Postpartum Running and IT Band Syndrome: Core, Glutes and Strength

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 your co-host Sebastian with the Restoring Human Movement podcast today. Thanks for joining the Movement Movement. This is going to be a podcast on answering an email that we had from a listener and it's focusing on a knee injury, an outer knee pain associated to this is a three-year out postpartum mother runner. So, someone who's trying to regain their fitness, get back to running again three years after having given birth and have tightness in the outer part of the knee.

So, here's the question. And, so, hello, my name is Blank. I'm a runner who gave birth three years ago. I'm experiencing persistent tightness and pain on the outer side of my knee, specifically the IT band region. I've been increasing my mileage as well. I'm a big listener of your podcast. Appreciate your focus on biomechanics. Thank you. I suspect the changes in my running form potentially related to lingering pelvic instability or muscle imbalances from pregnancy are contributing to this issue. I've noticed tightnesses in my hips and glutes and wondering if this is affecting my knee alignment.

I've also experienced some discomfort in my hip. I'd love to hear your insights on the biomechanical factors that can lead to IT band syndrome in outer knee pain and runners, especially those with history of pregnancy. I'm curious about your thoughts of gait analysis, specific strengthening exercises, strategies of addressing muscular imbalances. Thank you so much. It's a lot to unpack there. I'm going to do my best to keep everything concise, nice and tight. I think the first thing that we should talk about here is the commonality associated to conditions like runner's knee or IT band and postpartum.

If you've listened to some of the other shows already, you realize that with a lot of the other knee conditions that runners have, they also have typically valgus collapse or inward knee cave. And this is with men and female. They found that men, especially with chondromalus patella, I know it's a little different than IT band, but it's similar in ways as well, has to do with hip drop. And we also know that postpartum or we'll go parnum, there tends to be an anterior tilt to the pelvis and lumbar hyperextension. A lot of times that type of stabilization strategy should be momentary during pregnancy and it's totally valid.

It should be used, but sometimes there's collateral associated to it. And sometimes that compensation stays around because of C-sections or poor return back into activity or poor physical conditioning or lack of activity during pregnancy in general. So there is a type of discipline of treatment out there called DNS, which is dynamic neuromuscular stabilization, which kind of leans on this whole principle. And if you look at some of the papers that people have written on it, and there are some literature papers as well, but they talk about something called the open scissor. The open scissor is essentially the anterior part of the pelvis dropping in anterior pelvic tilt, lumbar going to extension, and also the rib cage, bottom part of the rib cage, which you can see how people just popping up.

And it kind of opens up like a scissor with the hinge point being the lumbar spine. This is obviously can happen where it can create lower back issues and sciatica and stuff like that. We see people that aren't necessarily pregnant have this type of scenario as well. It typically revolves around some old type of old lower back condition or an old hip injury. Now, these types of mechanics can cascade down the chain. And I had spoken to a friend about this in the past where I was saying, I'm going to be talking about groin pain. Do you think I should start with the hip flexor gets tight or the groin gets tight and then talk about internal pressure and core instability associated to it?

Or should I just reverse it? And he's like, I think I would start with the core approach. Because we know that good core activity tends to allow better stabilization, which leans towards the less of having a necessity of depending upon an open scissor stabilization strategy, which then allows the pelvis to then get out of so much anterior tilt, which also allows the hip to have better range of motion. So there's less hip and pinching cases, less groin pain, which oftentimes will lead to the glute max working better. And don't worry, I'll get to the IT man here soon. And when the glute max works better, then we see less internal rotation and valgus collapse of the knee, which then leads to less knee conditions.

And we can cascade this all the way down into the chain. So if you looked at a Google image of valgus knee and biomechanics of the lower limb, you'll see that all of this kind of coincides together. A lot of times people do focus just mainly on the hip and downward when they're talking about this, but it all starts with the core as well. Core stability being a fundamental component of it, which is what DNS principles are generally revolving around. So I would say that the – and I lost track of the question here because we went into the basic biomechanics of it. But let me start with the idea of IT man first just because it's fresh on my mind.

