As a practicising Chiropractor in Penrith and as a keen runner and cyclist, ITB syndrome is a common condition that Toby encounters. Below are evidence based management strategies that have proven to work within a consistent environment.
1. Education and advice
Education regarding load monitoring and acute chronic workloads and allowing 36-48hrs of rest between loading to allow restoration of tendon and fascial tissue. Tissue adaptation and restorative rest is crucial to returning from any tendon/fascia injury and better scheduling of running and strength work will need to be done and adhered to. Also no increase in load greater than 10% per week, this also applies to sets/reps and weight in the gym. Irritability of pain and aftermath pain will be used to monitor running and strength related load and some pain during rehabilitation is ok. Specific phrases such as "settle the tissue down" to then "build the tissue back up" will be used. Theories of mechanotransduction will also be implied to help convey that rest is ok, but mechanical loading is required to stimulate change. Graded exposure, progressive overload will also be explained.
2. Passive modalities
Some passive modalities will be used to help settle tissue irritation these may include heat, ice, compression; hip and knee joint PAM's and PPM's to increase range of motion; soft tissue work directed at "tight" muscles for pain relief.
3. Strength training
To manage gait abnormalities, including excessive hip adduction, hip internal rotation and hip extension. These abnormalities are similar to patellofemoral pain syndrome and so it is suggested that strength training of hip extensors, abductors and external rotators can help manage ITB syndrome.
4. Gait retraining including external cueing
Important gait abnormalities to detect include excessive hip adduction (as per PFPS), narrow step width (cross-over gait) and loud heavy running.
Example of gait re-training:
Real-time feedback is optimal but not always feasible, some evidence suggests that 3D motion capture > 2D video > mirror for gait training. This might be running on a treadmill with a mirror in front and practicing the below examples of external cues.
Examples of external cues:
“run on a line or just outside of a line”, this can be utilised on a treadmill with tape running down the middle during gait re-training practice.↑ cadence and instructions to “run quietly” and “let your feet strike under your body as you fall forward” allowed pain-free running within 6-weeks.4Acute ↑ in step width (5% change) ↓ ITB strain and strain rate, respectively.
At Sydney Muscle & Joint Clinic our approach is consistent, high quality and based on the best scientific knowledge. We deliver evidence-based physiotherapy, exercise physiology and chiropractic for a range of musculoskeletal conditions, which means you get an approach that is effective, safe, and efficient. Contact your local Penrith physio today.
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