(fun intro music)
- Welcome my friends to the Bob and Brad podcast.
My name is Mike Kenitz and I'm a PT assistant.
Today I am interviewing RT Hill
and Niraj Vara from the Stride Shop
both are physical therapist and they own a running clinic
in Baton Rouge and New Orleans, Louisiana.
So we are gonna talk about different running injuries
and how to work through 'em
and different exercises you can try to fix these problems.
So without further ado
here are the gentlemen from the Stride Shop.
- [Mike] We're gonna talk about IT band syndrome now.
So I kind of have a tight IT band.
So I guess this relates to me too.
So what is your approach to IT band syndrome?
- [Niraj] Yeah, I mean IT band syndrome again is
is one of those things that's I think probably approached
in a million different ways
if you walk into a PT clinic and
and I think that there are things that people are like
you should never foam roll.
Other people are saying you should always foam roll
and you should stretch your IT band.
Or there's no way to stretch your IT band.
It's useless.
And, and I think that's fine
and we're very much evidence guided as opposed to like
you know, this is what the research says,
so that's the only thing we're gonna do.
I, I myself have gone back and forth
between foam rolling, not foam rolling, foam rolling.
It's pretty painful and sometimes it's useless
but I think it has its place
if we can do something that, that's helpful.
I I, I think we should absolutely use it
but really I think we're gonna approach it
the same way we do most injuries.
To start, you get a great history of
of what has led to this.
Has something changed in your training?
Do we need to adjust volume or intensity or frequency?
Do we need to adjust your surface?
Have you been running a ton of downhill
or you know
have you just recently changed surface where you moved
and now you're in this hilly place
and all of a sudden you don't have the tolerance for it?
So running,
- [RT] Running a track in one direction,
- [Niraj] Yeah,
- [RT] the whole time, right?
- [Niraj] Yeah.
- [RT] Running on the street on one side.
- [Niraj] Yeah. And so, you know
you take all these things into account.
I think generally speaking IT band related treatment
is going to consist
of us making sure we train your quadriceps really well.
Eccentrically
as well as concentrically.
We're gonna train your lateral hip muscles quite a bit
and I think a lot of times we forget
about what the foot and ankle are doing.
A lot of times the foot
and ankle create things upstream and, and
and we forget about what's going on with foot
and ankle may contribute to, to IT band pain.
So we have to address those things
and then we wanna watch you run if there's this, you know
kind of heavy crossover pattern
with your feet where you know you're
you're crossing side to side with your feet.
It's, it's a kind
of a simple cue where we want you to create some
some width
in between your feet to offload your IT band a little bit.
And then if you are rehabbing from an IT band injury
you probably would do well to start on an incline.
So maybe you do start on a treadmill
it just decreases the force of the
the quadricep and the knee flexion angle a little bit.
So you may start uphill and then progress the flat ground.
- [Mike] Would you say most people
so I've heard people experience IT band pain by their knee
but I've also heard at their lateral hip
what do you guys normally see?
- [RT] I think they're, I I mean we see both, right?
Yeah. And I think, I think you're dealing
with kinda the same, it's the same tissue just
in a different location of where it's creating a
creating the pressure at or the compression at.
Lateral hip,
You, you know, I think you can differential diagnosis is it
well is it a issue of bursitis?
Is it a bursitis on the lateral portion of the hip?
But that's running underneath like the tissue
that eventually turns
into the IT band right there.
Down by the knee,
a lot of times that's one
of those deals where the, the knee for
for relevance purposes pretty pretty simple joint, right?
It's hinges back and forth.
It has a little bit of rotational stuff
but for the most part it's just a hinge.
So you look above or below the joint upstream
or downstream to, to see what's going on there with runners.
I think a lot of times looking at the, looking at
the foot is probably where I'm gonna gonna start at there.
But in terms of where we see it the most,
I'd say it's about even for, for me,
you know,
personally one of the ways that I'll,
I'll tend to get in there you'd mentioned like the
the gate analysis Niraj
and looking for that crossover pattern,
kind of what I'm looking for a lot of times in that
in that gate analysis is
how much actual like spring
does someone kind of have, right?
Are they kind of bounced off the ground or is it more
are they just shuffling the feet forward?
And, and what that's kind of telling me there is
if someone's just basically just kind of shuffling
and puttering, you're just pulling it kind of
the top of that, top of that hip up there
and that just creates this, this disconnect
or this this imbalance where we start pulling
that IT band forward a little bit more
which can then translate a little bit further
down the down the hip.
