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Överskrift Here are some useful tips ? and exercises ? for recovering from iliotibial band syndrome
Upplaga May
Sidor 10-11
Överskrift Here are some useful tips ? and exercises ? for recovering from iliotibial band syndrome
Beskrivning The iliotibial band (ITB) is a thick tendonous band running from the hip down the outside of the thigh, across the outside of the knee to the top of the tibia. Its function is to stabilise the leg during weight bearing. ITB syndrome (see also SIB, issue 7) is caused by a rubbing of the band on the outside of the femur, where it becomes inflamed and sore, resulting in a throbbing pain on the outside of the knee during exercise. ITB syndrome is a classic runner?s overuse injury. Often it is associated with a large increase in training volume or intensity. This increase is too much too soon for the athlete?s body and the excess load results in injury to the ITB. This is known as a ?training error?, and is possibly the most important cause of most running injuries. ITB syndrome is also related to poor or worn-out shoes. Specifically, shoes that do not provide enough cushioning will affect the ITB more, because the impact forces on contact with the ground will be greater. Therefore, quality shoes which are less than 500 miles old must be used if you have this problem. Similarly, running on hard surfaces can also cause ITB syndrome, and simply swapping from road to grass or trails can solve the problem. Biomechanics are important As with many running injuries, ITB syndrome is caused by a combination ? or interaction ? of factors. Often this is an interaction between the external factors mentioned above (too much training, poor shoes or hard surfaces) and the biomechanics of the individual?s running form. Logically, those with very good biomechanics while running will be able to endure harder training schedules and be less affected by poor shoes and hard surfaces than those with biomechanical problems that predispose them to excessive loads when running. For example, runners who spend too much time in a pronated (foot rolled in) position while in contact with the ground, place more stress on the calf and lower leg muscles during running, increasing their risks of a lower leg injury such as shin splints. Runners who over-pronate might be symptom-free when they complete a moderate 20 miles a week, but become injured immediately they boost their mileage to over 30 miles a week. In this case, its hard to distinguish the cause between the training error and biomechanical problem when the injury probably stems from an interaction of the two factors. The primary biomechanical problem associated with ITB syndrome is having a tight ITB itself. Tight ITBs lead to a greater likelihood of the band rubbing against the femur. More often than not, the ITB tightens up simply due to lots of training. Stretching is thus a crucial part of ITB syndrome rehab. Bow legs and weak abductors Extra stress can also be placed on the ITB by poor abductor muscle function, by a varus knee alignment (bowlegged) or by an excessively supinator (foot rolled out) running style. The abductor muscles of the hip ? gluteus medius and minimus ? should be able to control the pelvis position during a dynamic movement such as running. Each time one lands on one leg, these muscles that are positioned at the top of the hip contract to prevent the free leg side of the pelvis from dropping down. Too much drop and this causes balance problems as well as pulling the support side hip inwards. When the abductors are weak, then the ITB takes a lot more strain in stabilising the pelvis during one leg support. This can contribute to any symptoms that may develop. Checking that a runner maintains a stable pelvis during the gait cycle and correcting any weakness in the abductor muscles could also be useful in ITB syndrome rehab. If a runner has a varus knee (or bow legged) alignment then this can also contribute to ITB syndrome. The bow alignment places more force on to the outside of the knee, which means the ITB is stressed more during an exercise like running. Likewise, runners with an ?oversupinator? foot action place more stress on to the outside of the knee and ITB. The over supinator doesn?t really over together. Lean the upper body away from the injured side, pushing the injured-side hip out. Hold this position. To boost abductor strength If you feel the patient could benefit from some increased abductor strength and better pelvic stability, the following exercises are very useful. Side lying leg raise. Lie on the uninjured side, with your body completely straight. Get your top hip above your bottom hip. Use your top arm to support you. Bend your injured leg so the foot is by the uninjured-side knee. Tuck your belly button in and fix your lowback position. Using the top of your buttocks only, lift your knee up, keeping the foot on the floor by the uninjured side knee. Hold at the top and lower slowly. Perform 2-3 sets of 20-30 reps. This is an isolation abduction exercise. By fixing the low back and lying on his/her side the patient has to focus specifically on the abductors to raise the knee out to the side. It is the perfect exercise to help patients learn to recruit the muscle more. One leg standing hip drops. Stand on the injured leg in front of a mirror. Stand with good posture, making sure both hips are level and your back is in neutral. Slowly, drop the free-leg hip down to one side and then using the top of buttocks on the injured leg, pull the hip back up again so it is level. Perform 2-3 sets of 10 reps. The purpose of this exercise is to teach the patient to use the abductor muscles in a functional manner, by purposefully dropping the hip into a ?poor? position and then using the abductor muscles to pull it back into a ?good? position. One leg standing mini hops. Stand on the injured leg in front of a mirror. Stand with good posture, making sure both hips are level and your back is in neutral. Place your hands on your hips as a guide to check that your hips stay level. Perform mini hops on the injured leg. As you do these hops, focus on maintaining a stable pelvis each time you land. This means your abductor muscles will be working properly to control your pelvis with each impact. Perform 2-3 sets of 30-50 mini hops. The purpose of this exercise is to get the abductors working in a runningspecific manner. If the patient can maintain a stable pelvis during the impact of hopping the chances of running with better form are increased. For the over-supinator Exercises to help with the patient with a over-supinator foot action are less common, but here are some ideas you may wish to try out. The main problem with the over-supinator as described above is that the foot and ankle complex are too rigid and cannot roll inwards. Flat foot walk. It may sound silly, but the patient with a very rigid and high-arched foot may benefit from purposefully trying to walk flat footed. Wobble board rolls. While standing with one foot on the wobble board, use the board to roll the foot and ankle inwards. Take your shoes off for this one. Keeping the knee still, tilt the inside of the board to the floor using just the lower leg and foot muscles. In addition to these exercises, massage and joint mobilisation exercises may also help make the foot less rigid. Raphael Brandon MSc is a sports conditioning and fitness specialist. He currently works with players on the England netball squad, England women?s rugby squad and international junior tennis players.
Källa Sports Injury Bulletin
Publicerad 2002
Författare Fugh-Berman A., Kronenberg F, Raphael Brandon

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