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Have you ever had recurring knee pain when walking, running or squatting? You're not alone: Thousands of people are suffering from the dreaded IT Band syndrome. We see and treat people with this kind of knee pain all the time, and have been able to get them back to the activities they love. In this article we'll guide you with the information you need to get rid of this annoying pain. What is an IT Band? ITB is short for iliotibial band. It's a thick band of fascia structure on the outside of your upper leg. It originates from a muscle on the side of your pelvis (the TFL or Tensor Fasciae Latae and some fibres of the gluteus maximus) and inserts just below your knee. It flexes and extends the hip and helps with rotation of the leg as well, and plays an important role in knee stabilisation. One of the most common and dreaded injuries associated with the ITB is called IT band syndrome What causes ITB tightness - what causes pain on the outside of the knee? IT band syndrome occurs when the IT band becomes painful due to irritation and overuse: flexing and bending the knee repetitively. When we repeatedly engage in a movement; like bending and extending the knee, this can cause friction and irritation of the area. This almost always happens when the IT band is too tight and causes friction on the outside of your knee. This can result in pain and / or inflammation and is very common in active people. When will you experience the most pain? The discomfort, irritation or pain from this issue will most likely be when moving: running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, although it may take a while before this annoying feeling disappears. Why does the IT band get tight? This is the most important question to answer in order to get the right treatment in place. In many cases, we see a biomechanical issue that's a big contributing part. It could be an issue with foot mechanics or lower leg dysfunction; where one of the bones in the lower leg isn't moving well. It could also be higher up the leg, or even in the lower back. When one of the lower vertebrae in your spine is stiff or when there is tightness in one of the muscles in the pelvis, this can cause the pelvis to tilt. Even if this tilt is slight, it will result in more tension in the IT band. The discomfort, irritation or pain from this issue will most likely be when moving. Running, walking or squatting (with or without weights) will usually offset the symptoms due to the friction on the outside of the knee. Resting will normally ease these symptoms, though it may take a while before this annoying feeling disappears. You’ll need one of these if you want to roll your IT band! :-) How to treat ITB pain? Let's start with explaining what will NOT resolve your problem. Many health practitioners focus on the symptoms and will give treatment on the painful spot: somewhere around the knee. This is unlikely to solve your issue because although this is the spot where your pain or tightness is, it is not necessarily the cause of the problem. Another unhelpful treatment option: foam rolling your ITB! We see so many active people foam rolling their ITB in the gym. Let me tell you: you cannot release your IT band with a foam roller. Whilst a foam roller is an amazing tool that can be used to release muscle tightness all over your body, the IT band is not one of them. Because the IT band is very strong connective tissue and not muscle, you would require far more pressure than you could generate with a foam roller to make the necessary impact. Foam rolling the gluteus maximus and the TFL muscle to ease IT band tightness The clue with treatment is finding out what is moving well in the body and what is not moving well. Foam rolling your glutes and TFL muscle can be a good start (find out how to do this correctly here ), but a proper assessment of the biomechanics at play is needed to address the underlying cause of your pain. At Physio K, we are experienced in finding and addressing the root cause of your problem and guiding you in your rehab, so you can get back to doing what you love. To book an appointment with one of our experienced practitioners: click here

WHAT IS SCIATICA? Sciatica is a term that tends to get thrown around quite a lot especially in reference to any nerve related pain in the lower extremity. Yet despite its common diagnosis, there are many misconceptions surrounding what it really is. It is a vague term used to describe pain that is associated with the compression or irritation of a nerve root located in the lumbosacral region of the spine (lower back). Now grasping that this pain originates from the lower back can be a touch more complicated, especially when factoring in that most symptoms are felt down the leg. However, this begins to make more sense when looking into the major anatomical structures involved. Sciatica derives its name from the condition’s involvement of the sciatic nerve which is the largest and longest nerve in the human body. Starting in the buttock and travelling down to the lower leg, this nerve is formed by a cluster of smaller nerve roots that can be traced back to the sacral plexus within the lower back. If these nerve roots are irritated in any way it can manifest in referring pain down the nerves pathway which can include the buttock, thigh, calf, and foot. HOW CAN THESE NERVE ROOTS BE IRRITATED? To