IT Band Syndrome

2018 is the year of running (at least for Dr. Emily). With this, Dr. Emily is spending more time with runners, and she is hearing more about aches and pains with runners. Enter this blog post about IT Band Syndrome! 

Definition and Causes of IT Band Syndrome

First things first – what is the IT Band? IT stands for iliotibial; the IT band runs from your ilium to your tibia. The ilium is the science term for your hip bone and your tibia is one of the bones in your leg. Check out this picture to better visualize the IT band.

Looking at this photo, you can see the white tendinous fibers if the IT band. The top part of the IT band is thinner and fanned out. It is made up of fibers from tensor fascia latae (TFL) in the front, gluteus maximus in the back, and gluteus medius on the underside. As you travel down the IT band, fibers from vastus lateralis (one of the 4 muscles to make up your quadriceps) contribute a bit. The lowest portion of the IT band is a narrow, thick band that you can feel just above your knee.

So now that we are familiar with the IT band, we can look into IT band pains. IT band pains can come whenever the IT band isn’t able to move and support your body the way it is supposed to. If any of those muscles we talked about get too tight/aggravated, it can pull on the IT band and alter the biomechanics of your hip, knee, and leg. But there’s even a bigger picture than that! The IT band is not only connected to those muscles but to the ilium and the tibia. Both of those bones also serve as attachement sites to MANY other muscles. That means that any number of muscles can affect the ability of the IT band to work as it is supposed to.

There are some activities that can put more stress on the IT band. These include running downhill, running on slanted surfaces, always running on the track in the same direction, or simply over exertion. Wearing shoes that are worn out can also change your biomechanics and put more stress on the IT band.

Signs and Symptoms

IT band pain presents differently depending on where the problem started. Some common symptoms are:

• Nagging pain on the outside of your knee
• Sharp pain at the outside of your knee
• Swelling pain around your knee
• Feeling a click, pop, or snap on the outside of your knee
• Pain up and down the outer part of your upper leg

Many times the pain around the knee comes on during a certain part of a run and gradually gets worse. Many runners will feel that this pain is worse while going downhill.

The pain may also be noticed while cycling. It can come and go during the downward pedal stroke and upward pedal stroke (when your knee is bent around 30 degrees).

Sometimes the pain will go away with rest, but it will return with activity.

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the IT band irritation. A series of orthopedic tests, movement assessments, and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the IT band syndrome dictates the treatment. 

If the cause is any of the muscles whose fibers directly feed into the IT band, the treatment will likely be focused on soft tissue therapy to those muscles. Manual soft tissue treatments (like massage) and instrument assisted soft tissue treatments (see this page for more info) are often very effective in treating IT band syndromes caused by this.

If the cause is due to joint restrictions (either in your feet, ankle, knee, hips, pelvis, or low back), we can correct those through chiropractic adjustments.

If the cause is due to muscle imbalances pulling on the ilium or tibia restricting the natural movements, we will work on correcting that imbalance by strengthening/activating the weakened muscles and stretching the tight/overactive muscles.

Some patients may have multiple causes contributing to their IT band syndrome, so we treat all the causes. We are also a big fan of home stretches and exercises to help eliminate future flair ups. Many patients benefit from foam rolling or using massage sticks over the musculature of their thighs and legs. 

After your first treatment, we will go through specfic exercises and stretches that are targeted towards correcting YOUR causes of IT band syndrome. 

There is no need to live with insistent, irritating pain. Call us today! 

Plantar Fasciitis

Most people wouldn't think to go to their chiropractor for plantar fasciitis, but I'm here to educate you on the condition and why chiropractic care can help!

Definition and Causes of Plantar Fasciitis

Plantar fasciitis is a term often used for pain on the bottom of your foot or by your heel. We can start by defining it by looking at the parts: plantar means the sole of your foot, fasciitis (fascia + itis) means inflammation of the fascia. Fascia is the science word for the connective tissues that cover your muscles and tendons. The plantar fascia is the thick piece of connective tissue that runs from your heel bone (calcaneus) to each of your toes. Check out this anatomy pic below to see the thick band of plantar fascia. 

So now that you know the definition of plantar fasciitis and you can picture the plantar fasciitis, we have to figure out what CAUSES that inflammation of the plantar fascia. A likely cause is simply irritation either deep to the fascia or more superficially.

