About focusbodywork

I am a massage therapist specializing in bodywork for athletes. My clients are athletes ranging from weekend warriors to professionals in a wide variety of athletic pursuits. I help athletes stay healthy through their training, treat a variety of acute sports injuries such as strained hamstrings, and work with my clients medical team to ensure a speedy and through recovery from serious sports related injuries such as ACL repairs. I rely heavily on Neuromuscular Therapy, Myofascial Release and Myoskeletal Alignment techniques for specific soft tissue repair and am regularly participating in advanced trainings to further my education.

Just Run Through It?

Holly's beautiful running form at the end of the Mid-Mountain Marathon

Holly’s beautiful running form at the end of the Mid-Mountain Marathon

By Emma Maaranen

It is prime time running season with runners all over the Wasatch Front training for the Wasatch 100, Mid-Mountain Trail Marathon and St. George Marathon.  At Focus Bodywork we are often asked how to decide if a pain experienced during a run is okay to run through or not.  First, pain is your body’s way of letting you know that something is not okay and needs to be investigated.  Listen to your body!  I lump running pain into two categories: pain that develops while running and pain that develops after or continues several hours after a workout.

Pain That Develops While Running

Discomfort while running is part of the game; if you run you will experience pain now and then.  There are times, however, when you need to listen to your body and call it quits. When running pain causes you to alter your gait, it is time to call it a day.  Your compensated gait is a sign that there is a problem, and to run through it in this odd gait will most likely cause more problems and/or usher the painful site into full-blown injury status.  If the pain is not altering your gait, slow down for five minutes and focus on good running technique.  At the end of five minutes check in to see how the pain has changed.  If is the pain has reduced, pick up the pace and see what happens.  If is the pain has stayed the same, try another 5-minute technique period.  If at the end of this second test period the pain has increased or your gait has altered, it is time to walk home.

Pain That Develops or Persists Several Hours Post-Workout

You need a rest day! If the pain has subsided after a day of recovery try an easy run and see how it goes.  If you do not have pain while running and it does not return a few hours after rest, you can resume training.  If not, start with some good home therapy.

Home therapy:

1.)    Day 1 – Take a rest day- a real rest day!  Don’t even go to that yoga class.  RICE (rest, ice, compress, elevate) as often as you can.  Sit in a hammock (with your legs up and iced) and catch up on some reading (If you NEED to call this day a training day I recommend reading “The New Toughness Training for Sports: Mental, Emotional and Physical Conditioning from one of the World’s Premier Sports Psychologists” by James Leohr.)

2.)    Day 2 – If your pain is still hampering you, try a regiment of OTC anti-inflammatory, such as Ibuprofen.  Initially this will mask pain symptoms, but if taken as prescribed for 5 days you will reap the anti-inflammatory benefits of the medication.  RICE.  I know you are panicking about your fitness diminishing already (it is not, this takes two weeks), so try some cross-training, such as swimming or biking.  If your cross-training sport increases any of your pain symptoms, you need to try something else.

3.)    Day 5 – If your pain has not resolved, it is time to see a professional.  A sports massage therapist (like the ones at Focus Bodywork), a physical therapist or sports medicine doctor can help you develop a plan to get back to running pain free.

Endurance sports regularly require athletes to push through discomfort.  Should you “just run through it?”  It is important to evaluate your pain keeping in mind that cutting a training day short may save you several weeks of being side-lined.

Now That Summer Has Arrived, It’s Time for Ribs!

BBQ ribs

By Emma Maaranen

Ribs – not the barbequed ones, yours!  At Focus Bodywork we have seen many rib injuries lately, and I have my own handlebar-induced one as well.  Rib injuries come in many flavors: bruised, separated, cracked, broken, and even collapsed.  These injuries are common in athletes participating in sports where contact or crashing occurs.  You may have heard a friend talking about one of these (hopefully you have not had one of these injuries yourself), but few people actually know what these terms mean and what a rib injury really is.  Let’s clarify.

