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What is it?

Rotator cuff injuries are some of the most common shoulder injury. The rotator cuff is comprised of four muscles: subscapularis, suprasinatus, infraspinatus, and teres minor. These four muscles are responsible for stabilizing the shoulder girdle throughout the shoulders range of motion. Pain or weakness in curtain range of motion can determine which muscles are hurt. Subscapularis creates internal rotation. Supraspinatus creates abduction. External rotation is created by both infraspinatus and teres minor. Common injuries are rotator cuff tendonitis, rotator cuff impingement syndrome and a rotator cuff tear. This blog will focus on rotator cuff tendonitis.

What causes it?

Rotator cuff tendonitis is an overuse injury due to poor shoulder mechanics. To learn more about shoulder mechanic, please read through our blog "Shoulder Mechanics". Rotator cuff tendinitis affects the tendons of the 4 muscles stabilizing muscles. Tendinitis means that these tendons are inflamed or irritated. Tendinitis of the rotator cuff can be caused from keeping the shoulder in one position over a period of time, sleeping on the shoulder every night, or participating in activities that require extending the arm over the head. Sometimes rotator cuff tendinitis can occur without any known cause. Most individuals with rotator cuff tendinitis are able to regain full function of the shoulder without any pain.

What are symptoms and how do you diagnosis it?

Symptoms of rotator cuff tendinitis tend to worsen over time. Initial symptoms may be relieved with rest, but eventually the symptoms can become constant. Symptoms of rotator cuff tendinitis include:

·         pain and swelling in the front of the shoulder and side of the arm

·         pain triggered by raising or lowering the arm

·         clicking sound when raising the arm

·         stiffness

·         pain that causes you to wake from sleep

·         pain when reaching behind the back

·         loss of mobility and strength in the affected arm

Through the physical examination, including history and special tests, the treating provider can determine if the patient is suffering from rotator cuff tendonitis. The exam may include movement of the arm, shoulder and neck to test mobility and strength.

Your provider may order imaging tests to confirm the diagnosis of rotator cuff tendinitis and rule out any other causes of your symptoms. An X-ray may be ordered to see if you have a bone spur. Your provider may order an ultrasound or magnetic resonance imaging (MRI) to check for inflammation in the rotator cuff and to check for any tearing.

How do we treat it?

Conservative treatment

Conservative treatment is always the first line of defense. Shoulder strengthening, corrective exercises, postural changes, proper stretching and soft tissue work can be used in conservative treatment. Severe cases way require the use of a sling to prevent excessive use of the shoulder during the healing process.

Steroids

If the rotator cuff tendinitis is not responding to conservative treatment, your provider may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain. This approach is used as a band-aid to the problem not a long term fix.

Surgery

If nonsurgical treatment is not successful, your provider may recommend surgery. The most non-invasive form of shoulder surgery is accomplished by arthroscopy. This involves two or three small cuts around the shoulder, through which your doctor will insert various instruments. One of these instruments will have a camera, so your surgeon can view the damaged tissue through the small incisions.

Open shoulder surgery is usually not required for rotator cuff tendinitis. However, this method may be used if there are other problems in the shoulder, such as a large tendon tear. Any type of surgery involves recovery that consists of rest and physical therapy to restore strength and range of motion.
 
 
Did you know a thorough clinical exam has been shown to be more accurate than MRI for properly diagnosing meniscus (Cartilage) injuries in the knee? Furthermore MRI shows meniscus (cartilage) changes in 24% of patients that are asymptomatic? Does this make you question what really is causing your knee pain? It should.

Although we've said it before, I'll say it again. Understanding the underlying cause of your injury and taking a look at your whole health and injury history are very important factors to ensuring you have adequate and high quality treatment.  Be sure your provider has given a thorough exam, is not only relying on MRI or other imaging, and that your treatment addresses the underlying problem not just the pain itself.

