Iliotibial band friction syndrome (ITBFS) is an overuse injury, a common cause of knee pain in the running and cycling communities, and typically caused by “ramping up” too quickly in a training program.

The IT band is a flat, fibrous tendon that runs down the outside of the thigh from the ilium to the tibia, and is the common tendon of the glutes and tensor fascia latae muscles.  A tendon is simply the tapered “rope” at each end of the meaty part of a muscle, and is how muscles attach to bones.  This particular tendon crosses both the hip and knee joints, and can therefore cause problems not only in the knee but also in the hip or even the lower back.

Problems develop in the IT band when it becomes inflamed or irritated by rubbing on the outside of the knee with extended use — as when running or cycling.  Since inflammation is an irritant itself, prolonged inflammation can cause micro-scarring in the tendon over time, making it stiffer, shorter and less elastic than it should be.  Because this tendon crosses the lateral part of the knee joint and has a partial attachment to the patella (the kneecap), shortening of the tendon can cause problems by altering the normal bio-mechanics of the knee joint.

IT band friction syndrome can be sharply painful, can force you to cut your runs or rides short, and is famous for becoming a nagging injury that never seems to recover completely.

So, why is it a good knee injury?

Here’s why.  We tell our patients it’s the best knee injury you can have because once you have the right treatment,

• it responds quickly,
• it recovers completely, and
• it’s easy to prevent this injury from coming back.

Our IT band treatment protocols typically last only a week or two at most, and we generally get our patient athletes back into their sports before their treatment plan is even completed.  To fix it we use a systematic approach that includes the following types of therapy:

1. Myofascial release, to lengthen the ITB and break up scar tissue
2. Proprioceptive training, to speed muscle response time
3. Core conditioning, to increase stride efficiency & distribute stresses more evenly
4. Eccentric training, to increase tendon strength
5. Training modification, to avoid recurrences and maximize performance

And once the tendon is longer, stronger and pain-free, it’s easy to keep it that way.  A simple knee maintenance rehab program is all it usually takes, along with some rules of thumb about training techniques.

And by the way — even though we’ve discussed IT band friction syndrome as it relates to endurance athletes like runners and cyclists, it actually occurs quite often in less active individuals as well.  If you think you may have ITBFS, schedule an appointment with us, or with any good sports medicine provider, and get yourself checked out.  And if you do have it, that’s good news!  You’ll be able to get out of pain quickly, recover completely and keep yourself healthy in the long run with very little effort.

Have you had IT band issues before?  Leave a comment about your experience!

A well-designed pre-play warm-up is the single most important thing you can do to both improve your performance and prevent injury.

How a good warm-up helps you:

• “Pre-heats” muscles.  Studies show that increasing muscle temperature with dynamic movement makes muscles more resistant to tearing.  Hamstring and calf strains are quite common, and a pre-play warm-up can help prevent these injuries.
• Reduces muscle stiffness.  “Looser” muscles handle loads better, and are less likely to “snap” during heavy exercise.
• Rehearses movement patterns you’re about to use during play.  A good warm-up “tunes up” and coordinates the muscle groups you’ll be using in your sport, re-familiarizing them with their jobs and enabling you to perform more precisely as an athlete.  Translation: you can run faster, jump higher, throw farther.

What makes a good warm-up?

It’s pretty simple, actually.  It needs to be at least 10 minutes of continual exercise, using the muscle groups and joints you plan on using during play, progressing from low to high intensity, and finishing with brief bouts of 100% output.  Essentially this means it starts easy and gets harder, starts simple and gets more complex, starts with low impact and moves to high impact.

The whole idea is to create some intermediate steps between being “cold” before play and pushing as hard as you can during play.  By doing this we help ensure that each of your moving parts and motor systems is “dialed in” and able to function at high intensity, safely.

Build-your-own warm up

Here are the 3 components every solid warm-up is built around:

1. “Train like you play” by choosing drills that mimic the movements in your sport.  Focus on the joints you’ll be using in your workout or sport, gradually increasing intensity, eventually reaching the intensity of the most red-hot moments  in  your upcoming workout.
2. “Mix it up” by choosing some drills or movements that you may not encounter in your workout.  Runners, when is the last time you did some backpedals, high-knees, butt-kickers or side slides?  You may use none of these movements during your job, but they help keep your joints stable and supported throughout your run.
3. No static stretching!  “Stretch-and-hold”-type stretches before play — contrary to what your high school coach told you — are a waste of time.  They offer zero protection against injury and they’ve actually been found to make you slower by reducing your power output.  For more on static stretching, read my article “Why You’re Stretching Too Much”.

