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Sports Injury Prevention: Your Definitive Guide for Preventing Injuries

Wed, 24 Sep 2008 10:45:10 -0500

What is Considered a Sports Injury?
A sports injury is any condition that is commonly associated with involvement in general fitness, recreational activities and training/competing in athletic events. Sports injuries are either “Traumatic” or “Overuse” in nature. Traumatic injuries occur as a result of an immediate overload to your body and can be associated with a specific event. An example would be, “Two weeks ago I stepped in a hole while running and twisted my ankle.” Overuse injuries occur as a result of a repetitive overload to your body and are not associated with a single event. An example would be, “The outside of my knee started hurting about 6 weeks ago but has gotten worse in the last two weeks. It now hurts to run and go down stairs.”
Do I Have to be an Athlete to have a Sports Injury?
Sports injuries are commonly associated with athletes but you do not have to be an athlete to have a “Sports Injury.” All you have to be is an active individual to sustain a sports injury. They will occur chasing children, working around the house, moving furniture, getting back into working out, changing your workout program, playing a recreational sport, participating in endurance sports (running, triathlons, cycling).
How Common are Sports Injuries?
If you are active or participate in sports long enough, sustaining a sports injury is inevitable. To give you an idea of how common sports injuries are, if you are active or participate in sports you have more than 80% chance of sustaining a sports injury within the next 12 months.
What are the Most Common Sports Injuries?
Contrary to popular belief, the large majority of sports injuries are Overuse in nature. The most common overuse sports injuries include, but are not limited to:
• Spinal Disc Herniation (Sciatica)
• Spinal Facet Syndrome (Pinched Nerve)
• Sacroiliac Dysfunction
• Iliotibial Band Syndrome
• Plantar Fasciitis (Heel Spurs)
• Shoulder Impingement Syndrome (Rotator Cuff Syndrome)
• Patellofemoral Syndrome (Runner’s/Jumper’s Knee)
• Lateral Epicondylitis (Tennis Elbow)
• Medial Epicondylitis (Golfer’s/Pitcher’s Elbow)
• Thoracic Outlet Syndrome
• Scapulothoracic Syndrome (Shoulder Blade Pain)
• Shin Splints
How Do I Recognize a Sports Injury vs. Muscular Soreness?
Sports injuries are easy to distinguish from muscular soreness by using the “Two Day Rule” of thumb. Here is how you use it; if you are hurt the day after being active and it gets better over the next two days. This is called “Delayed Onset Muscle Soreness” or DOMS in sports medicine. It is your body’s normal response to doing something more than it is use to. It is normal and natural for your body to recover within 48 hours (Two Days). If you do not progressively heal and recover from your activity within two days or if it comes back with activity, it is more than DOMS. It is a sports injury.
What is the Difference in a Sports Injury and Muscular Soreness?
DOMS is the soreness and stiffness associated with the normal repair and rebuild process of your muscles. It is your body’s way to getting ready and preparing for the next time you do the same activity by becoming more fit. You have had this experience before, the day after doing a new activity or changing up your workout. Eventually, if you repeat this same activity over a 4-6 week period your muscles will no longer have DOMS and your fitness level with plateau as a result. The difference with a sports injury is that there is an excessive overload placed not only on the muscles but also the tendons, ligaments, cartilage and bone, in which the body struggles to cope and repair from. Excessive inflammation and tissue adaptations and compensations are the result of this excessive overload. You can think of this as the difference between a fire in the fireplace and one that turns into a house fire. Activities that cause DOMS are safe but activities that drive your body beyond DOMS are destructive to your body’s structural integrity.
What Causes a Sports Injury?
Sports injuries are caused either from an immediate overload or repetitive overload to the tissues in your body. As we discussed previously, the majority of sports injuries arise from repetitive overloads.
How Does My Body Initially Respond to a Sports Injury?
Your body initially responds to a sports injury with inflammation, swelling and pain. This is a call to your body’s repair cells to rush to the area to repair, heal, protect and eventually strengthen the tissue against reinjury.
How Does My Body Naturally Heal and Adapt to a Sports Injury?
Your body is incredibly intelligent when you abuse it. Much like painful experiences in life, your body learns to avoid painful experiences from overload and overuse. The initial Inflammatory Phase is meant to be painful and uncomfortable to alert, warn and eventually stop you from continuing to do what caused overload and damage in the first place. The Inflammatory Phase is followed by the Repair Phase, where any damage is repaired and replaced with a less structurally sound, weaker tissue which will eventually be made more structurally sound and solid during the Remodeling Phase. Each of these phases has their time frames for completion but you can get stuck in anyone of the phases if you reinjure or hamper the normal process and progression of healing.
Example of a Sports Injury Timeline:
Medial Collateral Ligament (MCL) Injury*
i. 0 - 30 min: Injury/Degeneration
ii. 0 - 36 hrs: Coagulation/Platelet Plug
iii. 2 hrs - 2 wks: Inflammatory Phase
iv. 48 hr - 6 wks: Repair Phase
v. 3 wks - 2 yrs: Maturation/Remodeling
*6 wks: Tensile strength of healing tissue “relatively” normal
More Details on Phases of a Sports Injury:
I. Inflammation: This initial phase lasts 72 hours or more. The sports injury irritates or tears body tissues, particularly the small blood vessels called capillaries. This results in pain, swelling and damaged tissue in between healthy tissue. With the oxygen-carrying capillaries damaged, an oxygen-poor (hypoxic) environment is created. The immediate response is from cells that require little oxygen, such as mast cells, macrophages, and granulocytes (The immune system’s "clean-up crew"). Visible signs such as swelling, redness and pain may or may not be present at this time.
II. Repair & Regeneration: This phase lasts up to six weeks or more. The early part of this phase is concerned with capillary restoration and the cleanup of the debris. Macrophages and granulocytes devour debris (similar to the cleaning crew on a construction site) as the capillary system regenerates and bring oxygen and nutrients back into the injured area. Once there is available oxygen, collagen proteins are necessary to bridge the gaps in the soft tissue created by the injury and clean up. Unfortunately, instead of being a strong, flexible criss-cross pattern of the original tissue, this repair tissue is characterized by a weaker, stiffer and more pain-sensitive, rope-like pattern (aka “scar tissue”).
III. Remodeling: This final phase of healing lasts up to 12 months or more. In this phase, collagen is remodeled to increase functional capabilities in the healing region. It is important that controlled motion be introduced during this phase. When motion is introduced, the collagen fibers will slowly arrange themselves more like the original pre-injury tissue. Motion also minimizes the weakness, stiffness and pain-sensitivity of the healing tissue. Each of the three types of motion has a role in the remodeling process: (1) Active Motion: You Move The Area, (2) Passive Motion: Someone Else Moves the Area and (3) Paraphysiological Motion: Getting the Joint to Move to End Range for Returning Full Flexibility. The more complete the remodeling process, the less likely the you will suffer future aggravations or exacerbations of areas injured by the car accident.