Here is a starter guide to knee pain, most likely causes and what to watch for.  Treatments vary by condition, but as a general guide: 
    • Active Release Technique, Graston and Guasha are 3 of the best techniques for many of these injuries. 
    • Rest, Ice Massage and anti-inflammatory cream at home will help control symptoms.
    • Proper rehab is a key to preventing reoccurence.
    • Additional, specific treatment options for some conditions are listed below.
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PAIN LOCATION

FRONT

(Anterior)


  • Most Common condition categories:  

    • Patellar Tracking Disorders/Cartilage irritation aka "The knee cap doesn't glide where it should" causing irritation of any number of tissues/structures around the knee.
    • Degenerative Changes- breakdown and irritation of cartilage, bone, and/or ligaments. May be the result of previous injury, or most commonly due to improper mechanics. 
    • Tendinosis- inflammation or tissue thickening of tendons (attaching muscles to bone)

  • Who: Most Commonly related to overuse. Runners, jumpers, activities require excessive starting/stopping, stair climbing, jumping or impact. 

  • What to look for:

      • Swelling- may indicate irritation/inflammation of a bursa (fluid-filled sac)
      • Popping/Clicking- may indicate damage/degeneration of the meniscus (Knee cartilage) or the presence of a plica, a band of tissue under the knee cap which can friction causing noise and sometime pain

  • Underlying Causes: Improper Mechanics. See knee mechanics article here. Overuse. Improper training regimen/progressions.

  • Diagnosis: Clinical Exam

  • Treatment Options: usually responds to properly prescribed homecare, rehab and conservative methods (ART, Guasha/Graston, etc)

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INSIDE (Medial)



  • Most Common condition categories:  

    • Medial Meniscus- cartilage within the knee may be degenerating, irritated, frayed or torn
    • Ligament Damage- Specifically MCL or the Medial Longitudinal Ligament. 
    • Tendinosis- Sartorius, Gracilis, Semitendinosus most commonly
    • Bursitis- Pes Anserine Bursa protects the three tendons listed above from rubbing on the underlying bone

  • Who: Soccer, Football, Basketball, Tennis and Racquetball players. People suffering from weak hips and/or feet causing the knee to "fall" inward during walking, running, stair climbing, etc. 

  • What to look for:

    • Swelling- may indicate irritation/inflammation of a bursa (fluid-filled sac) or the MCL
    • Popping/Clicking- may indicate damage/degeneration of the meniscus (Knee cartilage)
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury
    • Pain unchanged by knee movement or that cannot be reproduced. Rarely, a problem in the lower abdomen can refer pain here. 

  • Underlying Causes: Trauma/Injury where the knee is forced inward (sometimes with rotation) Improper Mechanics. See knee mechanics article here. Overuse- most notably with weak hips, weak feet, and poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for Meniscus or MCL damage. Meniscus tears are categorized by a number of factors. Surgical intervention is required for some types of tears, however many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.  

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OUTSIDE (Lateral)







  • Most Common condition categories:  

    • Lateral Meniscus- cartilage within the knee may be degenerating, irritated, frayed or torn
    • Ligament Damage- Specifically LCL or the Lateral Longitudinal Ligament. 
    • Tendinosis- Iliotibial Band (ITB), Biceps Femoris (one of the hamstring muscles), Popliteus (small muscle behind the knee)
    • Bursitis- protecting the ITB from the underlying bone

  • Who: Runners, Contact sport athletes

  • What to look for:

    • Swelling- may indicate irritation/inflammation of the bursa or the LCL
    • Popping/Clicking- may indicate damage/degeneration of the meniscus
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury

  • Underlying CausesTrauma/Injury where the knee is forced outward (sometimes with rotation) Improper Mechanics. See knee mechanics article here. Overuse- most notably with weak hips, weak feet, and poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for Meniscus or LCL injuries. Meniscus tears are again categorized by a number of factors. Surgical intervention is required for some types of tears, however many tears respond best to conservative care, rest and rehab. Proper diagnosis is very important in determining the best treatment methods.  