Bottom line, get creative and have fun with your warm-up.  Make sure you budget time for it, too.  The most cited reason our patients give for not warming up before play is that they didn’t have enough time to warm up and do their workout.  Set aside an extra 10 minutes for your workout to help ensure that you perform better and stay safer.

See a dynamic warm-up in action

We have designed a high quality pre-play performance and prevention warm-up that you can try, too.  You’ll find a free instructional download of the Volleyball Injury Prevention (VIP) warm-up protocol here, and you’ll see a video clip of the UT men’s volleyball team running through it on that page as well.

Try it out and let us know what you think.  Your warm-up can help keep you healthy, and it’ll make you a better athlete.

Whether it’s basketball, volleyball,or even football — the urge to launch yourself high above your opponent is completely primal.  In fact, vertical jump ability is generally considered to be the single best predictor of an athlete’s success.  It requires two things: strength (horsepower), and explosiveness (get-up-and-go!).

Only thing is, landing a jump can be rough on your knees.

It’s common to land with an impact that’s 4 times your body weight.  That means, if you weigh 170 pounds, you’re smacking the ground with 680 pounds of force – every time.  And a volleyball player may jump hundreds of times in a match.  That’s a lot of smacking!

Why your knee hurts:

Jumper’s knee — also known as patellar tendinosis – is a repetitive stress injury (RSI) caused by giving your knees more work than they can handle.  The patellar tendon (where your thigh muscle attaches, just below your knee) is what keeps your knee from buckling when you land a jump.  The repetitive stress of landing causes little pockets of weakness in the tendon, similar to swiss cheese.

Symptoms:

Symptoms start slowly.  First it may be a dull ache right below the kneecap after running or playing.  Then the pain may become sharper, making a squatting motion excruciatingly painful.  Bumping the kneecap or kneeling on a hard surface can be very painful.  As the condition progresses, everyday activities like walking down stairs or running become difficult to impossible.

If you don’t change what you’re doing and get the right treatment, your patellar tendon can actually rupture.

How to treat jumper’s knee:

The good news is, patellar tendinosis is totally treatable.  Our goal for these high-flying patients is to get them out of pain & back in the game as quickly as possible — and we almost always succeed.  By the way — there are no drugs or surgery in this treatment program.

The main thing to remember is:  if you think you may have jumper’s knee, stop doing things that make your knee hurt.  The continual aggravation of an already-weakened tendon can be disastrous.  Come see me.  You may be surprised how quickly you can get your knees back!

To read more about patellar tendinosis, click here: http://www.wheelessonline.com/ortho/patellar_tendonitis_jumpers_knee

And while they’re extremely common among athletes, it’s important to note that you don’t have to be an athlete to get a sports injury.  Plenty of non-athletes get sports injuries, even though they may not participate in sports or even engage in regular exercise.  For example, tennis elbow, ankle sprains, rotator cuff tears, plantar fasciitis and cases of tendonitis are all quite common among less active individuals, even though they are generally considered to be sports injuries.

If you do hurt yourself, your first question will probably be, “What do I need to do — should I see a doctor, or is it okay to wait a while?

This is a very common question, and a good one.  We’ve all had “aches & pains” before, and most of the time they go away on their own, without any special treatment or doctor visits.

But how do you know when giving it some time might actually be making it worse?  Here are some good general rules.

When to call 911:

1. Bleeding
2. Exposed bone or tendon

When to seek immediate medical attention:

1. Joint deformity (it “doesn’t look right”)
2. Inability to use the joint (it won’t bend, bear weight, etc.)
3. Intense pain (enough to make you “wince”, limp, etc.)
4. Sudden swelling (ever sprained your ankle?)
5. “Weird” symptoms (numbness, tingling, “doesn’t feel right”)

When it’s okay to wait:

1. Pain only happens once
2. Joint moves normally
3. All symptoms are mild (feels “stiff, sore or achey”)
4. Moving the joint actually relieves symptoms
5. Symptoms improve quickly

NOTE:  If your pain starts happening more often, is more severe each time you get it, or takes longer than a week to go away, come see us or another sports medicine doctor right away.  You could be doing additional damage.