What is R.I.C.E. Therapy and Why is it Not the Only Answer?
R.I.C.E. stands for Rest, Ice, Compression and Elevation. R.I.C.E. is beneficial because it helps keep the Inflammatory Phase from getting out of control. If the inflammatory phase is a fire, R.I.C.E. helps to keep it from burning the house down. Rest means stop doing the activity that caused your inflammation (does not means stop all activity). Ice is a fast and powerful anti-inflammatory. Compression helps to squeeze the swelling and excessive fluid out of the region and Elevation helps keep the fluid from pooling up in your extremities.
What about NSAIDs or Cortisone?
NSAIDs are Non-Steroidal Anti-Inflammatory Drugs. Examples of over the counter NSAID products are Advil and Motrin (ibuprofen), Aleve (naproxen) as well as Aspirin (acetylsalicylic acid). Cortisone is a powerful anti-inflammatory steroid. Both NSAIDs and Cortisone have wonderful anti-inflammatory effects if absolutely needed but come the hefty cost of slowing tissue healing time (longer recovery). What does absolutely needed mean? If R.I.C.E. is absolutely not working and the inflammatory phase is persisting longer than 2 days, then NSAIDs and Cortisone can be used as a last resort. If that persist longer than necessary or normal we get greater breakdown and degeneration of tissue. This is where NSAIDS or Cortisone comes in for as long as it takes to allow R.I.C.E. to start controlling the inflammation. Most people will pop Advil regularly not knowing the downsides to full recovery.
What Happens if I Repetitively Overload My Body?
Just like you, your body is smart. It learns very quickly to avoid painful situations and to keep them from occurring again. This is where your body learns to adapt and overcome the repetitive overload.
How Does My Body Adapt in a Repetitive Overload Situation?
When your body is overloaded, muscles can fatigue and develop trigger points. This is the most common adaptation to repetitive overload we see in our clinic. A trigger point is a small, tender, nodule located inside a muscle. Trigger points cause muscles to dysfunction by weakening the muscle. When one muscle weakens, another muscle takes over and pulls the extra load. It accomplishes this by overcompensating for the weaker muscle.
When the over compensating muscle shortens and pulls harder, it shifts your normal biomechanics or body mechanical alignment. When your biomechanics shift, it starts to overload another set of muscles. Then the adaptation process occurs all over again. The weakness/overcompensation/biomechanical shift pattern is called the adaptation process or more commonly known as muscle memory. Your muscles are memorizing the overload situation and trying to adapt, overcome and avoid the overload. This would be a fortunate situation if that is all that occurred but unfortunately, this memorized pattern causes another overload situation to another set of muscles which caused another muscle memory pattern. Sound like a domino effect? You’re right, that is exactly what happens. When these adapted muscle memory patterns persist long enough, they eventually cause wear and tear to the joint cartilage, which leads to joint degeneration.
Why is it That Overtime My Area of Pain Has Seemed to Move?
Have you ever noticed that your pain use to be on one area and then down the road it shifted to another area. This is a result of the domino like effect we were talking about earlier. Most people will not connect the dots but if we question people enough, they eventually remember that long ago they use to have ankle pain and then started dealing with more shin splint pains, then knee, then hip, and eventually low back pain. The song is really true!!! “The Knee Bone’s Connected to the Thigh Bone!”
Why is it That I Seem to Be Getting More Prone to Injury?
With enough time passing and multiple muscle memory patterns setting up, your body becomes wound up. Think about your body as a rubber band. As you twist the rubber band at one end while the other is held stationary, it starts to spiral on itself. Those spirals are muscle memory patterns. If you keep twisting you will get kinks, which are overuse injuries. If you keep going, eventually it snaps; that is when tissues tear and have to be surgically repaired.
Why is it That My Pain is No Longer Going Away on its Own?
Once your body adapts and learns these muscle memory patterns, they become hard-wired and locked in your biomechanical memory. That means the strength, flexibility and biomechanics your body use to have is no longer possible. You are locked into the “muscle memory” of your body unless you find the right combination of therapies to “unlock” and “reeducate” your muscles. You have to remember this pattern your body has gotten locked into is just like a combination lock. If you have enough time, energy and money to try every combination possible, you will eventually figure out the combination to unlock your muscle memory adaptation patterns. Most people will search, hunt, invest time and money into looking for the correct combination of therapies to unlock their body. They will try their medical doctor, massage, acupuncture, yoga, Pilates, chiropractic and various self therapies (braces, wraps, foam rollers, bosu balls, etc). Most of these professionals and therapies will only offer temporary, short-term results if nothing at all. Most people are left frustrated and hopeless.
Why is it That No One Has Been Able to Give Me an Accurate Description or Explanation of My Sports Injury?
Sports injuries are multifactor in nature. That means there are “culprits” and a “victim”. The culprits are the multiple causes or factors that cause injury to a specific tissue (the victim). When you get a standard diagnosis it is identifying the victim and not the culprits. A few examples are IT Band Syndrome, Sciatica, Plantar Fasciitis, Rotator Cuff Syndrome, Tennis Elbow, Patellofemoral Syndrome, Shin Splints, etc. All of these injuries have several culprits, which means there is no one “sliver bullet” that will fix these injuries. There are multiple muscle memory adaptation patterns involved that caused the injury. So to explain your injury means explaining how it worked its way from the ground up and locked up your biomechanics. It means fitting all the puzzle pieces together until you can see the complete picture. This means fitting pieces that once seemed unrelated but when brought closer together you see that they fit and go together. Once you understand where your injury came from and the path it took, you can then plan an accurate road map to get your body back to where it once was.
Why is it That I Have Not Gotten Full Resolution with Long-Lasting Relief from My Sports Injury?
If all you do is treat the location of your symptoms, the “victim”, you will only have temporary relief at best. Unlocking and reeducating the muscle memory adaptation patterns, the “culprits”, which restore proper and ideal biomechanics to your body, is the only way to achieve long lasting relief and resolution form your sports injury. Unfortunately, most treatments and therapies are focused on the victims and not the culprits.
What Do I Need to Do to Fully Resolve My Sports Injury?
