Tag Archives: running

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Exercises to End Iliotibial Band Syndrome (ITBS)

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Learn some exercises that can help treat and prevent ITBS

Iliotibial Band Syndrome (ITBS) is one of the top five injuries affecting runners. (1) The Iliotibial band (IT) is a frequent location that can suffer from overuse stress. The Iliotibial band (ITB) runs down the outside of the leg to the knee. The knee can be affected by both the hip and foot. In most cases of ITBS patients have weakness in the Gluteus Medius and Maximus on the affected side. To treat ITBS effective you most both address the inflammation in the ITB and the weakness that occurring in the hips. Another helpful component is to address running form or the other actives that aggravates it.

Hypertonicity or overdevelopment of the TFL and not having the Glutes function optimally can cause ITBS. ITBS is common in long distance runners when they are fatigue and the hip muscle become tired. Once tired they no longer control the IT correctly. Causing extra loading of the IT and then to leading to it break down.

The knee is a slave to the hip and foot. Research confirms that strengthening the glutes will correct this imbalance and reduce symptoms of ITBS. When patients who incorporate hip abductor strengthening into their ITBS rehab will experience symptom resolution within six weeks. (5,6)

“Strengthening and activation of the gluteus maximus and gluteus medius while minimizing the contribution of the tensor fascia lata are essential components in the treatment of many lower limb injuries. (4) 


Clams for the win!
A squat and a Clam what could be better?

Another important thing to do If you’re having knee pain related to running, is to have your running gait evaluated. I Like to video tape the patient running in slow motion. Must phone have a great slow Mo setting. This make it easy to see if there is anything that could be contributing to their symptoms. Running with a “crossover” gait, can aggravate or injury the iliotibial band, hips, knee as well as the feet.

  1. Kakouris N, Yener N, Fong DT. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021 Apr 20. Link
  2. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat, 2006;208:309-316.
  3. Michaud T. The Real Cause of Iliotibial Band Syndrome Dynamic Chiropractic November 18, 2012, Vol. 30, Issue 24
  4. Fetto J, Leali A, Moroz A Evolution of the Koch model of the biomechanics of the hip: clinical perspective. J Orthop Sci. 2002; 7(6):724-30.
  5. Barton N. Bishop, Jay Greenstein, Jena L. Etnoyer-Slaski, , Heidi Sterling, Robert Topp. Electromyographic analysis of gluteus maximus, gluteus medius, and tensor fascia latae during therapeutic exercises with and without elastic resistance. The International Journal of Sports Physical Therapy Volume 13, Number 4 August 2018 Page 669
  6. Fredericson M, Cookingham C, Chaudhari A, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med, 2000;10:169-175.
  7. Pepper TM, Brismée JM, Sizer Jr PS, Kapila J, Seeber GH, Huggins CA, Hooper TL. The Immediate Effects of Foam Rolling and Stretching on Iliotibial Band Stiffness: A Randomized Controlled Trial. International journal of sports physical therapy. 2021;16(3):651.
  8. Sulowska-Daszyk I, Skiba A. The Influence of Self-Myofascial Release on Muscle Flexibility in Long-Distance Runners. International Journal of Environmental Research and Public Health. 2022 Jan;19(1):457.
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An Example of Gait Changes After Treatment

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I recently posted a research journal that stated that after an injury patient’s gait might need to be retrained. Here is an example of a patient with a dysfunctional gait:


Take a look at this patient’s gait. Watch her left leg and then watch the right leg. The left knee tracks outward. Look at the patient’s knee. It points outward right instead of pointing forward. Look at the patient’s foot. This patient is towing off laterally and not getting into her big toe.

The second video is after treatment of adjustment to her foot, ankle and lower back, plus a week of home exercises along with some mental corrections. Patient was cued on the changes in her gait and how to improve the lower extremity function. We practiced in the office and the patient was sent home with some homework.


This is an example of how gait retraining can help improve a patient’s function. Strengthening the body is very important but strengthening dysfunctional movements will not progress the patient towards optimal.

foot and ankle.

Ankle pain for two weeks started during an exercise class.

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Dorsiflexion is a important movement that occurs in the ankle. Dorsiflexion the ability for the ankle to bend upward towards your head. We need a minimum of 10 degrees to have good functioning ankle. Its common to lose this motion. Pointing our toes down is called plantar flexion. Look at this patient feet. The left ankle lost its dorsiflexion.

I want to thank the patient for lettings me use these pictures.

Loss of range of motion can be treated with with adjustments and home exercises. Look at how much better the ankle bends after an adjustment to the foot and ankle. This patient responded very well. He is young and the problem was not going for too long so he responded super well.

Patient was also given one strengthening exercise as well as a stretching to do at home to help him heal faster.

We treat ankle pain all the time here at Sikorsky Chiropractic. If you’re experiencing any pain or an injury to your ankle give the office a call!

Images used with the patients permission.

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Running Injury Prevention Strategies Part 2

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Having good running form is another way to prevent running injuries. There are many nuances to running form. We’ll discuss the big three. They are Cadence, Posture and Foot placement.

