Iliotibial Band Syndrome

Introduction

The Iliotibial band (or IT band) is an extension of fibrous fascia that extends from the top of the plevis, down the side of the leg, and attaches to the lateral aspect of the knee. The IT band is involved in flexion and extension of the knee, and as a result, is a key player in activities such as running, cycling, weight-lifting (especially squats), and hiking.

It is commonly injured in runners. Especially those that have increased distance recently or amount of training. The IT band rubs against the tibia during knee flexion and extension, and thus becomes inflammed after repetitive movements. Pre-disposing factors include old shoes, and excessive heel wear, running in the same direction on a pitched surface, leg-length discrepancy, and lack of stretching (or warm up before stretching).

Signs and symptoms of IT Band Syndrome Include:

1. A sharp pain over the lateral femoral condyle posteriorly
2. Pain that starts half-way through a run
3. Hypertonic muscles and trigger points found in tensor fascia lata, quadriceps, and hamstrings
4. Weak hip abductors
5. Increasing pain on running or walking when the foot strikes the ground

Treatment:

Activites that aggravate the condition should be curtailed or avoided completely. If actively inflammed the RICE method of treatment should be in the fore-front (Rest, Ice, Compression, Elevation).

In the long term, orthotics can be prescribed to help improve the mechanics of the feet and to reduce stresses on the knee joint. Soft-tissue therapy, aimed at the aggravated muscles, including the IT band, can help with any residual tightness exhibited. Proper stretching should be done for the IT band, including a proper warm up before any activity or stretching is done. Shockwave treatments and/or laser can help with the healing process. A rehab program will address muscle weakenss in the hip abductors (gluteal muscles), as well as strengthening the quadriceps and hamstrings.

The following is a good stretch for the IT band. But make sure the tissue is warm before proceeding to do so. A hot towel placed on the tissue can help warm it up, or you can also do something like 20 jumping jacks, to help warm up the tissue.

1)Stand upright
2)Cross the involved leg BEHIND the opposite leg
3)Lean to the uninvolved side until a stretch is felt across the affected iliotibial band
4)Hold for 30 seconds
5)Repeat X 5

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Ankle Sprains Demystified

Typical mechanism of an inversion-type sprain of the ankle is stepping on an uneven surface (i.e. another foot). Ankle sprains are, by far, the most common sports injury. The good news is that most will almost inevitably heal within 4-6 weeks, and most show modest improvement within 2 weeks. Most commonly, ankles are sprained as a result of sudden movements such as twisting. All it takes is one awkward step, an uneven surface, or jumping and landing on another foot, that can set a barrage of symptoms into motion. It is common in sports such as basketball and volleyball when the players comes down from a jump and lands on another player’s foot. The pain results from injury to the ligaments of the foot. These ligaments are responsible for helping the joints and bones of the foot and ankle maintain stability and to prevent excessive movements. There are two main categories of ankle sprains.

1. Inversion Ankle Sprains

If you were to bet on the type of sprain, put your money on this one. Almost 90% of ankle sprains are inversion sprains. Pain is on the outside of the ankle and there is usually no pain inside of the ankle joint. There is also limited and painful dorsiflexion. The main ligament involved is known as the anterior talofibular ligament (ATFL).

2. Eversion Ankle Sprains

The other type of sprained ankle is called an eversion injury, where the foot is twisted outwards. When this occurs, the inner ligament, called the deltoid ligament, is stretched too far. Patients will have pain on the inner side of the ankle. The deltoid ligament is one of the strongest in the body, and often a fracture is present if this ligament is torn.

Commom Symptoms of Ankle Injury

There are 3 different grades of sprains, which have to do with the amount of damage to the ligaments.

Grade I: Grade I ankle sprains cause minor stretching of the ligament. The symptoms tend to be limited to pain and swelling. Dorsiflexion of the ankle is also painful. Generally tendons of the calf muscles become irriated, and should be addressed. Sometimes the joints of the ankle can also become immobile and locked.

Grade II: Grade II ankle sprains are more severe and involve partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.

Grade III: Grade III ankle sprains are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.