To fully resolve your sports injury you need to find all of the culprits that are causing your sports injury. Once all of the culprits are identified, then you can systematically set out eliminating these culprits one by one until you are completely free from dealing with these culprits. Culprits can be overcompensating muscles, trigger points, myofascial adhesions, joint restriction, ligament laxity, biomechanical issues, abnormal flexibility, inadequate balance, lack of strength, lack of endurance, shoes, bike set up, running technique, sports technique, strength training technique, stretching technique, and the list can go on and on. Each sports injury has its own unique list of culprits. Once the culprits are identified, eliminated and reeducated, not only does the sports injury resolve immediately but also never returns. It is officially unlocked from your body.
How Do I Find Professional Care That Will Fully Resolve My Sports Injury?
You must find someone who knows how to accurately diagnose the victim, your sports injury, plus the culprits of your sports injury. They also must be able to explain it to you by fitting all of the puzzle pieces together so it makes an understandable complete picture of what is going on, why it is there and what needs to be done about it. The best way to find this professional is to call their office and ask for a complimentary 15 minute phone consultation so you can ask them some questions to see if they are the right health care profession for your condition.
What Questions Should I Ask to Evaluate a Healthcare Professional (Print & Use as Check List)?
• Do you specialize in Repetitive, Overuse Sports Injuries?
• What is your background in treating these types of sports injuries?
• Do you currently take care of these same injuries with any professional or collegiate athletes?
• Are you currently an athlete yourself? What sports are you personally training for and competing in right now? In the past?
• Do you understand what it feels like to have sports injuries?
• What credentials do you hold as a sports injury specialist in your field?
• For Medical Doctors: Are you a “Fellow in the American College of Sports Medicine (FACSM)”?
• For Osteopaths: Are you a “Fellow in the American Osteopathic Academy of Sports Medicine (FAOASM)”
• For Chiropractors: Are you “Certified from the American Board of Chiropractic Sports Physicians (CCSP or DABCSP)”
• For Podiatrist: Are you a “Fellow in the American Academy of Podiatric Sports Medicine (FAAPSM)”
• Other Important Credentials: Certified Strength & Conditioning Specialist (CSCS), Certified Applied Kinesiologist (ICAK), Certified USA Triathlon Coach (USAT).
• Do you teach for your profession in the field of sports injuries? Who do you teach for?
• Can you email me your professional resume (a.k.a. Curriculum Vita) so I can see your professional training and continuing education you have done?
• Will you spend at least 45 minutes taking a compete history and examining my sports injury?
• Will you evaluate and test for any nerve damage or nerve compression?
• Will you evaluate and test for any orthopedic or degenerative conditions?
• Will you be checking my structural alignment?
• Will you be checking the biomechanics of my joints?
• Will you be checking my flexibility and range of motion?
• Will you be checking the functional strength of my muscles?
• Will you be checking for muscular trigger points?
• Will you be checking for muscular overcompensations?
• Will you be checking for myofascial adhesions?
• Will you be checking my shoes and giving me a shoe prescription that is accurate for my biomechanics?
• Will you be taking X-Rays or MRI’s to confirm your diagnosis or rule out anything unexpected?
• Will you be spending at least 30 minutes with me to explain and help me understand all of the results of your examination?
• What happens if you are not the “Best” at treating my particular injury?
• Will you be giving me a detailed written treatment plan with (1) the exact number of treatments, (2) what will be accomplished on each visit, (3) what I should expect and (4) the total cost of my care?
• Do you have a goal or purpose for each treatment I receive?
• Will I notice any results after my first treatment? With every treatment?
• How will you know if I am making progress? How will I notice?
• Will you be teaching me exercises and stretches that will keep this condition from ever coming back?
• Will your exercises train and improve my balance, coordination, stability, strength and flexibility?
• Will your exercises be given to me in a staged progression as to overcome the “Plateaus” and allow me to keep making progress and improvements in balance, coordination, stability, strength and flexibility?
• Will you be making sure I am comfortable with and know these exercises and stretches? Will you be making sure I am doing them correctly?
• How will you know when I have “Arrived” (a.k.a. finished my care)? How will you be sure I will not go back into having this injury again?
• How confident are you about treating and fully resolving my condition?
• Do you have a list of patients who are willing to talk to me about your care and your treatment methods?
• Do you have patient testimonials I can read?
• Will I have direct access to you through email and/or mobile phone in case I have questions or concerns?
• Will I be able to schedule online appointments or check my appointment schedule after hours and on the weekends?
• Do you guarantee all your care/results? In other words, what will you do for me if I pay for and go through your care with little or no results? What if I am not satisfied with your care, what will you do for me?
• Do you have financing options for your care? Is there a discount if I pay with cash or check?
What Should I Expect from My Healthcare Professional?
You should expect your healthcare professional to spend time listening to you, evaluating your condition and all of the possible causes, spend time explaining to you and helping you understand what is going on, what caused it, what can be done about it, how long it will take and how much it will cost. You should feel well educated about your condition and understand it better than ever. You should also be able to have direct access to your provider to ask them questions as you think of them (ask for their email address or mobile number). You should ultimately feel confident in your provider’s knowledge of your condition, treatment plan and guarantee of resolution.
Where Can I Learn More About Specific Sports Injuries?
The Physician & Sports Medicine Journal:
• Managing Overuse Injuries: A Systematic Approach
• Overuse Injuries in Children and Adolescents
• Delayed-Onset Muscle Soreness: Work Out Now, Pay Later?
• Identifying and Treating Myofascial Pain Syndrome
• Overuse Tendinosis, Not Tendinitis: Part 1: A New Paradigm for a Difficult Clinical Problem
• Overuse Tendinosis, Not Tendinitis: Part 2: Applying the New Approach to Patellar Tendinopathy
• Hip and Pelvis Injuries in Runners
• Overtraining
• Overtraining Syndrome: A Guide to Diagnosis, Treatment, and Prevention
• Overtraining Syndrome: Why Training too Hard, too Long, Doesn't Work
• Knee Pain and Bicycling: Fitting Concepts for Clinicians
eMedicine:
• Overuse Injury
AAPSM:
• Overuse Knee Injuries: Evaluation and Management
AOSSM:
• Overuse Injuries
Last Note:
We trust this report has provided some valuable information and insights into this complex, yet common topic. We hope we have answered most of your questions. We also trust that you have learned enough and have enough information at your disposal to make an informed and educated decision for yourself. You know where we are, what we can do and how to get a hold of us. We would be honored to help you if you ever need us.
Author: Dr. J. D. Hasenbank, CSCS, CCSP - Sports Injury Specialist, Strength & Conditioning Coach & USA Triathlon Coach. Founder of Spine & Sports Therapy and F.A.S.T. (Functional, Athletic, Sports Therapy).