Resist the urge to “put up” with the pain, swelling or disability of an injury just because you want to be “tough” and soldier through it.  If you need treatment for your injury, no amount of “toughness” is going to make you better, and delaying treatment can definitely make your injury worse.

Remember: when in doubt about how to address an injury, it’s always better to know what’s wrong.  If you’re not steadily improving, see a doctor.  Early treatment always has better results, and it might just be an easier fix than you think.

Commonly known as a “bump” on the inside to the big toe joint, a bunion is actually much more than that.  It represents a progressive, structural deformity that over time can affect the position of the big toe, cause painful arthritis in the joint, and ultimately lead to other debilitating forefoot pathologies, including a crossover second toe deformity.

Causes

This is mostly an inherited problem, but other causes can include trauma, systemic arthritis and a few developmental diseases.  One of the biggest misconceptions about bunions is that they can be caused by poor-fitting shoes or high heels.  While this is not the case, poor shoe gear can definitely cause an existing bunion to worsen, become more painful, and even accelerate the growth of the bunion deformity.

Symptoms

Symptoms include:  Pain, Inflammation , Redness , Swelling,  Burning sensation  and Numbness.  Additionally, symptoms occur most often when wearing shoes with a tight toe box or high heels, which is why bunions are typically more painful for women than men.  Prolonged standing, running and other weight-bearing activities can also increase the pain caused by bunions.

Diagnosis

Bunion deformities are easily identified by the “bump” on the inside of the big toe joint, but to fully evaluate the deformity, we will will perform x-rays and a thorough examination to determine the extent and type of deformity.  Since not all bunions are created equal, a thorough assessment is crucial to helping us establish the best treatment plan for your individual needs.

Treatment

Treatment is personalized for each patient, and may include observation, shoe modifications, medications, ice, activity modification, injections and in some cases orthotic therapy.  Surgery is only recommended if these treatments have failed and your pain persists.

If your bunion is not painful, we do not operate on it.

And if you do have painful bunions, surgery is designed to correct the deformity before it can start to cause arthritis to develop in your joint.  The surgery does require time to fully recover which generally involves protecting the foot with a boot while you’re weight-bearing, physical therapy to rebuild strength and stability and a gradual return to full activity.  The type of procedure we’ll recommend for you depends on several important factors, including the size and location of the deformity, your future activity goals, your age, health status and many other factors.

The good news is that outcomes tend to be quite impressive after treatment.  In a survey conducted by the American College of Foot and Ankle Surgeons (ACFAS), 92% of the patients said they were able to increase their physical activities — walking, golf, tennis, exercise — and 90% said they would recommend a bunion surgery to others.

If the pain from bunions has been causing you to limit your life, it’s definitely worth it to seek treatment.  The sooner we can catch the bunion process, the sooner we can begin treatment and start to get you back into your active life.

Steven A. Walters, DPM, FACFAS
Board Certified American Board of Podiatric Surgery in Foot Surgery
Board Certified American Board of Podiatric Surgery in Reconstructive Rearfoot/Ankle Surgery

To schedule an appointment with Dr. Walters, visit his practice website:
Capital Foot & Ankle Surgeons of Austin

Huge thanks to Dr. Walters for sharing his expertise with us.  He and his wife, Trinity Mereau, DPM, practice together at Capital Foot & Ankle Surgeons here in Austin, and they are the only foot and ankle specialists we refer our patients to.  Whether it’s a bunion, a talar fracture, an Achilles rupture, a subluxating peroneal tendon or a stress fracture, these are the only two guys I entrust with my patients (and myself).  I can’t recommend them highly enough.
-Dr. Bockmann

Your spine is made up of 24 bony vertebrae, and in between each of them is a disc.  The discs perform 3 functions:

1. They act as ligaments, by holding the vertebrae and spine together.
2. They act as shock-absorbers, by carrying the downward weight (axial load) of your body while you’re upright.
3. They act as pivot points, allowing the spine to bend, flex and rotate.

