Physio Tips

The Illiotibial Band (ITB) has long been plagued the bad guy of the lower limb, the scapegoat for a plethora of injuries – ITB friction syndrome, runners knee, trochanteric bursitis and as far down as medial tibial stress syndrome to name a few.

WHAT IS THE ITB?

The ITB is thick piece of fascia some compare with big thick elastic band. It originates from the Upper Glute Max and Tensor Fascia Lata at the hip, then creates septum down the leg between the outer quadriceps and the hamstring finally inserting into the girdy’s tubercle below the knee.

WHY DOES IT GET TIGHT?

The ITB creates problems for activities requiring repetitive hip and knee movements and is generally problematic in runners or cyclists. It is associated with the knee falling inwards and creating excessive tension where the band inserts onto the knee usually to poor motor control at the hip and pelvis.

A common “quick fix” is using a foam roller to alleviate pain and “loosen” the fascia. This is generally counter productive, only further compressing the ITB into it’s painful position.

SOME TIPS TO HELP YOUR ITB

Avoid stretching and foam rolling

Thomas Test – Assess hip flexor passive restriction

• Find a table, hug one knee to chest and lie down keeping the opposite leg on the table
• A positive test for this is when the bottom knee does not fall pass the line of the table and therefore stretching the hip flexor may be indicated

Check hip muscle control (pictured below) – Which is working harder – your glutes or outer upper quads? Your glutes should be doing most of the work. You can use the simple, quick tests below to check your hip-muscle control.

• Single leg stance – check for uneven hips and dropping on one side
• Single leg squat – check for uneven pelvic drop by using the waistline on your pants as a guide
• Single or Double leg bridge – sustain a 30 second hold, a good clue here is to consider what is working the most performing this task – if it is your lower back, hamstrings, groin or quads we can infer that your glutes aren’t pulling their weight.

Hip and Trunk disassociation – Can you rotate your trunk without dropping or twisting at the hip?

Get strong at the hip and the foot – The knee often becomes the meat in the sandwich with a dysfunctional hip and a weak foot

It is time to re-think the common misconception that the ITB can be at all lengthened and start looking behind the scenes at other common culprits.

Achilles tendonipathy

Achilles tendonipathy is a common conditioning affecting people from all walks of life. It is characterised by pain in the achilles tendon, generally following a period of overuse.

My top 10 tips to help your achilles tendon!

1. Tendons will not get better with rest only – It will ease the symptoms in the short term but it will return very quickly upon resumption of activity.
2. Achilles tendons are SLOW and takes TIME to adapt.
3. Anti-inflammatories are not indicated for achilles tendon pain as it is not an ‘inflammatory condition’. (In some specific cases short term use of anti-inflammatory medication may be indicated).
4. Exercise therapy is key – A graded strengthening program is fundamental for recovery and return to 100% activity.
5. Passive treatments should be an adjunct to your exercise rehab NOT the only treatments.
6. Isometric holds provide instant pain relief – Contracting the tendon without movement and holding this for 30-45 seconds and repeating as tolerated for 3-5 sets (Eg. Calf raise holds).
7. Respect tendon pain – Monitor your symptoms during exercise and immediately after exercise, as well as the the next 24-48 hours. During your rehabilitation
   try to not push past a 3-4/10 pain level.
8. Stop annoying it – Deloading the tendon is critical in settling down an irritated tendon. As your strength capacity increases so does your activity.
9. In most cases avoid the temptation of corticosteroid injections and/or surgery.
10. Stretching can irritate it – Always prioritise strength work over stretching.

Good luck managing your achilles 🙂

To start, lets get the elephant out of the room – dead lifting is not bad for your back 🙂

Deadlifting is making a serious come back within the exercise world due to the functional pattern movement and full body workouts. It is often seen as a ‘bad’ exercise for your back but if performed with good technique it can have a raft of benefits including:

• Eccentric hamstring strength
• Perfecting your hip hinge movement pattern
• Build a strong posterior chain
• Lengthen your hamstrings
• Creating strong stable core positions that integrate into life and movement

Technique is key to avoid injury.

Common errors completing the deadlift movement pattern:

• Pulling the weight off the ground with a rounded back.
• Get your feet in a good position prior to the lift – grip the floor with your feet, and lift your arches up.
• Trying to ‘squat’ your deadlift.
• Incorrect diaphragm breathing & bracing technique prior to lifting.
• Poor hip hinge and not utilising posterior chain muscles correctly.
• Lifting to much weight.
• Not gripping the bar to create tension in the system.

