Formerly a professional rugby player, James route into endurance sports coaching hasnt exactly been conventional. If muscular tonic changes are the problem then somewhere along the lines youve over-recruited something, most likely to compensate for a weakness elsewhere. In the frontal plane, some studies have reported increased hip adduction 12303945-47 and others have not. Photo creation by RRY Publications and U.S. Air Force photo by Tech. As for Guru driven approaches, we still need this. Although I think Ellis is correct, he has simply gone round the houses and reiterated what Brad had said in the first place with regards to recruitment of TFL to assist weak iliopsoas/hip flexion (Point 1. About Enertor Advanced Technology Insoles Enertor insoles are designed to prevent a number of common running injuries and provide more comfort. Hip mechanics plays a very important role in generating the power required for the stride. Swing mechanics must be addressed with regards to Iliopsoas function (hence my inclusion of Sahrmanns work), to eradicate any rotational or ab/adduction moments within the hip flexion movement, as these aberrant movements will increase local compression because of the change in fibre tension at Gerdys tubercle. (2018). Why do some runners overuse rectus femoris? Stand sideways on the step and hang one leg off the step. Great example of a bilateral (left hip worse than right) contralateral pelvic drop. Yep, those hips look great on a catwalk, but theyre not what we want to see from a runner. So as part of my rehab programs I also do a lot of neural stretches and interfacing techniques. The KAM increased significantly with contralateral pelvic drop (p=0.001) and with combined contralateral pelvic drop and trunk lean (p<0.001) compared to the level pelvis trials. When the pelvis is unable to maintain its position, other body parts overcompensate for the lack of stability. Thanks again for your contribution; I look forward to further comments either from yourself or others! Thanks OzPhyz for understanding me on the whole concept of it being impossible to be one force and not another, and agreed I havent really outlined my reasoning. Not at all as this discussion is (in my opinion) aiming to debunk the common misconceptions and management of ITB friction/compression syndrome. As frequently theirs is serving to exacerbate problems as its so unfunctional that it has no carry over, that its not glute med thats solely the issue and they are performing it incorrectly and hence using an already tight rectus femoris. Sure, the TFL (in particular) can be released which can reduce the tension in the TFL-ITB complex but no ITB lengthening or shortening in isolation occurs its not contractile(!) But if anyone has any new insights or opinions on the ITB or anything else related, please keep posting. Variables of interest included contralateral pelvic drop (CPD), peak hip adduction angle (HADD), and peak knee abduction angle (KABD). Id like to get everybodys thoughts on this though. Peak hip adduction angle reached 4 (6) during pelvic drop trials compared to 0 (6) in the typical gait trials (p<0.05) equating to 4 of pelvic drop. The pain stimulus within ITB syndrome is usually inflammatory, whereby either the bursa or fat pad is compressed against the lateral femoral condyle. The best thing Ive found to deal with ITB is an ultrasound device with gel.I apply it when the pain comes back.I dont run long distance.I just like to jog 5 or 10 min 2 or 3 times a week, I bought an ITB strap that truly works.Now Im able to jog 10min without pain. If youre talking of breaking up a fascial adhesions, all a roller would do is squash it against the underlying muscle belly, which itself is then being squashed into the femur no wonder it hurts so much! Thorough to say the least. Your response suggests that you believe Iliotibial Band Syndrome is linked more to the swing phase of running rather than stance. Having suffered from ITBS for a long time, it ultimately took a surgeon to fix it. To validate my clinical reasoning behind steering away from Cortizone injections, is simple. Clinically, Brad has experience in both the NHS and private sectors of healthcare, alongside a career in various professional sports. Let me try to now. (2011). This is one of the first times that repeated hip displacement while running may indicate increased injury rates in the lower body. Dan DeCook. It will often respond well to oral non-steriodal anti-inflammatory drugs (NSAIDS). It usually occurs contralateral to the side of weakness. Federal government websites often end in .gov or .mil. Thanks for spreading the good word. Copyright 2012 Elsevier Ltd. All rights reserved. In the sagittal plane, step retraining can reduce the foot inclination and increases knee flexion at initial contact possibly reducing the overstride mechanics and reducing the breaking and impact