Your ribs surround your torso, protecting vital organs.  With the assistance of several muscles, ribs help our lungs expand and contract so we can breathe; two very important jobs!  Each of your twelve thorasic vertebrae (the part of your spine between your neck and low back) has a pair of ribs attached to it that wrap around your torso, and all but the bottom two attach to your sternum (also called your breast-bone) on the front of your body.  When your ribs experience a serious blow, they can be injured.  They are designed to displace or crack to absorb a serious force so your organs below are not damaged.  They are not invincible, and sometimes lungs can be punctured,  or other organs experience trauma despite the ribs’ aid.  Here are the common rib injuries:

Bruised Ribs – The muscles and connective tissue around the rib were injured, but the rib bone is ok.  The area will be sensitive to touch, and moving the torso (looking over your shoulder, bending forward) will be painful.  Discomfort from sneezing and laughing are common.  Rest, avoiding jostling activities, and icing the painful area should resolve bruised ribs in a few weeks.

rib-fractureSeparated Ribs – The rib has sprung free from its attachment on the sternum.  The site of impact will feel deeply bruised, any torso movement will be uncomfortable and it will be very touch sensitive at the sternum where the rib attaches.  A separation is a joint injury where the ligaments that hold the rib in place are injured, similar to a sprain.  This will take about six weeks of rest to heal.  Many athletes get frustrated with the healing time of this injury and return to play too soon. Separated ribs can progress to a chronic inflammatory condition that is very painful and will require ongoing medical care, do it’s best to see the rest period through.

Cracked Ribs – This is where the rib is cracked, but does not actually break.  It will be extremely sensitive to touch, and any torso movement (including breathing) is very painful.  Rest and minimal activity for 6-8 weeks is the typical protocol for healing a cracked rib.  Athletes that return to play too early risk the cracked rib progressing to a displaced fracture (where the bone breaks into two or more pieces).

Broken Ribs – This is a displaced fracture, the jagged edges of the broken rib may shred the muscles around it and can puncture the lung.  This is an extremely painful injury where moving or even breathe is excruciating.  It will be extremely sensitive to touch, may be visibly deformed and will likely bruise severely.  Six to eight weeks of rest are needed to heal, but athletes with broken ribs are typically in so much pain they won’t return to play too early!

Flail Chest – This is where several ribs are broken, and the rib cage is no longer able to assist the lungs to breathe.  This is a medical emergency.

Pneumothorax – This is where a broken rib punctures the lung.  This is a medical emergency! Fortunately there are two lungs, so breathing is sort of possible before a medical team can intervene.  Again, six to eight weeks of well-deserved rest are the norm.

Rib injuries are frustrating.  Your arms and legs work just fine, but you can’t bend, twist, lift, breath hard, laugh, sneeze and I hope you don’t get a cold with cough!  There is little you can do to speed  the healing ; it just takes rest.  Ice and anti-inflammatory drugs can help with the pain. Increasing your protein intake will ensure you have the building blocks needed for tissue repair and taking a calcium/magnesium/phosphorus supplement will aid in bone repair.  An acupuncturist can help with the pain and stimulate your body to put a lot of effort into healing the injury.  In the past, rib injuries were taped or supported with an ace bandage.  This is no longer recommended because the limited rib motion from the brace can lead to pneumonia.  The last thing you want is to have more problems breathing with a rib injury, and coughing may make you more miserable and lengthen healing time.  When the rib injury has healed to where it is not very touch sensitive and any broken bones have knit back together, massage therapy can help to restore normal rib motion.  When rib injuries heal, it is common for the intercostal muscles (the ones between ribs that pull two ribs together) to develop scar tissue and adhesions.  These muscle restrictions can limit  torso motion and the ability to breathe deeply.  Often the diaphragm (the muscle at the bottom of your lungs that helps the lungs expand and contract) has developed adhesions as well.  Using neuromuscular therapy and myofascial release, your massage therapist can resolve these tension sites, which helps you return to pain-free activity quickly.

I sincerely hope you do not have a rib injury this summer; but if you do at least it’s BBQ season.  While gnawing on some baby back’s and resting in a lounge chair, you can share some rib injury trivia with your friends.

Since your egg can be in only one basket, it might as well be a helmet!

Will this helmet make me faster?

Will this helmet make me faster?