Pictures: Rounded, squatting the deadlift

Quick Tips

• Practice your hip hinge using a band
• Get your glutes firing prior to lifting
• Lift the bar from an elevated height (Plates under the bar) to decrease movement capacity

Practice makes perfect. Get the basics right.

1. Barbell over midfoot and weight centred over the bar.
2. Screw feet into the ground and imagine ‘ripping the bar apart’.
3. Hinge at the hips by dropping hips back and feeling hamstrings tighten.
4. From here think DRIVE up from hips not PULL up.
5. Once the bar crosses your knees squeeze glutes and finish the movement without swaying back.
6. Repeat the hip hinge movement to return the bar down.

Have you got sore butt when you sit on it? Do you stretch your hamstrings A LOT and continue to get high hamstring pain? Do you get a pull at the base of your butt when you run upstairs or the next day after hill training?

You may have a proximal Hamstring Tendonipathy.

WHAT IS IT?

The hamstring complex is made up of the 3 muscles (biceps femoris, semitendonosis & semimembranosis) which all attach to the inside aspect of your sit bones or the ischial tuberosity as pictured here. This area can be injured through acute mechanisms e.g. a dancer stretching passed normal range and straining the high hamstring. More commonly, we would see this as a progressive overload which injures the tendon e.g. increasing running distance/intensity or adding lots of deadlifts to a program.

The biggest cause is “compression” of the tendon around the sit bones and “tensile” load as the muscle contracts around the insertion and quick increases in “load”. For the tendon heal it is paramount you address the compression and tensile factors.

HOW CAN I ASSESS HAMSTRING PAIN?

1. Sitting tolerance: How long can you sit for?
2. Does it hurt to touch your toes?
3. Does it hurt to do a single leg bridge?
4. When you pull your knee to your chest and straighten the knee
5. If you feel the ‘sit bones’ and the top of the hamstrings does it feel more tender than the other side?
6. Seek professional help to exclude lumbar spine, hip joint or referred pain

QUICK TIPS ON MANAGING HAMSTRING TENDON PAIN?

• Do NOT rest completely
• You will need a cushion for hard chairs and the car
• AVOID stretching the hamstrings
• Start isometric loading for pain relief  e.g. bridges
• Shorten stride length
• De-load by reducing plyometric or hill training
• Then lastly LOAD the tendon to its former glory in positions that do not add to the compression e.g. standing leg hamstring curls or bridges

Osteoarthritic knee pain generally manifests as a diffuse ache over the middle of the joint. It is worse with weight bearing tasks such as long walks and can be painful to bend and straighten at times. The Physio Depot are here to help manage your symptoms and provide an effective treatment plan.

What is oesteoarthritis of the knee?

The knee is made up two joints called the tibiofemoral (femur and shin) and the patellofemoral (knee cap) joint. When we experience wear and tear between these joints over time the cartilage surface becomes exposed and starts to break down. This breakdown causes less shock absorption and increased friction between the bones which can cause pain, stiffness and decreased functional capacity.

What causes knee osteoarthritis?

While ages is a major risk factor for osteoarthritis of the knee, young people are not necessarily immune. For some individuals, it may be hereditary, for others, injury, infection, illness of being overweight can be causes.

5 Quick Tips to improve your knee joint health

1. Keep moving

General exercise is the easiest way to warn off arthritic aches and pains. Low impact loading is important to maintain bone mineral density and joint health. Walking, cycling, aqua aerobics and cycling are common favourites for managing knee osteoarthritis.

2. Improve your knee strength locally and globally

Quadriceps strength is the number one target for knee arthritis this helps promote shock absorption and create stability around the knee. Gradually advancing your local quadriceps strengthening and mastering functional movements to improve hamstring, gluteal and core stability will all help improve knee symptoms.

3. Activity modification

High impact loading, jumping and HITT classes are not going to be the safest choice for an arthritic knee. This high intensity and impact loading tends to aggravate symptoms. Unless you have adequate strength around the knee, these activities will tend to make your symptoms work. Cycling, swimming and low impact exercise is preferable for your knee health to have a lasting result.

4. Maximise your flexibility

A basic stretching routine can help maintain normal joint range of motion. A direct consequence of knee arthritis is generally joint stiffness, so getting into a daily stretching routine can help maintain joint range and flexibility.

5. Weight loss

Weight gain has direct consequence on joint loading and joint wear. Weight loss shows a direct decrease in knee joint loading which is only going to hold up that knee replacement a little longer.

Good luck with getting your knees happy, healthy and strong!!