Cadence (Stride Length)

The amateur runner may not put much thought into their running beyond putting one foot in front of the other, however, if you are finding yourself with consistent pain in your shins or recurring lower leg injuries the way you run may be playing a role. New research has demonstrated that when you take a longer stride as you run, the ground reaction force on your legs will be increased. This increased force can lead to more injuries and micro traumas that can lead to chronic injuries and discomfort.

With Cadence think quick feet. A faster stride will reduce the amount of time you spend on the ground and decreased ground-reaction force. This reduces the impact on your body gets hitting the ground.

 If you think that this may be affecting your ability to run pain-free, try taking some shorter runs and actively think about taking shorter steps while running. Your legs will have to move faster to maintain the same pace as before. It will take some time to retrain your brain to alter your running pattern, but with some regular training, you should be able to make the transition.

Photo by sasint–3639875
See how long her stride is? If the foot is landing far in front of you, your cadence is most likely low.

Posture

Good posture will help you run with less pain and prevent injuries. Basically good posture will create good running posture. Your head should be over your ribcage and your rib cage should be over you pelvis and pelvis over your feet. This posture will let you run using less energy. If your posture is good it will be easier to fill your lungs with air. Next is to engage your core and build midline stabilization.

Foot Placement

Stand with your feet shoulder width apart. This is a very stable position. Now stand with one foot in front (heel to toe). That’s harder right? Standing this way or running this way takes a lot of balance and energy. We’ll call this cross over gait. When we run we should land with our foot under our knee and our knee under our hip. This will support your center of mass better. Think leaning tower of Pisa, the top is not over the bottom making it unstable.

Photo by John-Silver–3202135
The base would be the foot and the hip would be the top.
Take a look at this runner. His foot is on the midline of the body. The leg is not stacked The hip is not stacked over knee or foot. Can you see the pelvis dropping on the left side as well?

Photo by Andrea Piacquadio
Can you see the cross over gait? The foot is midline, the hip once again is not stacked over the knee and foot. Look at her stomach muscles. Can you see the twisting? Here’s an example of the core not being engage and lack of midline stabilization.

If you are new to running or experienced and need help we are here! Please call the office to set up an appointment.

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Running Injury Prevention Strategies Part 1

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Running has become one of the most common forms of physical activity in today’s society. It can be a community building activity, a personal challenge and most importantly a great work out. It is a sport that everyone can participate in; all you need is a good pair of shoes and a little motivation. That being said running can be extremely hard on your body, especially when you are just starting.  We are finding that injuries among runners are very common. From shin splints to rolled ankles, no one is immune from getting hurt; however, here are some tips to keep you healthy and on pace.

Photo by RUN 4 FFWPU

Do not do too much, too fast

            When runners are just starting and begin to make progress, they tend to push their limits. Although this is a great way to challenge yourself, it is important that you understand your body has a threshold that when exceeded results in injury. Your mileage should be tracked on both a daily and weekly basis. If you have never done much long-distance running, then your weekly mileage should begin quite low. It is important that as you improve your mileage increases gradually. A consensus among the running community is the rule of 10%. Do not increase your mileage by any more than 10% on a week to week basis. For many runners and new runners specifically, 10% may even be too much of a jump. This is why when preparing for a distance race, whether it is a 10k, half marathon or a marathon it is recommended you start as early as possible. Could you train and complete a half marathon in 6 weeks? Maybe, but the toll it could take on your body and the injury risk you are exposing yourself to are likely not worth it. A recent study showed that runners who only increased their mileage by 3% a week had a much higher rate of success in their upcoming races than runners who ramped up their mileage quicker.

            So how do you know where to start? First, start with walking. If you can walk an hour a day with out any injury you may start running. As a new runner, start with short runs and accumulate miles over the week. It is important to understand how far you have been running, so I recommend using an app on your phone such as “Map My Run” to help track each run. Personally I have a Garmin GPS watch , that links to Garmin connect. Garmin connect is an app. Most GPS watches can be linked to an app.

Photo by Mateusz Dach

Do not run through significant pain

As runners, we all understand some discomfort is a part of the sport. Your legs and feet will likely be sore after a long run; however, if you begin to notice significant pain or discomfort while running consider taking a break. Breaks are one of the hardest things to convince a runner of doing, but it could save you from more severe injury. Aside from the odd rolled ankle, very few running injuries are acute and traumatic. Far more commonly runners ignore the pain and “tough it out” when they begin to feel discomfort.

This can result in a cumulative injury cycle. What is that you might ask? It means if you continue to stress an injury by running, you will continue to make it worse and it can become a much more significant issue. Sometimes all it takes is an extra day off when symptoms are minor to allow your body to recover. This is important because if you have an injury, it is very common for your body to adapt by altering your gait (running pattern).

This may lead you to be less efficient, develop bad habits or in a worst-case scenario cause an injury elsewhere in your body. Remember, everything is connected, so if you are running with a limp the biomechanical stresses will be placed on a different part of your body. Give your body a chance to recover and if you think that an injury is nagging have a medical professional look at it. It is much more beneficial to have an injury taken care with a couple of sessions of treatment rather than letting it persist and having to deal with it when it is much more serious, and your recovery time is extended.

