IT Band Syndrome or Calf Strain? Ruling Out a Low Back Referral

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's Sebastian, your co-host with the Restoring Human Movement podcast. Thanks for joining the Movement Movement. It's a lovely day in Southern California today. I'm driving out to my weekly baseball game on Sunday, and I hope you guys are out doing what you love as well. Now, we are covering lower back disc herniation topics today, specifically with runner populations and how it may manifest to where you may actually have a misdiagnosis because you're looking more at runner-based overuse types of conditions.

Now, the ones that are top of this list that are so misdiagnosed when someone does have some type of discogenic symptom is IT ban and calf strains. So I will go into that fully today, as well as some signs and symptoms, some past history that you may want to be aware of, and some simple things that you could do to remedy this problem as well. Again, if you guys are looking for other runner-specific topics, we have tons on this channel for us. Dr. Mandy Riehl, DC, is a great resource on return to running protocol, and she has various podcasts on this channel as well. And we always have virtual or in-person services.

If you guys want help directly, that's 714-502-4243. Our contact is in the description for the podcast player, and we're licensed in various different states, and we have lots of great online programs for knees and IT bans and low backs and so on. So if you guys are interested in self-help, we have some great bullet-pointed 12-week session, 12-week programs in there that I created myself. Now, let me start first with what a disc herniation is just briefly, and then I'll talk about how it typically presents, especially with runner populations. A disc herniation is an injury where part of what we say the jelly of the donut of the disc in between the vertebral bodies, which are the small bones of the spine, starts to migrate outward.

Now, there's various different types of disc injuries. This is something you would probably want to Google pictures on. So you can look up disc herniation, disc prolapse, disc sequestration, and so on. And you'll probably find a few pictures that show different migration patterns of this jelly material. Now, it's important to note that if you've had back pain in the past from this, then you actually don't need to have a migration of the jelly too far or too much of an advancement of the injury to have discogenic types of pain and referrals. It just has to migrate to the outer third of the disc, which it kind of interweaves between what we call the yarn of the disc or the annulus.

It just kind of soaks into the yarn and then it kind of hits some nerve roots that are out there as well or some nerves that are out there as well. Now, some of you are listening to this. You may be thinking, oh, I don't have any back pain and my back is just stiff, but that's normal for me. Yeah, but the manifestation of how it presents down the leg is the reason why you should continue listening to this podcast because I fully know that many runners with IT band pain or what they believe is IT band pain and calf cramping or calf strains are actually just discogenic referral. I know it's startling to think if you guys want to look online, you can look up L5 or S1 level referral patterns from the lower back and this can be from the disc or it can be touching onto a nerve root.

Everybody has little variances and you'll see that almost every one of those lumbar referral patterns has the SI joint area involved. A lot of them have the piriformis area involved and sometimes like around the glute medius. So if you've been dealing with a stiff SI joint or you feel like your glute muscles are always tight or your hip is always tight or your low back is stiff, those would be signs, not symptoms. They'd be signs of a discogenic presentation into the IT band or into the calf. Now, the differentiators that I tend to use with like true, which are like true IT band or calf conditions for local tissue issues, like the overuse model that you may have been aware of.

Let's start with IT band first. IT band is what we call, IT band syndrome is what we call friction syndrome. The friction syndrome is where the section of the IT band as it crosses over the knee, it starts to rub onto a bony prominence and right there, there is a bursa too, so it can become inflamed as well. And the consistent friction is what tends to increase this problem. Remember, friction at a certain location, like say if I took my hand and started rubbing it across my wrist like I'm trying to rub my wrist apart, usually creates local symptoms. It's like right at the side of the knee. And then this isn't a dead giveaway that this is IT band friction syndrome.

But the reason why I'm bringing this up is because if you actually have a friction syndrome, like imagine like you've gotten your shoes and you rubbed part of your Achilles raw, that's a friction syndrome. It's a friction problem. It doesn't manifest up into the calf. It doesn't travel to the bottom of the foot. And similarly, when people actually have lumbar referrals that mimic IT band that they're being treated for, that's just not going away, it's not just at the side of the knee. It may be intensified at the side of the knee, but they feel stuff into the side of the thigh, like where the band of the IT band is.

Sometimes they feel it into the hamstring or the upper glute or the TFL area, like the front side of the hip. Those are pretty good signs that there's probably some lumbar spine involvement. It may not be a big old lumbar spine disc injury, but it means that there's lumbar spine involvement, which means we should probably be working on hip strength as well as core stability as part of this, which luckily a lot of IT band programs do include anyways. But what I find is that if we're looking to actually reduce symptoms quickly, those exercises like glute ones and core ones, they can be helpful, but for some subset runners, they actually don't help super fast.

