♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together,
we are the the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- Congratulations, Brad.
- Thank you.
- Uh, today, Brad, we're gonna talk about IT band syndrome,
iliotibial band syndrome,
and we're gonna show you the exercises and stretches,
and we're gonna even show you a test
to see whether or not you might have a tight IT band.
- Right.
- But generally what this refers to is knee pain
on the outside of your knee.
By outside I mean this way.
- Yep, we call it the lateral side.
- By the way, Brad,
I just saw some new people out there that just joined us.
- Sure.
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- Excellent.
- Alright, let's talk about IT band syndrome, Brad,
and why it occurs and what we're trying to do with it.
You need to understand this.
- Right. So we've got Leopold here
and we got a wonderful-
- Napoleon Bone-a-part.
- Oh, Bone-a-part.
- [Both] Yeah.
- And, uh, this is just a really nice anatomical model here
I think, Bob.
- What you have around your whole thigh here is what we call
the fasciae latae, and it's made out of a tough, fibrous,
ligament type material. Right, Brad?
- Right. And you know, and I, from school,
I still don't remember that it goes around the whole leg
but you just refreshed your-
- Yeah. It's very thin.
It's very thin on most parts of the thigh.
But as it gets to the outside of the thigh,
it's a very thick-
- Okay.
- It's a very thick ligament,
and that's the IT band, iliotibial tract-
- Right.
- ligament.
- So we got the ileum here and we got the tibial.
So it connects the two pieces of anatomy
and that's how it gets its name.
- There's two muscles that attach into that band for sure.
One's the glute max and also your butt muscle basically.
- Right, large muscle there.
- And then there's the tensor fasciae latae.
(Brad laughs)
That's how we always had to say it in school.
Tensor fasciae latae.
- You like that, Huh?
- I like that, Yeah.
So the reason that's important is because, when you,
I don't know that you can stretch this band that well,
it's very tight.
- Right, it's-
- It's very thick.
- Right, it's a ligament, it's wide, and it's,
I mean, right, it's tough.
It's a very tough piece of anatomy.
- So we wanna stretch the muscles that go into the ligament.
So, um, so by stretching the band
I think you're stretching the muscles.
So we'll do stretches
but we're also gonna show you some things
that are specific toward the muscles.
- Sure.
- The reason why this band gives you trouble
on the outside of your knee.
So it comes down, attaches into the tibia here.
Gerdy's tubercle-
- Yep.
- Brad, and as you can see,
as it crosses over the outside of the bone here,
it can rub against that.
You see that?
- Right here, there's a bump or protuberance they call it,
on the outer bone of the femur, the condyle,
and it only gets, what did you say?
Past 30 degrees?
- Right. At 30 degrees it's right on the top of it.
- Okay.
- So when you go past 30 degrees it's gonna be behind it.
- It slides over it.
- Yep, and when it, when you go less than 30 degrees
it's gonna be in front of it.
- Right. So you can see right there,
it's kind of getting hung up
but when you straighten it out
it goes past it and you have less pressure so-
- Right.
- I can see where, if you're a runner you have continual,
you're crossing that 30 degree mark repetitively.
And that's why they get this problem.
- It's big in runners. It's big in any sport
where you have a lot of flexion extension going on
which biking would be the other one, Brad-
- Sure, yep.
- very common in bikers.
Um, if you are going up hills a lot
or possibly, Brad, if you're a skier too.
- Sure.
- A lot of flexion extension going on.
So you, we're gonna wanna maybe make sure that this,
you know, if this band is tight, really pull on,
it's gonna rub against that more than anything else so...
So, we'll talk about some other things that you can do,
besides stretching, at the end of the video
but let's start showing the stretches around.
- Sure.
(Brad dragging skeleton across floor)
(Bob dragging chair across floor)
- Um,
you know what the first one I think we should show, Brad?
I think we should show that,
where you can use a tennis ball or the cross ball.
- Yep.
- And, you wanna show this?
- Sure.
- Just tensor fasciae latae and also on the glutes.
- We just called it the TFL box-
- [Bob] Alright.
- Because we couldn't pronounce that big word.
