Friday
Jun072013

So You Want To Run Fast Huh? - Part 2: Help! My IT Band Just Exploded!

In the second entry of my So You Want To Run Fast Huh? series, we're going to be looking specifically at a constant bugbear for the serious runner - Illiotibular Band Syndrome.

If you've been running and felt a pain on the outside of your knee, you may have this particular problem.

What the IT band is and does, is by in large misunderstood by most people and saying "Oh, you've pulled your IT band" is a really really long way from knowing how to fix it. I continually encounter experienced runners, personal trainers and (somewhat surprisingly) physiotherapists, that don't have much of a clue of how to deal with this common cause crippling knee pain.

Here we are going to look at what Illiotibular Band Syndrome is, how is it caused, and most importantly, what you can do to make it go away for good. Let's get started!

This is going to be a really long article, because the condition is quite complex. If the geek stuff is over your head, ignore it and just do the exercises. :-)


Iliotibial Wha...?

The Iliotibial band (sometimes Iliotibial tract) is the longest tendon in the body. A tendon is a piece of connective tissue that links a muscle (or muscles) to a bone. In this case the muscles are the gluteus maximus and the tensor fascia latte (Or "TFL" as he's known to his friends).

Pictured here

The majority of people who treat IT Band pain will offer up this exercise.

The idea here is that by applying pressure directly to the IT band (and rolling up and down), you are causing it to stretch, you are breaking up some of its fibre, thereby elongating the IT band and taking pressure off the knee joint. This doesn't work very well for two reasons.

 

1. Foam rollers are too big and soft to have any meaningful impact.

Tendons like the IT band are made up of strong, thick, hard to break up connective tissue. Foam rollers are big and soft, meaning that they impact minimally, if at all, on such a tough part of the body.

Because muscles are more pliable than tendons, more likely, the act of rolling on the side of the thigh with a foam roller will, break up some of the surface muscle structure of the vastus lateralis (The muscle that sits directly beneath the IT band) but not the IT Band itself. This is not a bad thing and will provide some initial relief, as it will reduce the amount the IT band is being stretched over the vastus lateralis, but it isn't really addressing the primary cause, and therein lies the problem.

Because the actual issue causing the IT band to be tight isn't addressed, this technique will likely see the eventual re-emergence of the condition later on, unless foam rolling is continued for the long term.

...and frankly that is tedious.

(Insert joke about how my overly technical analysis is also tedious).

 

2. Even the IT Band is not actually the cause of the problem!

The two muscles that attach to the IT band are the TFL and the gluteus maximus. It is possible for both of these muscles to pull on the IT band causing the pain in your knee. However, the gluteus maximus is almost always stretched out from sitting all day, meaning it isn't likely to be the cause of the problem.

The TFL on the other hand is pretty much constantly in it's shortened position, all day long.

Spending 8+ hours a day like this...  And maybe even going to sleep for another 8 hours like this...

... means that the tensor fasciae latae is getting accustomed to being short. After years and years of doing this the muscle will no longer be able to fully lengthen. This means that when the person stands up, it pulls on the IT band it connects to, and causes that knee pain you've been feeling.

Simples.

So how do you fix it?

For that you will need a bit of equipment.

The first is a...

  • A lacrosse ball. (Shown right)
  • A cricket ball.
  • A baseball.
  • Any strong hard spherical object that can fit in the palm of your hand.

 

The second is a...

  • A PVC pipe. (Shown right)
  • A strong wine bottle.
  • A rolling pin.
  • Any other hard cylindrical object that can support your body weight. 

 

First, we go to the tensor fascia latte with the lacrosse ball.

To do that we need to help you find your tensor fascia latte. Below is a handy map I drew using MS Paint on the side of a lady's leg (I asked nicely :-) )

The cross indicates the head of the femur - the very top of the bone in your thigh, that inserts into your pelvis As you can see the TFL is right in front of it.

Take the lacrosse ball and using the above "map" place it directly onto the head of the femur and then roll it forward (anteriorly) which will land you directly on your TFL. Once you're sure you've found it you can then lay on top of it, as shown below.

