itb-syndrom rehab with step-width modification
Dov Werdiger stashed this in Running
Stashed in: Walk Jog Run Sprint Bolt
Spring marathon season is quickly approaching here in the northern hemisphere, and as such I’ll be bracing myself for the influx of keen runners presenting with the characteristic lateral knee pain of ITB Syndrome, as their weekly milage and long run duration increases.
Over the years my approach to assessing and rehabilitating runners suffering from ITBS has evolved significantly. The most notable changes in approach coming as a result of developing an improved understanding of the biomechanical factors affecting the injury.
CROSS-OVER GAIT & ITBSWhile it’s vitally important to understand the biomechanics of both stance and swing phase of running gait, I feel a there’s often a lack of appreciation for how one affects the other. How the biomechanics of swing phase directly help to dictate those of the subsequent same-sided stance phase.
In his excellent recent article, Jeff Moreno DPT reminds us of the cyclical motion of running gait, and how swing phase just prior to initial contact, and proximal control of the contralateral stance phase, is just as important as the loading phase itself.
The image above demonstrates a common trait of many runners: increased hip adduction during late swing phase leading to the beginnings of the typical ‘cross-over’ gait pattern. Running on a tight-rope, if you will…
As was the case with this runner, this pattern often comes hand-in-hand with a contralateral pelvic drop in stance phase, and poor neuromuscular control of the limb in early to mid swing phase. See the slow-motion video below to watch her in action.
Consider the basic ITB anatomy for a moment… As our in-house physiotherapist Brad Neal mentioned in his article about thebiomechanical causes of ITB Syndrome:
The tension within the Iliotibial Band will ONLY increase when the origin and/or insertion are moved further apart…
Brad Neal, Running Physiotherapist
Combining the landing foot position across the midline of the body, with a contralateral pelvic drop, we’re doing exactly what Brad describes above. We move the origins and insertion of the ITB away from one another, mechanically increasing strain acting upon the ITB.
Add to this the fact that dynamically, loading of the lateral hip will be increased in this position – the athlete will be experiencing increased strain acting upon the ITB, thus potentially stirring up quite a hornet’s nest (not-so clinical term!) local to the distal ITB