Okay. I like a tennis ball
'cause a lacrosse ball's a little aggressive,
but you can use a lacrosse ball
and it's easy to see
'cause we got a nice, bright yellow one here.
I wanna start it on that TFL.
It's more towards the front.
- [Bob] Right.
- So I'm gonna face more down,
and you may not be able to see it in there, but you know
when you're on that muscle, whoa,
and you're just gonna work.
You can work right to left, forward, backwards, up and down.
And you'll do this for 30 seconds, a minute,
depending on how long you can tolerate it.
Now I'm gonna go to the glute max.
And now you're gonna shift just about 45 degrees there
and you're gonna work it way up towards the belt line
because that glute muscle does catch-
- [Bob] Goes all the way up there.
- all the way up to that ileum or the pelvis muscle.
That wide pedal like muscle. Yeah.
- And it may seem a little strange
to people that you're working up here
in order to stop a problem down here but it's-
- Exactly.
- [Bob] It's part of the whole chain.
- Yep, exactly right, Bob.
- [Bob] So-
- Can I stop now, Bob?
- Yes, you may stop, Brad.
Alright, I will now show the wall stretch.
Lonnie, if you wanna, if you can catch me over here.
So I'm gonna stretch this side-
- Yep.
- and very simple,
you can do this a couple of ways.
One, you can just put the elbow to the side here
and then I'm just gonna lean the pelvis over this way.
- Sure.
- Like this.
And can you see how I'm stretching that behind?
- Right. So we got connected here.
It's wrapped up 'round here and he does it,
it stretches just,
just as you can see it stretch in his pants,
it stretches the tissues in there.
- Right. And what I like to do better even, Brad,
is to do it this way.
Cross over like this and go like this.
Now I can really stretch it.
- Right. And that gives you a little more balance too,
I think.
- Right, exactly.
- Yep.
- Good, 30 second stretches, you know,
works out really well.
Alright, I'm gonna show one on the bed here now, Brad.
(Brad moves chair across floor)
- That's a plinth.
- Well, not to them,
they don't, they don't know that.
- The table.
- Again, because we're trying to stretch
the tensor fasciae latae a little bit,
which is, does serve as a flexor, Brad.
You can lay on your side like this,
grab your ankle, and pull back like this.
- Okay.
So here we're getting things stretched more in the front.
- Right.
And it's stretching the quad obviously, too but-
- Yep.
- it also will, um,
stretch the tensor fasciae latae a little bit so, um,
how about a Ober stretch-
- Yeah.
- over the bed?
- There you go.
- So,
on this one,
I'm gonna stretch this side now.
This side here,
and all I'm gonna do is I'm gonna lift it
up like this, Brad, and I'm gonna anchor the,
lower it like that and I'll let it hang down like that.
- So you need to get close to the edge
of the bed and let that leg cross and you'll feel it,
it stretch right up in here.
This one is, can be a little uncomfortable
so you just, you know, use your judgment.
- And as you can see, Brad,
I don't think mine is very tight.
Although my, my pelvis is, is collapsing down,
so it's really hard to tell
whether or not it's tight or not.
Um, another one, Brad.
You can hook this foot behind the knee.
I'm gonna stretch this side
and you're gonna bring it over like this
and kind of pull over like this.
- Okay.
- Now we're getting that glute again more
but a little bit of the IT band too.
- Sure. Yep.
Yeah. So again, you gotta hook there
and it's harder to see it in the camera
but that's what he's doing pulling over here.
And you're trying to keep your pocket-
- Whoa, that really does pull.
- Yeah. You get a little...
(Bob yelps in pain)
There.
- Alright. One I do, Brad.
I dunno if you ever do this one
where you put across like this and you lift up like this.
- Oh, the old figure four.
I do like this one.
- So I'll do it on the other side.
You could just cross your leg over.
I'm pulling up on the opposite leg
and it's stretching on this one right here.
- Take your time with this one.
It should not hurt.
It should just be a stretch feel.
- Alright.
And then you can do also a prone stretch this way, Brad.
Where you can do a prone quad stretch
where you can go like this.
- Oh yeah. Mm-hmm.
- Again, getting more of that tensor fasciae latae
on that one.