The disc itself is designed like a jelly danish.  The outer rim (annulus) is tough and fibrous, while the   “jelly” center (nucleus pulposis) is about the consistency of toothpaste.  It’s when the nucleus starts to protrude through the layers of the annulus that problems start.

How disc injuries happen

When a damaged disc bulges outward, the “bubble” can compress or irritate spinal nerve roots, which can cause the numbness, radiation pain, weakness and tingling associated with disc injury.  This most commonly happens in the cervical or lumbar spine.  This injury may also be described as a disc bulge, disc derangement, disc extrusion or protrusion.

Disc injuries are quite common, and may be caused by attempting to lift a heavy object, spending time in a bent-forward position or from traumatic events.  They may also occur during seemingly benign activities like sneezing or tying one’s shoes.  Injuries that occur during these “harmless” activities are usually the result of a gradual weakening of the disc over time.

What disc injuries feel like

The symptoms of a disc injury vary greatly and depend on what part of the disc is bulging or damaged, how large the bulge is, whether it’s pressing on a nerve, and if so, which nerve is being compressed and to what degree.  You may feel a deep ache in your back or neck, feel radiating pain, weakness, numbness or tingling in your leg, or even develop bowel or bladder incontinence in severe cases.

The good news is, many disc injuries (even severe ones) can be dramatically improved without surgery.  While a damaged disc may never actually return to its original, healthy state, a good low back rehab program can often get you back to your normal, everyday activities without pain.

Treatment for disc injuries

A physical rehab program works by rebuilding the muscular support system around the damaged joint, training it to take over the job of the disc.  Our low back rehab protocol is a progressive functional rehabilitation program that includes McKenzie exercises, core stabilization, proprioceptive training, joint mobilization, myofascial work and return-to-play techniques.  Even with severe disc herniations, the right low back rehab program can start improving pain quickly and can often help make your disc injury a non-issue.  And once the acute pain is gone, a regular program of core conditioning can help minimize recurrences.

For those disc herniations that don’t respond to conservative care like physical therapy and chiropractic, a series of epidural steroid injections or even surgery may be the best option.  And even if you do end up requiring back or neck surgery, maintaining a regular spinal exercise program will be crucial for helping you maintain a healthy back.

There are 4 general causes for that deep, achy pain you feel around your shin bone, and if you’re a runner it’s very important to know the difference between them.  Here are the 4 biggest causes:

1.    Medial Tibial Stress Syndrome (MTSS).  The most common cause of leg pain in athletes, period.  A deep, achy pain felt on the inside and sometimes around the back side of the tibia (or shin bone).  Caused by micro-tearing of the posterior tibialis muscle where it attaches to the back & inner part of the tibia.
2.    Tibial Periostitis.  An irritation or inflammation of the periosteum, the thin membrane surrounding the tibia.  Pain is felt directly on the front of the shin bone, usually near the ankle and extending part way up the leg.
3.    Anterior Compartment Syndrome.  The muscles on the front of your lower leg are encased in a thin, leathery sheath, or compartment.  Excessive swelling within that sheath can quickly compress nerves and blood vessels, causing pain on the front of the leg, outside the shin bone.
4.    Stress Fracture.  These are small, sometimes microscopic cracks in the shin bone that can quickly worsen if you continue running.  Caused by the repetitive impact of landing strides while running, the pain from a stress fracture is usually localized to a very specific area, rather than spread out across the bone like the other 3 conditions.  Early diagnosis and treatment is critical, as stress fractures can lead to COMPLETE fractures if left untreated.

Overall, these conditions are HUGELY prevalent.  Depending on which study you read, up to 1 in 5 runners have at least some degree of “shin splints” at any given time.
And shin splints are notoriously slow to recover on their own.  Runners may take 4, 5, even 6 weeks off from running, then return to find that their shin splints are back in force.  Symptoms may start off as just a nagging ache after running, then can progress to becoming painful during running, and if left untreated may actually be painful at night.

So what causes all of these conditions?  Simple.  Each of these conditions is caused by overuse — meaning too much work was done at one time, work was done for too long at a stretch, or training was ramped up too quickly.