If you are having difficulty finding the muscle, you should try to imagine half putting your hand into your pocket if you were wearing a pair of trousers. The portion of the leg your hand covers will likely be the correct area.

(If that still doesn't work then lay on the ball in the rough area and feel around until you get it.)

 

What should this feel like?

Once found you should feel a distinct pulling sensation down the outside of your leg, along the IT band. It is not uncommon for this to be quite painful  in those suffering from IT band trouble (In fact I'd expect it), so please don't be alarmed if it is very tender the first few times you do this.

The pain should subside after about 5-8 minutes of lying on the muscle, and subsequent sessions will see the discomfort reduce significantly, along with the time you need to spend on it, as the overly tight muscle tissue finally separates.

Persist with this exercise and remember, if it hurts in the manner described then you're probably doing it right. :-)

 

Second, we use the PVC pipe thusly...

Earlier in the article I gave my take on foam rollers being too soft and having too large a surface area to really do any effective release work on the strong and thick tissue of the IT band. This is where PVC pipes distinguish themselves.

PVC pipes trump foam rollers for two main reasons.

  1. They are much cheaper.
  2. They actually work.

Because the PCV pipe has significantly lower contact surface area and is much harder, it stands a better chance of getting into the fibres of the IT band. Lay on top of the pipe, using it to put pressure on the side of the thigh and slowly roll up and down the full length of the thigh, from just above the knee, to the head of the femur. Have a look at the image below.

What should this feel like?

As you try to roll up and down the thigh with the PVC pipe, you may find this area to be quite tender. If that is the case, use a softer surface to roll on like a carpet or a yoga mat until the pain becomes more bearable (It will).

If rolling still proves to be too painful, then you can simply lay on one area, keeping the pipe still and applying consistent pressure, before moving onto another spot on the IT band and repeating the process. After a few days of doing this the rolling will become easier when attempted. 

 

Finally, we might need to streghtnen the "Deep Six" and Vastus Medialis Obliquus muscles

This bit isn't necessarily for everyone but it needs to be considered as a possible contributer to the condition. If your deep six muscle group is too weak, then the research indicates that this could be a reason for the pain you've been feeling.

 

... "The Deep Six"?

The deep six are a group of six (duh) muscles that articulate and stabilise the hip joint and they sit  underneath the gluteus maximus. Here is a handy diagram to help you imagine what I'm talking about.

Shown here (with the glute minimus - not considered one of the six, although it also contributes to hip stability)

One of the functions of the IT band is to stabilise the knee joint in a run. It does this by attaching partially to the bottom of the femur and then to the top of the tibia. The TFL then acts as an abductor of the hip joint to keep the knee from collapsing inwards by pulling it outwards.

Shown on the left here.

One of the roles of the the deep six, is to assist the IT band by pulling on the head of the femur to keep the leg outwards. If the deep six are week then the IT band has to work doubly hard to keep the knee from collapsing inwards when someone is running. As a result it becomes tender in the knee area where it attaches.

 

Do I have a weak deep six?

The easy way to tell this is to perform the following test.

Squat down using one leg. If your knee collapses inwards when doing so, then you probably have a weak deep six.

 Here's me doing my best impression of this in short shorts :-)

Note the knee collapsing medially (inwards).

 

How do I strengthen the deep six?

This is where the test becomes the exercise.

In order to strengthen the deep six, we want to do the above exercise, whilst consciously keeping the knee aligned laterally, thereby preventing the collapse inwards. When you do this correctly, you will feel the deep six engage in your bum.

Here's a handy diagram below in short shorts again :-)

Notes on this exercise:

  • Push your knee to the outside of the body to keep it aligned correctly as you squat down.
  • Always keep your body weight over your front leg when performing this exercise. This prevents a shearing force being put on the knee.
  • Perform this exercise on a stable stable surface, like a sturdy chair - don't risk falling over.
  • You can also put your hand up against a wall to assist with balance if you find this aspect challenging. 
  • Repeat for 10-30 repetitions each side, starting low and then moving to higher reps as you get better at the exercise.

 

 And that should just about do it.

Keeping the above up for a few weeks and then doing it periodically thereafter, will fix IT band issues in almost everyone. These techniques have worked not only for myself but also my clients and I hope that by doing this, you'll be able to reach whatever running goals you set out to get. If you have any questions, please feel free to get in touch :-)

Nick.