IT Band Syndrome: Your Definitive Guide to this Common Injury

Tue, 12 Aug 2008 16:24:32 -0500

What is the Iliotibial Band?
The iliotibial band (a.k.a. IT Band) is a thick fibrous band of tissue, much like a tendon, that runs down the outer thigh. The IT band begins at the hip and runs down the outer thigh to just below the knee on Gerdy’s tubercle. The muscles that control tension and tightness of the IT band, the Tensor Fascia Lata and Gluteus Maximus, function in coordination with several other hip and thigh muscles to provide stability and support to the pelvis, hip and knee joints. Much like a tight Achilles tendon, do not believe anyone who tells you the myth that you can stretch out the IT band if it is tight. Tendons and fascial bands can withstand hundreds of pounds of pressure before stretching or deforming. Only the muscles, which control the tension in the tendons, are capable of stretching or lengthening.
What is Iliotibial Band Syndrome?
Iliotibial band syndrome (ITBS) occurs when there is irritation to tissues under the IT band. The irritation usually occurs as a result of a friction injury over the outside of the knee joint, at the lateral epicondyle. The IT band crosses lateral epicondyle at point and has a slight gap between the tendon and the bone. This gap is filled with a bursa that creates a fluid cushion as well as facilitates smooth gliding and reduces friction as the tendon moves past the bone with knee flexion and extension.
However, if the gap between the tendon and the bone is reduced and excessive friction occurs between the IT band and the lateral femoral epicondyle, the bursa is irritated and inflames. This condition develops into a bursitis (inflammation and swelling), which is analogous to developing a blister on your heel as a result of excessive rubbing from your shoes. When the bursitis is present, the IT band will no longer glide back and forth easily across the lateral epicondyle.
What Are the Symptoms of IT Band Syndrome?
When IT band glides across an irritated and inflamed bursa, the movement of the knee joint becomes painful. Pain is usually felt on the outside of the knee and worsens with continued activity and movement. It starts out as a dull and achy pain with every stride or turn of the pedal and can quickly and relentlessly develop into a sharp and stabbing pain that can halt you in your tracks. The pain is most intensely felt during the heel strike while running, the downward stroke while cycling, the kick while swimming as well as descending a hill or flight of stairs. With all bursitis conditions, they are typically resolved with Rest, Ice, Compression and Elevation (RICE). RICE is necessary for reducing the swelling and inflammation associated with the bursitis but unfortunately will not take care or fix what caused the bursitis to occur in the first place. You will have symptomatic relief, but not full and complete resolution of the cause. Your condition will keep coming back and returning with a vengeance once you start training again.
What Is Causing My IT Band Syndrome?
There are many theories out there behind what causes IT band syndrome and why certain athletes develop it and others do not. Some of these theories are without merit and validity and others get close to the mechanical causes but miss the bulls-eye. The majority of articles on the internet and in sports medicine journals are still fishing for the reason and cause of IT band syndrome. They leave you with a long list of possible causes and hopeful suggestions or treatments. The list includes but is not limited to increasing mileage, increasing the volume of activity, increasing the intensity of training, a change in training surface, training on crowned roads, training on a tight track, hill training, running style, worn shoes, overpronation, leg-length discrepancy, bow-legged, knocked kneed, quadriceps/hamstring weakness or adductor/abductor weakness.
Sound confusing and overwhelming? I agree! So what really is the cause of IT band syndrome? Without a doubt some of the above can be contributing factors but they are not the primary cause of IT band syndrome. If fact, most of the factors listed above are also touted as causes of plantar fasciitis, shin splints, patellar tendonitis, Achilles tendonitis, patellar-femoral syndrome, chondromalasia, low back pain, pirifomis syndrome (sciatica) as well as hip bursitis. So why do some people get IT band syndrome and others develop these other common overuse sports injuries? How come only a handful of athletes will develop IT band syndrome and others will not?
There is a definitive answer to why someone is prone to developing IT band syndrome and others are not, even though their training programs are exactly the same. The answer lies in understanding proper and improper IT band biomechanics. Just like your car, improper alignment leads to greater wear and tear in specific locations. The same concept occurs in your body, especially when IT band syndrome it present. Improper IT band biomechanics leads to the tendon snapping back and forth across the lateral epicondyle (outside of the knee) and as we described earlier this will cause the painful bursitis we call IT band syndrome.
Let’s look at the proper and improper biomechanics of the IT band and why this syndrome develops in the first place and why most healthcare providers are missing the boat when trying to fix it.
What are Normal IT Band Biomechanics?
As discussed earlier, the IT band runs from the outer thigh to just below the knee. Through the actions of Tensor Fascia Lata and the Gluteus Maximus muscles, the IT band not only provides support to the pelvis, hip and knee but also assists in flexion and abduction of the hip as well as flexion and external rotation of the knee.
During knee flexion and extension, the IT band should easily glide past the lateral femoral epicondyle with minimal or no contact. The amount of space or gap between the IT band and the femoral epicondyle is determined by the Q-angle at the knee.

The Q-angle (or "quadriceps angle) is very important for proper IT band biomechanics. It is formed in the frontal plane by two line segments:
1. From the Midpoint of the Patella to the Tibial Tuberosity
2. From the Anterior Superior Iliac Spine (ASIS) to the Midpoint of the Patella
A normal Q-angle in adults is typically 15 degrees. Women typical have larger Q-angles than men simply due to having a broader based pelvic structure than men. A normal Q-angle allows enough space for the IT band to repetitively move past the lateral epicondyle without irritation to the bursa.
What Causes Abnormal IT Band Biomechanics?
Anything that reduces the Q-angle of the knee will cause a narrowing of the space between the femoral epicondyle and the IT band. This will cause increased friction across the bursa which leads to the irritation and inflammation of IT band syndrome. In the illustration below you will see that the Q-angle is too small in the Varus position and too large in the Valgus position. Both of these extremes will cause very common but unique sports injuries. The Varus position is more commonly associated with IT band syndrome due to having a reduced Q-angle.