Like it's almost frustrating how long you have to wait to really feel better. And so there are some more specific movement-based lumbar spine treatments that can help reduce symptoms over the course of even two weeks or so by 50%. Now, let's talk about the calf area now. So a calf strain or a calf, I hate to say strain, but let's just say strain then. A calf strain is usually some type of increase in workload. It's not necessarily a tear, a strain and a tear are different things. I know that you've probably heard of micro tearing. I'm sure those are around. I think it's been talked about too much over the years.

The body's natural process of build and break down and rebuild is some micro tearing. So why do we care? You know, so it's not that big of a deal. Now, sure, maybe there's scar tissue in there from a really old injury, but if you've been dealing with this for under six months, there's probably not any appreciable scar tissue in there. It takes like decades to start to form. The strain aspect of the calf, again, is usually based upon an increase in workload. Like you started doing more jumping. You started doing more trails than you're used to. But again, why is this one side acting this way and not the other as well?

Sometimes if you've had an old foot or ankle injury, that may manifest as more of a strain on the calf musculature because we know there's a local problem right there. But let's just say it hasn't changed in color. It's not visibly swollen. There was no pop that you felt, which would indicate more of a tear. It's just kind of tight all the time. Whether you run or you're just getting up in the morning and hopping around like pogo hops or jump rope, those are a good way to test it. If it's just tight all the time, consider the possibility that it may be another type of strain, which is what we call a lumbar referred strain.

Now, I've done a podcast on this topic so many times over the years, but I feel the need to go back to it repeatedly. There used to be three types of muscular injuries, a strain, a partial tear, and a full tear. The strain category encompasses about 60-70% of the injuries that people come in with to a sports medicine office, but those actually break down into two basic categories. There's actually four, but no one comes in for the first two. So the two categories that most people will end up coming in for is number one, as you guessed it, overuse, which is more of a muscular and balanced type of model.

Like my calf is working too much, but because I have another tissue, it's not working well. A tibialis anterior, a small foot musculature, and so on. And those are all valid, and that does happen quite a bit. We see a lot of people with that. But we see equally as many people who are the second category, which is lumbar referral. And so the lumbar referral people, a lot of times, actually the study, I saw this was a consensus statement. It's called the 2012 Consensus Statement of Muscular Injuries. If you want to look it up, it's a free PDF. It talks about how hamstring injuries or hamstring tightnesses and hamstring pain are oftentimes related to a lumbar spine referral.

It's because the hamstring tightness becomes protective. And so a calf can happen the same way. Basically anything where, in this case, we're talking about S1, anything that the S1 nerve innervates, such as the hamstrings and the glutes and the calves, can be overly tight. And it's not necessarily that the back is pulling on it, but just the fact that the electrical impulses from that level of the spine are a little bit haywire means that things that it contacts and touches and gives motor function to may become a little bit taut or what we call hypertonic. So treating this area from a calf raise perspective, yeah, that could work.

But why not just change the electrical impulse aspect of it? And that may be something as simple as doing a spinal-based intervention. No, I'm not talking about an adjustment. But there's simple breathing exercises you can do. There's certain positions that make you feel better. We call positions a comfort. I find one that helps a lot of the runners that we see is what we call a campfire squat. A campfire squat is when you're, you find when you're around a campfire and if you're a true camper, you don't actually bring chairs. You just find a log. And so you sit on something low like a foam roller and you just sit there and put your elbows on your knees and you relax.

And then you sit here for a minute or two and you get back up and you test your calf. And for a lot of people, it actually feels a lot better. And that means we've changed the electrical impulse in the lower back because we all know that doesn't do anything to the calf. We all know it doesn't do anything for, if this was the IT band we're talking about as well, it doesn't do anything to the IT band. In fact, if anything, it actually puts more contact on it because of the bend point right there. But changing it from a central perspective is probably the easiest one that you can possibly do for people who are non-responders for typical treatment.

Like if you've done typical physical therapy or chiropractic or you're doing typical home exercises and stretches and scraping and so on, it's not working. It's because you're missing something very simple, typically. Now, when it comes to rehabilitation for it, I would say that there's actually crossover. I'm not going to say the things you guys have been doing are wrong. Obviously, if you're listening to this podcast, you feel like you can probably improve in some way. It's something that hasn't worked for you. But as I mentioned earlier, a lot of IT band programs tend to include hip exercises anyways, which is important.