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BACK 
(Posterior)





  • Most Common condition categories: 

    • Medial or Lateral Meniscus- degeneration, irritation, fraying or tearing usually in the back aspect of the cartilage.
    • Tendonopathy- Hamstring, Gastrocnemius (Calf muscle). May indicate irritation, inflammation, thickening or tearing in one of the these primary muscles.
    • Capsule involvement- irritation or contraction of the capsule surrounding the knee joint
    • Radiculopathy or referred  pain from the low back, a pinched nerve or disc related injury

  • Who: Runners, Contact sport athletes

  • What to look for:

    • Swelling- may indicate a cyst which can be related to meniscus tears or damage to the Anterior Cructiate Ligament  (ACL) or Posterior Cruciate Ligaments (PCL)
    • Popping/Clicking or Locking- may indicate damage/degeneration of the meniscus or may indicate a "loose body" in the joint; these range from calcium deposits to chunks of bone which have broken away due to injury.
    • Feeling unstable/giving away: may indicate ligament damage, loose bodies, muscle weakness or meniscus injury
    • Pain unchanged by knee movement or that cannot be reproduced. Pain may be coming from the low back, hip or another area.

  • Underlying CausesTrauma/Injury where the knee is forced backward (sometimes with rotation), improper warm up prior to activity. Overuse and occasionally poor mechanics.

  • Diagnosis: Clinical Exam, possible MRI

  • Treatment Options: Possible surgical intervention for meniscus, depending on classification or location of injury. Chiropractic manipulation, McKenzie technique, rehab or additional techniques may be needed if the cause is related to low back concerns.


FINAL NOTES

Hopefully this has helped you understand the basics of knee pain and concerns. As always, be sure to understand the underlying causes of your injury, proper diagnosis, and appropriate treatment options. 


 
 
The knee is one of the most unstable joints in the body. The stability comes from the ligaments and muscles that cross the joint, opposed to the hip which is largely stabilized by the body structures. The knee is comprised of two joints, the tibiofemoral joint and the patellofemoral joint. The tibiofemoral joint composed of the femur sitting on top of the tibia to create the hinge joint that moves the knee. The patella (knee cap) sits in a groove of the femur to create the patellofemoral joint. 

The tibiofemoral joint’s job is to transmit body weight and forces from the femur through to the tibia allowing constant energy movement. Because the tibiofermoral joint is a hinge joint it can only move in the sagittal plane. This plane allows flexion movement (bending the knee) and extension (straightening the knee).  The tibiofemoral joint has a small amount of rotational movement due to the shapes of the contacting surfaces and a few of the soft tissues that connect the two bones. One of those soft tissue factors is the ACL (anterior cruciate ligament). This rotational movement is called the “screw home” mechanism. The tibia externally rotates 5 degrees in the last 15 degrees of extension.  So what that means is when the knee locks out into extension the foot points out away from the body. This mechanism happens to take load off the quadriceps (thigh) while standing.

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The patellofemoral function is to transmits tensile forces generated by the quadriceps to the patellar tendon. The patella glides in a groove of the femur as the knee bends and straightens. Common injuries include patella tendonitis, patellofemoral tracking issues, and bursitis. Injuries to the patellofemoral joint occur when too much load is being transmitted through it or the patella is not tracking properly because of muscular imbalance.

Some common knee injuries include either a sprain or tear to the ACL (anterior cruciate ligament), MCL (medial collateral ligament), or LCL (lateral collateral ligament). The ACL is the most well known sports injury. The ACL's job is to prevent anterior translation of the tibia from the femur. So the ACL stops the bottom half of the leg from moving too far forward. The MCL is commonly hurt by a valgus force to the knee. An example of a valgus force to the knee is when a lineman in football gets hit on the outside of his knee causing his knee to fall inward towards his opposite knee. A varus force causes injury to the LC, which is just the reverse valgus force. The blow is to the inside of the knee pushing the knee out. 