1. Functional Hallux Limitus (FHL)
The most hidden and often overlooked cause of a reduced Q-angle leading to IT band syndrome is “Functional Hallux Limitus.” Functional halli…what? The hallux is your big toe. The name of this condition means the big toe is not fully and properly extending in the push-off phase of the gait or propulsion cycle as a result of a functional (biomechanical) condition and not a pathologic (arthritic) condition.
It is interesting to note that in functional hallux limitus there is full and complete range of motion of the hallux in the non-weight bearing position but a major limitation of hallux extension is noted as soon as the foot is loaded in the weight bearing position. The functional limitation is due to the improper function of Hicks “Windlass Mechanism” which brings the foot from a pronation position, during the loading phase, into a supination position just prior to push off.
For the windlass mechanism to work properly, it is critical for the big toe to fully extend during the propulsion phase of the gait cycle. This allows for proper supination of the foot and push off the big toe (hallux). If this mechanism is not occurring properly, you will unconsciously roll to the out side of your foot during push off, which will reduce your Q-angle at a critical time.
The failure of this mechanism forces the foot to push off the outer foot versus the big toe resulting in an over-supinated foot at push off. We use computer motion analysis of the feet to assess the mechanical effects of FHL. Below is an example of FHL and the effects of the higher peak pressure on the outer forefoot (yellow region) of a right foot. An over-supinated foot at push off causes outward rotation of the tibia and femur, which reduces the Q-angle of the knee. As discussed earlier, a reduced Q-Angle narrows the gap between the IT Band and the femur, which causes excessive friction at the lateral epicondyle leading to IT band syndrome. Dr. David Walther describes the reason why this is most often overlooked is because, “symptoms caused by functional hallux limitus can be almost anywhere in the body, but are rarely in the foot.”
The main reason I came to know this information so well is due to researching my own IT band problem that nobody else could figure out. I had tried just about every therapy under the sun and all were only temporary fixes. After figuring out and fixing my own FHL and eliminating the swelling in the epicondyle bursa, I have yet to have another IT band episode since 2003. I have repeatedly used this procedure on many IT band patients with full and complete resolution and return to activity and training without reoccurrence of symptoms.
2. Leg-Length Discrepancy
A leg-length discrepancy is when the legs are uneven lengths (one is shorter and the other is longer) in a lying position. A discrepancy in leg lengths will affect stride length and stroke length during running and cycling. This will cause abnormal lower extremity biomechanics and a disruption of the normal Q-angle alignment. In the picture you will see the Longer Leg with with its Reduced Q-Angle (Right Leg) and the Shorter Leg with its Increased Q-Angle (Left Leg). The right leg will be the one predisposed to developing IT Band Syndrome.
Leg-length discrepancies can either be functional or anatomical in nature. Over 80% are functional in nature and a result of an anterior or posterior fixated hemi-pelvis (half of the pelvis is tilted and locked at the sacroiliac joint). If this condition is discovered during the examination process, it must be corrected before determining the need of a heel lift on the short leg side. Once a functional leg-length discrepancy is ruled out or corrected a anatomical true leg length check can be preformed. Most practitioners make the mistake of fitting for a heel lift prior to ruling out pelvic involvement.
3. Weakened Adductors or Hamstrings
Another underlying cause of IT band syndrome that can be a stand alone condition or accompany functional hallux limitus and leg-length discrepancy is a weakened or fatigued abductors and medial hamstrings. Weakness in these muscles can cause a reduced Q-angle by causing external femur (hip and knee) rotation as well as over-activity of the tensor fascia lata (IT Band Tightness) and IT band snapping across the lateral epicondyle. This needs to be considered and addressed if present but is not the primary cause of most IT band syndromes.
What is the Treatment for IT Band Syndrome?
There is no one “Magic Bullet” for treating IT Band Syndrome. To eliminate the symptoms of IT Band and get a full recovery you have to cool down the irritated and inflamed tissue with “Acute Care”, correct the biomechanical components with “Corrective Care”, and then prevent the reoccurrence with “Supportive Care”.
Acute Care:
The focus of acute care is symptomatic relief and to cool down the swelling and inflammation in the lateral epicondyle bursa. This is achieved through the use of a combination of localized anti-inflammatory and tissue regeneration therapies. We do not include oral anti-inflammatory medications as an effective treatment because the medication must absorb, travel through your body and make it to an area about the size of a silver dollar to have an effect. In rare occurrence that someone does not respond to the therapies listed below we recommend a cortisone injection as a last resort.
1. Cryotherapy (Local Application):
• The most essential anti-inflammatory modality “cryotherapy” or cold therapy. This reduces swelling and inflammation via vasoconstriction as well as reduced pain and tenderness. You need something moldable so make sure to use a frozen gel pack, frozen peas or corn, or ice with water in a ziplock baggie.
• Use cold therapy for the “20 minutes on / 40 minutes off rule”. Do not use for longer than 20 minutes at a time and do not place directly on the skin (use a thin towel, shirt or paper towel as a barrier against frost bite).
• Use ice more frequently in the first 72 hours after a flair-up (4-6 times a day). This will have a major impact on reducing the inflammation in the bursa.
• Another option initially (replaces ice pack for 20 mins) is to do an ice massage for 7-10 minutes. Do this by making an ice cup (paper dixi cup filled ¾ full with water and frozen) and tearing off the top half of the cup to expose the ice. Press ice firmly into tissue and rub in a circular pattern for 7-10 minutes.
• After this initial period, ice is essential after training or competing for the next 4-6 weeks (Ice Pack for 20 minutes or Ice Massage for 7-10 minutes). This will keep it cooled off and prevent any flair-ups as mileage increases.
2. Arnica Cream (External Application):
• Arnica is also commonly called leopard's bane. The arnica plant has a bright yellow, daisy-like flower that blooms around July. Preparations made from the flowering heads have been used in homeopathic medicine for hundreds of years. It is popular in Germany and over 100 drug preparations are made from the plant. Arnica is a perennial that is protected in parts of Europe. We suggest the product “Traumeel” which can be found in our clinic as well as Whole Foods or Central Market (And noooo...we do not receive any financial compensation for recommending this product. It is simply the BEST in our minds! Just ask all of our athletes who have used it.)
