IT Band Rehab...UGH

Pic from this site.

As promised, not that there isn't already enough info out there about IT Band issues for runners, I have put together my own little blurb on this painful bugger after going though some downtime and rehab to return back to my regular training schedule. The IT Band, which originates on the ilium (hip) bone from the tensor fascia lata tendon and part of the gluteal tendon and inserts on the lateral aspect of the tibia (just below the knee), is typically irritated from overuse or repeated stress as is recognized in distance running....in my case from too much mileage too quickly before the body (muscle and connective tissue) was ready to handle the load AND poor running form. So I figured I would put my snowball of mistakes and some of the rehab work that I tried out there for anyone nursing this "irritation" just in case you are on the same slippery path and would like to make the decision to change your fate.


In my case, while preparing for the Chicago Marathon, my longest training run turned out to be slightly over 16 miles - due to poor scheduling, late summer travel, an increase in work duties since the student-athletes were returning back to campus, quitting my 20 miler 8 miles into (literally) a monsoon, and overestimating my ability to recover evidenced by my scheduling the Folsom Half Iron a short 6-7 weeks prior to Chicago...among any other excuses I came up with during that time to cut my long run short by a few miles. What turned out to be an amazing running experience, also became pretty dang painful after mile 22. This was the start of more "knee pain" to come during the Philly half marathon which ultimately forced me to take it super easy for almost 2 months and stay religious to my therapy regimen. I hadn't fully and appropriately prepared my body to endure the marathon, my running form had broken down (yeah, I started heel striking at some point as I made my way into the late teens during that 26.2), and thus my connective tissue had deemed it appropriate to let me know loud and clear. The following are some of the options I tried out with our athletic training staff on my road to recovery:


Ice and Rest.DUH. While this may the most highly recommmended, logical duo for an overuse injury that everyone knows, how many people skip right over this "easy fix" for some magic trick that they think will get them back to running faster and farther than ever? Rest is also probably what HELPS THE MOST to recover from this case. Sometimes the addition of an anti-inflammatory medication can assist in reducing the pain if it is bad enough. Stop doing what is causing the irritation, look at your training (and maybe your shoes) for the root of the problem, then change your training to fix it. In my case, after the hip surgery I completed a ton of therapy on a single side of my body...this left my non-surgically repared side weaker (especially the glutes). So what have I done to help this? I've changed my lifting program (just a little bit) by adding additional single leg hip and glute work. Some of the specific strengthening exercises I now perform ~2x/week include: Pistol Squats (known by some as Hip Hikes), weighted hip abduction (through use of a machine or resistance band), weighted hip flexion, single leg glute bridging, and single leg leg press.


Flexibility is also another biggie that is suggested to individuals struggling with IT Band issues. Most adopt this practice thinking that they will actually stretch out this crazily tough band of connective tissue. Not exactly the case. It's very very tough to increase the flexibility of the IT Band, but on the other hand, increasing the flexibility of the surrounding musculature couldn't hurt now could it? Certain tight muscles can actually inhibit others from functioning appropriately, if at all. Over the course of 13.1, 26.2, or 50+ miles that is a lot of pounding on and work being done by a body that is not working properly. When I walked into the training room after feeling the effects of Philly I was asked "well, what's tight?" and all I could do was laugh because I couldn't answer anything other than "well, what isnt?!" Other than the standard hamstring, quad/hip flexor, and glute stretches, I have also adopted some stretching through the movements of internal and external rotation of the hip. If you don't know what I mean, check out the pics below. And if you decide to try either of these out, be sure to communicate with the individual stretching you since only a slight increase of motion into the stretch can be pretty aggressive. Ease in gently.


Myofascial Release. This can be self performed through use of a foam roller or through a potentially more beneficial approach (or expensive....but ah, the perks of having access to trained individuals where I work) called A.R.T. (Active Release Technique) which should be performed by a practicing therapist/chiropracter. It involves some pressure or manipulation of the tissue and light dynamic stretching and while this is lightly painful, I definitely think it helped throughout my recovery process.


Friction Massage and Graston Technique. I lumped both of these together since they consist of actually inflicting friction to an area thats already flared up because of friction. (Funny and backward, right?) Maybe, maybe not. While not totally proven, the belief is that the manual friction used in these types of treatment on the scar tissue or affected area will actually promote tissue repair. Since we don't yet have the "official" Graston tools as shown in the linked video, we used a scissors handle to do the job. I'm not going to lie, during the first treatment I almost jumped off of the table and while we tried it a few times, I'm not sold that any benefits from this technique for IT Bands are actually worth the pain. 



Plunger Technique. I had never heard of this practice until one of our new sports medicine guys brought it to our athletic training room. Through use of the plunger, one can actually seperate the IT Band from some of the surrounding tissue which further allows the therapist/trainer to gently massage under the IT Band and break up some of the adhesions. Will you still be a little sore or irritated after this type of treatment, sure, but it just takes a different approach at easing this issue. You can check out the plunger method video here to get an idea of this technique. I definitely prefered this style treatment as compared to the friction treatments.



Running Drills. Outside of the ice/rest and strengthening, I highly suggest cleaning up your running technique as a means to steer clear of future IT Band pain, especially if your running form tends to break down during runs. Some drills recommended to me were: high knees, butt kicks, A skips, lateral A skips...all of which should be performed both forward and backward on the balls of the feet and feet striking directly under the hip. Simply running more can also improve your running economy, but by no means am I suggesting you head outside for a 10 miler right now if you are just starting back into running...ease in. 