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Proper knee mechanics is important to living life with ehalthy knees. Using correct form while performing everyday life activities, especially weight lifting, can decrease knee pain throughout your lifetime.

 
 
Recap from Part I.... You experienced horrific pain from doing none other than scooping a sock up from your floor. You cursed and crawled to the couch to lay in agony. Unfortunately this hits you yearly and you are sick of dealing with ongoing low back problems. Here are some treatment options to explore.

Part II: Treatment Options

There are 2 goals to treatment (as always at MSWC): get rid of the pain then FIX the underlying problem.

Stage I: Pain Relief

  • SI Belt. Unlike a back brace, this supports the ligaments to allow healing without turning off or weakening your core muscles. Worn 24/7 (to help with that pain rolling over in bed) for several weeks, then gradually reduced. Think of this as the "cast" to help the ligaments and joint heal.
  • Stability, stability, stability. Unlike an ankle injury where a cast or crutches allow healing, SI joints don't have that luxury- they still have to work! SI Belts help, but improving stability from the muscles in the area reduces force in these joints truly allows healing to occur. Depending on your case, we prescribe any assortment of "spinal -sparing" core exercises to strengthen and activate core muscles.  This may be as "simple" (but HUGELY important) as breathing properly, activating your pelvic floor muscles or tensing your abdomen. As you progress it may include planks or more physically taxing exercises.
  • Don't forget the classics: Rest, Ice, Compress, Epsom salt bath, anti-inflammatory cream/oral supplementation.
  • Kinesiotape- Used to reduce inflammation.
  • ART, Graston and soft-tissue techniques. These become most beneficial in Stage 2. We can use these minimally to reduce pain and improve circulation to the injured area. These are great for reducing muscle spasms trying to protect the injured joint. We do want to be cautious here; too much tissue work may destabilize the area too far and take away the hard earned support your stability exercises are giving us. It's all about balance!!!
  • Adjustments- For the same reason as ART, Graston and soft-tissue treatments, adjustments have their place. Adjustments are great for stimulating the nervous system to reduce spasm, opening up these joints to allow better circulation and improved healing. They also create movement in an area being "casted" by muscles and the belt to allow healing. Some cases adjusting is a needed tool, some cases it is a better tool in Stage II.
  • Muscle Relaxants. Pros and Cons. Pros- provide very effective, fast relief. Cons- they destabilize  the area and effectively slow the healing process, they also may interact with other meds and carrying some side effects like drowsiness, dizziness and mental fogginess. In severe cases, these may be needed and thank heavens for modern medicine! In most cases, other techniques should be used first.
  • Cortizone Injections or Radiofrequency Ablation These more aggressive techniques have their place, especially in chronic cases or cases which aren't responding to conservative care. As always, start with the least invasive and least risky then progress as needed.
Stage 2: Fixing the "Why"

If you slipped on ice- don't do it again.....doctors orders. If you "didn't do anything-" keep reading.  

  • FOCUS: Movement Repatterning: Retraining how you put groceries in the car, climb stairs, unload the dishwasher or get up and down from your desk are integral parts of your treatment. Although you are feeling better, remember that years of bad habits have culminated in this horrible experience. An ounce of prevention is worth a pound of cure!
  • Kinesiotape- Used to activate muscles that aren't working hard enough or deactivate the overactive ones.
  • ART, Graston and soft-tissue techniques. After an injury, scar tissue is produced. Scar tissue is only detrimental when an excess is developed. These techniques promote healthy tissue (collagen) formation and encourage the new tissue to have improved strength and resilience to reduce risk of reinjury.
  • Adjustments- Adjustments are great in this stage. Encouraging the nervous system to function properly and ensuring that each SI joint and the surrounding joints are moving properly to reduce compensations.
The next time you hear this story from a friend, neighbor or loved one (it should no longer be you), help give them hope. Please share this article with anyone who can relate and encourage them to seek the prevention or treatment that will break the cycle!