• The active components in arnica are sesquiterpene lactones, which are known to reduce inflammation and decrease pain. Other active principals are thymol (an essential oil), flavonoids, inulin, carotenoids and tannins.
• Arnica works by stimulating the activity of white blood cells that perform much of the digestion of congested blood, and by dispersing trapped, disorganized fluids from bumped and bruised tissue, joints and muscles.
• Arnica is known to stimulate blood circulation and has anti-bacterial and anti-inflammatory qualities that can reduce pain and swelling, improving wound healing.
• Common use: It is typically rubbed on the skin to soothe and heal bruises, sprains, and relieve irritations from trauma, arthritis and muscle or cartilage pain.
3. Low Level Laser Therapy (Clinic Therapy):
• We use a high frequency cold laser (programmed for anti-inflammation and pain reduction) to rapidly reduce pain, swelling and tenderness of the IT band bursitis. This laser has been shown to have these effects through stimulating the production of cellular anti-inflammatory chemicals as well as stimulate production of RNA for a more rapid cell turn over which speeds the healing time of the damaged tissue.
• Laser sessions last about 5 minutes and pain is typically reduced by over 50% in one session. Six sessions within two weeks will normally resolve all pain and tenderness of IT band bursitis. Contact our office for more information.
4. Acupuncture (Clinic Therapy):
• That’s right...stick needles in it! Sounds sadistic huh? Well, the research backs up the crazy thinking. They took one group of patients and gave them cortisone injection (anti-inflammatory medication). They took a second group and gave them a lidocaine injection (numbing medication). Then a third group got a dry needle (no active medication injected). The research showed the results for all three groups were equivalent and each just as effective as the next. What we learned was the needle was the most effective ingredient in the therapy. How does it work? We use surgically sterilized acupuncture needle to puncture the inflamed tissue. When anything punctures the skin, it sets off the protective alarms in the body, like a calling all cars alert. It makes your body mobilize and concentrate white blood cells, fibrocytes and anti-inflammatory prostaglandins to jump start the healing process. How fast does it work? Would you believe in 20 minutes. When combines with low level laser therapy, the results are immediate and almost unbelievable for most patients. They believe they just experienced a magic trick!
• Six sessions within two weeks will normally resolve all pain and tenderness of IT band bursitis. Contact our office for more information.
Corrective Care:
The focus of corrective care is to fix the biomechanical (muscle, joint and alignment) dysfunctions that cause the acute symptoms of IT Band Syndrome. These biomechanical dysfunctions have usually persisted for months if not years prior to an acute episode of IT Band syndrome. Most people don’t even know they are at risk for developing IT Band Syndrome until they ramp up their milages or pace and then it is too late. The beauty is that you can be screened for your risk of developing IT Band Syndrome.
1. Functional Hallux Limitus (FHL) Correction:
• After testing and verifying normal motion of the hallux in non-weight bearing position, we test for normal extension and presence of the windlass mechanism in full weight bearing posture. Limited hallux extension and abnormal windlass function suggests functional hallux limitus. Compression of the distal tibia-fibula joint should return normal motion and confirm diagnosis.
• Correction of this condition includes elimination of articular dysfunctions via manipulation/mobilization to the joints between the cuboid, calcaneus, talus, navicular and cuneiform bones in the foot as well as the proximal tibia-fibula joint.
• Once full mobility is achieved, we use a taping technique on the distal tibia-fibular joint. This will immediately return full range of motion to the hallux as well as return the function of the windlass mechanism. This must be paired with the correct running shoes. Avoid stability and motion control shoes. We lean towards neutral shoes for FHL and IT Band Syndrome. We have our favorites and give our patients a shoe shopping list with specific brands and models, we do not vary from our list because these shoes simply work with the taping technique to shift your Q-Angle back to normal (Email our Front Desk and we will forward it to you. We will also highlight them in our Shoe Clinic podcast when it is posted.).
2. Leg-Length Discrepancy Correction:
• If a leg-length discrepancy is noted (a.k.a. short leg present) we determine if the discrepancy is functional or anatomical in nature. This discrepancy can cause an abnormal gait pattern (long/short stride combination), reduction of the Q-angle, as well as muscle compensations in the IT band muscles.
• Functional leg-length discrepancy is a result of an anterior or posterior fixated hemi-pelvis (half of the pelvis is tilted and locked at the sacroiliac joint). Once released via manipulation/mobilization to the sacroiliac joint a true assessment of leg length can be preformed.
• Once a functional leg-length discrepancy is ruled out or corrected a true leg length check can be preformed. There is a procedure to determine if shortness is in the tibia or femur on the short leg side. A heel lift is tested for and sized to correct the anatomical discrepancy. Stride length normalization will be noted immediately by the patient once the correct heel lift is fitted.
3. Muscle Imbalances:
• Muscle imbalances are adaptations that set up as a result of repetitive overload or overuse to a group of muscles responsible for specific body movements. When repetitive overload is placed across muscles that control the Q-Angle of the knee during running or cycling, these muscles become fatigued and develop trigger points. Trigger points cause muscles to weaken. For every weak muscle, there are always other muscles that overcompensate to pull the load. Overcompensating muscles are the ones that are excessively tight and feel like rubber bands. No matter how much you stretch them out or get them massaged, they never seem to relax and loosen up. They also shift the alignment of the body, which alters your body’s biomechanics, which causes excessive wear and tear to ligaments and joints. The articular dysfunction requires manipulation and mobilization to free up the joint and return it to its normal motion. It also requires fixing the muscle memory patterns by eliminating the trigger points and overcompensations to return strength, stability, coordination and flexibility back to the joints that participate in the body movement patterns. Sound like a “domino effect”? That is pretty much how it happens. It may take weeks or years to develop but these patterns are found in the majority of patients who have IT Band Syndrome or are on their way to developing IT Band Syndrome.