And I am driving, so I just want to make sure that I'm not looking too much on my phone for the questions. But IT man itself is an interesting scenario where, number one, if you have pain at the outside part of the knee, it's called a friction syndrome. So it's friction over what we call the lateral femoral condyle, which is a section or a bony prominence of the femur of the knee. And so if it's rubbing excessively on that area, you can inflame the tendon or as it comes down and attaches to a section of the knee or it can inflame like the bursa that's underneath it. So it's a friction syndrome, but the interesting thing, and one of my friends came into town and he did a great presentation on knee conditions.

And so he said – he brought our attention to the lack of awareness that the glute max muscle attaches 70% of its fibers to the IT band. We also know that the TFL is attached there, which everybody blames as being part of the condition of being too tight and creating IT band syndrome. But everybody kind of forgets the glute max and how many fibers, percentage of the fibers, are attached to the darn thing. I mean, you'd think if 70% of the fibers of a muscle were attached to that, it would be pretty important, right? Like the glute max is a very powerful muscle, which contributes a lot of the lateral knee support, which limits how much inward collapse there is.

It also limits how much femur internal rotation. It also limits – or it is – when your glute is strong, when your glute max is strong, it also is a large contributor to keeping your hip happy and also low back conditions. So there's a lot that goes into – there's a lot of merit to just considering, like, is my glute max working well? And I think that if you are a runner dealing with IT band problems, I think you can probably look back into some of your glute strengthening exercises. Let's just say one that's not even a strength exercise. It's just a facilitation one called a bridge. Do you actually feel your glutes working or do you feel your hamstrings and your back doing more?

Like one of the big factors that we see that people have their first aha moment when they realize their glutes aren't working is when they're doing a glute exercise and they don't really feel their glute on one side, but they feel on the other. Or they feel like a small section, like a piriformis muscle or like a crease of the hip working extra. So I think you guys have to really audit to see, is your glute max generally working in glute exercises? I know when I work my quad with something like squats or like knee extensions, I feel my quad working. Like I shouldn't feel other things. When you're working your glute, you should feel your glute working.

So another consideration in this email is about the mileage. So they said that they did just recently increase their mileage. And the unfortunate thing with emails is that, you know, I can't ask follow-up questions. But my question would be, by how much? I forget the general rule, but I think it was a rule of 10%. I'd have to ask Dr. Mandy, though she's more of the experts of our actually managing runners back into return to running protocol. But generally speaking, I think from what I understand, the 10% rule is pretty fair. Like if you run 10 miles a week and you up that by double, that's kind of a lot.

Even though it doesn't seem like a lot for some people, it's mainly because we want to make sure that we don't increase exposure spikes at your body's tissues. Tendons, muscles, ligaments aren't really used to. Not to say they can't get back there again, but an exposure spike is one of the easiest things where you can predict possible injury or risk factors associated to injury. Other questions in this email was lingering pelvic instability. Three years removed, I don't, I couldn't, I couldn't say it. I have to ask Dawne Costantino this, but I don't feel like the hormonal components associated to pregnancy would really be around three months, three years removed.

Maybe months removed, possibly, but three years removed. I think you should be back to your hormonal old self. Some of the listeners that are maybe endocrinologists or OBGs can probably correct me on some of that. I'd love to hear what you have to say. But I think reasonably speaking, like, I'm not going to say the pelvic instability is necessarily from the hormonal aspect of pregnancy. It may be associated to other factors associated to your pregnancy, like C-sections or time off your feet. Were you bedridden for X amount of time? Have you, were you doing any core work? Some people don't do any exercise when they're, when they're pregnant.

I know tons of people who aren't actually physically active before or during pregnancy. And once they get over the hump of actually giving birth, then they realize, oh, I better do something to be physically active now. I got to get back to my old self. And that's when the activity starts. So, but they never really had the pelvic stability to start with. So, I don't know if we can really blame the pregnancy on that. My thoughts about gait analysis, specific strength training. I think those are, that'll be a good conversation. So, personally, my thought on gait analysis is I think that most of it is kind of not useful for most people.

And I'll tell you the reasons why, and I know I'm going to get some pushback on this, but I know, like, so right now, if you've been listening to the podcast, I, I had another hamstring tear. I've had four, this is my fourth hamstring tear, and I've gone back to running or sprinting again. If you've been listening to the podcast too, you know, I don't really love distance running. I like sprinting. That's my thing. But if you like running, I'll definitely help you get there. But the thing is that I've torn my hamstring two days ago, and I am limping right now. So, the best thing, the easiest thing to do to change my gait is to just tear something.