 
 

 You wake up one morning, feling great. You bend over to pick up a sock and suddenly you can't stand up. Excruciating pain sears through your low back, just over the left hip. After remembering to breathe again, yelling for help, and quietly screaming expletives through clenched teeth; you hobble to the couch and lay in misery the rest of the day. Missing work, your kids hockey game and ordering take out because it is too painful to cook; you know this is just the beginning. Gradually your pain improves but for weeks you question every movement and twinge.

I hate to say it...classic.  We commonly hear a variation of this story and it often suggests injury to the SacroIliac (SI) joint. Sound familiar? This 2 part series gives you some background followed by treatment options.  

PART I: THE BACKGROUND
HOW LONG AM I STUCK WITH THIS?


The "lock up" is from muscle spasms which typically improve by 3-5 days, but leave your SI joint (the actual cause of injury) relatively unprotected. Without treatment, pain often reduces to a scale of 1-2/10 within 4-6 weeks. With proper homecare and treatment, we can often reduce pain to this level within 1 week.

WHAT IS THE SI JOINT?

A large joint in the lower back. You have a left and right joint where the pelvic bones meet the large triangular sacrum. These joints are tightly supported by ligaments but move with EVERY movement you perform from walking or climbing stairs to transitioning between sitting and standing.

DEVIL IS IN THE DETAILS...

These joints carry your entire upper body weight and transfer that weight to the larger hip muscles and pelvic girdle. They function throughout the day as a foundation for your spine but also as an anchor point for the most powerful muscles in the body- your glutes.

CAUSES?

One cause is trauma like slipping and falling on ice.

More commonly, repetitive strain. There are "good" and "bad" ways to reach into your dishwasher, put on your shoes and pick up that sock.  A tiny change in how you move can put excessive force through this joint and these ligaments. Over time, the tissues around this joint can't support the forces you are demanding of them and they begin to break down. This process takes a lot of time and you won't notice pain until it is far underway.

THE STRAW THAT BROKE THE CAMELS BACK...LITERALLY

By the time you picked up the sock, the damage and irritation in those SI joint tissues has already reached a critical stage. Although the act of picking up the sock was "nothing," your daily patterns, habits, strengths and weaknesses have caught up with you.

 
AS IF ONCE WASN'T ENOUGH, THIS HAPPENS TO ME ONCE A YEAR...

This is the single worst thing to hear. This is a red flag that you have never addressed the injury fully and only on very, very, very rare occasions should I hear this from our patients. If you had a severe traumatic injury (car accident, etc) or have something in your history affecting your healing process or tissues, you are excused (and make up 99% of the rare cases I am allowed to hear this from). Otherwise....

If treated properly, you should only have re-occurrences that are predictable: aka....."I decided to help move a washing machine down a flight of stairs and I KNOW  I didn't move properly."

Cases that have never been treated, or treatments that stop when the pain stops will have re-occurrences. It is not an if.....it is a when and it is a disservice to patients without treating and educating you about the underlying cause.




STAY TUNED FOR PART II: Treatment Options





 
 

WHERE IS THIS COMING FROM?

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Did you ever think you may have something in common with big names like Kobe Bryant, Tim Duncan,  Ryan Hall, Pete Sampras, or Scott Podsednik? "Walking on sharp glass" especially early in the morning is one possible symptom of Plantar Fasciitis. Sharp pain localized in the heel can be another symptom. The reality is that from basketball to tennis, running to baseball, even football to hockey does not discriminate when it comes to this condition.