• The first thing we do is screen your body for trigger points by testing the muscles involved with your major movement patterns. If we find any muscle weaknesses then we palpate for trigger points. When a trigger point is compressed (pressing in on it) it will cause the weak muscle to immediately strengthen. This only lasts as long as you leave pressure on the trigger point. Once the pressure is removed the muscle goes back to being weak. Then we palpate for the overcompensating muscles. Trigger points not only cause muscles to be weak but when irritated from activity, they cause pain to be referred to specific parts of the body. Check out some of these common trigger points we find and their pain patterns. Look like IT Band Pain to you?

• Without these trigger points eliminated, the IT Band symptoms will always come back! There are various methods of eliminating trigger points, some faster than others (see our article on Trigger Points to compare). It takes on the average of 7 treatments to eliminate a trigger point. We have developed the F.A.S.T. method, which allows us to eliminate a trigger point and its’ overcompensating muscle as well as any articular dysfunction these muscle imbalances might have caused in a single treatment. We call it F.A.S.T. because it really is!
4. Prescription Orthotic & Shoe Support:
• As we mentioned earlier, FHL will force you to push off the outside of your foot rather than the big toe due to FHL. Once FHL has been corrected, orthotics support is important for retraining and reeducating the foot to push off of the big toe on toe-off. We place a lateral (outside) arch strip on the orthotic to assist and retrain the foot to push off of the big toe.
• We have found that by doing dynamic (real time) analysis on the feet as they go from heel strike to mid-foot load to forefoot load and then toe off we can get ultra-precise on our orthotic prescriptions. Essentially we can take an abnormal gait pattern (contact phase) and design the orthotic to return a normal gait pattern. We were one of the first providers in Houston (2002) to start doing computer based dynamic analysis of the feet combined with prescription orthotics to correct for the gait abnormalities.
• We also mandate that the IT Band patient wear shoes that compliment this action. This means avoiding stability and motion control shoes due to their ability to push your Q-Angle out, which is an aggravator to IT Band. We have found half-a-dozen brands and models of shoes that will help bring your Q-Angle back in and loosen the IT Band. Our list of shoes may change year to year due to shoe manufactures changing their designs or even manufacturing methods. We evaluate, buy and run in these shoes each year before they get our stamp of approval. We should have the current years’ list of shoes published on our site soon. For now, the Avia Tuned Trainer II is one of my personal favorites for 2008 but may not make the cut next year. You will feel this shoe help your Q-Angle and relax your IT Band immediately.
Supportive Care:
Once the irritation and inflammation has been eliminated and all of the biomechanical factors have been addressed and supported then it is time to take a proactive/preventative attitude toward keeping this from ever coming back. Most people want to jump right in and start the supportive type of care before they fix the biomechanical issues and wonder why they only achieve temporary results but nothing long lasting. Trying to do strength exercises when trigger points are present is like running in circles...you just won’t go anywhere. Same is true when you try to stretch overcompensated muscles. They are there for protective reason and will not release without eliminating the trigger points. When the muscle imbalances are eliminated, patients are shocked how quickly the strengthening and stretching exercises work and how effective they are! Here are recommendations:
1. Balance, Strength & Flexibility Exercises:
• Balance is critical to reduce side-to-side sway and pelvis/hip shifting while transferring your weight from one foot to another during the gait or even cycling motion. Balance is the least understood and under-appreciated by sports injury patients. If there is one thing that will improve your condition and athletic performance right away it is balance training. We have been shocked at how many runners and triathletes lack the proper balance to reduce hip sway. Not only does this raise your risk of an overuse injury like IT Band Syndrome but it also means you are wasting energy and effort. You are spending less time moving forward and more time moving side-to-side. A two inch hip sway can add an additional 1.3 miles to a marathon distance. Imagine the energy that wastes and how much faster you could be by shaving a mile off of your marathon. Balance responds quickly to a staged balance progression program in just 2-3 weeks. After 6-8 weeks you will have a minimal sway and a faster minute/mile pace.
• Strengthening exercises are also essential but quickly forgotten by patients once the pain goes away. Without building strength you will not have joint stability. Without stability, your body will not allow you to have flexibility. Flexibility without stability is called “Instability”. Your stretches will last longer and work better if you concurrently train strength and stability. Again, we are constantly amazed at the number of runners and triathletes who have weak core, hip, knee, ankle and feet muscles. They can put in the miles and push the pace but they do it at the expense of wasting energy and wearing/tearing their body. Strength takes longer to build so consistency and persistence is the key here. You can start to see results in 6-8 weeks but will want to stick with it for 3-6 months to get maximal results. Again a focused, staged progressed program is the best for ramping up strength and stability.
• Stretching with the intent to improve joint range of motion and muscular flexibility is important if you do it “correctly”. If you are not going to stretch correctly then just don’t do it! Research proves those who stretch incorrectly are at a higher risk for developing a sports injury than those who skip stretching and simply warm up properly before training and events. Your stretching should produce marked and sustained improvement in both joint range of motion and muscular flexibility. What do I mean by “marked improvement”? Let’s take the hamstrings into consideration; before and after stretching your hamstrings you should see your reach or flexibility improve by 4-6 inches. What do I mean by “sustained improvement”? The flexibility you just gain from your stretch session should last for 6-8 hours and when done daily for 2-3 weeks should last 24+ hours and stay at that new length. Does your stretching do this? If you are holding your stretch for 30, 60, 90 seconds you won’t be able to achieve these results. Research shows you need to hold a stretch for 5-7 minutes to achieve these results. With 639 skeletal muscles in your body your stretch routine should keep you busy for years. :-) Even with a 10-15 Position Stretch Routine you are still looking at 1-1.5 hours each day. Stretching for our patients maintains the corrections we have made in your muscle imbalances as well as reeducates the muscle memory of your body and its biomechanics. We understand it is unrealistic to spend an hour to an hour-and-a-half stretching each day. So we teach our patients an advanced athletic method of stretching called PNF (Proprioceptive Neuromuscular Facilitation). By doing PNF style stretches our patients can achieve marked and sustained improvements from each stretch position in 60 seconds versus 5-7 minutes. Their entire 10-15 Position Stretch Routine takes them 10-15 minutes. We believe this is a more realistic and effective method of stretching.
1. Run Technique:
• Most runners and triathletes want to talk about and try to make running technique changes. Remember, if you have any Muscle Imbalances or Biomechanical Dysfunctions no matter how you try to practice Mind Over Matter, you will not be able to coordinate and control your mechanics to achieve a proper run technique. Even our professional athletes can not achieve a market and sustained technique change without eliminating muscle imbalances, correcting and supporting biochemical dysfunctions, balance training, stretch training and last but not least flexibility training. Once these ducks are in a row, market and sustained technique changes as well as improvements in your energy utilization and performance are noted.
• We are fans of “Chi Running” and the “Pose Method” for their focus on correct body posture, mechanically reducing ground reactive forces to the body, and helping the runner conserve energy. If we had all learned to run like these methods teach while we were in elementary or middle school, I seriously doubt we would have as many muscle imbalances and biomechanical dysfunctions we see today in our practice.

