An irritated Iliotibial Band (ITB) is most probably one of the most debilitating injuries amongst runners. The onset is normally sudden and in the majority of cases follows a quick increase in mileage – too much too soon. The biggest problem with ITB syndrome is that once you’ve got it, you seem to be stuck with it for a long long time.
There are many treatment approaches for ITB syndrome. Your physio may recommend ice, ultrasound, dry needling, specific stretches and rest, the podiatrist may suggest an orthotic, the orthopedic specialist may recommend anti-inflammatories, cortisone injections and eventually surgery, but yet, most of the time the injury seems to resist all these modalities. Often rest is the only ‘cure’, but then as soon as you start running and get to the same mileage, the ITB shows up again!
A typical assessment performed by a medical professional will normally include tests of the hip, knee and ankle on the side of the ITB problem. However, if you do an holistic assessment which includes the whole body, athletes complaining of pain around the Iliotibial Band, always show that the body is locked in a spiral pattern, which causes irritation and strain of the ITB.
A locked spiral pattern can be caused by any of the following :
- Previous injuries or surgery i.e. sprained ankles, knee or hip operations etc.
- habits like sitting with your legs crossed ( but always the one leg only)
- carrying babies and toddlers on the same hip
- previous unilateral sports like golf, hockey, tennis, cricket etc.
- previous shoulder injuries
- asymmetrical sitting postures in front of a computer
- and many more..
All the above are examples of habitual movement patterns that cause overuse and shortening of the muscles of the one spiral sling, which eventually leads to connective tissue immobility resulting in dysfunctional movement patterns. It can be compared with a car of which the wheel alignment is out, resulting in wear and tear on one tyre.
The Spiral Line
So let us first follow the spiral line as it rotates the body:
Stand with your feet planted slightly apart and, without lifting the feet off the floor, rotate your body as far as possible to the left. When you focus on the muscles contracting in your back, you will clearly feel the contraction of the (L) Latissimus Dorsi, continuing though the thoracolumbar fascia into the (R) Gluteus Maximus, the (R) Biceps Femoris (hamstring) and the (R) Peroneii. Notice how a full contraction of the Peronius allows the (R) foot to plantarflex and rotate into eversion until you are literally twisting onto the (R) big toe.
At the same time the opposite spiral sling will contract starting with the (L) Splenius Capitis (rotating the neck), the (R) Rhomboid, (R) Serratus Anterior, the (R) External Oblique and the (L) internal Oblique (twisting the upper body), then into the (L) Tensor Fascia Lata (rotating the hip medially), the (L) Tibialis Anterior (lifting the foot into dorsiflexion and investion).
Note that in the spiral movement, there is always a link between the hip and the opposite shoulder, which means that a locked shoulder, could cause dysfunctional movement in the opposite hip.
While maintaining the same position as above, keep the full rotation of the hips, but now twist the upper body in the opposite direction. Note how the connection between the upper spiral slings and the lower spiral slings swop around in this position, connecting the anterior (front) upper sling to the posterior (back) lower sling.
It is clear that there could be many combinations of spiral slings which may all cause ‘fascia locks’ in cases where the muscles are overused or where the body is subjected to recurring movement in one specific direction.
When we therefor assess the movement patterns, there is a huge variety of possible dysfunctional patterns that may have an effect on the ITB. A lock on any of the muscles named above could cause strain and chronic irritation of the ITB and therefor shows the importance of a full holistic assessment in order to find the cause of the problem.
Once the practitioner has discovered the movement pattern which causes the strain on the ITB, it becomes very simple to unlock and release the fascia in order to restore full neutral movement. If the cause of the locked pattern was a previous injury or surgery, the release of the pattern should immediately take the strain off the ITB, allowing the band to recover.
If however, the locked pattern is caused by an habitual movement i.e. carrying your toddler on the same hip everyday, it is essential to add specific strengthening exercises in order to maintain the neutral function of the muscles.
Most recurring sport injuries are caused by dysfunctional movement patterns as a result of ‘locked’ fascia (connective tissue). Our bodies have a built-in healing function which will heal all soft tissue injuries in a maximum of 6 weeks and bone injuries in 12 weeks. If your injury takes longer to heal, it means that there is a disguised factor which is causing repetitive injury, preventing the body from completing the healing process. With all chronic and recurring injuries it is essential to perform an holistic assessment in order to find the cause of the injury.