 What most people don't realize is that there are a number of conditions that cause pain in the bottom of the foot or heel; yet the term Plantar Fasciitis is often wrongly used due to its familiarity to many people. It is important to see a professional for a correct diagnosis and to determine the underlying cause of the condition causing pain (muscle, fascia or tendon tears, nerve entrapment as well as stress fractures are just a few of the other conditions that should be considered). Early treatment is very important to better long-term outcomes, so instead of "running through it," read up on this 3 part series for information about treatment options, tips for home remedies and what to expect if you do need to seek care!

The Cause...



Before we can discuss how to treat it, we need to take a step back to understand exactly WHAT it is and what may have caused it to begin with. True plantar fasciitis was once believed to be inflammation of the thick band of tissue on the bottom of the foot known as the Plantar Aponeurosis (Fascia) - hence the name ending in "itis."  In recent years, a change in the cause of the condition has been recognized. Current research suggests that although inflammation may be present, the true cause of the condition may be atrophy or chronic degeneration of the fascial tissue (3, 4). The smaller and deep foot muscles (known as intrinsic muscles) are also sometimes affected by this degeneration or inflammation.  

Since everything in the body is about balance, we have to consider all 33 joints, 28 bones and over 100 muscles in the foot. The plantar fascia has direct connections to the muscles in the calf while at the same time opposing the muscles and tissue on the top of the foot. Each muscle, tendon and joint is responsible for sharing the load during standing, walking, running and jumping.  Improper fitting shoes, poor gait mechanics, lack of range of motion in any one of the foot or ankle joints, overly tight calf or ankle muscles are all possible causes, just to name a few.

Studies recently have used MRI imaging to link pain and chronicity to the size (and therefore assumed strength) of the small muscles in the foot which are used to support the inside arch of the foot (1, 2).  Weak foot musculature and/or lack of endurance in these muscles can lead to changes in pronation and the ability of the foot to distribute forces evenly and smoothly. Increased tension on the fascia or very fast transfers of force to the fascia cause irritation and eventually inflammation.

Diet and hydration can always be culprits. "You are what you eat" is an old saying for a reason. The types of proteins, fats and carbohydrates you eat are the building blocks of your tissues. The quality of your tissue is largely dependent on the quality of food you eat; furthermore your general inflammation is higher when you eat poorly and will be more difficult to calm down after an injury. Drinking plenty of (quality) fluids keeps your tissues more pliable and helps your body repair more quickly.

Training schedules and of course general overtraining are hugely detrimental. As a general rule, intensity of your workout should be increased by no more than 10% each week. Many people also fail to give themselves the recovery they need to heal and stay healthy after each workout- it is important to listen to your body and give it ample time to recover so it can adapt and get stronger. Using cross training, or mixing up your workouts with different types of activities is a great way to give yourself recovery time while working different muscle groups which pays off in the end as well!

Any combination of factors may lead to the inflammation that causes Plantar Fasciitis pain. As part of the natural healing process, the body creates scar tissue along the areas of inflammation. Scar tissue is not like the healthy tissue that lies underneath it; reduced pliability and stretch as well as increased diameter of the tissue leads to changes in how the foot functions. Changes in foot function leads to changes in the amount of force distributed throughout the foot during activities which can increase the irritation in the original tissues. It is easy to see the vicious cycle that makes Plantar Fasciitis such a chronic problem for so many people.

TREATMENT OPTIONS:

Every case of Plantar Fasciitis should be treated differently because every case has a different underlying cause. Improper fitting shoes, poor gait mechanics, weak foot musculature, lack of range of motion in any one of the foot or ankle joints, overly tight calf or ankle muscles, are all possible causes, just to name a few.

The first step in treating this condition should be obvious: stop doing whatever caused the pain. Whether it was increasing mileage for running, standing for a long time, wearing high heels or jumping during training for you sport, the longer you keep pounding and aggravating the tissue, the harder it will become to treat and the longer it will take. Depending on why your pain has begun, varying treatments can be used to improve your outcomes.

Initial treatment can be performed at home with little to no equipment. Stay tuned for Part II of this article which describes many commonly used homecare techniques in more detail. If your pain has not improved considerably within 7-10 days of diligent homecare, then it is time to seek professional care sooner rather than later. Part III will discuss professional care techniques that are commonly used.

