Dr. Perry discusses the supraspinatus trigger points that play a role in rotator cuff, shoulder clickingsnapping, and subdeltoid bursitis pain complaints. Successful ITBS treatment understanding IT band anatomyby Brad Neal. Injury Rehab Information, ITB Syndrome    5. Comments    Affiliate Disclosure   ITB Syndrome is, I feel, a common running injury which is often treated poorly. This is despite the prevalence of ITBS amongst recreational distance runners. Id like to share with you how I treat runners with ITB Syndrome from a biomechanical and IT Band anatomy stand point and the success that can be achieved with the correct approach. FREE DOWNLOADRunners Knee Rehab Resources PDFIT Band Anatomy. Let us start by refreshing our IT band anatomy. XS.jpg' alt='Quadratus Femoris Activation Exercises' title='Quadratus Femoris Activation Exercises' />Anatomy of course should of course be the basis of all biomechanics. The IT Band commences with insertional fibres of both Gluteus Maximus and Tensor Fascia Lata and inserts into Gerdys Tubercle on the lateral aspect of the tibia, passing over the lateral femoral condyle. To protect the Iliotibial Band from the lateral femoral condyle there is either a bursa fluid filled sac or a layer of highly innervated fat that lies underneath the distal portion of the band 1. Quadratus Femoris Activation Exercises' title='Quadratus Femoris Activation Exercises' />The lower trapezius is the lowermost section of fibers in the trapezius muscle. It acts on the scapula, with its main role as the prime mover in scapular depression. Issuu is a digital publishing platform that makes it simple to publish magazines, catalogs, newspapers, books, and more online. Easily share your publications and get. The middle trapezius refers to the middle section of fibers in the trapezius muscle. It acts on the scapula and is the prime mover in scapular retraction. Want to improve your Mobility Include effective stretching techniques into your training program and increase your Range of Motion, flexibility and more. It is essential to remember that the Iliotibial Band is nothing more than a longitudinal fibrous reinforcement of the fascia lata and has no control over its own positioning or tone. The IT Band is often anchored to the intramuscular septum of the femur in a variety of places this is a natural variant of IT Band anatomy via fascial strands which pass through the periosteum lining of the bone, rather than merely attaching to the surface. The tension within the IT Band will ONLY increase when the origin andor insertion are moved further apart and we will discuss how this can occur later on. I would therefore question what one of the most common IT Band Syndrome treatment techniques employed to tackle ITBS, foam rolling, is physiologically achieving, attempting to release a non contractile tissue which has the tensile strength of steel and is anchored firmly to cortical bone. Image via afranklynmiller. Illustrated by Levent Efe. What Causes The Pain of ITB SyndromeId argue that this syndrome is one of compression as opposed to friction 1. The pain stimulus within ITBS is usually inflammatory, whereby either the bursa or fat pad is compressed against the lateral femoral condyle. This will occur whenever the IT Band is shortened by a change at either its origin or insertion. ITB Foam Roller Exercises Treatment for Iliotibial Band Syndrome Common features of inflammatory pain are that it is often worse with compression for example lying on the affected side or is most severe first thing in the morning. It will often respond well to oral Non Steriodal Anti Inflammatory Drugs NSAIDS, which are not contraindicated in such a condition as there is no collagen based healing that needs to occur. It is often clinically beneficial to have the region examined under real time ultrasound scan, which will determine the need for a guided corticosteroid injection, which can provide a positive reduction in symptoms in severely irritable cases. It is here that I will point out that the dreaded foam roller can often exacerbate patients symptoms, by further increasing the compression against the lateral femoral condyle. FREE DOWNLOADRunners Knee Rehab Resources PDFBiomechanical Dysfunctions. Hip Flexor Imbalance. One biomechanical flaw that will case a increased strain of the Iliotibial Band is Hip Flexor imbalance. Poor Iliopsoas function will result in a compensatory firing of Tensor Fascia Lata, which has the ability to assist with hip flexion because of its anatomical lever arm 2, 3. Over a period of time, the length of the Tensor Fascia Lata will reduce become hypertonic, which means that the Iliotibial Band origin is moved AWAY from the insertion. A secondary consequence is a rise in the anterior hip joint forces and an excessive abduction moment, which is counteracted by an additional compensation within Adductor Longus. An underactive Iliopsoas muscle is very common within running athletes who have a tendency to use Rectus Femoris, the main Quadricep muscle, to generate hip flexion, instead of Iliopsoas. This is an extremely common running technique flaw. The hypertonicity of Tensor Fascia Lata can be effectively treated with targeted soft tissue release. In my opinion this is most effectively performed with a large acupuncture needle, to manipulate the myofascial restriction and release any myofascial trigger points within the muscle. However, this can also be achieved with hands on soft tissue therapy if you prefer. For those of you that are fans of the dreaded foam roller, please roll local to the Tensor Fascia Lata roughly near your pocket on a pair of trousers, but remember that muscles and tendons arent amazed by compression either, and that you run the risk of causing Gluteus Medius tendinopathy as a result 4. Dynamic Knee Valgus. The most commonly seen biomechanical flaw in the running population is dynamic knee valgus, a combination of femoral internal rotation with adduction and tibial internal rotation 5. This will result in the insertion of the Iliotibial Band being moved AWAY from the origin. This pattern of movement was linked to patients in a recent high quality prospective study by Noehren and colleagues 6. Dynamic knee valgus can occur as a result of several muscle imbalances but the most common pattern that I see is a weaknessinhibition of Gluteus Maximus. I feel that Gluteus Maximus is more influential than Gluteus Medius in this presentation as it is a three dimensional single joint muscle, the most powerful external rotator of the hip and the superior fibres contribute significantly to hip abduction. Gluteus Medius contributes by fixing the pelvis relative to the femur 7. IMAGE Journal of Orthopaedic Sports Physical Therapy. Contralateral Pelvic Drop A highly relevant biomechanical flaw within ITBS is a contralateral pelvic drop. This occurs in single leg stance, with the pelvis dropping down on the non stance leg relative to the femur in the sagittal plane. Microsoft Query Excel 2003 Parameters Means. This will result in a subsequent lift of the pelvis on the stance leg, meaning that the origin of the IT Band is being moved AWAY from the insertion. This occurs as a result of a much more specific pattern of muscle imbalance, whereby Gluteus Medius stance and Quadratus Lumborum  External Oblique non stance fail to fix the pelvis relative to the femur. This pattern often results in over activity within the lateral trunk on the stance limb and can be a significant contributing factor in patients with unilateral spinal pain. Key Points for IT Band Syndrome Treatment. The point that I would like all readers to go away with is that it is muscle imbalance, and not a tight IT Band that causes this common problem and that it is rehabilitation activationstrengthening and not compressionstretching that will cure your symptoms. Please remember that we are not robots and not all patients will fit into these simple biomechanical boxes. People often present with combinations of these movement patterns and certainly dynamic knee valgus can be as a result of many muscle imbalances, which I will happily elaborate on in the discussion section of the blog if the questions arise. The challenge for clinicians is to identify them, rehabilitate them and most importantly teach the patient how to transfer what they learn in the gym to their running style. Please do not throw out the baby with the bathwater.