PT on the Net Research

Kinetic Chain Dysfunctions (I-T Band)


Question:

I have just started with a 37-year-old male client. He is a banker and works 70 hours a week. Exercise history: long distance running, fixed resistance machine training such as leg extension, leg press two to three times a week. Build: ectomorph. Problem areas: mild upper cross, weak wrists (can't do weight baring exercises), sharp shooting pains in the left leg vastus medialis/sartorius, tightness/soreness in the left semimembransous, acute pain right erector spinae, tight right medius gluteus and soreness through the right iliotibial tract. These are the areas that stand out to be of main concern to my client and myself. My view on his problem areas is repetitive movement syndrome. He carries a heavy suitcase (right hand) every day, sits for 12-16 hours typing with the right hand and using the mouse with the left with a more than likely bad postural alignment. Out of all the problem areas, the iliotibial tract is the one that concerns me most. Do you have any suggestions on how to relieve the pain? I will be working with a physical therapist to help with these issues; however, I feel I am in need of some professional education to understand the role of the iliotibial tract in more detail. Thank you. Your web site is a goldmine of information!

Answer:

Thank you for your question. To answer and therefore provide a possible solution, I would like to "tweak" your thought process on what sounds like an isolated assessment (although still viable). In other words, what you mentioned in your question are body parts as opposed to movement successes/faults. To resolve his ITB problem, it is critical to know how your client deals with the natural forces of life movement (gravity, ground reaction forces, momentum, etc.), especially while running seeing as running is most likely the more intense activity (compared to what is mentioned).

Our recommendations

  1. Video tape his running mechanics and search for GROSS abnormalities. If this isn't a skill of yours, still video tape and search for someone that can analyze the video to search for the CAUSE - or at least give a clue to the cause. After this global assessment, perform a balance reach test to test his hips ability to move and transform (functional strength) through all planes of motion. If you are unfamiliar with these assessments, contact Functional Design Systems (www.functionaldesign.com) and order their Total Body Functional Profile book. This book will give hundreds of different assessments.
  2. Omit his traditional exercises and replace them with exercises that are total body so the entire "chain" is stimulated as opposed to "parts"(see the PTontheNET.com Exercise & Flexibility Library for total body exercises). His occupation requires him to sit and use parts of his body repetitively - why go to the gym and sit and over stress the body in the same manner? In fact, if he were to properly stretch after a long day of sitting and train his body correctly (not on machines), his ITB probably will feel a lot better.
  3. You may need isolated tissue work to the hip-knee-ankle/foot region, depending on the outcome of your functional assessment. For that, I would recommend an ART Practitioner (www.activerelease.com). Just click onto provider and look up your area.

The ITB and TFL provide stability to the knee. The ITB is fascial and can become adhered to the vastus lateralis. Problems with the ITB can cause lateral knee pain, chronic fixation of the fibula and clicking or locking of the knee due to malposition of the lateral meniscus or fixation of the fibula. In addition, the ITB lies on the vastus lateralis and, in some cases, must SLIDE over it. An adhesion between the two causes problems with the actions of both structures. The solution is to trap the ITB with proximal tension (ART technique) and move the vastus lateralis distally.

Keep in mind, before you use our third recommendation, assess and re-test so you know you're on the right track. Everybody is different, although it may sound like the same complaint.

Good luck!