Although I don’t have the time to go into detail on specific training methods in this article, here’s the takeaway point:  Pain high enough to make you “wince” or limp is NEVER normal.

What to do if you have shin splints

If you have persistent pain, pain that worsens over time or “weird” symptoms (weakness, swelling, discoloration, deformity, etc.), TAKE ACTION.  Come see me or another health care professional right away.  Your pain could be caused by something relatively harmless, but it could be caused by an insidious process that needs to be addressed right away.  Don’t risk it!

And BTW, if you have recurrent bouts of shin splints, consider this.  Barefoot-style running dramatically reduces impact forces at the foot, leg and knee, thereby reducing your likelihood for these injuries.  Consider making the switch!

While the “hamstring” is frequently thought of as one muscle, it’s actually a group of three muscles on the back of the thigh, made up of the semimembranosis, semitendinosis and biceps femoris respectively, labeled from medial to lateral.  This is a large, powerful group of muscles whose primary job is to bend and flex the knee, and to a lesser degree, extend the hip backwards.

The reason hamstring injuries are so common among explosive athletes is because during sprinting the hamstrings work extremely hard to decelerate the tibia as it swings forward during each stride, and the forces involved with slowing the leg are very high.  Accelerating, cutting or changing direction suddenly means the hamstrings are asked to contract against massive loads very quickly, and sometimes they just plain can’t.

How bad is it?

When the hamstings are asked to handle a load beyond their capability, they will fail to some degree, resulting in a strain or “pull”.  In the sports medicine world we grade strains on a 3-point scale:

1. Grade 1 Strain: May have tightness on the back of the thigh.  You’ll be able to walk normally, but you’ll be aware of some discomfort during certain activities.  You’ll have little to no visible swelling, and pulling your heel toward your buttock will probably not cause you much pain.
2. Grade 2 Strain: You’ll find yourself limping due to tightness and pain.  You’ll get sharp “jabs” of pain with certain movements, and some swelling may be visible.  Applying pressure to the back of your thigh will probably hurt, and pulling your heel toward your buttock against resistance will definitely not feel good.  You might not even be able to straighten your leg completely.
3. Grade 3 Strain: You may need crutches to walk, since weight-bearing will be too painful.  You’ll have severe pain and weakness with any activity that involves bending your knee.  Immediate and noticeable swelling on the back of your thigh, and bruising will be visible within 24 hours.

Here’s what you can do

Since a hamstring strain is really a partial tear of the hamstring muscle, treatment needs to start immediately, even if your symptoms are fairly mild.  Limiting the ramp-up of the inflammatory cycle and preventing the build-up of scar tissue need to start happening right away.  Here’s what to do:

• Apply ice as soon as possible for 15 minutes, repeating every hour for the first day, then every 3 hours thereafter.  This helps reduce swelling, inflammation and pain.
• Essential fatty acid (EFA) supplements are as effective as ibuprofen at reducing inflammation.  Take 2,000 mg/day of a quality brand like OmegaPlex for 1 week.
• Use a compression bandage to minimize swelling and bruising, as well as to provide some basic support for the injured area.
• Avoid activities that reproduce sharp pain in the hamstring.  Walking is usually fine, but prop your leg up when you’re seated to help drain fluid that may accumulate.
• Light stretching and a variety of low intensity movement helps prevent scar tissue from “welding” tissues in the thigh together during healing.  In general, stiffness, soreness and tightness is okay to push through.  Sharp, consistently jabbing pain, or steadily rising pain levels should be avoided.
• See a sports injury specialist.  We’ll make sure it is in fact a hamstring strain, and that there are no additional injuries to be addressed.

When we treat these injuries in clinic, we’ll prescribe a progressive program of therapies including range of motion exercises, ultrasound therapy or electric stimulation, sports massage, myofascial release and rehabilitative exercises to help speed up the healing process and ensure a much stronger mend in the torn muscle.  In severe cases we’ll order an MRI to ascertain the extent of the damage, and rare instances, surgery may be necessary.

In most cases a pulled hamstring doesn’t have to be a season-ending injury, but delaying treatment — or going without treatment — can turn a fairly routine sports injury into a  much bigger problem than it has to be.  Don’t make the mistake of putting off your treatment.