3. Shoe Replacement Schedule:
• It is the “opinion” of most running stores and websites that you replace your running shoes after 350-500 miles. Most runners typically put in excess of 500 miles on their shoes prior to replacing them. If one of your shoes’ primary function is to shock absorb, why wouldn’t you replace them as soon as they significantly failed to shock absorb? The research shows, in the American Journal of Sports Medicine, that the absorptive capacity of the mid-foot section of a running shoe shows a 25% loss by the first 50 miles, 33% at 100 miles, and >40% by 250 miles. Another research study showed that breakdown caused a 100% increase in peak pressure at the heel (rear-foot) by 300 miles. What does this mean for you? Your risk of overuse injury increases 100% by 300 miles. You are safer replacing your shoes sooner than later!
• We advise our patients to take a proactive, injury prevention approach and replace their shoes at 200 miles. Interestingly enough, they usually show very little wear on the tread at this time. By the time you see tread wearing, it is too late, your biomechanics and alignment has been dysfunctional for miles! Do the math...200 miles for a fitness runner (3x/week for 3 miles) is 5 months and for a triathlete or marathoner it is 2-3 months. Best thing you can do is save your shoe box and count down your milage on the box (start at 200 and subtract/recalculate after each run). Milage is milage!!! Do not kick around or hang out in your shoes after you run. Take them off, and put on your “kick-around” shoes or sandals. This will not only save your running shoes from breaking down faster but will also help them rebound from your run. After 200 miles, make your running shoes your “kick-around” shoes since you do not need peak shock absorption to hangout, shop or walk around town. After 500+ miles, make them your work or yard shoes. Another wonderful idea would be to donate your seemingly new (200 mile) shoes to a ministry or an organization who distributes shoes underprivileged school children. Now you can say you run for philanthropic causes! :-)
• So what is rebound in running shoes anyway? Why do I not want to hangout in my running shoes? During your run, you compress the absorptive materials (red stars) in your shoes and squeeze the absorptive gas, which are responsible for cushioning your foot strike. It take 48 hours for your shoes to completely reabsorb the gasses and “rebound” to full shock absorption status. If you hang out or kick-around in your shoes, they will continue to be, in a sense, “deflated” of the necessary gasses to shock absorb. This is also why you will want to have two pairs of shoes if you plan to run back-to-back days. With two pairs of shoes cycling back and forth you can now wait until 400 miles to buy more shoes.
• Like you need anymore ideas...well, just in case you do, here is one more. If you are training for a marathon, half-marathon or longer distance triathlon you can cycle your shoes from long distance shoes to shorter distance shoes. Use a pair of shoes for your long-runs until 100 miles and then make them your weekly, short milage shoes for the next 100 miles. That way you always insure you have a pair of shoes with maximal shock absorption for your longer milage runs. Want one more idea? Just kidding...on to the next subject!
4. Training Location:
• Sloped or Crowned Surface: If you are running either on a sloped/crowned road or running path, your down-slope leg will be functionally longer than your up-slope leg. You know what condition a long-leg leaves you predisposed to? You got it...IT Band Syndrome! So, Here are your solutions: (1) Run in the middle of a crowned road/running trail, (2) Have your un-affected leg on the down-slope side and/or, (3) Switch sides or directions every 10 minutes...e.g. For a Crowned Surface: Run on the right side for 10 minutes and then switch to the left side for 10 minutes (repeat until finished) / For Sloped Surface: Run in one direction for 10 minutes and then turn around and go back for 10 minutes (repeat until finished with training).

• Track/Circular Running: Running on a track or tight circular pattern in a gymnasium means you have to lean in to turn. Even slight amounts for a prolonged period or repeated often causes your outside leg to be longer than your inside leg during the turns (For a 1/4 mile track you will spend 50% of your time turning and 50% on the straights). Need I say anything about a long-leg and IT Band Syndrome? I think you got that one nailed down by now. So here is Your Solution: Change up your running direction every 10 minutes or mile, which ever comes first.

• Hill/Stair/Stadium Training*: The downhill or step-down motion puts more load and pressure across the IT Band and outside knee area. Often this is associated with the Q-Angle being too far out. There is a work-around to minimize the the negative effects from Hill/Stair/Stadium training. The solution is to run up and walk down; especially focusing on pulling your knee in towards the mid-line (knee cap should track or stay inline with your big toe). As your muscles retrain and you can effectively control your Q-Angle while going down, you can slowly increase your pace downhill. *Please Note: Downhill fast running or sprinting should solely be reserved for professional athletes (too much load and risk if you are not getting paid big bucks to do it).
5. Training Volume & Training Intensity:
• Your body tissues need time to ramp-up and adjust to the demands of your training. Your bone, cartilage, tendons, and muscles become more dense to handle the increased load. We have all experienced what it feels like to do “too much, too soon”. If you ramp-up your volume (distance) or intensity (pace) to quickly, your tissues not only lack the proper time for recovering and healing properly but will not build up. Worse than that, they will break down little-by-little until your tissue is either severely inflamed, tears or breaks. So be smart, ramp-up properly and let your body rest and recover properly.
• Since one of the main causes of injuries is a sudden increased training volume, you should only increase your training volume by no more than 10% per week with plateaus every 2-3 weeks to reduce injuries (see sample progression chart). If you can not safely increase your volume by race day you are better not cramming for your race or simply plan on another race to compete in.

• Also, never increase your training volume and training intensity at the same time, choose to increase one or the other (that’s the way the pros do it). It is too risky to work on increasing your volume and your speed in the same week. Best time to increase intensity (pace/speed) is during your plateau weeks. Then maintain your new pace /speed as you roll into increasing your volume again. Again, no more than a 10% increase in intensity at a time.
• Remember, you are in this sport for the long haul not just to compete in the next race. Injuries will cause major setbacks and regressions in your training, which ultimately postpone training goals and PR’s.
6. Rest & Recovery:
• This subject is last in most athletes minds but should be regarded as first. Rest and recovery are an essential part of training. Without rest and recovery, you will never progress in your fitness (Fitness = Training + Recovery). Training is a self induced physical stress to your body that produces an overload leading to fatigue. Your body must recover fully from this fatigue. With adequate rest and recovery your body will “super-compensate” and have an increased level of fitness.

• Rest and recovery is half of the Fitness Equation...it is critical for increasing your athletic performance (going further and faster). With proper rest and recovery, your body will continue to super-compensate and progress in its athletic abilities. Sleep is your best method of recovering (ever wonder why olympic athletes do not hold full-time jobs...if they are not training or eating, they are sleeping...several times a day). Want to progress as fast as possible with your training? Get a nap after each training session as well as 9-10 hours of sleep a night. Couple that with all of the above recommended therapies and you will be blown away at how fast your athletic performance improves!

• What happens if you do not get enough rest and do not fully recover from your training? You will have a gradual decline in your fitness and performance as well as have a higher risk of injury, which is why we are talking about this subject. If you continue along this path you will slowly progress into a state of overtraining.

• Most athletes are often unaware they are slipping into overtraining until they hit the later stages. The early stages of overtraining can be overcome and reversed by some extra sleep. The later stages of overtraining is a slippery slope that is hard to recover from and is commonly experienced just prior to a major competition. You will typically feel more fatigued in the morning as well as throughout the day, have a higher resting heart rate than normal, be more susceptible to colds and bronchial infections, and have a loss of endurance and speed while training/competing. If you are starting to feel overtrained, your best option is to take a whole week off and get several hours of extra sleep. You will come back to training feeling more energized and feeling stronger than before. If this does not do the trick, you will need professional guidance. We are happy to help!
Last Note:
We trust this report has provided some valuable information and insights into this complex, yet common condition. We hope we have answered most of your questions and that you have learned enough and have enough information at your disposal to make an informed and educated decision for yourself. You know where we are, what we can do and how to get a hold of us. We would be thrilled to help you if you ever need us!
Author: Dr. J. D. Hasenbank, CSCS, CCSP - Sports Injury Specialist, Strength & Conditioning Coach & USA Triathlon Coach. Founder of Spine & Sports Therapy and F.A.S.T. (Functional, Athletic, Sports Therapy).