 

Where Is Nick?


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Nick Kinsella is currently working from

LA Fitness Picadilly, Rex House,

4-12 Regent Street, London SW1Y 4PE

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"I met Nick in the months leading up to my wedding, when I was struggling to make a difference to my body on my own.

I had a terrible posture (from sitting at a desk all day!), which together we managed to completely correct, along with dropping a dress size!

Nick's enthusiasm and expertise helped me transform my body and feel fit and confident on my wedding day. He also helped me change the way I eat, focusing in on how to fuel my body for optimum weight loss and long term health benefits. I would recommend Nick without hesitation, he really changed my life and the way I feel about exercise."

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"I had previously spent a ton of money trying to fix certain problems that Nick made short work of. That alone made it worthwhile."

"I originally signed up to see Nick because after discovering a love for running a couple of years ago I was fed up with experiencing daily knee pain and was on the verge of giving up. I'd seen a physio, bought the best trainers I could find, spent hours on a foam roller etc etc. From Nick's profile I could see he was a runner and worked with other runners so it made sense to choose him...

... After 8 sessions I'm pretty much pain free in my knees and if I do start to get a bit of pain one day I know which stretches I need to be doing to stop it. The other day I was talking to someone about it and I couldn't even remember which knee it was that use to cause the most pain!"

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"I had a 'lightbulb' moment when I met Nick in my gym just after Christmas. 

I had decided to increase my gym visits as I'd been told my cholesterol was too high and the GP suggested statins which I wanted to avoid if possible.  Nick spoke to me about the exercise routines I should follow to get the most from my gym time, teaching me how to use weights, kettlebells etc when I hadn't touched them before (and didn't think I needed to!)   In our weekly sessions everything seemed to fall into place and make sense.

...I  persuaded my GP to hold off prescribing statins for 3 months to see if my bloods improved after a change of diet and exercise routines.  In early April 2013, repeat tests were done.  I'd lost 25 lbs, my overall cholesterol was down from 7.2 to 6.4, HDL ratio improved from 4.2 to 3.0 and triglycerides down from 1.7 to  0.8.  I know the GP was shocked!"

- Lynn C

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Are You An Office Worker?

If so, your gym strategy could have a number of serious mistakes in it.

Most workout plans and trainers do not take into account the unique problems that office workers commonly have.

In the best case scenario this can lead to slow progress, in the worst case this leads to serious injury.

Learn how to avoid silly mistakes that can ruin your chances of succeeding, with the free downloadable guide. The Seven Dangerous Mistakes Office Workers Make at the Gym.

When you do, you'll also be subscribed to my email list for whenever I write a new blog post. That's usually just one every couple of months - so I won't be spamming your inbox :-)

Below is my daunting and complicated form.

 

 

 

You'll notice that I don't even ask for your name. I'd only need that if I wanted to send you those annoying emails like "Hey (Name) how are you feeling today? Have a look at this..."

So no fake friendliness from a complete stranger ;-)

The Fine Print: Your details will ONLY be used for this purpose and will be shared with no one.

The Even Finer Print: When you complete the bits above, you will get an email asking to verify that it was actually you who filled out this form. You MUST click the link provided.

This slightly annoying extra step is just to protect people's contact details from practical jokers.

After that you will be redirected to a page on this website where you can download the free guide, which you can use to change your workout strategy for the better :-)

Client Results

I  have a better understanding of how to adjust my diet and my training to suit the races I run.

Nick is the most knowledgeable trainer I have ever worked with. Amongst other things, he has helped me get fit enough to run 250km across a desert and has helped me come back from illness and injury along the way. He pushes me in a way that made me want to improve without being aggressive and has an intelligence in his approach that really shines through in everything he does.

I also really value his tenacity; if you have an issue he will continue to work with you to resolve it without letting up. For me this issue was a serious injury and I am grateful for his help because I think I may have hung up my running shoes without him.

