This slow release energy coupled with sufficient caloric intake allows me to be moderately active and mentally present, so neither my movement practice or patient interactions are compromised.
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When spinal hygiene is neglected you find yourself saying, “All I did was bend down to put my socks on and my back went out!”. Indeed, you did, but it wasn’t just one time, it was 5,000 times and it was done with a flexed low back and no core activation.
Rolling your IT band is getting you nowhere
“Runner’s knee” is a common phrase used around the running community and is often correlated with a sensation of tightness on the outside of the leg and pain on the outside of the knee. The Iliotibial (IT) band is the commonly accused culprit for this condition, and the most common do-it-yourself approach to fixing this problem is using a foam roller on the painful leg.
Because foam rollers have been shown in the literature, at least initially, to increase range of motion and reduce pain in muscles, it’s a reasonable approach. However, the IT band is not muscle, it’s what’s called fascia, and it reacts differently.
The IT band has deep attachments to the femur (the long thigh bone) and is very strong, but not very elastic. It’s so strong in fact, that you, or any manual therapist, will never be able to “lengthen” this tissue. However, a therapist can improve tissue movement at the junction between different hip and leg muscles which the IT band crosses, but the ‘shearing force’ required to make improvements can’t be done with the foam roller. And finally, the IT band is almost always being over stressed already, or over stretched if you will. You're better off staying away from the actual site of pain aside from maybe ice.
Foam rolling the muscles around the IT band in the quads, hamstrings, and calf will assist in improving the condition, but it’s an incomplete approach at best. This condition is not typically a knee issue. It’s a hip, foot, or core issue, so try this instead.
Roll the foot comfortably on a ball to ensure the joints of the foot are getting good movement, and make sure the big toe is sufficiently mobile. While weight bearing, you should be able to pull your big toe off the ground with ease to about 60 degrees of extension. You can also simply spend time out of your shoes on a natural surface which will “wake up” the tiny support muscles in the foot. Without a mobile foot, especially in the big toe, you will likely have less activation of the gluteal muscles which help stabilize the hip and therefore, has a huge effect on the knee.
For the hip, you need quality extension and internal rotation. Most people have very poor hip extension, and when they get into what appears to be hip extension (think of your back leg on push off), they arch in the low back creating a focused area of extension in the small of their back which will lead to joint and muscle pain of the lower spine/SI joints. Performing a good hip stretch followed by active hip range of motion will provide better joint motion over time. For a few good stretches for the hip YouTube the following phrases: “Bretzel 2.0” and “tactical frog”. For an example of active hip motion I’ve posted a video on ChiroStrength’s Instagram page.
Also, staying with the hip and core, you need to have good balance. Runners spend up to 95% of their race on one leg, however, most people don’t train any one legged exercises. A little more advanced, but fantastic exercise, is the single leg dead lift (with or without weight). This is a challenging exercise when a focus is put on maintaining a neutral spine and good hip extension on the up leg. And because we are bipedal creatures (walk on 2 legs), we must train more transverse plane core exercises instead of frontal plane exercises. That simply means, core exercises need to be focused on controlling or resisting rotational forces, (think Chops, Lifts, or Pallof Presses) instead of frontal plan exercises like planks, sit ups, or leg raises. A core that can properly handle the rotational force associated with throwing the right leg and left arm out in front of the body, for example, will be better able to support the lumbar spine, pelvis, and hips thereby saving the stress on the knees.
When these areas are ignored in a runner’s routine, you’ll commonly see them land on a knee that cave’s in, which stresses the IT band. Not because the knee is somehow functioning improperly, but the support system is failing. Runner’s knee is almost always a mix between stability and mobility problems, so if you want to foam roll the painful leg, follow it up with some quality stability routines or be prepared to deal with this issue for a long time.
Dr. Scott Dunaway is owner and Chiropractor at ChiroStrength Located in Clarksville TN. This facility combines corrective treatment with group classes in order to educate clients on how to maintain their bodies regardless of what their sport or hobbies are. Visit www.ChiroStrength.com or call 931-321-1414 to learn more.
Teaching the Right Way, Not the Easy Way
My journey through the Healthcare field has been one of many lessons. Lessons in communication with patients, lessons in treatment of patients, but most importantly, lessons in understanding where I offer the most value. After 3 years of shaping my professional career, I’ve come to the following conclusions:
Our current healthcare model is failing.