By Emma Maaranen

It is spring, and after a cold and inverted winter along the Wasatch Front the bikers have taken to the streets again.  As I pedal around town running my errands, I cannot help but feel love for my fellow cyclists: the serious commuter bogged down in panniers, a hipster on a fixie, the matching-kit roadies headed up Emigration, and the mountain biker dusty from the just-dry bobsled trail.  But many of these cyclists are testing heart by not wearing helmets!  This appears to be a new trend, and it terrifies me.

I have heard all the excuses and arguments against wearing a brain-bucket. “It will flatten my hair”, “I’m just riding on the sidewalk to the corner market”, “I’m a careful rider.” I’ve even been in a debate with a guy who thinks buying and wearing helmets prevents more people form riding bikes and therefore a “critical mass” is not being reached.  A critical mass of cyclists, he believes, would change motorists driving habits thus alleviating auto/bike accidents.  I say that even a careful driver can be surprised by a cyclist from time to time, but fear of auto/bike accidents is not the only reason to don a brain bucket.

A tire puncture on a steep descent, a railroad track that grabbed a wheel, sand, ice, operator error… I have been victim to each of these, and once I walked off the sting of the ground I was able to ride home with only a rattle to my noggin and a renewed apprehension of gravity.  My ER doc friend has seen minor plops to the ground from bikes lead to concussions, traumatic brain injuries, strokes, comas and deaths that he believes a helmet would have prevented.

Some facts from the CDC (Center for Disease Control and Prevention):

* Head injury is the most common cause of death and serious disability in bicycle-related crashes; head injuries are involved in about 60 percent of the deaths.

* Many nonfatal head injuries from bike accidents produce lifelong disability from irreversible brain damage.

* Bicycle helmets are a proven intervention that reduces the risk of bicycle-related head injury by about 80 percent, yet bicycle helmets are not worn by most riders. Only 19 percent of adults and 15 percent of children use helmets all or most of the time while cycling.

Much research has been published in the past year about the long term effects of head trauma, and stories about athletes experiencing serious neurological and psychological diseases believed to be a result of repeated head trauma are surfacing.  Early onset Alzheimer disease, dementia and depression are believed to be directly related to a history of head trauma.  What’s frightening is that these diseases are turning up at high rates in athletes who experienced only a few hard head hits over their careers or who experienced many mild ones.  This is not a consequence of boxers and football players alone.  There is also evidence that brain deterioration is more profound if the individual is younger and if there are repeat injurys before the brain has completely healed.  For example, a mild (grade 1) concussion, which causes temporary amnesia but not loss of consciousness, will reduce motor control and the ability to focus while the brain is healing.  This may take up to as long as three months!  With these afflictions, the individual is at greater risk of another trauma.  Another head injury in this window is likely to have more severe symptoms and increased future consequences.

I think the new research into head injuries and especially repeat trauma may be enough to inspire any intelligent cyclist into the pro-helmet camp.  I’m going to invest in a few more helmets and see if I can start a fashion forward health trend!

Lift Without Lower Back Pain

Professional mover exhibiting bad lifting habits

Professional mover exhibiting bad lifting habits

By Emma Maaranen

I recently moved into a new home, and although I hired professional movers, I did a fair amount of lifting myself.  It is so easy to injury your lower back when lifting and moving heavy or odd shaped objects, but a few simple tips on lifting safely can go a long way to ensure your spine stays safe.

We put our lower back at risk when we lift heavy objects by bending at the waist.  This becomes exponentially more risky if the object is held away from the body and/or if the lifting motion involves twisting.

Here are some guidelines:

1.) To lift a heavy object like a moving box, squat as close to the box as you can.  Move your feel shoulder-width apart, and lift the box by straitening the knees and tightening your core.  Keep the box as close to your body as possible, keep your knees slightly bent while  you move and do not lean back as you walk forward!  If you need to move the box to one side, avoid twisting your body.  Instead, shuffle your feet around until they are directed at where you plan to set down the box.  Do not forget good body mechanics when you put the box down; reverse the lifting motion!

2.) If you are placing the box on a shelf or on something above waist height, move as close as possible to the shelf. To get more support, take a wide stance with one foot in front of the other, and do not lean forward or extend your arms while holding the box.  Lift the box chest high, keeping your elbows at your side, and push the box up onto the shelf.