I am not just fitter than I have ever been, but I am stronger, more supple, and have a better understanding of how to adjust my training to suit the races I run. After a year of working with Nick, I would count him as a close friend as well as my trainer – he has always gone above and beyond in helping me to achieve my goals. If you want to partner with someone who is really passionate about what they do, Nick is definitely your man!

- Veronica R

Good Meat And Fish Vs. Bad Meat And Fish... What's The Difference?

High protein, lower carbohydrate diets.

They're a staple of anyone who knows how to shred body fat off in a short time without compromising muscle mass. I use them to help get my clients rapid fat loss results without starving them three quarters to death.

When compared to more traditionally recommended high carbohydrate low fat diets, they've been shown in many cases to better aid the treatment of obesity, cancers, type two diabetes as well as much more, and getting yourself on a diet like this will almost certainly involve eating meat.

Unfortunately there have been many headlines recently about the dangers of meat consumption. Often without fully clarifying what kind of meat is actually being discussed. This has lead to confusion about what is good and bad for health.

  • Is it possible to eat meat that is bad for you? - Yes
  • Is all meat bad for you? - No

In this article we're going to be talking about that distinction, and how you can use it to make better choices about what to put in your body. In this article we are going to talk about three major factors regarding meat consumption.

  • Pesticides
  • The Omega 3 / Omega 6 Ratio
  • Mercury contamination

All three are worth knowing about, but before we begin let's look at why we eat meat in the first place and take a step into our collective history.


Why do we eat meat at all?

Here is a handy to scale infographic that illustrates how long we operated as hunter gathers vs how long we have operated an agricultural based civilisation.

The point is that for the vast majority of human history, our species mainly lived a subsistence hunter gatherer lifestyle, and there is strong evidence that higher protein lower carb diets were the norm. One of the stronger pieces of evidence is based on the idea that rich sources of carbohydrate in the natural world are mostly one of the following...

  • Indigestible to humans - in the case of cellulose.
  • Seasonal - in the case of fruits
  • Hard to find - in the case of tubers (i.e. potatoes) and root vegetables.
  • Difficult to get a hold of - for example honey. (Though not impossible)

All other forms of rich carbohydrate that you might know of, such as pasta, bread, rice, wheat or other cereals, either didn't exist until comparatively recently, or have only been domesticated and farmed in the last 2,500 - 8,000 years, meaning that these modern "staples" simply weren't available. Any other sources of carbohydrate were either low density or low content in nature, such as vegetables and nuts. It seems that for most of our collective history, we simply didn't have a dense source of carbs to rely upon like we do today.

Erm... weren't we supposed to be talking about meat?

Okay, let's do that. Here's something you might not have thought about. Your brain. It's really, really, really friggin' expensive.

Erm... no, that isn't exactly what I meant.

The average human brain only accounts for around 2% of a person's body mass, which in fairness isn't really that much, and you'd be forgiven for thinking that this low mass to body weight ratio explains a lot about human behaviour. Yet a 2004 paper from the Yale University's School of Medicine has suggested that the brain uses a whopping 20% of the body's total energy requirements. So in terms of energy use, the brain is by far the most costly of the body's tissues.

Furthermore, according to other research on the subject, it is also highly likely that tasks that are more difficult mentally, require more energy to be directed to the brain. Interestingly this means that: yes, thinking actually requires calories, and yes, harder thinking requires yet more calories. This means that being "too tired to think" actually is a real thing, something that anyone with multiple children will no doubt confirm.

In order to meet the energy requirements of something as ridiculously decadent and indulgent as the largest brain of all primates, a rich energy source is needed and as we pointed out earlier, rich carbohydrate was extremely unlikely to be that source.

Meat, fish and eggs are the most easily available, densely packed source of calories, widely available to humans, both in the past and today. In our early history it has been suggested that the shift from a more plant based diet to a more animal based one, spurred development of our larger cranial capacity. There doesn't seem to be another way to get the huge number of calories into our bodies that building a brain like ours would require.


But if all that's true, then why does everyone make such a fuss about eating too much meat?

To put it simply, the meat that we eat isn't the same as the meat our ancestors ate, and there are a number of problems with it. One of which is...

It's not safe to breathe but fine to eat?