Right? Like, it takes, like, internal changes to really get a immediate gait change. And I'm not saying this gait change is better for me. It's certainly not. I'm limping. But it certainly poses a question of, is it easier to think about changing your gait, or is it just easier to change the individual, whether that be an injury, like myself, or a bruise, like kick someone in a leg, which both of them are probably negative, build strength in a leg, build balance. Like, how do you get someone to actually have good single leg stance if they can't balance in the first place? Maybe that's from something like a vestibular problem or inner ear issue, right?

So, who's to say that focusing on leaning forward into your stride or drawing your heel up to your butt is really going to change anything because balance is an issue. So, we can change more of the aspect of the individual here. We can also work on flexibilities. So, if there's a limitation in hip range of motion, like we had a gentleman recently, he came in, he had some back pain when he would just run just a mile on the treadmill. And so, we did a little bit of hip extension protocol on him to improve the stiffness of his hip on the involved side, and that decreased his lower back pain. And he was able to run two miles with no pain outside.

In this case, he didn't go back on the treadmill. But all we did was we changed the individual. We didn't change his thought about what he should be doing, and we didn't give him any drills to do. So, part of strength training, which will lead you into the last part of the question, is strength training. Strength training, flexibility, or mobility, stability, all these are big parts to changing the gait that may be your non-painful gait. Because currently, right now, the gait that you're using is enough to create rubbing of the IT band to create the problem. So, we need to give your body another means to change its gait on its own, but it may need certain attributes to do so.

If you haven't conditioned it or stretched it into those changes, then how do we expect it to really change? So, I'm not a big fan of telling people to change their gait. I'm more of a fan of changing the person to change the gait. Okay? Strength training exercises for this. I think that typically things like squat, like if you're not doing just basic squats, goblet squats are a good choice. I'm not a big fan of barbell squats. Front squats are okay, but most people fare very well for a very long time doing goblet squats, double front rack kettlebell squats, split squats, step back lunges, single leg RDLs, dead lifting with or without blocks, with or without barbell for trap bars or various different objects.

So, there's many different things that we can do, but generally what we want to do is adopt a hip and knee dominant exercise, which is going to be a squatter hinge pattern. And if we're going to go back down the route of biomechanics, I think we have to make sure that we're actually doing correct core support as primer exercises, really challenging ones for the belly and the sidewalls to make sure that those carry over into our running, but also some of our weight training too. I wouldn't do any exercises that provoke the knee. I'm sure there's a couple of them that do. Maybe lunges would, and so in that case, maybe step back lunges are a better option.

Not to say you can't do them forever, but right now maybe that's not the best choice because it's rubbing. We need to give it a chance. We need to give it a break. But I think that doing different types of carries are a good option. Suitcase carries are a really sneaky core exercise. Also, doing sled pushing is a very sneaky core exercise. And I think if we are trying to decrease our problems or risk factors associated to knee valgus or knee collapse as well as hip drop, then the carry series is a very good one to do. So I hope that was helpful to everybody to get an understanding of maybe how the core and the hip are connected to the knee.

There's plenty of research, and I'm not going to go find research to present this because there's literally hundreds of research articles that can link core and hip function to knee conditions. But there are also ones that can link foot and ankle ones to knee conditions as well. And that's a topic for another day. But especially if you have an old history of ankle-foot conditions, that would be a better starting point than possibly low back and hip. But usually when we have a post-pregnancy person or a postpartum person, then we need to consider that there's a lot more pelvic aspects to the problem than probably foot and ankle unless they've had a past history of that.

So if you guys are looking for help, we do telehealth. As you heard in the other podcasts, we're licensed in various different states, and we specialize in helping people with groin and lower core conditions such as IT band and hip issues and low back and cytokine and so on. So we'd love to help you guys via telehealth, and we're excellent at diagnosing people in that way. Find our contact in the description for the podcast, or call us at 714-502-4243, email info at ptusportscare.com. Schedule a discovery session, which is our version of a consultation, and we'll figure out if we can help you or not.

Take care.