What is ITB Syndrome “Hip Bursitis”
As your racing schedule heats up many of you will arrive in my office with “hip pain.” What most people don’t know if that pain coming from your actual “hip joint” shows up in your groin. The pain most runners attribute to their hip is actually right over the outside of the femur bone and traveling down your leg.
You know this as either bursitis or IT Band syndrome but did you know you develop ITB (iliotibial band) Syndrome because your butt is too weak to support your pelvis?! During each step your body tries to stabilize the pelvis by tightening the muscle at the top of the IT Band, the tenser fascia lata, and tightens the IT Band itself. This tightness can inflame the bursa (soft tissue sac) underneath the ITBand and actually effect both your stride and the fluid motion of your knee.
We can prevent and fix ITB syndrome with 2 easy solutions: increasing Butt strength and Foam rolling your IT band.
Build a better Butt:
My favorite exercise for maximizing butt strength is called the monster walk and focuses on the all important gluteus medius. You will feel the burn just behind the lateral hip (greater trochanter).
Place a continuous exercise band around your ankles. Begin with your feet facing forwards and shoulder width apart. Bend your hips and knees into a short arc squat and stick your butt out. Now step to the right with the right foot and then to the right with the left foot. Always keep tension on the band. Repeat with 10 steps to the right and then repeat to the left. Perform 2 sets.
Stretch the IT band:
There are many stretches out there for the IT band but the only truly effective method I have found for lengthening this tight fascial tissue is foam rolling! This is like giving yourself a deep tissue massage and will break up all the micro-scar tissue that keeps your IT band tight.
Lay with the side of your hip directly on the foam roller. Using your upper body slowly pull your leg back and forth over the roller from your hip to your knee and back.
Let me warn you…this may initially hurt but it will hurt so good as it stretches out the stubborn ITB and increasing blood flow to the area.
You should foam roll problem areas daily before your workout.
Stretch your Butt:
50 % of your Gluteus muscle inserts directly into the ITB. If your butt is tight it will pull on your ITB and increase the friction. Prior to running you can use your foam roller to loosen up your butt. After your run spend 30 seconds stretching each gluteus medius with the pictured stretch either standing or laying on your back.
When you finish a run and your post workout stretching, make sure you take to ice your hot spots. I recommend my runners use ice “massage” instead of simply slapping a bag of ice on. To do this, freeze Dixie cups of water ahead of time, peel back the paper and rub/massage the ice over your IT band for 20-30 minutes. This minimizes inflammation and speeds healing by increasing circulation.
Hot spots, sore joints and ITB syndrome are not simply painful but centers for inflammation and the chemical defenses your body uses to protect and heal your tissues. Too much inflammation is not great. You can cool those hot spots and minimize the pain that comes with by using natural (omega 3 fish oil, tart cherry juice) or over the counter (Advil, Aleve) anti-inflammatories.
Follow these simple prevention and treatment tips and you are going to eliminate IT band syndrome and bursitis.
Whether you are a seasoned marathoner ramping up for your next race or just lacing up your running shoes for the first time, pain in the front of your lower legs, commonly known as “shin splints” can really slow you down.
“Shin splints” the pain you feel over the front of the lower leg with activity, more appropriately known as Medial Tibial Stress Syndrome (MTSS), is almost a rite of passage for recreational runners and accounts for 60% of all over use injuries.
The pain creeps up on you about 3 weeks into your period of increased training and feels like an ache that intensifies with pounding. It can progress to sharp pain with each step. When you touch the front of your shin- bone (tibia) and the muscle beside it (anterior tibialis) you will feel reproducibly tender. Most of the pain will be localized over the lower 1/3 of your leg and will increase with resisted plantar flextion (like pushing against the gas pedal).
Shin Splint Terrible Toos!
There are 3 reasons most of us develop MTSS at some point in our athletic careers. I call them the “Shin Splint terrible toos:”
- Too much medial foot pressure (ie: poor biomechanics):
with each heel strike onto the central part of your heel, too much pressure is transferred towards your arch and medial column of your forefoot. If you are naturally “knock kneed” this is even worse. All this leads to altered internal rotation of the tibia and overwork/pressure on the front of your leg and therefore pain!
- Too little lower leg strength (ie: you’re weak)
Runners pay too little attention to the strength of the muscles in their lower legs! A weak posterior tibialis (the muscle responsible for supporting the medial column of your foot) leads to early fatigue and over pronation. Anterior tibialis and gastroc weakness also contribute to early fatigue and worse mechanics. Beginning runners with low initial fitness and strength levels are 3.6 times more likely to develop shin splints.
- Too much activity, too soon, with too much intensity
This is true for seasoned runners ramping up as well as newbies! Shin splints show up during the first 3-10 weeks of a new training schedule.
How to Treat Shin splints
Previous MTSS predicts future MTSS so don’t ignore it!
- Cross Train: runners who only run without a plan for total body conditioning are set-ups for injury. You will be a better runner if you cross train on a spin bike or rowing machine and with total body cross training circuits such as those you can find in my latest book Fitness After 40: Your STRONG Body at 40, 50, 60 and Beyond!
- Get a foot pressure evaluation or running evaluation to make sure your are not overloading your foot’s medial side. You may need an orthotic to correct your mechanics.
- Strengthen your lower leg in 4 directions using bands: dorsiflexion, plantarflexion, eversion, inversion. Do 2 sets of 10 in each direction with both feet daily during the initial recovery period and then several times a week as maintenance. (see pictures and video that accompany this blog)
- ICE massage: Freeze Dixie cups of ice, peel back the paper and massage the front of our legs with the ice for 20 minutes several times a day. This not only decreases the inflammation but stimulates blood flow to repair the injury.
- NSAIDS: Non-steroidal anti-inflammatories are not for pain but actually act to decrease the explosion of inflammatory factors at your injury site…as a consequence the pain decreases. It is not a pain masker…it is actually treating the problem.
- Return to Sport: When your pain is gone with rest, there is no pain with pressing on the front of your leg and does it not return with light activity, begin walk/running again on soft surfaces. Gradually increase your activity.
- Go to a Sports Doc: If your pain is not responding to these steps in 2 weeks, your point tenderness is increasing, if you have known osteopenia, or you just need to know you are not hurting yourself. They will rule out stress fracture and compartment syndrome.
With early active intervention, MTSS can resolve in 2 weeks. IF you ignore it you may be saddled with chronic leg pain for months.
I hope this article has helped you understand and how to treat ITB syndrome & shin splints! For more health tips, check out my three books Fitness After 40: How to Stay Strong At Any Age, Guide to Thrive, Fitness After 40: Your STRONG Body at 40, 50, 60 and Beyond!
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