Pesticides often quite justifiably get a bad rap. Yet being a quasi-scientifically minded person, I like to view things in a fairly pragmatic way, and before I go into how bad some of these substances are for you, I want to acknowledge that pesticides have done a lot for food security. They have allowed higher yields of less bug ridden crops ever since their induction, enabling us to support our ever growing population.

(Hate mail to the usual address please)

Unfortunately there are certain consequences about spraying our food with what is effectively a mild poison. Doses that are sufficient to kill a bug are normally not enough to cause a human much harm, but through a lovely process called "bioaccumulation" these chemicals get concentrated the further you go up the food chain.

Each living thing in that diagram (apart from the crop sprayer) is called a trophic level, and as a general rule every time you move up a trophic level, your organism needs to consume 10 times it's own body weight of the organism below it, to maintain it's body weight. 10% goes to make the Cow or Human and the 90% goes to things like energy expenditure.

So yea, in a food chain you lose around 90% of the system's total energy every link. It's not what you'd call a very efficient process. On the other hand, do you know what is a very efficient process? Toxin transmission.

While an organism might only hold onto 10% of the food energy, it holds onto 100% of the toxins. As you move up the trophic levels, each organism consumes ten times it's body weight and therefore gets ten times the dose of toxin. So yea, that's bioaccumulation.  

This accumulation of pesticide related substances in the body's fats has been shown in some studies (though not all) to increase the risk of certain cancers.

In 2004 the Journal Environmental Perspectives published a study looking at the level of different pesticides in the fatty tissue of humans, and compared it with the incidence of a particularly nasty group of blood cancers called non-hodgkin's lymphomas (NHLs). Of the 656 subjects, 175 were diagnosed NHL cases and the rest were used as controls.

The study found that the pesticides

Were all associated with increased incidence of NHLs. Thankfully these substances were either banned or heavily controlled as far back as the 1980's in most countries including the UK and US. However they are often said to be "stable" meaning they don't break down in the environment easily and can continue to show up in our food years later. I mean this study was conducted in 2004 and these substances were still detected, even after such a long time of disuse.

Source: Quintana PJ et al. (2004 ). Adipose tissue levels of organochlorine pesticides and polychlorinated biphenyls and risk of non-Hodgkin's lymphoma. Environmental Health Perspectives. 112 (8), 854-61.

As I said before, on crops these things are largely benign, but because animals eat such an enormous amount of them, they can accumulate in their tissue at high concentrations. We then eat lots of these animals meaning we can accumulate a higher dose as well. 

Study into this area remains ongoing, and if currently used pesticides have a negative impact on human wellbeing remains to be seen. Many of these substances have only been used for a short time, meaning we wont know with certainty if continued exposure leads to some negative impact further down the line.

The question you want to ask yourself is: do you really want to eat a chemical that was designed to kill pests? It's a matter of preference of course, I mean these pesticides will have passed EU safety regulations, but what if you wanted to avoid this stuff? What strategy could you take short of avoiding meat all together?

 

How do I avoid this stuff?

Animals that are fed harvested crops are far more likely to be exposed to these substances than ones living naturally off the land. Meaning that grass fed grazing animals are generally better for you than cows that are given feedlot (A mixture of grains including corn and soy) for a portion of their lives.

If you don't know weather you're eating grass fed or grain fed meat products then you're probably shopping at a supermarket. Go to a proper butchers and speak to the owner about where his produce comes from. Ninety nine times out of a hundred he will know a thing or two about it, including what it was fed.

Onto the next problem...

Omega 3 and Omega 6 fatty acids are hugely important molecules for regulating our immune system (among other things). They play key roles in the body's inflammatory response that allows our body to rush nutrients and infection fighting agents to an area of trauma. The amount of Omega 3 and Omega 6 relative to one another dictates whether or not our body is going to be overly inflamed, or just the right amount of inflammation.

We're going to look at this in a little more detail so that things become more understandable.

After a short lived infection the body does something called acute inflammation whereby the part of the body that is injured or infected becomes inflamed to bring the body's resources to bear on the problem. This is perfectly normal and not to be worried about.

