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Posted on 04-24-2015

Advice from Dr. Greenapple
Foam Roll, Stretch or Exercise my Way Back from Injury?
by Dr. Greenapple


As spring is upon us and the weather warms up, the streets become not only filled with flowering trees, but an ever increasing amount of runners. After a few months of winter hibernation and a few extra pounds, the masses are hitting the pavement, to run their way back to health and happiness. Unfortunately, as the running increases, so do the injuries, along with all the blogs and social media posts on how to manage and fix all of your running-related issues. There seems to be an amazing amount of FB qualified medical advice out there. Of course, I also have my own opinions and comments and like to stir up some controversies and offer some of my opinions with sound reasoning behind the opinions.

Let's talk about one of the most common spring injuries, the Illio-Tibial- Band syndrome (ITB). The often misunderstood reason why runners get this, the function of ITB and all of the Doctors of the Internet's advice from ice to stretching to foam rolling to rehab.

The myth: "My massage therapist, P.T., and Chiropractor told me my ITB is really tight." They are all correct, it's always tight. It is supposed to be tight! That is its function. The ITB is a type of ligament, a thick band of connective tissue made up of the muscles from the Tensor Fascia Latta (TFL) and the Gluteus Maximus. It helps movement of the leg and stabilizes the lateral (outside aspect of the knee). Knee's, tend to go medially or inward when certain muscles are weak. You can see this with some simple tests like squatting or one legged squat test. Usually, the Glut Medias is not firing properly and the TFL is overworked and becomes tight. The ITB itself is a very thick, strong, fibrous band and should be tight.

When you roll the ITB with a foam roller, it may feel temporarily good, but it will not make any structural change. "Oh, but it hurts so good." Of course it hurts. You are compressing the ITB against the femur (thigh bone). "Wait, I thought the foam roller is supposed to compress, that's why it works". Let's speak a little about compression.

Compressive forces: Compression of tendons and ligaments usually leads to tendon injury. This can be tendinitis, or chronic tendinopathy. Or, you can compress a nerve under a muscle causing nerve damage. I had one case of this over the past week with this exact injury. Foam rolling caused entrapment of the lateral femoral cutaneous nerve which lead to burning, numbness and pain down the front of the thigh. Contraction of a muscle causes tension on a tendon. Too much tensile loads can cause injury to the tendon by compressive forces. If a tendon wraps around a bone to its attachment, and it is pulled on by stretching or foam rolling it, it will cause a compressive load at that site. Think of a pulley system with a cable over a curved surface. As you pull the cable over the curved surface, it causes irritation and compressive forces. The ITB, hip Abductors (muscles that move the leg out), hip adductors (muscles that move the leg in), are perfect examples of this, as well as the hamstrings. An example is when you cross your leg. You are pulling the outside muscles of the hip (the gluteal muscles) across the bony prominence of the front of the femur and pelvic bone. There is a lot of good data and studies out there supporting this theory.

So, what can we do? I will give you some of my ideas and show some exercises.

Always start with a proper evaluation that must include function assessment to muscles of the gait cycle. Stop chasing the pain! Think kinetic chain. From there, you may need some sort of treatment to the injured area to calm down and address the tissue that is "injured or painful." There are many types of treatment out there for this. We then need a system of exercise to gradually increase the mechanical load. As you adapt, you become stronger. The tendons and muscles 'learn" to take increasing loads on them. Avoid compression and get creative in your rehab trying to adapt the body to movement patterns. There are an infinite number of ways to address rehab for injuries. You may seek out a professional who has training in this. Do not stretch an injured area especially when the muscle and tendon wrap around the bone to its attachment. Avoid compressive forces that pull the area of pain over a curved attachment. Stay off the direct area of pain and work around it. If rolling, roll over big strong large muscles vs smaller ones. Get strong and functional. Do your own research or seek out someone you trust to help with a program. Be judicial in listening to advice from all the experts on FB. Most of all listen to your body, do not push through pain. Running is a sport that should last you a lifetime. Your body is the most important piece of equipment, listen to it.

Dr. Greenapple (DC, CCSP, FIAMA) has been practicing for the past 29 years. His specialty is sports injuries with heavy emphasis on running, triathlons, gait analysis, golf and performance enhancement. He was the first to bring ART (active release technique, was teaching ART since 1995) Graston, Kinesio Tape, and Laser treatments to the athletes in Charlotte. Dr.G also incorporates Acupuncture in his practice and uses traditional eastern philosophies as well as specific sports and orthopedic Acupuncture.  He is also certified in Dry Needling. To learn more, check out his website. 

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