One thing I did not try was K Tape (kinesiology tape) - I don't know enough about it, other than after the last beach volleyball Olympics it seems to be booming. What I do know that it must be applied by someone trained using this product in a specific pattern for each certain type of injury. Maybe I just haven't met anyone who uses this practice, or maybe I'm just a skeptic...but like I said this is one I chose to skip. If you have any info or experience with this method, feel free to share.


Notice in my first sentence I said that I would be writing a "little blurb." False. Such was my intention, but you got the long version of my take on this pesky injury. I can now once again sleep on my right side, cross my legs while sitting, AND run without much snapping so I must have done something right! Best of luck training and hopefully someone picked up some useful knowledge!

A cheerful heart is good medicine,

but a broken spirit saps a person's strength.

~Proverbs 17:22

Tess's Top 5 Nutrition & Exercise Tips for 2013

Tess, a friend whom I met this summer through a mutual friend and the sport of triathlon is currently completing her Master's in Nutrition in Colorado (I know, I'm jealous too).  She has taken the time to put together her top 5 nutrition and excercise tips for 2013!  Enjoy!

Tess and fiance, Tucker, at Super Bowl Sunday 10K in CA.

Happy New Year Everyone!  I am a personal trainer and on my way to becoming a Master Nutrition Therapist.  As you may or may not know, exercise and nutrition go hand-in-hand to produce desired results, so I came up with a few tips that relate to both topics.  Please feel free to contact me if you have questions about anything I wrote, or if you have other general nutrition or exercise-related questions! pasternak.tess@gmail.com


1.  Commit to TWO weeks. If you are having a hard time getting started on an exercise routine, just commit to two weeks of consistent exercise.  This can be anything from walking 30 min a day, to taking a Zumba dance class.  In a span of two weeks, the mitochondria in our body has the ability to double, which translates to increasing our endurance noticeably.  At the end of two weeks, your body will be acclimated to the exercise you have been doing and it will feel much easier and more enjoyable than the first few days.  

   

2. Avoid carbs post-exercise.  If you are trying to lose weight, avoid eating carbs for at least 2 hrs after exercise.  Instead, aim for vegetables, proteins and healthy fats to help build muscle and encourage your body to burn up it's glycogen stores.  If you are not trying to lose weight and exercise with the purpose of performace, eating healthy carbs and proteins post-workout are important for recovery.  

3. Listen to your body.  Before you eat or drink, listen to what your body is asking for.  Are you hungry?  Are you thirsty?  Many people have stopped listening to what their body is asking for, and therefore have a hard time identifying these feelings.  Take a moment and ask yourself what your body wants and needs, and then act accordingly.  If you begin doing this and never notice a feeling of thirst, you may have to put yourself on a water schedule to ensure that you are drinking enough throughout the day.  This will help remind your body that it needs water, and eventually your feeling of thirst will return.  

4. Stop drinking plastic.  When liquids sit in plastics long enough, the plastic begins to decompose and leech into the liquid. To avoid drinking plastics, dry out your plastic water bottles after each use, and refill them with fresh liquids.  This is especially important if your bottle is heated by the sun on long bike rides, or sits in your hot car, since this expedites the leeching process.  Another option is to use a stainless steel or glass bottle (that does not have a plastic lining) instead.  



Wouldn't surprise me if Tess made that popsicle!

5. Avoid the sugar crash. If you are an endurance athlete, try fueling with whole foods rather than sugar during long training sessions and races.  Yes, processed sugar provides an instant pick-me-up when you are starting to feel sluggish, but your body burns through it very quickly and then asks for more.  Instead, try eating a little bite of food that contains some natural sugars, proteins, carbs, and fats.  Your body will be able to use the natural sugars first, and then move onto the other nutrients for longer-lasting energy.  If you are already in the habit of consuming sugars such as GU, sports drinks, etc, experiment with whole foods slowly.  Your body needs a little time to adjust to different fuels so take your time introducing new foods.  Examples of good sources of fuel include: 

• Peanut butter and sliced banana or honey on whole wheat or gluten-free bread.  (Cut this sandwich into bite-sized pieces so that you can easily grab a piece)
• Lara Bars or other natural fruit/nut bars that only contain ingredients that you recognize as real foods
• Dried Figs.  These contain ample amounts of natural sugars, but also enough fiber to slow down the digestion process.

Tess was also kind enough to put together one of her favorite healthy recipes.  This is a good hearty meal to have as a lunch or dinner. It provides the body with healthy carbs, proteins, fats and lots of vegetables. It has a lot of option for variety, and is really tasty - plus it is super easy to put together!

Pre-race pic before Folsom Half Iron - Terra, Tess, & myself.

Tess' Favorite Gluten-Free Power Bowl

3/4 gluten-free grain of choice (quinoa, brown rice, farro, etc)

1 c beans (black, pinto, kidney)

1 c dark greens (kale, spinach, chard)

1 c chopped veggies (bell peppers, carrots, celery, tomatoes, cucumber, anything you like)

1/2 avocado

Salsa and/or hot sauce

Salt and Pepper to taste

  

 

I'd like to say thank you to Tess for her words of wisdom.  These really are some great tips that anyone can put into practice whether one is looking to enhance their state of wellness or increase athletic performance!  Once again for any questions on this post or other general nutrition questions feel free to e-mail Tess at the address listed above - also, from time to time she shoots out e-mails with nutrition tips  If you would be interested in being added to that list, let her know!! 

 

 

Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own, for you were bought at a price. Therefore honor God with your bodies.

1 Corinthians 6:19-20