When the body is overly inflamed for long periods of time it is called chronic inflammation and is very bad for you. It creates the impression that the body is having to fight a constant low level infection round the clock, meaning that the immune system is left overactive. Over time this constant war footing of the body takes it's toll, causing cellular damage of otherwise healthy cells, and is at root with such joyous afflictions as cardiovascular disease, many cancers, rheumatoid arthritis, autoimmune conditions and all kinds of other completely not fun stuff.

What has omega-3 and omega-6 got to do with this?

The Omega-3/Omega-6 ratio is one of the more dominant factors in determining how inflamed the body is. If it's out of balance, bad things happen.

Largely speaking Omega-3's are anti-inflammatory in nature and Omega-6's are pro-inflammatory. The ideal ratio between the two is 1:1. That is the same amount of Omega-3, for the same amount of Omega-6. Unfortunately developed world ratios sit around 1:20. That is one part Omega 3 to twenty parts Omega 6. This largely because of society's reliance on grain based foods and grain fed animal products, which are omega-6 dominant.

In essence...

This kick-starts the whole chronic inflammation process.

 

How do I avoid this stuff?

To do to get around this problem is to drastically reduce the amount of grain based carbohydrate in your diet by favoring potatoes and other tubers as well as some fruit, over wheat, soy and other grain based products. Furthermore you want to go for grass fed cuts of meat and wild caught fish. If you don't know whether your meat wild caught or naturally raised, you probably shop at a supermarket (again). The benefits of going to a butchers where they know their produce are many. 

This is the natural way of eating that everyone has been telling you is so healthy. Now you know exactly why natural is better.

The last two parts we mostly spoke about terrestrial animal protein, but we've been missing the most abundant source of it in the world. Sea food.

Sea food is abundant with Omega 3 fatty acids. I mean the first time Omega 3's were noticed for their health benefits was in the Greenland Inuit population, who eat almost an entirely marine derived diet. Greenland, as I've said in a previous article, isn't very suitable for growing plants of any kind, despite what the name may imply.

The thing is that we humans have been rather bad to the oceans over the years. Historically we've treated them like the world's garbage disposal unit. As a result of this there are some problems with marine derived protein. The one I will discuss here is mercury poisoning.

Mercury is dangerous to ingest. To the human body it is a neurotoxin, meaning that it damages nerve cells, and this is kind of a big deal as you need those nerve cells for like... everything.

Everything.

It is also a liquid, which means that it get's transported in water very easily. Unfortunately for us it also has a strong affinity for organic matter, as it bonds very easily with the sulfur present in animal protein structures. Some of the bad things it does to your body include:

  • Brain and nerve damage.
  • Kidney damage.
  • damage to the gastrointestinal tract. 
  • Muscle atrophy

As well as much more.

 

How do I avoid this stuff?

Although heavy metal toxins vary significantly from species to species, in general small marine species with short life spans tend to have lower levels of mercury than bigger species with longer life spans. This is due to that bioaccumulation effect we spoke about earlier, a marine based example of which works like so:

Each organism concentrates the levels of mercury ten fold until an apex predator like a human, gets it's hand on the lovely lovely tuna.

Compounding this effect is that if the mercury stunts the growth of the anchovy (which it almost certainly does), then more anchovies have to be eaten to satisfy the hunger of the tuna. More anchovies eaten means more mercury ingested and that leads to even higher concentrated levels in the tuna.

Mercury has a half life of about 70-90 days in the human body which means it eventually dissipates from our tissues and the tissues of the animals affected (unless they are continuously exposed to it), nevertheless it is still best avoided as the damage it leaves is long lasting and sometimes severe.

Here is a convenient guide to help you make good choices with sea food:

Annnnd concluding...

So does this all mean that you need to spend more on your meat sources? Well, maybe. I think a better way of looking at it, is that now you have a better understanding of what you're putting into your body. Doing this cheaply is more than possible and it isn't necessary to buy Aberdeen Angus fillet steak for every single meal. In fact sticking to smaller varieties of animals lower on the trophic levels will likely save you money, especially when it comes to seafood. I imagine that shark is a lot more expensive than prawns, but then I've never tried to buy great white in a restaurant before.

The point is that there will be a way to apply this knowledge for most if not any budget levels. Research and use your imagination :-)

 

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