understand how the nerve roots can be irritated we need to look at where these nerve roots are and what structures can influence them. As can be seen in the image below, the nerve roots are the yellow cords exiting either side of the spinal cord. These nerves send and receive information from the brain all the way down to the tips of the toes and are therefore a very important travel route for sensory (feeling) and motor (muscular) control. Another important structure to consider is the discs, depicted as the blue semi-circles. When it comes to nerve root pain there are two primary types: mechanical pressure and chemical irritation. The concept of mechanical pressure is relatively straightforward. It postulates that when a nerve root experiences compression, as can be seen in the image above on the right, this can limit the amount of blood flow to the nerve. Without the appropriate blood flow there is reduced oxygen being delivered meaning the nerve will not be able to perform its functions properly. Furthermore, if this reduced blood supply is prolonged it can lead to nerve degeneration and the development of abnormal impulses within the nerve. This is what can often be experienced as the burning, pins and needles or electric shock type of sensations down the leg. The chemical irritation system is slightly more complicated and has two additional schools of thought. The first is that the discs contain powerful chemicals that when spilled onto the nerve can lead to inflammation making the nerve angry and dysfunctional. Discs are very active tissues within the body. They are constantly laying down new cells and breaking down the old ones to ensure they are always healthy and functional. For the discs to be able to break down old cells they need to have powerful enzymes that can damage and discard them. Therefore, if a disc herniates and some of the chemicals spill onto the nerve roots, they can irritate the nerve and start an inflammatory response from the body. The second is that the disc can cause an autoimmune response which will often catch the nerve in the crossfire. Whilst it is very rare that a tissue in the human body has no nerve or blood supply, this is the case for the discs after the first few months of life (like the inside of the eyeballs!). As a result, the discs are quite foreign to the body’s immune system, to the point where it is unrecognizable. Therefore, when a disc herniates the immune system reacts to this as it would a foreign body, such as an infection or a virus. This means it attacks the disc tissue resulting in an inflammatory reaction which will end up affecting the nerve root given its proximity to the disc. WHAT ARE THE SYMPTOMS OF SCIATICA, WHO DOES IT AFFECT AND FOR HOW LONG? The most common symptoms associated with Sciatica is pain travelling down the back of the leg. Key areas include the buttocks, back of the thigh, calf, and foot. Some people can experience a burning, electric shock or pins and needles type pain or in rare cases a sensation of cold water running down the leg that may be associated with numbness or muscle weakness. The intensity of the symptoms can be quite broad ranging from mild, barely noticeable pain to severe pain, likened in some cases to childbirth. Sciatica can affect people of every age however it is mostly seen in the forties and fifties. Expected timeframes for recovery from a sciatica diagnosis can vary greatly however the pain is generally the worst for the first 2-4 weeks. At the 12-week mark 50% of those with sciatica will have nearly a complete resolution of initial symptoms. For a small group of people, pain may not improve at the rate normally expected however by the 12-month milestone over 75% of patients are asymptomatic. HOW TO MANAGE SCIATICA? When it comes to the management of Sciatica there are a range of treatment options available, including physiotherapy. The most important factor in most of these is allowing the appropriate amount of time for recovery. Other common non-surgical treatments include adjusting lifestyle factors such as smoking cessation and weight loss as well as introducing general exercises or specific spinal/ nerve movements targeted at mobilising the sciatic nerve. In extreme cases medications, specialist nerve injections or surgery may be used as a last resort however for most this is certainly avoidable! If you are unsure about what may work best for you then book an appointment with your health professional who can provide you with an accurate diagnosis and a suitable treatment plan that is built around you and your lifestyle! References Dower, A., Davies, M., & Ghahreman, A. (2019). Pathologic Basis of Lumbar Radicular Pain. World Neurosurgery, 128, 114-121. doi: 10.1016/j.wneu.2019.04.147 Goldsmith, R., Williams, N., & Wood, F. (2019). Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population. A qualitative interview study. BJGP Open, 3(3), bjgpopen19X101654. doi: 10.3399/bjgpopen19x101654 Jesson, T., Runge, N., & Schmid, A. (2020). Physiotherapy for people with painful peripheral neuropathies: a narrative review of its efficacy and safety. PAIN Reports, 5(5), 1-e834. doi: 10.1097/pr9.0000000000000834 Schmid, A., Hailey, L., & Tampin, B. (2018). Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence. Journal Of Orthopaedic & Sports Physical Therapy, 48(2), 58-62. doi: 10.2519/jospt.2018.0603. Background photo created by jcomp - www.freepik.com