3.) Lifting an object with a handle, such as a bag of groceries, to your side can put excessive stress on your lower back.  Stand alongside the bag, bend at your knees, grasp the handle and straighten up preventing the back from bending to the side or rotating.

4.) Finally, if the object to be moved is really heavy, odd shaped or the bulk of the weight of the object will be away from you when you move it, get a friend to help you!

Following these simple lifting principals will reduce the wear and tear on you back, make it easier to lift and carry heavy items, and keep you from needing to come into Focus Bodywork to have us work on your sore lower back. (Great for you, bad for us!)

One Of My Favorite Clients And Why

By Emma Maaranen

I work with athletes of all flavors: a stay-at-home Mom  training for her first marathon to lose baby fat and carve out some time for herself, a professional Extreme skier trying to keep his spine healthy as he drops 80-foot cliffs, and a 14-year-old US Figure Skating Team member who trains more hours in a day than I am even awake for.  I love the variety of motivations my clients have to be athletes.  I am regularly introduced to new sports (like skeleton) and constantly dive into medical journals to learn how to meet each of these clients’ novel sport and injury needs best.  Recently I have met my biggest challenge.  Her name is Micah, and we can all learn a lot from her about injury psychology, trusting the healing process and the importance of “homework” to get back to the things we love.

Micah is a runner and, through some poor footwear decisions, developed pain in her feet.  Because she was unable to continue running, she saw several specialists to diagnose her foot pain.  Many doctors, MRI’s, and cortisone injections later, she did not have a diagnosis or relief.  She was recommended to rest and hope that the problem resolved itself; it did not.  It soon became painful for her to even walk.  Months of limping soon made her hip painful.  This is the point where I started working with Micah and her medical team.  An insightful podiatrist radically changed her footwear, which  changed how her heels interacted with the ground until finally she showed signs of improvement in her feet.  However, as her feet improved, her  hips got worse.  I surmised that all the gait alteration to escape the pain in the feet required new and novel uses for her hip joints.  I released the tight and overused muscles in her hips, stimulated the muscles that were not pulling their weight, did gentle joint gliding for the hips and lower back to encourage synovial fluid production (lubrication for joints), and introduced lateral movement into Micah’s rehab work to strengthen her atrophied muscles.  I was glowing as a therapist after this first session.  Micah was in the least amount of pain that she had been in for months, and she was finally hopeful she would return to racing on the trails again.

The next morning I received a panicked phone call from her mother.  Micah was worse, much worse! I reviewed the therapy I had done with her and was completely confused; at worst she should have had no change in her pain but be a little touch sensitive in the muscles I released.  We talked further and I learned that Micah felt so fantastic after my work that she promptly ripped around in the foothills with her friends that evening.  She believed that since she felt good she could go back to doing everything she did before, right away. Even though I explained to her during our session that she would feel better, a slow and methodical return to activity was essential.  This often is ignored by clients as the thrill of experiencing some improvement is seductive.  There are muscles to strengthen and movement habits to change that will take time and practice, plus some tissue healing that will take about six weeks to complete.  We set up an immediate follow-up session.

During our second session I spent considerable time with Micah teaching her the strength and movement exercises necessary to properly restore her hip biomechanics, showing her which tight muscles could benefit from self-massage, and some stretches to promote a full range of motion.  After our session I believed Micah understood the process to get her hips healthy again and a realistic time-line for returning to sport.

A few days later I received another call from Micah’s mom.  This time, Mom was laughing!  Mom shared with me that I must have gotten through to Micah as she was going out of her way to show her the exercises she was doing, and was doing them almost every chance she got.  Relieved, I saw Micah again to further therapy.  This time Micah had to show off.  She spun in circles demonstrating the lateral movement exercises I had asked her to practice; she did a forward fold placing her head between her legs to open up her hips, then went over to a piñon tree and pressed her hip into a knobby branch she obviously had pruned so she could do some self-therapy.  I was amazed;  Micah is a horse!