Pain and swelling are the most common symptoms of an ankle sprain. Patients often notice bruising over the area of injury. This bruising will move down the foot towards the toes in the days after the ankle sprain--the reason for this is gravity pulling the blood downwards in the foot.

Do I need to see the doctor if I have an ankle sprain?

If you do have significant symptoms following a sprained ankle, you should seek medical attention. Signs that should raise concern include:

• Inability to walk on the ankle, for 4 steps or more
• Significant swelling
• Symptoms that do not improve quickly or persist beyond a few days
• Pain in the foot or above the ankle
• Sometimes an x-ray is needed to differentiate between a sprained ankle and a fracture. While moderate pain and swelling are common symptoms following a simple sprained ankle, symptoms such as inability to place weight on the leg, numbness of the toes, or pain that is difficult to manage should raise concern. If you think you may have done more than sustained a sprained ankle, you should seek medical attention.

What is the treatment of a sprained ankle?

Treatment of sprained ankles is important because returning to normal activities in a timely manner is important for most patients. Early treatment of a ankle sprain is the "RICE" method of treatment. If you are unsure of the severity of your ankle sprain, talk to your doctor before beginning any treatment or rehab. The following is an explanation of the RICE method of treatment for ankle sprains:

Rest:

The first 24-48 hours after the injury is considered a critical treatment period and activities need to be modified. Gradually put as much weight on the involved ankle as tolerated and discontinue crutch use when you can walk with a normal gait (with minimal to no pain or limp).

Ice:

For the first 48 hours post-injury, ice pack and elevate the ankle sprain 10 minutes at a time every 20 minutes or so, for 3-4 hours. The ice pack can be a bag of frozen vegetables, allowing you to be able to re-use the bag. Do NOT ice a ankle sprain for more than 15 minutes at a time! You will not be helping heal the ankle sprain any faster, and you can cause damage to the tissues!

Compression:

Use compression when elevating the ankle sprain in early treatment. Using an Ace or tensor bandage, wrap the ankle from the toes all the way up to the top of the calf muscle, overlapping the elastic wrap by one-half of the width of the wrap. The wrap should be snug, but not cutting off circulation to the foot and ankle. So, if your foot becomes cold, blue, or falls asleep, re-wrap!

IMPORTANT NOTE: Please remove footwear. I've witnessed people instructing shoes to be kept on during an acute ankle injury because 'it prevents swelling'. This is FALSE and shoes should be removed. If the ankle swells too much with the shoe on, it could cut off circulation and make your life more difficult. And furthermore, you need more direct contact to the area in order to ice it.

Elevate:

Keep your ankle sprain higher than your heart as often as possible. Elevate at night by placing books under the foot of your mattresses--just stand up slowly in the morning. Later, treatments involve addressing the muscle and joint issues with soft tissue treatments and an active rehabilitation program, focussing on proprioception. Laser is a modality which can help patients deal with pain and promote faster healing of the injured ligaments. Mobilizations and adjustments of the ankle joint can help promote tissue healing and create optimal mobility within the ankle complex, should mobility be compromised as a result of injury.

Ankle Braces:

One of the best pieces of experience that I can share has to do with ankle braces. They are an excellent way to compress and protect the ankle after an injury, but more importantly, can be used to help prevent you from rolling over on your ankle in the first place. I would suggest anyone who is involved in any sort of sport whereby ankle injuries are common, to invest in a pair of ankle braces. They are very much worth the effort and can save you a lot of trouble in the end.

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References:

Wolfe, MW, et al. "Management of Ankle Sprains" Am Fam Physician 2001;63:93-104.

Osborne MD, Rizzo TD "Prevention and treatment of ankle sprain in athletes" Sports Med. 2003;33(15):1145-50.

Tips For Recreational Athletes

Looking to be more active and healthy?  Looking to play a sport?  Getting involved with an organized sport is an excellent step to take for your health.  You don’t have to be the best, the most experienced, or a pro athlete to gain from the immense health benefits of sport.  Competition can be fun and healthy.  Organized sport will get you up and moving and off of the couch watching television for a night.  Have you ever said: “I’d like to really try that!” or “that sport has always interested me.”?  Then stop thinking about it and take action! 

