensor Fascia Latae) is to bring the hip backward, to the side, and turn the hip inwards.2 The muscle also assists in keeping the pelvis level when standing on one leg and helps to straighten or bend the knee depending on its position.2

Who gets Iliotibial Band/Friction Syndrome (ITBS)?

Roughly 15% of knee injuries in bicyclists and 10% of running-related injuries are related to Iliotibial Band Syndrome (ITBS).3,4 While there is some debate for the cause, some believe it is the repetitive bending and straightening of the knee causing recurring friction of the IT band. This can lead to increased pain and discomfort on the outside of the knee, during activities such as cycling and jogging.4

Risk factors5

  1. A drastic increase in exercise volume
  2. Riding or running the same route over and over again
  3. Decreased length of the IT band and Tensor Fascia Latae

How can YPT help?

Your Physical Therapy can help resolve this issue by addressing training errors, improving muscle strength, and increasing flexibility depending on your needs and impairments. If you want to hit up the trails, but are dealing with this annoying issue, let us know in the contact box below and we will get you started with a free phone consultation and have you on your way to enjoying your favorite outdoor activities again in no time!

Disclaimer: Several conditions can cause knee pain other than ITBS. Other causes of this pain may not benefit from the advice shown above. However, you could still benefit from physical therapy to determine the cause and how to resolve your symptoms. If you are dealing with this issue or other musculoskeletal-related problems, please contact YPT to schedule your free phone consultation.

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References

  1. Neumann DA. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010 Feb;40(2):82-94. doi: 10.2519/jospt.2010.3025.
  2. Neumann, D. A. (2016). Kinesiology of the musculoskeletal system (3rd ed.). Mosby.
  • Ménard M, Lacouture P, Domalain M. Iliotibial Band Syndrome in Cycling: A Combined Experimental-Simulation Approach for Assessing the Effect of Saddle Setback. International Journal of Sports Physical Therapy. 2020;15(6):958-966.
  • Charles D, Rodgers C. A Literature Review and Clinical Commentary on the Development of Iliotibial Band Syndrome in Runners. International Journal of Sports Physical Therapy. 2020;15(3):460-470. doi:10.26603/ijspt20200460
  • Dressendorfer R. Iliotibial Band Syndrome. Richman S, ed. CINAHL Rehabilitation Guide. October 2018.