Carolina Spine & Sports

Its no surprise that the most commonly injured structure in runners is the knee. At a running pace, ten times our body weight is transferred to the knee joint. Knee injuries account for over half of all running injures. One such condition is Iliotibial Band Syndrome (ITBS), also called Runners Knee.

What is Iliotibial Band Syndrome (ITBS)?
The ITB is essentially an enlarged tendon that connects from the Gluteus and Tensa Fascia Latea (TFL) muscles of the hip and runs down the outer thigh and attaches to outer (lateral) portion of the knee. ITBS presents as a unilateral burning pain on the outside of the knee. It can also cause pain to radiate up the side of thigh and/or the hip. Early on in the injury cycle, pain occurs most often at the end of the run (i.e. >45 minutes into a run). As the injury progresses, the symptoms become more pronounced in severity, occur at earlier frequencies (i.e. 10 minutes into a run) and can begin to affect both knees. Changes in your running program (either increases in total distance, or speed) are most often the mechanism of injury. Other factors can also contribute to the process including: running on hard surfaces, running on the crowned surfaces of paved roads, hill running (both up and downhill), asymmetric arches of the feet (over pronation or supination), leg length inequality (both structural and functional) and muscle imbalances of the hip/thigh. The ITB is long, strong, and prone to tightening. Recently it has been discovered that, like many conditions, it is a multi-factor injury that occurs as a sequence of events.

Stage 1 – Deconditioning
Deconditioning is another way of saying “out of shape” or “weak”. Two major events can arise as a predictor of ITB Syndrome: ITB tightening and Gluteus Medius weakness. In ITB tightening, faulty running biomechanics can place increased strain on the ITB causing it to tighten, and thicken. Tightness or uncoordinated movements in a single muscle can change the way the body moves. Altered running patterns create a less elastic ITB that is more prone to be injured. For this reason, a proper treatment plan always begins with an analysis of your running gait.

With Gluteus Medius weakness, faulty running mechanics are once again to blame. The Gluteus Medius is a small muscle designed to stabilize the hip while the leg is in contact with the ground. As it weakens, the body begins to recruit larger muscles to stabilize the hip. Surprisingly, this weakness leads to a chronic low-grade spasm of this muscle. The end result is an unstable hip which then transfers more strain onto the ITB itself. Gluteus Medius strengthening must be a part of any rehabilitation program.

Stage 2 – Secondary Effects
As the body’s usage of the ITB changes, increased “friction” arises between the structures surrounding the ITB. These alterations are the ultimate cause of the pain associated with ITB Syndrome. However, a true fix always goes beyond what causes the symptoms and addresses the root of the problems as well (the deconditioning).

There are three components to ITB Syndrome: ITB Bursitis, ITB Tendonosis, and Soft-Tissue Adhesions.

ITB Bursitis: Because of the tightening of the ITB, a compressive force is applied to the ITB bursa causing bursitis. ITB Bursa are small fluid filled sacs located just beneath the IT Band and are designed to lubricate areas of high friction between tendons and bones. They are highly prone to inflammation, and when irritated, cause pain and limitation of movement. This condition is especially resistant to therapy and the traditional approach of management is rest from running. However, new research highlights the importance of resolving the true cause by releasing the excessive tension of the ITB through effective soft tissue therapies.

ITB Tendonosis: The tightening of the ITB also causes it to rub on the bone of the lateral knee. This friction causes an irritation and breakdown of the tendon’s tissue at the cellular level. The body lays down adhesions within the tendon to compensate making it less elastic and thicker. As the tension increases, it deteriorates faster than the body can repair it. Over time, the adhesions cause more pain due to the inability to stretch. Gradually the symptoms increase and your runs become less and less enjoyable. In some cases, this can last for years and/or become episodic.

Soft-tissue Adhesions: This is quite often overlooked by many healthcare providers treating ITBS. Adhesions develop between the ITB and the Quads/Hamstrings. Essentially the IT Band sticks to the surrounding muscles causing further complications in regards to ITB function. Without releasing the soft-tissue adhesions in the surrounding muscles, resolution is incomplete and the condition is more likely to recur.

With all the possible factors, and involved structures, a thorough evaluation is the foundation upon which your recovery is built. To prevent a temporary solution, decreased performance or even a premature retirement from running, it is impertative that all these factors be considered when adressing this type of injury. An experienced profesional will be able to identify and correct these structural issues leading to a more enjoyable, even an enhanced, running career.

I have been getting alot of questions about vaccines as well as flu prevention. This came across my desk and thought I would pass it on. It is very old school and traditional but all the information checks out as described. Sometimes the most expensive most complex medicine is not always the answer. Hope this helps.

H1N1 – SWINE FLU PREVERNTION TIPS…

Dr. Vinay Goyal is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital, Bombay Hospital, Saifee Hospital, Tata Memorial etc. Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W). The following message given by him, is important for all of you to know the only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it’s almost impossible not coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). H1N1 takes 2-3 days after initial infection in the throat/nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, clean your nostrils at least once every day with warm salt water. Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.

5. Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. Drink as much of warm liquids as you can. Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

Headache sufferers have been reportedly helped by chiropractic manipulation since the profession’s early days. Movement abnormalities of the spinal joints (vertebral subluxation complex), particularly in the upper part of the neck, can refer pain to different aspects of the head and/or irritate nerves that provide pain sensation to various parts of the head and face. A number of accounts of relief from both tension and migraine headaches have appeared in the both chiropractic and rehabilitaion journals in recent years.

A particularly interesting study compared six weeks of drug therapy using the antidepressant Amitriptyline with six weeks of chiropractic manipulation. The patients selected for this study had a history of at least one headache per week over a period of three months or more.

Chiropractic therapy was just slightly more effective at reducing headache pain. However, drug therapy relief was accompanied by side-effects in more than 82 percent of the patients. These side-effects included dry mouth, drowsiness and weight gain. Previous studies indicated that glaucoma and cardiac problems could be further side-effects of this drug. By contrast, less than 5 percent of the patients receiving chiropractic manipulation reported the minor side-effect of slight neck stiffness most liketly attributed to the physical hands on nature of the treatment.

A further chiropractic advantage became apparent during a follow-up period, four weeks after the interventions were stopped. Headache relief continued for the chiropractic group, while members of the drug therapy group returned to their previous levels of headache suffering. The chiropractic group also reported higher levels of energy and vitality than the drug therapy group during this follow-up period.

The advantage of the chiropractic approach over drug therapy has become even more apparent with the widespread recognition of “rebound headache,” sometimes called “medication headache” or “analgesic headache.” Long-term use of headache medicines more than twice per week can interfere with the body’s natural pain-control circuitry. After a while, the medication gives transient, partial relief, but the headache returns (rebounds) as the medication wears off. Sometimes, the rebound headache is more severe than the original symptoms, and the patient requires higher and higher dosages of medication. Even relatively innocuous over-the-counter headache remedies can have serious side-effects, especially when used for six months or more at dosages higher than recommended.

References
1. Curl DD. Chiropractic Aspects of Headache as a Somatovisceral Problem. In Masarsky CS, Todres-Masarsky M (eds). Somatovisceral Aspects of Chiropractic: An Evidence-Based Approach. Churchill Livingstone, New York, 2001.
2. Boline PD, et al. Spinal manipulation vs. Amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995;18:148-154.

Carolina Spine & Sports is the premier provider of Chiropractic and Soft Tissue Treatment in Uptown Charlotte. The office focuses on providing an accurate, thorough diagnosis in combination with state of the art treatment and rehabilitation of disc, joint, and muscle injuries of the spine and extremities, as well as performance enhancement.