Iliotibial band syndrome. The I.T. band is not the problem.

iliotibial band syndrome

Regularly I come across  people receiving seemingly endless treatment sessions iliotibial band syndrome, with the main focus of the treatment being to try and loosen out the I.T. band. Below are a few things I believe you should consider when  treating  iliotibial band syndrome.

1. A client is told they have certain weak muscle groups which are causing the problem and are given a load of exercises to correct these weaknesses. Sometimes they are told that they need orthotics. Sometimes these treatment protocols may be necessary, but more often this is just an overuse injury that is being made way too complicated. Say you have been running for a year(or years) with no issues, why are all these ”weaknesses” just now causing you problems? Most likely they are not the cause.  Why do you suddenly need orthotics. Did you change your feet(joke)? It is more likely you are overdoing it a bit in your running.

2. All the emphasis is often placed on the I.T. band and treatment of same. The I.T. band is a long tendon and is a fairly inflexible structure, so concentrating on loosening out that is not going to give much relief in itself. Now if you shift the focus to loosening out the tightened outer quad muscles which attach to the I.T. band by fascia(connective, supportive sheet of tissue, kind of like a very strong clingfilm) and as a result pull on the I.T. band, you will generally start to recover fairly quickly. There is nearly always a section of the outer quad about a quarter of the way up from the knee which will be tight and ropy in this injury. Also don’t forget the Tensor fascia lata muscle. This is up near the hip. It is the muscle that attaches directly to the I.T. band. If this has tightened it also needs to be worked out and loosened also. The I.T band should not be totally ignored of course. Instrument assisted soft tissue release can be excellent in loosening it somewhat, as well as for loosening out tightened quad muscles and fascia.

3. Another problem with this condition is a lack of understanding as to what is causing the pain at the side of the knee. The tension and resulting friction on the I.T. band causes the bursa under it at the side of the knee to become inflamed. This is what causes the pain. Treatment options here include a combination of non steroidal anti-inflammatories, compression with ice(very effective), maybe some electro-acupuncture. You want to compress the icepack into the side of the knee to flatten the inflamed bursa and reduce inflammation. A packet of peas or one of those gel packs will not be cold enough.

4. Rest is needed. This is an overuse injury, remember, but the better and more effective the treatment, the faster the recovery.

Above is not necessarily stuff you will find in a text book but comes from knowledge of anatomy and experience in  successfully treating this condition hundreds of times over the years, often in about two treatment sessions. Injuries are often over-dramatized. Sometimes you just need a little rest, with the right physio treatment protocol to aid recovery.

Carpal tunnel syndromeCarpal tunnel syndrome is a condition that causes numbness, tingling and weakness in the hand and arm. The condition is caused by  compression of the median nerve within the carpal tunnel, a narrow passageway on the palm side of your wrist. The median nerve runs from your neck  down along the arm and through the carpal tunnel to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb .  Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to this condition. The anatomy of your wrist, health problems and possibly repetitive hand motions may also contribute.   A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation resulting from rheumatoid arthritis.

Proper treatment usually relieves the tingling and numbness and restores wrist and hand function. It is worth noting that carpal tunnel syndrome is often misdiagnosed and the main site of median nerve compression can be occurring up at neck and shoulder level. Often by freeing up neck and shoulders muscles and surrounding joints with physio as well as working out muscles down along the arm through which the median nerve penetrates, and loosening and stretching the wrist structures, much relief, often total relief can often be achieved.

 

Symptoms

Syndrome symptoms usually start gradually.

Numbness: The first symptoms are usually tingling or numbness usually in the thumb, index and middle or ring fingers, but not your little finger. The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from your sleep.

Weakness: You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.

 

Carpal Tunnel Risk factors

A number of risk factors have been associated with carpal tunnel syndrome.  Although they may not directly be the cause , they may increase your chances of developing or aggravating median nerve damage.

These include:

Anatomic factors: wrist fracture, dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.

Sex: It is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.

Nerve-damaging conditions: Some chronic illnesses, such as diabetes, increase your risk of nerve damage.

Inflammatory conditions: Illnesses that are characterized by inflammation, such as rheumatoid arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.

Obesity : Being obese is a significant risk factor for carpal tunnel syndrome.
Alterations in the balance of body fluids. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally resolves on its own after pregnancy.

 

Carpal Tunnel Diagnosis

History of symptoms, Physical examination. Nerve tension tests.

X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other causes of wrist pain, such as arthritis or a fracture.

Electromyogram. This test measures the tiny electrical discharges produced in muscles. During this test, your doctor inserts a thin-needle electrode into specific muscles to evaluate the electrical activity when muscles contract and rest. This test can identify muscle damage and also may rule out other conditions.

Nerve conduction study. In a variation of electromyography, two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel. This test may be used to diagnose your condition and rule out other conditions.


