ITB

Common biomechanical problems with runners – flexibility

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Stretching running physiotherapy

Last week’s blog looked at strength in key muscle groups for runners. This blog is highlighting areas of the body where flexibility is useful at preventing pain associated with running. There has been a lot of research on muscle length / flexibility relative to preventing injuries and the summary is commonly that it doesn’t help. However sometimes the research doesn’t give us the full picture on how to help an individual with pain and that is where having an experienced physio counts. Helping runners return to exercise after pain or injury results in a wealth of experience based knowledge. In relation to muscle length it is that if you don’t have the mobility in the correct places it can lead to injury. An obvious example is a hurdler who tightens up in the hamstring and lacks the flexibility to get the front leg over the bar.  The key area for everyday runners to maintain flexibility is in the front of the hip.

The front of the hip / hip flexors includes 3 muscles, one of which is the TFL (tensor fascia lata) that connects to the ITB (iliotibial band). One example of a common runner’s problem is not having enough hip flexor length which can impair the buttock (gluteal) muscle function and lead to the TFL muscle working harder to stabilise the pelvis whilst running. This can then lead to ITB tightness and pain in runners. Another example is tightness in the hip flexors leading to an increased arch in your back. When this combines with the glut’s switching off hip or back pain are common.

hip flexor tightness and low back pain
Tight hip flexors

Correctly stretching your hip flexors should be comfortable. It is possible to make short lasting improvements in muscle length so if you are tight you need to stretch before you run (despite some research assumptions!). Don’t forget to control the pelvis when stretching.

hip flexor stretch
hip flexor stretch – pelvic tilt / roll

The best plan is if you have pain then get one of the experienced NU Moves physio’s to assess and determine if that’s what you need to get you back to running pain free.

ITB and knee pain in runners

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Running

Our NU Moves Physio team recently debated the current beliefs surround the ITB and how it can give you lateral (or outside) knee pain which is also referred to as ITB syndrome. Here is a simple take home message from a complex discussion.

* The diagnosis of ITB syndrome can be made clinically without investigations

* The lateral meniscal cartilage of the knee needs to be considered as a possible source of pain which may require MRI imaging. A clinical assessment will predict if this is likely.

* The most common cause of the problem is an increase in the amount of running or ‘load’ on the knee. Treatment of acute ITB syndrome must include initially managing the load to help reduce inflammation.  This is usually via modifying the running program.

* The hip is the key to controlling this problem. Most importantly the strength and timing of the gluteal (buttock) muscles need to be sufficient to hold your pelvis and leg stable enough during running. Secondarily having enough flexibility in the hip flexor muscles often helps get the gluteal muscles functioning better.

* Rolling the ITB is a common form of treatment utilised if tightness is perceived as part of the problem. If rolling gives you relief of pain associated with running or any other exercise then we cannot argue with that however understanding the reason behind why it may or may not help is the challenging part. Roll it if it helps you but make sure you start your rehab at the hip.