STAY TUNED FOR PART II: HOMECARE OPTIONS TO FIND OUT WHAT YOU CAN DO AT HOME TO HELP!

 
CITATIONS:

1. Chang R, Kent-Braun JA, Hamill J. "Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs."  Clin Biomech (Bristol, Avon). 2012 Jun;27(5):500-5.

2. Chundru U et al. "Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot."
Skeletal Radiol. 2008 Jun;37(6):505-10. doi: 10.1007/s00256-008-0455-2.

3. Kaikkonen M, et al. "Treatment of Plantar Fasciopathy." Duodecim. 2012;128(17):1777-85.

4. Cornwall MW, McPoil, TG. "Plantar Fasciitis Etiology."
J Orthop Sports Phys Ther. 1999 Dec;29(12):756-60.

 
 
What is IT band syndrome?

The first question to answer is what is the IT band? IT band stands for Iliotibial band which is a large sheet of thick fibers that connect the hip to the knee on the outside of the leg. Various muscles and other kinds of soft tissues connect to the IT band. IT band syndrome is an overuse injury common in runners and cyclists. The distal (bottom) portion of the thick band crosses over the lateral epicondyle (outside bony part) of the knee. As the knee bends and straightens that portion crosses over the lateral epicondyle which can cause irritation and/or a popping sound.

How do I prevent IT band syndrome?

Athletes can help prevent IT band syndrome from occurring. Proper mechanics should always be used while exercising regardless of the intensity. It is important that our muscles and joints are used the way that they were designed to be used. Incorporating a dynamic warm up and cool down decreased the rate of injury. This allows blood flow to the muscles while stretching the muscles. IT band syndrome can be an effect of tightness of one or more of the muscles that attach to the IT band. Also, a number of soft tissue techniques could be used including ART (active release technique) and Guasha (a scraping technique). Most soft tissue techniques have the same end goal with different approaches. People react different to different techniques.

How do I treat IT band syndrome?

There are many treatments for IT band syndrome ranging from conservative care or surgery. It is common practice to begin with conservative care, working of proper mechanics, soft tissue techniques, and stretching. From there if no results are found then the injury would be re-evaluated and the case would progress from that point.

-Amanda Roberson, MAT, ATC, LAT
 
 
Written by Susan Voss. Edited by Dr. Therese Miller, DC.

What is it and why does it happen? 

Iliotibial Band Syndrome is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The IT band begins at the hip (iliac crest) and extends to the outer side of the lower leg (fibula) just below the knee joint.  The band functions in coordination with several of the thigh and hip muscles to provide stability to the outside of the knee joint, which is where the irritation usually occurs.  Irritation can also occur at the hip or cause hip "bursitis" as well. 
 
Iliotibial band syndrome is an overuse injury most common in runners and bicyclists.  Runners can develop ITBS when making mistakes in their training or with poor mechanics.  Roads are banked to allow for  water runoff.  If a runner always runs on the same side of the road, it produces the same effect on the body as having a leg-length discrepancy. Running too many hills can also inflame the IT band.  Bicyclists may develop ITBS if they have improper posture on their bike and most commonly if they "toe in" when they pedal.  This increases the angle of the IT band as it crosses the knee, increasing the risk of inflammation.
 
What are the symptoms of ITBS? 

Pain on the outer side of the knee is the most common symptom but pain on the outside of the hip is also common.  There may initially be a sensation of stinging or needle-like pricks that are most often ignored. Some people may feel a snapping or notice a popping sound at the knee, and there may be some swelling.  Occasionally the pain may radiate along the IT band on outer side of the thigh between the knee and
hip.
 
How is ITBS treated? 

