ITB Syndrome - Most effective technique?

[Robert T]

I've had several runner clients with ITB syndrome lately. Although I'm familiar with release techniques for the glutes and cross fiber work at the insertion, I'm wondering if anyone has come across a consistently effective treatment protocol?

 

[Greeen_Pixie]

ITB Syndrome - Most effective technique?

First I need to say I love these silly smiley faces! I feel compelled to use them all!

Anyway, ITB - I'm an expert from personal experience! My most effective treatment has been a combination of stretching, proper warmup, othotics, running on trails instead of streets, and liberal amounts of ice.

The stretch I've found most effective is what I call the "pretzel stretch". - Sit down with one leg in front of you, knee bent pointing straight in front of you, foot almost under your butt. The other leg crosses over with your foot next to the outside thigh of your other leg. Pull the knee of that leg towards  your chest while driving your butt cheek down to the floor. You should feel this stretching deep in your glutes. It's worked wonders for me! Stretching is especially important after the activity.

Also - one of the leading causes of ITB is running on a street which tapers down. I discovered this after working exclusively on clients with ITB on the left side! Encourage your runners to run on flat surfaces, or at least surfaces that don't tilt the same way all the time.

Best of luck! Let me know how it goes.

Smile! ;D

 

[Dr. Tabas]

ITB Syndrome - Most effective technique?

Piriformis must also be addressed. Chances are BIG that the ITB is affected from the nervous system further up. "Sciatica" is something that for some reason alot of my clientelle is affected by recently, (myself included). That pretzel stretch is one of the few stretches that helps me. P.S.- Can you assist a client with that stretch on the table?

 

[Old Kid]

ITB Syndrome - Most effective technique?

Hi. You can alter that stretch to be done standing, and can be done with the therapist 'spotting' the client, so they gain the confidence necessary to do it alone. Stand in front of a pole or very sturdy, tall fixture & hold onto it a comfortable arm's distance away. Cross one foot over the opposite knee (as if you were to cross your legs in an 'open' manner) and sit back into the supporting hip. This is where the therapist can assist, helping the client find their balance & proper body mechanics. It's important to emphasize that the supporting foot be oriented straight ahead, not flayed out to the side at more than a small degree. Likewise, the knee must align over the ankle. It should really be as if they are sitting into an imaginary chair. Not everyone will be able to sit into the stretch all the way, but the point is to sit as far as you can until you feel the deep piriformis stretch & stay there for at least 15 seconds.

Me, personally, I wouldn't assist the client with the afore-mentioned 'pretzel stretch' on the table. It's probably best demonstrated by you on the floor. The padding on the table could alter the postural relationship between vertabrae, or spine & hips, etc. Plus, the client may not have the flexibility in their back (or too much after their great massage) & then a new set of circumstances can arise.

Just my two cents.

As far as the bodywork for piriformis syndrome, ITB syndrome & sciatica.... I do a positional platform with the client prone that is very profound (so go easy at first) and effective. Bend the lower leg at the knee, and support (and drape!) appropriately while you draw the bent leg out to the side. (for you dancers, it's 'pique'... knee bent to the side with the foot resting near the inner calf, knee or thigh of supporting leg.... 'tree pose' for yoga students) Use your bolsters to secure & comfort the leg & foot. This alone will stretch the adductors & work the hip flexors with the weight of the body. Use your forearm (not elbow) and run up the ITB, figure-eight circling the glute pockets (staying with active triggers with elbow if the client can deal well) & back down toward the lateral side of the knee. I alternate this with cross-fiber friction done with soft fists or open palms. If you have warmed the leg up appropriately, it's usually not painful, but it can be surprisingly deep. I usually jostle the leg gently afterwards & apply a little Biofreeze, etc afterwards to 'make friends' again! ha. Relief is usually as profound as the stroke is deep.

Jill/Sagetherapist

 

[kshollywood]

I use the same stretch and technique that Jill uses on my cycling/running patients.  They love it because it works so well.  Good luck.