BARRIERS TO ACTIVITY

It’s no secret that physical activity is an important part of a healthy lifestyle.  I have much respect and admiration for those of you who incorporate this into your everyday routines.  You are making an investment into yourself and your future. I have come across many reasons why people are discouraged from joining an organized sport or activity.   Excuses range from: I don’t have the time; I’m not very good; I don’t know anyone; It’s too expensive; I’m too old to start playing sports again, and the list goes on.  While you may be discouraged for some of these reasons, you need to keep a lot of things in mind.  These excuses are really just that, and do not usually hold any grounds in the bigger picture of things.

Organized sport often take place only for a few hours per week.  You can certainly afford that much time, and it is an investment into your health and wellness.  If being active regularly means you live 5-10 years longer, then how much is your time worth?

Many organized sports also have a range of skill sets for you to draw from.  Usually there are total beginners who need to learn everything from the beginning, to intermediate players who know the basics and are working on retuning their skills, to advanced players.  Often the sport will accommodate you to what ever level you feel comfortable.  The more skilled players can help you to improve your game, and make sure that you understand the sport.

If a particular activity interests you, then go for it. Sport is a very social atmosphere that will introduce you to others who have the same interests as you. The shyness that you perceive as a block to your activity will be short-lived and give you a great and healthy social outlet that you will enjoy returning to again and again.
For the most part, if you have a heart-beat, you can be active.  There is no such thing as too young or too old.  Everyone can benefit from some form of physical activity.

There are many different inexpensive ways to enjoy sport and activity.  Even getting a group of friends together to go for walks is a great idea.  You can explore new and different areas of your neighbourhood or city that you might not have had the chance to do before.  All while you are reaping the benefits of physical activity.

Focus on what your health goals are and work towards them.  Try not to focus on minute details.  Rather than focusing on what’s deterring you from the sport or activity, try and focus on what made you want to get involved in the first place.  The bottom line is to stay motivated. You CAN do it! 

THE BENEFITS OF ACTIVITY

Client’s with an active lifestyle make up a great proportion of the sorts of people that I see everyday.  Many of them are active through a variety of different means, of either regular walking, jogging/running, yoga, weight lifting, and/or sport.

Being physically active can help you maintain a healthy weight, reduce blood pressure, build strong bone, and muscles, relieve stress, prevent pain and injury, and maintain flexibility and good posture.

Recreational sport is an excellent way to enjoy physical activity.  It doesn’t matter whether you pick up a hockey stick, soccer ball, golf club, racquet, paddle, or running shoes.  The important thing is that you get moving!

Canada’s Olympic Athletes have long benefited from chiropractic care to help them avoid injury and get the most out of their favourite sport. 

TIPS FOR HEALTHY, SAFE, AND INJURY-FREE SPORT

Take a look at this simple guide for recreational athletes.  This is some good information to follow whenever you are looking at participating in any activity:

1. WARM UP:  Before swinging a racquet, running a race, and slapping a hockey stick, you should warm up for a good 20 minutes – no less.  Warm up exercises generally include deep breathing, gentle stretching, and range of motion exercises, as well as a brisk walk or easy job to warm up muscles and joints.
2. LEARN THE PROPER TECHNIQUE:  Learn the right technique for your sport from the beginning.  Using wrong-sport specific technique can create faulty muscle memory and can form bad habits that are difficult to break.  If your body is not positioned correctly during a sporting activity, then it is more prone to injury and pain.
3. USE THE RIGHT EQUIPMENT: Make sure that the equipment you use if the right fit, height, and capacity.  People who are new to a particular sport should have their equipment professionally fitted and checked before starting out.
4. AVOID OVER-TRAINING:  Take your time to work up to it slowly before pushing yourself too hard.  Remember – rest is as important as training.  Take a break and give your body a chance to recover.  Too much, too fast, too soon is a recipe for injury.
5. COOL DOWN: This is just as important as warming up.   Take a good 20 minutes to do a light jog, and stretch out your muscles and joints before heading to the change-room or car

Chiropractors are trained in aspects of sport injury treatment and prevention, as well as sports performance.  The above tips are excellent things to incorporate into any sport.  The longer you stay pain and injury-free, the longer you will be able to enjoy the recreational activities you love.

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