First we will look into causes of irritation deep to the plantar fascia (between the plantar fascia and the bones in your feet). Not to overwhelm you, but under the plantar fascia there are FOUR layers of muscles and tendons before you even reach the metatarsals! You have the abductor hallucis, flexor digitorum brevis, abductor digiti minimi; lateral plantar nerve and artery, medial plantar nerve and artery; quadratus plantae, lumbricals, tendons of flexor hallucis longus and flexor digitorum longus; adductor hallucis, flexor hallucis brevis, flexor digiti minimi; interossei. It's easy to look at your foot and go, "there's no way all of that is in there!" They are though. There are 26 bones in your feet! Your body needs to be able to control the movement in all of those joints. If any of those muscles get tight/spasm, they may alter the functioning of the joints in your feet. That may be enough to trigger the inflammation of your plantar fascia. 

Second we will dig in to a more superficial cause of irritation to the plantar fascia. What is more superficial than the superficial back line (well aside from skin)? Some of you may be thinking, the superficial back line? What does that even mean? Based on Thomas Myers and his book Anatomy Trains, there are fascial lines through out our body that work to support us and help us perform various movements/tasks. One of the contiguous fascia lines is the superficial back line. The plantar fascia is the first part of the superficial back line. The line consists of the plantar fascia, heel bone (calcaneus), calf muscles (gastrocnemius/Achilles tendon), hamstrings, sit bone (ischial tuberosity), sacrotuberous ligament, sacrum, the muscles that run along side your spine (erector spinae),  and the fascia on your skull. Many times when one of the parts of this fascial line isn't working properly, that imbalance travels along the fascial line, and pain/dysfunction follows. So a problem in any of those areas can present as plantar fasciitis.

Signs and Symptoms

Plantar fasciitis is often associated with walking, running, tennis, gymnastics, and basketball. This doesn't mean that it HAS to be a result of this or more problematic during those activities. 

People with plantar fasciitis usually have pain in their foot that is worse when they wake up in the morning or after long periods of rest. Pain often increases with toe rises or running. The pain can also increase towards the end of the day. The pain is often noticed along the inside arch of your foot close to your heel bone (calcaneus). There may also be pain/tenderness to the touch of the bottom part of the foot. 

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the plantar fasciitis. A series of orthopedic tests and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the plantar fasciitis dictates the treatment. 

If the cause is deep to the plantar fascia, the treatment will be aimed at muscle release to the muscles in the foot and the muscles in the calf whose tendons run deep to the plantar fascia. After assessing the motion in the joints of the foot, often times adjustments may be performed on the foot. 

If the cause is along part of the superficial back line, the treatment will be targeted at the area causing the problem. Muscle release or work on the tendons and ligaments may be performed to help "slacken" the superficial back line and take pressure off of the plantar fascia. Adjustments may be performed on the back, pelvis, and/or the leg and foot. 

Some patients may have multiple causes contributing to their plantar fasciitis, so we treat all the causes. We are also a big fan of home stretches and exercises to help eliminate future flair ups. After your first treatment, we will go through those exercises and make sure that you are comfortable with your home care stretches. 

There is no need to live with insistent, irritating foot pain. Call us today! 

3 Ways to Beat June Gloom

Most people think that we always have perfect weather here in Southern California, but then they visit in June... Meet June Gloom.

June Gloom is the affectionate name for the heavy clouds and cooler weather that we experience most Junes due to some science stuff (cool waters and higher atmospheric pressure). Sometimes June Gloom comes early and we get May Grey. All this dreary weather can really put a damper on your mood. This week we're going to talk about 3 ways to beat June Gloom. 

1. Exercise more
2. Eat better foods
3. Get adjusted

Exercise is a great way to combat the woes of June Gloom. Studies show that exercise can help with treating and preventing depression. Exercise doesn't have to be super intense to get the benefits either. As little as 20-35 minutes a day of low level activities have been shown to help with feelings of depression. Need some motivation to exercise? Call a buddy! Find a group to exercise with! There are lots of free fitness groups around. You can also garden as a form of exercise. The cloudy skies and cooler weather are a great time to get out and dig in the dirt! Or make a deal with your pet to take it on daily walks. 

Eating better foods can also do wonders on your mood. The central nervous system (your brain and spinal cord) interacts a lot with your enteric nervous system (more than 100 million nerve cells lining your gastrointestinal tract from esophagus to rectum).  Older research thought that depression and anxiety could lead to irritable bowel syndrome (IBS) and other gastrointestinal complaints, but new research shows that it could be the other way around! So feed your body whole foods that aren't processed. Go for lean, grass fed meats or wild caught fish. Fill up on vegetables and fruits. Try kombucha for giving your gut good bacteria (probiotics) to help with digestion of nutrients. 

Lastly, get adjusted! Chiropractic adjustments keep you moving well! When you can move better, you feel better! And don't forget to focus on good posture still even though Posture Month is over.