Treatment

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel syndrome. Physical therapy by a practitioner experienced in this area can be very effective. This would most like involve deep tissue work, osteopathic manipulations, electroacupuncture and postural correction exercises, and nerve glide exercises as the condition improves. Other treatment options include wrist splinting, taking more frequent breaks to rest your hands, avoiding activities that worsen symptoms, medications(Nonsteroidal anti-inflammatory drugs) icing, rest etc. Surgery is also an option but is a last resort.

 

For treatment of this condition contact us on 0867700191

 

For more information see this video

 

 

 

 

Plantar Fasciitis – Foot Pain

plantar-fasciitisPlantar fasciitis is a painful inflammatory condition of the connective tissue on the sole of the foot(the plantar fascia). It is often caused by overuse of the plantar fascia, the tendons that help form the arch of the foot , running from the heel along the sole of the foot towards the toes. The plantar fascia  basically acts as shock absorber for the foot during movement while helping maintain the arch of the foot during standing. Plantar fasciitis is easiest treated when caught early. Longstanding cases often demonstrate more degenerative changes in the tissue than just inflammatory changes. This condition is called termedplantar fasciosis and can be much more difficult to treat.

While plantar fasciitis is often attributed to overuse in  athletes, among non-athletic populations it is associated with a high body mass index in combination with  long periods of weight bearing( Mc Poil et al. 2008).  Also people with flat feet or high arches tend to be more at risk.  A Flat foot tends to put increased strain on the origin of the plantar fascia at the heel (calcaneus) as the plantar fascia attempts to maintain a stable arch during the propulsive stage of the gait(walking, running etc.). Excessive movement of the forefoot in relation to the heel  during movement can also predispose to plantar fasciitis. In people with high arches there may be excessive strain on the heel due to the foots limited range of movement and thus a decreased ability to adapt  to the ground during movement.

Plantar fasciitis is commonly also associated with tightness in the calves, hamstrings and gluteal regions. Muscles in these areas have a significant effect on gait and thus foot biomechanics . Biomechanics is basically the science of movement, so when you here the phrase ”poor biomechanics” used it is basically referring to inefficiency during movement.

With the condition the pain is usually gradual in onset and felt on the medial aspect of the heel. Initially it is worse in the morning and decreases with activity, often aching afterwards. Periods of inactivity during the day are generally followed by an increase in pain as activity is recommenced. As the condition becomes more severe, the pain may be present when weight-bearing and worsen with activity.

Treatment

Effective treatment uses a multifaceted approach which may involve some or all of the following ; the use of nonsteroidal anti-inflammatory drugs (NSAIDs), deep tissue massage of the plantar fascia and along with deep tissue work to loosen out the calves, hamstrings and gluteal regions where necessary, stretching exercises for the plantar fascia(DiGiovanni  et al. 2003) and calf muscles, avoidance of aggravating activity, biomechanical correction with orthotics, electro-acupuncture and cold compression of the heel bursitis, strengthening exercises for the intrinsic muscles of the feet(Dyck and O’Neill ,2004), taping the heel into inversion (short term solution)( Radford  et al. 2006),  changing to proper supportive footwear containing well supported arches and midsoles (Yamashita, M.H. 2005). In extreme cases when all else has failed corticosteroid injections may be considered if there is a bursitis in the heel (Crawford et al. 1999) with surgery used as a last resort. This condition is usually resolved swiftly by an experienced practitioner without the need for surgery or corticosteroid injections.

 

 

Physiotherapist based in Tralee , Co. Kerry and open 7am to 11 pm weekdays, 7am to 2pm Saturdays.Please ring 086-7700191 anytime to make an appointment. We also specialize in proper deep tissue massage.

 

References

Crawford, E., Atkins, D., Young, P. et al. Steroid injection for heel pain: evidence of short term effectiveness: a randomized controlled trial. Rheumatology 1999;38(10):974-7.

DiGiovanni, B.F., Nawoczenski, D.A., Lintal, M.E. et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective randomized study. J. Bone Joint Surg. Am. 2003;85-A(7):1270-7.

Dyck, D.D., Boyajian-O’Neill, L.A. Plantar fasciitis. Clin. Journal Sport Med. 2004;14:305-9.

McPoil, T.G., Martin, R.R.L., Cornwall, M.W. et al. Heel pain – plantar fasciitis: clinical practice guidelines linked to the international classification of functioning, disability, and health from the orthopedic section of the American Physical Therapy Association. J. Orthop. Sports Phys. Ther. 2008;38(4): A1-18.

Radford, J.A., Landorf, K.B., Buchbinder  R. et al. Effectiveness of low-dye taping foe the short-term treatment of plantar heel: a randomised trial. B.M.C.

Yamashita, M.H. Evaluation and selection of shoe wear and orthoses for the runner. Phys. Med. Rehabil. Clin. N. Am. 2005;16:801-29.