Here’s a patient running through part of our hamstring strain rehab protocol:

Wrong.

Allow me to introduce the revolutionary new 10-20-30 Training Concept.  It’s just another example of science proving, once again, that the best results are often gained when you train smarter — not harder.

Researchers from the Department of Exercise and Sport Sciences at the University of Copenhagen developed this runner training technique, and tested it on 18 moderately trained runners over a period of 7 weeks.  The results are nothing short of remarkable.  In those 7 weeks, runners using the 10-20-30 Training Concept:

• Improved their performance on a 1500-meter run by 23 seconds,
• Improved their performance on a 5 kilometer run by almost a minute,
• Significantly lowered their blood pressure,
• Reduced their cholesterol, and
• Lowered their overall emotional stress, when compared to runners using traditional training techniques –
• All while cutting their training time in HALF.

The 10-20-30 Training Concept

The 10-20-30 Training Concept consists of a 1-km warm-up at a low intensity, followed by 3-4 blocks of 5 minutes running, interspersed by 2 minutes of rest.  Each block consists of 5 consecutive 1-minute intervals divided into 30, 20 and 10-seconds of running at low, moderate and near-maximal intensity, respectively.

All you need is 30 minutes

Because of the brief, high-intensity training sessions in this program, you’ll be done with your workout in half an hour.  This makes fitting your training run into a busy schedule much easier than trying to find room for an hour-long run every time.  Pretty nifty, right?

If you’re a runner and looking to boost your performance, lower your blood pressure and reduce your cholesterol and stress, try this technique out — then comment on this post to let us know how you did!

-Daniel Bockmann, DC

Want a tutorial?

Professor Jens Bangsbo walks you through the 10-20-30 Training Concept below:

Worried about wear and tear on your joints?  Add the supplement Dr. Oz recommends to help rebuild arthritic cartilage: Glucosamine with MSM.  Purchase Doctor-formulated Joint ProMotion here.

And although it’s very common among tennis players, plenty of non-tennis players get it, too.

The pain is usually located at the outside (or lateral part) of the elbow where the wrist extensor tendons attach, and it may be very tender to the touch and made worse by twisting or gripping actions of the hand and wrist.  It is an overuse injury of the wrist extensors (muscles that cock the wrist back), which means that these muscles have been pushed too hard, too frequently or progressed too rapidly through work they’re unaccustomed to.

This overuse causes the attachments of these tendons to become inflamed, painful and sometimes swollen — all three of which accompany any tendinitis.  While tennis elbow is almost never a surgical condition, it can dramatically limit your ability to perform all kinds of everyday activities, not to mention sports and recreational pursuits.  And left untreated or undertreated, lateral epicondylitis can linger painfully for months or even years.

But thankfully, there is a simple, effective solution.

We use a very simple treatment protocol for our tennis elbow patients using a tool called a FlexBar.  A physical therapist named Timothy Tyler developed this technique and his method is called the Tyler Twist.  This protocol uses eccentric exercises to strengthen both the muscles and the tendons that surround the elbow.  The term eccentric refers to exaggerating the “down” portion of a particular movement (often referred to as a negative).  Technically, eccentric contractions occur while the muscle is lengthening — not shortening.

We’ve using eccentric rehab exercises with our tendinitis patients for years, with great results, but the FlexBar makes performing these exercises extremely simple, and it’s about as cheap a treatment “fix” as you’ll find anywhere.  Eccentric movements do 3 things that are vital to the recovery of any tendon injury:

1. They build muscle strength faster
2. They recruit more fibers within each muscle, increasing the “strength-to-weight” ratio of any muscle, and most importantly,
3. They increase the tensile strength of tendons, making them capable of carrying greater loads.

In the video below you’ll see me demonstrate the proper way to perform the Tyler Twist for treatment of tennis elbow, as well as for “golfer’s elbow”, or medial epicondylitis.  We typically prescribe 3 sets of 15 reps per day, and it’s not unusual for us to see 80% improvement in symptoms within only 3-5 weeks, even for severe or chronic cases.

If you have elbow pain, give this technique a try.  It’s cheap, it’s very effective and it works quickly.  Then leave a comment on how it worked for you!