Photo by RUN 4 FFWPU

Call the office if you’re having pain. Do not tough it out! It could only get worse. We work with a lot of athletes and help them return to activity. Athletes looking to prevent injuries or perform better see us.

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How do shoes effect development of motor skills in children?

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New research published in Frontiers of Pediatrics found that children and adolescents who spend most of their time barefoot develop motor skills differently from those who habitually wear shoes. 👟 Further, they found the habitually barefoot children had noticeably better jumping and balancing skills compared to those who wore shoes habitually.

Walking barefoot not only has influences on developing proper biomechanics, but also has great influences on the brain 🧠. Walking barefoot allows for greater sensory afferentation to the brain, from the feeling of grass between their toes to balancing on pebbled sidewalks.

Try to give your young children enough time without shoes!

Zech, Astrid, et al. “Motor skills of children and adolescents are influenced by growing up barefoot or shod.” Frontiers in pediatrics 6 (2018): 115.
https://doi.org/10.3389/fped.2018.00115

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Hip Weakness is Closely Linked to Knee Pain

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In this study they found that hip weakness was linked to knee pain. I treat a lot of runners that have knee pain, and most of them have weak hips.

“Women with Patellofemoral Pain Syndrome had 33% lower hip abduction peak strength. They also had significant 70% lower knee extension force steadiness and 60% lower hip abduction force steadiness than pain-free women. Evidence-based treatments aiming at improving force steadiness may be a promising addition to PFP rehabilitation programs.“

Below is a helpful exercise to strengthen your hips. As always, if you need any guidance do not hesitate to call the office!

Ferreira AS et al. Knee and Hip Isometric Force Steadiness Are Impaired in Women With Patellofemoral Pain. J Strength Cond Res. 2019 Jul 22. Link 

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New Guidelines for Runner’s Knee

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Active rather than passive treatments are the key to recovering from “Runner’s Knee”, according to new international treatment guidelines co-authored by La Trobe University physiotherapy researcher Dr Christian Barton.

❇️ People with kneecap pain should engage in exercise-therapy, namely hip & knee strengthening

❇️ An exercise program that gradually increases activities such as running, exercise classes, sports, or walking, is the best way to prevent kneecap pain

❇️ Risk of kneecap pain can be reduced through improved leg strength, particularly the thigh muscles

❇️ Pain does not necessarily equate to knee damage

https://www.latrobe.edu.au/news/articles/2019/release/new-guidelines-for-runners-knee2?fbclid=IwAR3UfqQ5rHFTjZxcgzED5ypLsL5ukXufo6iNta-ODNulM70_g0naKrc_DD4

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Running Shoes part III: The latest Research

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Part 3: Running shoes

What happens if you don’t have pain or you are a casual runner that is just looking for a new pair of running shoes?

The research shows that selecting running shoes based on comfort is the best.

The best way to know if they are comfortable is by trying them on and run at least a quarter-mile.  If the shoe feels good then that is the right shoe for you! That’s it, pretty easy, right?  If the sneaker feels good, that’s the one to buy.

Keep it simple! Your body knows what it needs.

Below is a nice summary of shoe research.

Research on running shoes

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If you missed my other posts on running shoes click here! And if you need help with shoes or running in general please give us a call!

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Why does my back hurt in the morning?

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People that come into our chiropractic clinic for treatment after lumbar disc herniation or disc bulging frequently have a history of pain which is worse in the morning and then improves after they’ve been up moving around for a bit.

Often they have some questions about what exercises and stretches they can do in the morning to make them feel better. We learned more about morning back pain in a disc – injured patient after the research of Michael Adams in the 1980s.(1,2) Adams referred to the “diurnal behavior of the disc” which mostly refers to the tendency for the discs to absorb moisture from the tissues around them overnight.

The discs soak up the fluids from the tissues around them while a person is recumbent in bed overnight. So in the morning when they wake up the outer layers of the disc are under a bit more tension, which we refer to as hydrostatic pressure.

In turn, the disc becomes a bit more plump, adding pressure to nerves and surrounding structors.

So what should you do? Once you get out of bed you should not bend over right away. Try to keep your back straight or try stretching backward .

Next, use your hips to bend over the sink to brush your teeth.

A straight back using my hips to bend over.
Bending at the lumbar spine causing lots of pressure on the lumbar discs

The above picture is a great way to cause sharp shooting pain in the morning.

Try to sit up straight or use a back support in the small of your back like in the picture above.

Sitting with a more normal curve in the lumbar spine helps take the pressure off of the lumbar discs and helps decrease pain.

A wrong way to sit

Sitting like this cause more disc pressure causing disc irritation. It can cause the disc to bulge more.

Discs are fatter in the morning because the absorb fluid overnight. So think of a jelly doughnut if the doughnut has more jelly its more likely to shoot out if you put pressure on it.

So remember back straight, stomach tight will help prevent lower back pain and help you heal if you have pain.