So for me, I wanna see someone that's really
really creating that, that spring
out of the Achilles absorbing energy, expanding it
they've got some good posterior chain activation
that propelling them forward
type of deal that you,
that I would wanna see outta someone that
that that's dealing with an IT band issue.
- [Mike] Yeah, I would say a common thing
amongst a lot of runners
and probably me last year cuz it was the first
time I did heart rate training so I had to slow
down my gait and I think I was just really lazily running
and I think I was shifting more laterally
versus engaging my buttock.
So all that pre force, you know, 20 miles in is just going
on your hips instead of your butt where it's supposed to go.
- [RT] Yeah.
- [Mike] Yeah, so I think that's what causes a lot
of like IT band syndrome and lateral hip pain in runners.
- [RT] Yeah, for sure.
You know, running is,
you think okay
I'm just going on there.
That's the, that's the plane that I need to
to train in and, and I said you
you have these muscles on the outside of your hips.
Niraj mentioned it earlier, the, the hip abductors
a lot of muscles that
that's keeping your pelvis level.
And so if those get weak and pelvis lifts up on one side
and all of a sudden your knees taking this sharp angle
to the inside, that's gonna put more compression
both up at the top
of the hip and down at the, at the bottom as well.
Right? So you're absolutely right that that's one
of those root causes that needs to be fixed.
And again, going back to, you know
the foam rolling conversation of is it right or wrong?
You know, I think it can be if it's being used to help
with some acute pain that allows you to, to decrease pain
so that you can go and work your muscle in a larger range
of motion to fix a root cause then I think that's a
that's a great way of, of utilizing it.
But if you're using it as kind of the way to
cure your IT band pain
it's probably not gonna be very effective in the
in the long run or the long term.
- [Mike] Right. Yeah, that,
your explanation makes perfect sense.
Cuz after my last marathon, last year I did two,
Bob checked me out
and my pelvis was elevated on that painful side.
So then yeah, I'm stretching it out now.
It's a lot better.
Plus I'm not running
like that much anymore, but yeah, it's, it's all linked.
- [RT] Yeah.
- [Mike] Which is, it's, it's kind of sad
because a lot of people like you
and other PTs been working with are looking at the body
as a whole instead of like just treating individual areas.
- [Niraj] Yeah, I think it's, you know, in the,
the questions too is once we see somebody in clinic,
so somebody checked you out after the marathon,
is your, is your pelvis elevated because
in response to some of the pain you were having and
and there's some compensatory shift or pattern because
of the pain or did that lead to the pain?
And, and sometimes we don't know
cause we didn't have it before and after, right?
But we get to treat what we see and so
you know, you, you do, you do attack it
you do adjust it and usually that's lateral hip.
And I think too, to touch
on like shuffling versus springiness,
I think we have to be
like also very
careful what we relate
cadence to in terms of springiness or shuffling.
Cuz some athletes who myself not included
who just are very athletic
or came from a different background than running
you just see 'em and they're just like, you know, they're
they're almost like jumping along and
and are just have a lot of this liquid RT talked
about kind of this up and down, but it's not coming
from just their calf but they've got a very low cadence
versus somebody who's shuffling and has a higher cadence.
I think, I say that to mean cadence, a higher cadence
typically will offload the knee.
So we don't want somebody like bouncing up and down crazy
but we do want somebody who isn't also just
dragging their feet and has no flight time, right?
So there has to be this kind of in between
which is what I think RT was getting at too
- [RT] Yes.
- [Mike] Yeah, and you're talking about more
like people that translate vertically
versus forward propelling themselves running.
Right?
- [RT] That's what I'm,
- [Niraj] yeah,
- [RT] That's the point I was trying to
make is someone who's propelling forward versus
- [Mike] Yeah.
- [RT] Someone who's bouncing up and down.
- [Mike] You guys wanna mention your website
and where people can find you
on social media quick before we get too in depth here?
- [RT] Sure. Our website is thestrideshop.com.
We've got blogs and some free resources
and a newsletter that we, that we think is cool.
And we've also got an online course called Course,
video series called Building a Resilient Runner that
that we think stuffs a ton of information into
some 10 minute segments
that can be helpful
for runners of all, of all abilities.
And then social media, we are
at the Stride Shop on Instagram
and the Stride shop on Facebook.
(light outro music)