Micah Getting Therapy

It has been a bumpy road, but Micah is back to racing around the trails with the heard.  Even though Micah is a horse, her healing process from a frustrating injury is the same as yours and mine.  Injuries can be tricky to diagnose.  It often takes a few visits to various health care providers to figure out how to get an injury healed, and often there are multiple factors contributing to the pain. Often it takes a team of “experts” to come up with a plan.  When finally we see some improvement, it is difficult not to overdo it and set ourselves back.  Patience!  Being an active participant by doing your “homework” and becoming educated about your injury and healing process is essential.

Me, Teaching Micah Her “Homework”

Micah is my first equine therapy client, and it has provided an incredible learning experience for me.  I am available for other equine sessions; call Focus Bodywork if you would like to know more about my credentials, what is involved in a session and rates.

The Slippery Slope to Becoming a Dope

By Emma Maaranen

I don’t think I engaged in as many conversations about Lance Armstrong when he was topping podiums daily at the grand tours of Europe as I have been the past few months regarding Lance’s illegal doping scandal.  Serious cyclists argue about the edge gained and strategies employed with doping on cycling teams, parents ponder the safety of their athlete children in professional sports, even my Grandfather debated the role of politics and economics in the celebrated athlete falling from grace, but beneath each persons rants is a little voice inside cautioning us that if we had been in Lance’s shoes we may have befallen the same fate.

Me, trying not to be passed at the finish line of a race.

I am a competitive athlete.  I systematically train for races, I have a nutritional strategy to maximize my fueling for efforts, and I spend hours reading and discussing the nuances of my sport, mountain biking.  I know that I must suck down a gel twenty minutes before the start of a race to ensure I don’t bonk at the 40 minute mark.  I know I must carefully warm-up my adductors (inner thigh muscles) to prevent cramping.  I spend extra time training technical descents at speed because they are my weakness and visualize my success on these before I go to sleep.  I am not afraid to put in the time to train and try out new things to improve my athletic success, even if they are a bit strange.  This year I read an article about a molecule found in beets that would increase vasodialation (allowing more nutrients to reach muscles faster) if consumed pre-effort and actually tried it on a training ride just to see if it might give me more sprinting power.  If it worked, the effect was negated by having to slow down for vegetal burps.  I decided to stick with the pre-race gel.  However silly as my personal guinea-pig experiments may be, I wonder if this is a healthy scientific quandary into my athletic potential or if this is the first step into logic that can lead one to think using illegal substances for sport is ok?

This May at the Grand Fondo New York several amateur riders tested positive for EPO and HGH.  These were not twenty year old semi-pro riders on the cusp of being asked onto team Rabobank, these were fifty-something Cat. 2 or lower riders in recreational cycling clubs!  They may take their sport seriously, but they can not think they will “go pro” or get some serious monetary payout for their performances. These athletes simply got caught up in trying to be the best cyclist they could be.  By their accounts, dabbling with performance enhancing drugs started in an effort to keep up on the club rides as they aged.  But the gains in speed, endurance and recovery soon put them at the lead of the pack.  This new found role was exhilarating, enough not to want to let it go.  Soon they were adding more drugs into the mix, altering doses scientifically to match training and race day needs, even lying to doctors about medical conditions to get prescriptions for banned substances.  If you stopped, would your training partners become suspicious since your performance would drop? Who would ever think to drug test a recreational cyclist? But a podium finish in this case did warrant a sample collection and the gig was up.

In a candid account by one of the dopers, it becomes clear that the motivation to start performance enhancing drugs came from a desire to maintain a competitive level that was harder and harder to maintain with age, career and family obligations, not to cheat into victory.  But once you have success, how willing are you to do what it takes to have more?

It is obvious that using performance enhancing drugs is bad.  The side effects range from increased body hair growth and tender breasts to stroke and cardiac arrest.  Being caught will ostracize you from your sporting community and may hit your bank account. But is the seduction of glory so strong that these possibilities seem minor? As an amateur, bragging rights to my friends will not be enough to tempt me, plus I’m so terrified of unknown side effects of pharmaceuticals that I avoid OTC’s.  Still, I wonder if the possibility of success on the world stage along with pressure from a professional team would tip the scales?  For Lance it seems it was.  I take this as a cautionary tale, it is a slippery slope to become a dope!

