- ♪ Bob and Brad, ♪
the two most famous physical therapists on the internet.
- [Bob] Hi folks, I'm Bob Schrupp, Physical Therapist.
- [Brad] Brad Heineck, Physical Therapist.
- And we're the most famous
physical therapists on the internet.
- Oh, in our opinion of course, Bob.
- Like it just dawned on us.
Today, we're going to talk about
what is causing you knee pain.
Is it iliotibial band syndrome? ITBS.
And how to tell. Again, quite a mouthful Brad.
- Yeah, Iliotibial, it all make sense. If you break it down,
are we going to do that? Or just say what down.
- Well, I think well..
Well one of the best things right now,
Brad, is just to show it
- [Brad] Yeah
- [Bob] That's going to make the most sense.
So you do have a bit a muscle up here called
tensor fasciae latae, which ilial, but--
- [Brad] Another mouthful!
- [Bob] Yeah, but a whole bunch of muscles
here kind of attach into this band.
This is a heavy thick band.
It's like a ligament. And you know,
I've heard the case made where you could probably lift a car
with it. It's so thick and heavy.
- Yeah. And it is wide like this piece of K-tape.
- And then he comes wider up here.
- Yeah and then it goes up and it
connects to that TFL, the muscle belt.
- And also, I think like, like the glutes and it, it,
it attaches to a lot of muscles.
- And you can see,
it gives the lateral or support to the knee on the side.
So sideways that gives, offers some support. So it's,
it can be a stinker though,
particularly down here where the pain starts.
- So attached in is lower bone here, the tibia,
this one right here, and there's a bump right there.
And that's where it attaches right there.
- [Brad] The lateral epicondyle is that the-
- [Bob] If you want to find it on yourself,
this is probably the best way,
So here's the kneecap.
- [Brad] Yep.
- [ Bob] And right below is the bump
for the tibial tuberosity
- [Brad] Yep
- [Bob] Bump here. Now go take your finger out to the side,
and the first bump, you find it here.
That's where it attaches.
- [Brad] Don't get confused with the fibular head.
- [Bob] Right. Right, right.
Exactly.
- But anyways
- Yeah, it's a, it's around this area because
it's going to probably be hard
for you to find.
- [Brad] Yeah, if you're not really familiar
with anatomy it's sometimes it can be confusing.
- [Bob] So, what can happen is this band can
rub across that bony area and become irritated.
- [Brad] Right, Do we have a bursa there?
- [Bob] I'm not sure, there might be.
- [Brad] Well anyways, that's the location
where the pain is.
- [Bob] Yeah.
- [Brad] Sorry to say that by the way.
- Yeah. You would think there would be a bursa like,
you know, the knee has so many bursas.
- [Brad] I know.
- [Bob] And there's some that are prominent and
there's some are really small. I mean, so it's yeah.
Bursas usually help between tendon and bone.
So it's, it would be unusual if it didn't have one there,
but so the thing is,
this happens quite often with the endurance sports, cycling.
Did you know any cyclists that had it? Oh yeah,
you had your friend.
- Oh yeah, yeah Dan.
Yeah. Yeah.
His bothered him with biking.
- And we helped with his IT band right?
- And actually with walking, his was so bad,
but anyways, yeah.
- Weight training with heavy weights can bring it on or
- Up and down steps repeatedly.
- Yep. So what you're going to find is it's very simple.
you're going to find a pain or stinging sensation
felt over the bump on the outside of the knee.
And again, that's where it's sliding over the bone
and you might also feel some swelling or
thickening there.
- Okay.
- Again, you can just use your hands as diagnosis.
We're going to show you two tests you can do,
but it's generally the pain is most intense when the knee is
bent at 30 degrees. Brad do you want to show them?
Approximately 30.
- So there's, you know, there's 30, there's 90 degrees.
So we're going to go at about a third of that distance.
So right about there, you know,
obviously it doesn't be perfectly 30.
You just know you're in that ballpark.
- Yeah, and what you'll find quite often is
it may not hurt right away when you're doing biking
or running, but after, you know,
the repetitive nature of it and maybe after 10 minutes,
you know, kicks in.
So it can be very painful. Like you said,
you had that friend Dan, who,
who actually couldn't even walk there for awhile.
He had trouble walking across the street.
- Yeah , he was having some, the good news is
it's repairable.
I mean, you can do some things to improve it.
- Yes.
And we're going to do that in another video, Brad.
- Oh, we're holding back.
- What may have happened is your hip abductor muscles may be
weak. That's the muscles that pull your leg out to the side.
You may be internally rotating your hip.
That will make it worse.
You know, if your,
- Changes to the bio-mechanics there.