Initial treatment for ITBS includes rest, ice cup, compression and elevation; in addition to determining the underlying cause of the irritation. Depending on each individual case, any number of techniques may be helpful including ART, Graston, Kinesiotape, Trigger Point Dry Needling, Class IV Cold Laser Therapy, or many others.  Anti-inflammatory ointments can help to reduce inflammation.  
 
After the acute phase has subsided, focus should be on correcting muscle imbalances or improper mechanics which caused the inflammation to begin  with; this is different in each case. Treatment may include flexibility, stretching, and mobility or strengthening as well as gait retraining, bike adjustments or addressing other movement patterns. 
  
An important step in recovery is to evaluate the underlying cause of the problem. ITBS often becomes a chronic concern because steps are never taken to change and address why the irritation and inflammation actually occurs. 

Finally, patience is required for optimal results in healing ITBS. Whether it is waiting for mechanics changes to develop or simply returning to activity too soon-these common mistakes delay healing.  Listen to your body so you can return to and enjoy the sport you love!
 
 
The first concern when any athlete is suspected of concussion is to rule out the really serious that could be deadly or constitutes an emergency. Once this is done, evaluation can begin. There are several areas to evaluate: symptoms (what the patient reports), memory and ability to process information, and signs (what the healthcare provider can identify).

Symptoms: The patient is asked to describe their symptoms (which do not always begin immediately after the injury).

Memory/Cognitive: There are a variety of tests. Asking the patient to count backwards, recite well-known facts, remember items that will be asked approximately 5 minutes later are all common aspects of this portion of the exam.

Signs: This is often a major area of focus because these items cannot be altered or "faked." Many athletes are anxious to return to the game, and this portion of the exam gives a clear answer to some of the damage that may be present. There are 12 cranial nerves inside the skull as well as nerves that exit the spinal cord that can be tested for changes in their function. Changes in pupil size, ability to smell or hear, tracking of your eyes with movement, changes in sensation in particular areas or strength in certain muscles can be indicators of changes in your central nervous system.

These three areas will be tested at rest. If these areas are all normal under resting conditions, retesting under "exacerbation" or after performing challenging athletic tasks is used to further identify problems. For football, the athletes are likely asked to sprint 25-50 yards, perform jumping jacks, pushups, squats, etc to elevate the heart rate then are retested immediately. 

Based on the findings at rest and/or during activity, we can determine the degree of injury. Treatment is based and later, monitored, by these tests. 

Stay tuned for the next post on Treatment Options. 

 
 
Concussion itself is defined as a "mild traumatic brain injury" and its symptoms typically last fewer than 24 hours. It is important to realize that the head does not have to "hit" anything and there does not have to be a large force to cause a concussion. Our bodies are designed to absorb forces front-back better than any other direction, so a hit from the side or a jarring from an angle may be enough even under low forces.

The severity of a concussion and the severity of the after-effect are determined by a number of factors including the severity and length of the symptoms, previous history of head injuries, and severity of past injuries. The big concerns aside from initial complications are Post-Concussion Syndrome and Second Impact Syndrome.1

Post-Concussion Syndrome is a condition that causes significant aftermath following a concussion. These can range from personality and emotional changes (changes in anger, temperament, etc) to reduced response time, headaches, chronic pain, fatigue and a host of other problems. In many cases post-concussion Syndrome is short-lived but it may be a permanent change. These changes can quite literally be life-altering and must be taken seriously and treated properly.

Second-Impact Syndrome is a condition that can be deadly and is still not fully understood. First described in 1984, it involves a second head injury (typically prior to complete healing of the first). The brain swells and bleeds more severely than expected. There is a large hole in the base of the skull that the brainstem travels through on its way to becoming the spinal cord; as the pressure increases around the brain from the swelling the brain can actually be deformed and pushed through this hole. This is known as herniation and can be deadly. While still controversial, growing evidence supports higher risk with concussions that are not managed fully. This is the primary reason concussions are gaining so much more attention.

Stay tuned for the next post on Concussion Evaluation....