Impingment Syndrome Banter

Shown is a supraspinous muscle being squished underneath the AC joint

By Emma Maaranen

Here is an email conversation with Heather about a re-injured shoulder.  I am sharing this (with permission) as it illuminates a common sports injury and my home care recommendations for a minor joint injury that occurs so often when we are having fun.

Hey Emma,

[…] I went water skiing/tubing this weekend, and my shoulder is feeling quite loose and painful. Last time it felt exactly like this was from climbing, and I had you work on it. I think you said I had stretched a tendon at the AC joint…does that sound right? Anyway, same exact symptoms…:it hurts to put a seat belt on, I can’t sleep on my right side and I cannot hang straight armed without discomfort.

Any suggestions on recovery? You worked on my cemented muscles last time and it slowly got better. […]

Thanks! -Heather

My reply:

Yes, when I saw you for the shoulder thing a few years ago you had sprained the AC (acromial clavicular) joint climbing and the inflammation was squishing the supraspinous muscle that runs just underneath the AC joint – often referred to as impingement syndrome. In those jerky water-ski/tube motions it would be easy to disrupt this joint again, but difficult to seriously damage it.  With a little rest and good care it should turn around in two weeks tops!  (It should be notably better five days from injury and continue to heal for 2-3 weeks)  So, if it were my shoulder, I would avoid things where the arm is jerked (irritates the AC), doing things overhead (squishes the supraspinous muscle), and carrying things with that arm hanging down at your side (like how you would carry an old-school suitcase – this is where the supraspinous works the hardest).  I would ice the shoulder where it hurts, and at the front of the shoulder with the hand resting on your back (this exposes the squished part of the muscle).  If it is not 50% better by 7 days post-injury, let’s take a look at it.  We can release the guarded muscles around the AC joint and treat the supraspinous muscle and the ligaments of the AC joint so that they heal.

I often see clients with acute impingement syndrome caused by non-typical activities such as painting the ceiling or picking apples.  If shoulder discomfort develops over a few hours after atypical (for you) arm activities, not a trauma, especially an activity involving overhead work or repetitive jarring it is likely you have a mild case of impingement syndrome.  A few days of gently care: rest, ice and muscle therapy, should be all it takes to get it back on track.

Olympic Fever Possibilities

By Emma Maaranen

I am an athlete.  I am on go-go mode 95% of the time.  I hate sitting still.  But, for two weeks this summer, I couldn’t leave the sofa.  I didn’t have time for laundry or groceries, let alone distance training!  I had… Olympic Fever.  And I was not alone.  During the Olympics it seems like everyone is addicted to watching the TV feed: weekend warriors, spectators, and soccer moms.  Even kids are into the Olympics.  A five-year-old from my neighborhood nearly knocked me down while sprinting the length of the sidewalk yelling. “Usain Bolt coming through!”

I love sports, I love being an athlete.  I’ve even been known to play a team sport here and there, but I do not regularly follow sports on TV.  The Olympics, however, mesmerize me.  Like every girl growing up in the ‘80s, I wanted to be Mary Lou Retton and get a perfect 10, I was shocked when Tanya Harding made the desire to win a criminal act, and I noticed being an athlete might be risky with Greg Louganis’s infamous platform dive.    It is the combination of these things that makes the Olympics special to all of us.  Every single athlete there is AMAZING – yes, every single one of them!  On top of overcoming political turmoil, discrimination, financial obstacles, and homesickness, many of these athletes have overcome physical assaults that should keep them from being on the world stage doing their sport.  Did you see the swimmer who is missing a leg, the runner on two prosthetic legs, and the 47-year-old woman gymnast competing for her third country and sixth summer games?

Oscar Pistorius inspiring all of us!

No doubt Olympic athletes are great.  Heck, they may be mutants!  But they have a secret.  They know that our bodies are capable of unfathomable feats of repair and resilience.  They know that the mind, when put to task, can create things previously unknown.  They are not confined by what is expected or what has happened in the past.  These individuals ask, “What is possible?”  With this belief there is no reason to expect you can’t return from injury completely.  In fact, you should believe you will actually be better than before.  Jared Campbell, who returned to ultra-running after an Orthopedist told him that he never would, has a great outlook on injuries. “Injury is an opportunity for my body to adapt to the activities I love.”  With an attitude like that it’s no surprise that Jared is one of the most successful Ultra Marathoners out there for the past 10 years!