Not enough people are working to guide patients through the transition of being pain free into engaging exercise with low risk of re-injury.
My calling is to teach. Not just to make people feel better.
To make my first point, type this phrase into google search:
“World Health Organization – America’s Health statistics compared to other countries”.
Spoiler alert, we spend the most on health care and have the overall worst rank (11/11) when compared to other developed countries. Why is this? In treating life threatening or traumatic injuries, westernized medicine and the advances in technology has made America the place to be for this type of care. However, as smart and advanced as we’ve become, we have been unable to fully comprehend the complexity of the ecosystem that is our body. Therefore, lifestyle diseases or disorders such as diabetes, high blood pressure, degenerative joint disease, and other spinal/joint pains, have been grossly mistreated due to our false sense of understanding. Our current approach is symptom relief, which at best, simply muffles your body’s natural warning system that something needs to change. By suppressing the symptoms we lure ourselves into thinking all is well and we go on about our business as usual until the next thing breaks down. We take zero responsibility for the outcome of our lives and place the blame on “bad genes”. Clearly genetics plays a role in our health, but you don’t have bad knees because they “run in the family.” And the almost criminal component to all of this, is insurance pays for people to be sedated by the host of symptom suppressing drugs, but not for life changing habits like fitness or nutrition engagement. This by far was my most frustrating lesson.
If you have received Chiropractic care, massage therapy, or physical therapy, only to have the exact same pain a year, months, or even weeks later, it was because there was no transition from being symptom free into a sustainable movement/exercise routine post treatment. Ever wonder why you always need massages in the same spot, or the same spot in your back keeps “slipping out”? It is because of this lack of transition! It is my opinion that the fitness industry, accompanied by chiropractic and physical therapy, makes much better sense at resolving musculoskeletal issues than any other combination. Why? Because the true answer to alleviating symptoms in the human body, is developing a solid foundation with which that body can move often (sometimes meaning exercise) without breaking down so easily. Sadly this required time and lots of effort from both the professional and the patient and is not seen as practical enough to be covered by insurance. It is a lack of healthy movement that is keeping us sick and in pain. After all, the #1 reason for the development our brain’s outer cortex (you know, the part that distinguishes us from all other species), is for learning and application of movement.
And lastly, my passion for teaching. I believe my patients thoroughly appreciate the amount of time I spend, not only with hands on treatment, but educating them about their issues and what THEY can do outside the clinic to accelerate their healing. Though my experience, and also learning from my mentors in this profession, I believe the best thing I can be for my patients is be their teacher, not their “Doctor” (for the record “doctor” is derived from the Latin verb ‘docer’ which means “to teach”.) The human body is an amazing vessel which can adapt and withstand huge amounts of insult, and also has an amazing resiliency to bounce back if put in the right conditions. The most valuable thing I can do is teach a patient what these good conditions are, and how to avoid the bad conditions which result in pain and rapid degeneration. With this knowledge, my treatment will be much more effective and longer lasting.
With this in mind, I have developed the Chiropractic and Fitness integrated facility; ChiroStrength. I will use my background in Chiropractic, Active Release Technique, and biomechanics to address and eliminate as much dysfunction/pain in the joints and tissues as possible. When we have accomplished this, the patient will be guided through programs designed to make them injury resistant by improving the quality of their movement. My semi-private and group training programs are based on a brilliant quote from movement expert Ido Portal, “If you can not move your body and control it, then what business do you have moving other objects outside of your body.” These programs are not designed for the purpose of losing weight, gaining muscle, or improving cardiovascular endurance, because all of these can only be accomplished with low risk after improving your movement literacy. To accomplish this, we use a combination of body weight and kettlebell training. After going through my programs you can either return to your gym of choice with the confidence of being able to sustain your level of fitness with less risk of injury, or continue to be part of the ChiroStrength family and further your injury resistance and fitness goals. The aesthetic results of fitness will come naturally if you have the ability to move well. Because once you move well, you can move often, and when you move often you become stronger, regardless of where you’re starting from.
For more information please find ChiroStrength on Facebook, Instagram, Youtube and Twitter. I hope in the future I can help you in your journey to a pain free, active life!