- If your glutes, or your external hip,
external hip rotators,
These are all things you don't need to know.
We're going to mention in the video of how to correct it.
Training habits can also lead to this.
If you sit in, in the Lotus position, which is cross-legged,
- Cross-legged.
- I'm an old man, but I can still get it up there.
- But you're not crossing your legs.
- Well, it's just like this to me.
That's what I was. That's more Lotus.
Yeah. I don't know the Lotus from the whatever,
- But anything else?
- It's, it's all in the same ballpark.
- Sure.
If your knees want to bend in, you know,
like this knock-kneed.
Especially which again,
if your hip is internally rotated or if your feet are flat
that your knees are gonna tend to do that.
- Sure.
- It's funny. You know, Brad, I've heard this mentioned
many, many times and actually I just interviewed
somebody on the podcast. You know,
everything that happens to the knee is usually because of
something that's happening at the ankle foot or hip,
you know, it's not the knee that's going on.
It's upstream, downstream.
It's something affecting the
- Upstream and downstream like a river.
- Yeah.
That's, that's a Kelly Star term.
- Yeah. Well, it's amazing how people kind of relate
the body to other parts of the world.
- I kinda remember that one podcast, Guest City,
it was kind of an inconstant inconsequential joint.
He called it
- The knee?
- Yeah, because it was affected by everything else.
- Sure. It's just hanging out there being influenced.
- So if you want to, you know,
don't run on a surface that is banked or cambered.
- You know, like, like most roads,
like the side of a road that it can make it worse,
excessive running uphill or downhill now can make it worse.
Brad, you're the man on this one.
Right. Incorrect fit of the bike.
- Yeah. Usually the seat's too low.
Right. And it puts excess stress on there.
And that's probably the biggest common misfit of a bike
is the seat's too low.
- Sure.
Excessive heel strike force from running.
Now, Brad and I both have taught ourselves to
change our running from hitting heel first
to hitting more mid foot first or
fore first. And that acts as more of a shock absorber then.
And you'll just find out you're going to have less injuries.
I mean, it's just, I think it's,
I can't think of anybody that shouldn't be doing that Brad,
and this is my opinion. Right?
- Well, I, I kind of agree.
Although I ran heel strike for many years
- I did too.
- I was very comfortable with it.
And then I changed it. It was hard to change for me.
A couple of seasons.
- For me, I actually was getting a lots of hip pain
when I did heel strike.
I mean, I don't think I'd be running anymore.
Brad, if I, if I was still doing heel strike.
- Sure.
- Alright, hiking long distances.
Like if it's very common in the army running up and down
stairs, using the rowing machine too,
because you're constantly in that 30 degree range.
- Yeah, with a fair, not, not maximum force, but you know,
you got force on there consistently.
- Simple tests, very simple, sit on the edge of
a mat with your knee bent to 90 degrees,
place your finger over the bump on the outside of the knee,
the little bit lower one usually, or right about, yeah,
you'll feel, find it and just bend and straighten your knee.
and if that recreates your pain, that's indicative of ITBS.
- You'll, you'll probably find it a tender spot,
so to speak, it's not global.
- Right you can push around and find it.
- Yep.
- The other way is to just stand, actually stand
and place all your weight on the painful knee
and with your weight on the knee,
bend it to approximately 45 degrees,
and if you feel pain on the outside of the knee and again,
a good sign that it might be iliotibial band syndrome.
- This is probably easier.
- Right? You don't have to find it. Sure.
- Right, cause some people will be, you know,
that definitely, that fibular head can be confusing
with that other part.
- So this video, by the way,
is a part of a series of videos on the knee pain.
If you want to find the video on how to fix ITBS or
iliotibial band syndrome for good,
go to bobandbrad.com,
go to the program section and look in there for the
knee program. Under the knee program, there'll be,
we don't even know yet, I ain't even done making them up.
Brad, there's probably going to be 40. 40 videos
and watch the ones that are pertain to you.
You can find the one on iliotibial band
and on a how to treat it.
And also Brad, what else do we have with it?
- Well, along, with it is a big bonus is our,
you can click on the PDF button,
you print out a review of the whole video.
You don't have to go back and look at it and the exercises
and some of them the better the exercises have pictures of
them.
- Sure. Yeah.
- So, you know, you could take it with you
and perform the exercise without
having to go back to the video.
- Right. Exactly right.
And we don't even ask for your email completely free the
whole series.
- It's our gift.
- Yeah. We've got other series, back series,
tendon series, sciatica series.
Yeah. So good luck with everything.
- Broken heart, broken heart series.?
Well, we don't have that yet.
- That's a tough one, but we'll, we'll work on it.
- Thanks for watching.