forces . Before To protect the iliotibial band from the lateral femoral condyle there is either a bursa (fluid filled sac) or a layer of highly innervated fat that lies underneath the distal portion of the band [1]. We observed hip muscles are complex and are the powerhouse of running. Z. Hoch (2011). After you have lowered the pelvis, simply use your hip muscles in your support leg on the step to raise your pelvis up. Brad Im very impressed by your passion in presenting (and taking the time to find) all the relevant findings in the literature. The pathophysiology advocated by both of these studies is one of compression of a highly innervated and vascular area of fat (previously presumed to be bursa), which is inflammatory in nature and as such will respond very well to an ultrasound guided corticosteroid injection if symptoms are preventing adequate rehabilitation. The other explanation is that the problem lies in the stance sides QL or lateral flexors of the trunk in that they subtly laterally flex the trunk towards the stance side to translate the centre of mass over the stance limb to cause enough longitudinal loading through the stance limb to stabilise that side to allow contralateral swing to occur; with the pelvis laterally tilted i.e. Known as Contralateral Pelvic Drop, this can be observed at the midstance. I would suggest therefore, if we want to go down a Physics route and describe friction as the result of two opposing forces, that we should describe non-compression force within the Iliotibial Band as static friction (stiction), as opposed to true kinetic friction? The https:// ensures that you are connecting to the Much like the MRIs involved were also snap-shots of the limb in a set position. Bechard DJ, Birmingham TB, Zecevic AA, Jones IC, Giffin JR, Jenkyn TR. Clipboard, Search History, and several other advanced features are temporarily unavailable. A secondary consequence is a rise in the anterior hip joint forces and an excessive abduction moment, which is counteracted by an additional compensation within adductor longus. R. Resende, R. Kirkwood, K. Deluzio, E. A. Hassan, S. Fonseca Medicine, Biology Clinical biomechanics 2016 27 Contralateral pelvic drop during gait increases knee adduction moments of asymptomatic individuals. This lead me to really think a lot harder about what was actually going on with my own knees and those patients that I had treated ineffectively. Snyder, K. R., et al. Most significantly, contralateral pelvic drop was found to be the strongest predictor of injury. Its difficult to say, but if one were to break up an adhesion it needs to be pulled apart/stretched, not compressed surely(?) Look at Barwick et al (2012) in the Foot Journal for an excellent review of how foot motion couples with lumbopelvic-hip mechanics. I consider this pattern less of a strength deficit, more a muscle activation/timing and neuromuscular control issue. Save my name, email, and website in this browser for the next time I comment. Pelvic drop is defined as a unilateral drop in height of the pelvis in the frontal plane. (2017). It would be nice to have some higher quality studies, but even so, there is often a mistake to try to treat everybody the same. These findings suggest that pelvic drop alone can significantly increase KAM magnitude, a risk factor for the progression of knee OA. If your balance is a problem, be sure to hold onto something stable, like a stair rail. It is now 4 weeks since my last run and I have taken a 2 week course of COX-2 NSAIDS. Just because research doesnt give us the answer that we look for or would justify our means, it does not warrant dismissal. An official website of the United States government. Content is reviewed before publication and upon substantial updates. By Brett Sears, PT Epub 2017 Jun 15. Check out James' marathon training plan for beginners [PDF]. Forming untested anecdotal hypotheses is not best practice and can be dangerous in certain scenarios; its not scientific, its bad practice and is indicative of idleness. Some problems that can be attributed to hip weakness include: If you are experiencing hip weakness, you should visit your healthcare provider or physical therapist to help you find the correct exercises to strengthen the hips. Am J Sports Med 44(2): 355-361. I read the emails when I get them, Ultimate Injury Prevention Package [SAVE 20%], the influence of lower limb biomechanics in the development, persistence and management of patellofemoral pain, this excellent summary by my colleague Ian Griffiths, ITB or not to ITBthat is the question | EightLane, http://podoxygene.com/articles/articles.php?id=5&cat=3, http://zzathletics.com/Golf-Ball-Muscle-Roller-Massager-GBMR1.htm, Truth about the IT Band |Miller| Chris Miller DC Student, Elite Chiropractic Your IT Band Is Not The Problem (Maybe Its Your Foam Roller), CFH Training Plan 20/04/2015 26/04/2015 | Momentum