- Sure. Yeah.
- So Brad, I wanna show the Ober test
so we can tell whether or not your,
your tensor fasciae latae,
I mean your IT band, is tight.
- Sure.
- I wanna pull this out so I can be on the other side.
- Oh, yeah. Let's do that.
- So...
(Brad moves chair across floor)
- Alright, Bob, tell me what you do.
- Why don't you lay towards, facing toward me.
- Supine?
- Yep. Nope on your uh, there you go,
that side, there we go.
- Side?
- Yep. Sideline.
- We call that sideline, Bob.
- So we're testing the IT band on this side.
- Sure.
- So there's two ways people do it, um,
they call it, one's called the Ober test
and one's called the modified position.
So you're gonna bring it up, and you're gonna bring it up
into extension a little bit here.
And while I'm in extension here
I'm gonna hold onto the pelvis here, Brad.
- You're gonna stabilize it?
- Yep. I'm gonna stabilize the pelvis
because if I let the pelvis go,
it's just gonna collapse down
and it's gonna go all the way down to the...
- Right. So you're not, you're not isolating.
- Right. So I'm holding this on
and now I lower it down,
and we'll see if Brad's,
no, let's keep it bent, Brad.
- Bent, okay.
- And does yours just go any further?
- Not if I relax.
- So Brad's is actually,
that would be a negative because it, in other words,
it's not tight.
- Because my knee's going down?
- Right.
- And I think a lot of times you'll test both sides
to compare one to the other.
- Exactly. So again,
sometimes people bring it forward a little bit,
and then up into abduction, a little bit extension.
Now they also do it,
what they call the modified test
where they keep the knee extended, Brad.
- Straighten the leg.
- Yep. Straighten the leg.
Don't let the foot turn down, um,
'cause that would throw it off.
- Sure.
- So you're gonna go ahead
and just bring it back like this
and now you're gonna lower it down.
I'm gonna hold the pelvis,
again, Brad's just not tight.
- Sure.
- You're disappointing me, Brad.
I was hoping to find a tight one on ya.
- I usually have tight muscles, Bob, but not in that area.
But you know,
that's one of those things that probably you're gonna,
a therapist is gonna do.
You're not gonna do at home by yourself
'cause you gotta understand,
you gotta put your hands on proper landmarks and whatnot.
- Alright.
Other things you can try, Brad, is you can try icing,
you know, right here before and after treat, or
before and after running.
- Where that, that IT band's going over that bone
and creating that tender spot.
- Um, you're gonna wanna, you know,
if you're running you really should stop. Ideally.
I, I know that that's almost impossible to tell people.
- Yeah, to runners that's not an option.
You know what I'm saying?
- Yeah. Ideally, you know,
it often happens after you've increased your
distance or maybe you started doing hills,
so stop running on hills.
Also, you don't wanna run on pitched surfaces, Brad.
- Right.
- Like it often comes from a track, running on tracks.
- Sure.
- But also just normal roads have that rain runoff.
- That crown. Yeah.
- Yeah. And so you wanna, if you go down one side,
you wanna come down the same side,
so you're evening it out basically.
- Right.
- 'Cause if you're always on the same side of the road-
- That's probably, the outside leg is the probably
one that's gonna be irritated.
- If you have one leg that's longer than the other,
uh, that's a correction and you know,
you're gonna have to have someone determine that for you.
You may want to have that corrected
by putting a little heel wedge in the shorter side.
- Right. Right.
- 'Cause that also will play into it.
Um, you can also take, um, oral NSAIDs.
In other words, an anti-inflammatory-
- Ibuprofen, that type of thing.
- to try to help calm things down, so.
Um, softer running shoes, avoid running downhill-
- Sure.
- or on hills basically, um, will also help.
- I know you'll just keep running up and up and up.
How'd you get home?
(Brad laughs)
Just kidding. It's that time of the video.
- These are the things I gotta put up with, so.
Alright, Brad, remember we can fix just about anything.
- Oh, except for that broken heart.
But we're working on that.
We got that video coming out, don't we?
- Broken brain too.
We can't fix that either. Thanks.
- We could-
- Guys, we have a video coming out.