Now that my TV is collecting dust again, I am going to be an Olympic athlete in my heart and just see what is possible.

ITBS (Illio Tibial Band Syndrome) is not IBS (Irritable Bowel Syndrome), but it is Irritable

By Emma Maaranen

ITBS is a repetitive stress injury common to both runners and cyclists.  If you participate in either of these sports, either you or your training partners have likely experienced this injury.  ITBS is characterized by pain on the outside of the knee.  Unless you have experienced knee trauma recently, ITBS is most likely the sports injury you are dealing with, not a torn meniscus or knee ligament.

What is the ITB?

ITB anatomyThe ITB (Illio Tibial Band) is a long tendon (rubber-band like structure that connects muscle to bone) that runs on the outside of the thigh from the hip the knee.  The Gluteus Maximus and Tensor Fascia Latta are the muscles that connect to the ITB.  These muscles make a fan shape between the outside top of your pelvis (if you put your hands on your hips, they span from your index finger to thumb), and they narrow to the bony spot at the top outside of your thigh.  (Insert image here) The ITB starts at the bottom of this fan shape and travels down the outside of the thigh.  It then crosses the knee and inserts just below the knee on the outside of the tibia (lower leg bone). The ITB separates the quadriceps (front thigh muscles) from the hamstrings (back of thigh muscles).  If you have ITBS, pain is felt just above the outside of the knee.

How did this happen?

Most of us do sports that move forward and have little side-to-side motion with the legs.  Over time forward only motion weakens the muscles of the ITB.  To walk, run or to pedal these muscles work in a small range of motion, which trains the muscles to be strong only in a small zone and causes a loss of flexibility.  Sudden increases in training distance or intensity, as well as adding steep hills into run training, can overtax these muscles and tighten them.  This creates excessive tension in the ITB and begins to cause friction at the lateral epicondyle (the bony knob at the outside bottom of the thigh bone).  When you bend your knee about 30 degrees the ITB normally glides over this bony knob, but if it is too tight the ITB grates over it and gets irritated.  Once inflamed, the ITB becomes swollen and will grind over the lateral epicondyle more, making the condition worse as you push through the pain!

You have pain at the outside of your knee; what do you do?

The first time you experience pain at the outside of the knee it is important to end your workout.  Go home and ice the painful area.  Rest and ice for three days (no running/hiking/biking; avoid stairs and other activities that involve repetitive bending of the knee).  After three days, see how it feels.  A minor one-time irritation of the ITB should recover after this rest period, but be on notice that you need to strengthen and lengthen the muscles of the ITB.

If, however, three days of gentle care for your inflamed ITB does not alleviate the pain, you most likely have ITBS.  ITBS is a fancy tendonitis.  For it to heal, you will not only have to address the inflamed tendon, but you will have to address the cause of the excessive tension in the ITB as well.  The cause is often a combination of weak/tight ITB muscles, adhesions along the ITB to the quads and hamstrings, muscular or structural imbalances in the pelvis/hip complex, and foot/ankle biomechanics. Cyclists need to make sure they are not in excessive toe-in position when clipped in and runners should replace their running shoes if they have over 250 miles on them.

At Focus Bodywork we can help you sleuth the factors in your ITBS, address adhesions in the ITB, treat the associated muscles and recommend self-care practices.  Occasionally ITBS is stubborn and needs a physician’s care.  In these cases you may need a cortisone injection, orthotics or a regiment prescribed by a physical therapist.  We are happy to recommend some fantastic practitioners for you to work with and be a part of your return-to-play team.

In our next post we will cover self-care for ITB health.

I Love Being Called This, But It Gives Me Big Shoes To Fill…

By Emma Maaranen

“The Leg Whisperer”

In this blog post (click on the blue link above) are some very kind words from Jay Aldos, a gifted ultra runner and Focus Bodywork client about how sports massage has become an essential part of his training. Thank you Jay!

PS – Jay went on to win the Zion 100 last weekend.