Training, 8 Signs of Really Bad Youth Sports Coaching & More [Coaching Bulletin Issue #15] - Coaching Bulletin, How To Fix Runner's Knee - The Smart Runner, Iliotibial Band Syndrome: Prevention is Better than Cure | Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution, IT Band Foam Roller Exercises for Runners - Video | Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution. Am J Sports Med 34(11): 1844-1851. Appl Bionics Biomech. The KAM increased significantly with contralateral pelvic drop (p=0.001) and with combined contralateral pelvic drop and trunk lean (p<0.001) compared to the level pelvis trials. While clinical outcomes from biceps tenodesis are generally excellent, return to sport rates are highly variable. It is worth it if the problem is so bad like mine that even walking a few km could be a problem. 2012 Apr;64(4):525-32. doi: 10.1002/acr.21584. All evaluators agreed whether gait modifications were appropriate. Please enable it to take advantage of the complete set of features! The most commonly seen biomechanical flaw in the running population is dynamic knee valgus, a combination of femoral internal rotation with adduction and tibial internal rotation [5]. Frequently the one exercise they have been told to perform is a Pilates type clam for glute medius. The success of the contralateral pelvic drop was determined by visual observation as this would be consistent with a clinical evaluation of this movement pattern. Unilateral walking lunges (while holding weight on one side) is a good progression, as they help build the necessary strength to keep the pelvic stable while countering the weight on the other side. At least Brad has taken the time to appraise literature to support his reasoning (Im sure hes wasted his time in reading junk also but this has guided him to this reasoning process). Please correct me if I am wrong or my thoughts are incorrect but with a lack of explanation it is difficult to see where your reasoning is derived Ellis. A contralateral pelvic drop, a transverse rotation and a lateral translation of the pelvis are essential features of normal human gait. Ive lost track of the number of running and triathlon clients that I see complaining of ITB who have wasted both time and discomfort rolling up and down on a variety of foam roller torture devices to alleviate their ITB issues. Known as 'Contralateral Pelvic Drop', this can be observed at the midstance. Or because the individual runs on heavily cambered surfaces. Given that contralateral pelvic drop has been suggested to result from ipsilateral hip abductor weakness ( Perry, 1992 ), and those with knee OA have been shown to have significantly weaker hip abductor strength than those without OA ( Hinman et al., 2010 ), these findings are important. After a few days light, high rep, full articulation squats and warming, rubbing the side of the knee prior to training, all was fixed! Press the space key then arrow keys to make a selection. The key point that most people miss is that you should only go down as far as you can keep your pelvis level. I think what you have missed out is that the thigh muscles, In particular, vastus lateralis and biceps femoris also cause fascial tension that transmits to the ITB. Thanks for this Andy. I feel that gluteus maximus is more influential than gluteus medius in this presentation as it is a three-dimensional single joint muscle, the most powerful external rotator of the hip and the superior fibres contribute significantly to hip abduction. Frustrate me? Bramah, C., Preece, S., Gill, N., Herrington, L. (2018). Although you do present a worthy discussion Ellis, you dont actually report how this process occurs or your personal hypothesis behind it, apart from your own observation and anecdotally that your tissues were hypertonic and affecting your running mechanics (as Brad suggests is part of the problem during swing phase) i.e. 2018 Mar 20;2018:4526872. doi: 10.1155/2018/4526872. 2015;27(2):345348. "Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study." This is a significant finding. In particular, we found injured runners to run with greater peak CPD and trunk forward lean as well as an extended knee and dorsiflexed ankle at initial contact. Cambered surfaces could obviously cause a valgus effect in one knee whilst a Varus effect in the other but in my experience it is generally the knee that is on the lower side of the camber that is affected as the angle of the road forces the knee laterally. Upon substantial updates key then arrow keys to make a selection ) contralateral drop! Worth it if the problem is so bad like mine that even walking a few km could be problem. History, and website in this browser for the next time I comment or.mil contralateral... Sure to hold onto something stable, like a stair rail onto something stable, like a rail! 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