I don't think we need to be stretching and formalizing the IT band as much as we think. I don't think the glute medius in isolation is really that important. I think the glute max is much more important because it's a strength builder of the hip. The glute medius is not necessarily a strength muscle. It's more of a stabilizer, but also to get the glute max or glute medius to even work and kick on and stay on so the little muscles like the TFL stop having to work so hard to do movement or the hip flexor is that we need to get core support. And that comes down to proper breathing, comes down to intra-abdominal pressure coaching and cueing.

It comes down to doing exercises that don't provoke the area as well. Now, one thing that you guys may not be completely familiar with is actually the fact that there's another big difference between local IT band and calf strain issues and referred aspects to it. A lot of people we see end up saying that they have weakness or a loss of power in the leg. Like there's no pop. Like there's just lack of pop. It's not like they can't like walk. It's not like they can't do a calf raise. It's not like they can't hop. But it just feels like there's less pop. A lot of people tend to know too that it feels like my glute's really not working.

No matter what I do, I can't get that glute to really work. Those are pretty good giveaways that they're going to be more spine-based versus local tissue issues of only overuse of your IT band and your calf. Now, before we do exit from this podcast, because I want to make sure that we do cover both grounds of the IT band and the calf, I tend to feel that the calf rehab program is actually not, it's not very good typically across the board. Some of them do include hip exercises. And I at least like that when we have even a spine-referred IT band type of scenario or a real IT band, it includes the hip.

It tends to include core stuff. But when we get people with calf issues or even patellar, sorry, not patellar, plantar fasciitis, heel pain, and so on, they tend to localize their efforts only really below the knee and they start to do calf raises, bent or straight knee. Again, not bad, but just, it doesn't include the hip. They tend to put on things like Strasburg socks. They tend to do a lot of foot stretching and then scrunching towels and smearing peanut butter with their toes. And they do toe spacers and et cetera. I think that missing the hip component, the core component is a big problem.

And if you're not, if you don't really have that in other types of your program just as a default, that's something that you could add like very quickly, like glute exercises, side planks, front planks. Regressed front planks are oftentimes required for runners of various different calibers. I know you guys can do front planks from your feet, but regressed one from the knees actually helps out to get better core activity versus getting your back to be involved in a front plank, which isn't ideal because that further exacerbates the scenario. Normally, when we see people with either one of these conditions, we do try to keep them on their feet and running as much as possible.

Ideally, we don't decondition the whole athlete for getting a area to feel better, whether it be a local tissue issue into the calf or the IT band, or we have a spine referred aspect to it. It doesn't really matter. There are plenty of things that the person can do with maybe with variable speeds, maybe variable terrain, maybe we change shoes. There's a lot of things that we could do to keep this person active. And it's in best interest to do so because if we don't, then the person loses habits and also they lose fitness and other aspects as well. So because they're looking for help to keep your fitness up, especially if you have a race coming up and you want to be conditioned for it, usually about a 12-week window is perfect for being able to solve a condition like this.

And being able to account for any fallbacks, I'd love to say we do have success with all the people that we work with, like just from straight out the gate. Some people we end up working with, things get worse before they get better because there's just mistakes that are sometimes made, but on either our part with suggesting or with the person's part, doing too much too soon and so on. Or there's a chance that we find a little flare up as you start to build up volume again. And we need to account for those things. As my friend always says, anything can be done with time. If you want to make a brisket, you got to give me, what, 16 hours.

But if you want it now, I can do it, but it's not going to be good. And so we want to make sure that we give ourselves at least 12 weeks to manage these types of scenarios. If there's less time, we can do it, but it's just going to be a little bit more haphazard. But if you guys want help telehealth-wise, we do have virtual options and we are licensed in different states than the ones that we're in. We're in California right now. 714-502-4243. Take advantage of those online programs that we have. We have a great one for the knee, which actually encompasses certain exercises and stretches that are actually specific to both the back-referred ones and the actual knee ones.

We have what we call a first-A category that we do, and that has to be almost like a test-retest model. It's in week one. And people do sometimes struggle to find that on their own with knee cases, but they're really not too hard to find if you have a little bit of direction. So sometimes combining a single session with us and then doing the remainder of the 12-week program on your own is usually enough. All right, guys, hope you liked the podcast. Take advantage of the remainder of the shows and see you next time.