IT Band Pain: Why Stretching and Foam Rolling Fall Short

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, welcome to the Performance Place Sports Care Podcast. I'm Dr. Sebastian Gonzales. And we are going to talk about another comment from YouTube today. This one was on the topic of IT band syndrome, was the topic of the video. And this is one of the older ones that actually I made. And I'm kind of going from top to bottom to the most played or viewed ones to the least or the newest ones.

And this one is actually done by one of my friends in school or one of my colleagues, Dr. Chris Barkmar. You can find him in Garngrove, California. And I remember he took a lot of time to make this thing. And it was really, I think he did a really great job. It was really informative to me. But there was a guy who really didn't like it on YouTube. And I'm going to read his comment. Before I continue, if you guys want to leave your comments, your questions, and see if I'll answer them on air, go to p2sportscare.com. There is a voicemail box right there in the center of the page. We are reconstructing the site very soon here. So if it moves, I'll try to make it very visible to you guys. So here we go.

So this guy said, shut your dumb jock. Shut up, you dumb jock. No one wants to hear you flapping your gums. We want a stretch to make it better to use YouTube. Let's see. Wait, we want to stretch to make it better. Learn to use YouTube. Funny. I think I commented back something to the effect of, you know, kind of being snarky like, hey, it sounds like you found the wrong video because this is informational and education is key. So some guy actually came through, uh, and one of my fans and he backed me up and he said, quite honestly, and he addressed him. Uh, this video is quite informative to introduce to those like myself, the reason for pain and how to deal with it. Or even, even if it pertains to this area.

So, yeah, I did want to hear him flap his gums as you rudely stated. So first off, I want to thank, uh, uh, my viewer for defending me on that or defending actually my colleague. And, uh, I realized that over the course of the years, uh, cause this video was, I believe it was probably in 2011 or 12, um, that we put it out. And, uh, I noticed that YouTube is a lot about DIY or how to's, but I think it should be more so as a, uh, forum for education as well. And I found some really, really good informative, uh, videos on things that I'm not good at such as web design or even podcasting, even getting the equipment to learn how to podcast, um, was really, really helpful on some of the videos on YouTube.

I found, uh, the podcast answer man as well as Pat Flynn were great ones that, um, showed me how to implement and get my word out and really service, uh, and serve more people. So, um, just to comment back to this guy, I, I totally understand. I totally understand that people want, uh, stretches on YouTube, but the danger of this, and I'm sure you've heard it, heard me tell it many times is that we don't know what you have. And I don't want to, I want to make sure that everybody who comes into my YouTube page or into my podcast or into my, um, my website to be better, to leave better, not leave worse or not point them more so in the wrong direction.

Um, and education and self-realization, at least on the patient, patient's part from these self-help forums is the only way to do so. So going in first off, and, and I have, you can probably read these on some of the comment boxes as well. Um, I, I, I go through and I read these quite a bit and I, I, I'd say, I'd venture to say that probably less than half the people that describe their condition actually are on the correct video. And me, what that means is they are going to treat it the wrong way if they continue down that path. And actually I did a, uh, I did a study on this, which it was a very small scale study.

I needed to have some more subjects, but it was a, uh, ultrasound study on the accuracy of patient self-diagnosis. And what I wanted to see was how accurate are patients at knowing what they have so they can properly recommend their care. So I picked something actually very basic. It was, uh, Achilles tendonitis. And if you have had Achilles tendonitis, you probably know what it is. And it is the, if you go down to the foot back of the heel and there's that tendon in the back of your foot, which, uh, the historic lore legendary Achilles got shot through. And, uh, it's very big. It's easy to palpate.

It's easy to find. And it's a commonly injured one. And there's a lot of resources out there on it. So I would think that most people could be able to find it. Now there's a couple of conditions in the region, which, uh, can simulate, uh, IT or sorry, uh, Achilles tendonitis. Uh, one is, uh, retrocalcaneal, uh, fat pad bursitis or, uh, inflammation. Uh, another one is, uh, posterior pinion. Uh, another one is tibial, as opposed to your tendon, uh, irritation or I guess tendinopathy. So within that area, that's about two inches in the back there, there could be a few things which are creating the issue.

So what I did was actually, I went to a running group locally here. Uh, it was called ARAC. Um, and I handed out some flyers and just said for a couple, I said about a minute, probably or so. I stood up and said, I'm doing a study on ultrasound and self-diagnosis of Achilles tendonitis. If you think you have Achilles tendonitis and you don't have a supporting image, I want you to come and check. And I had a couple people ask me, what is Achilles tendonitis? And I said, I can't tell you that because this is on the accuracy of what people think they have. So they can actually be pointing at their shoulder and say, I think I have Achilles tendonitis.

And I'd say, great, cool. Let me image that. And I would image the ankle. And what we found through the study, I believe there's about 20 something people who came in, I think to make it scientifically valid or have a larger sample size, I was supposed to have about 10 more, which is kind of a bummer. And I'll probably revisit this study at some point pretty soon here because it was a really easy one to implement. They, I think we found that less than half the people were correct. And it was, it was amazing to see that something so simple to find was so hard for the laymen or athletes to correctly identify.

And I don't say that in a demeaning way. It's just that there are way more complex conditions that I wouldn't, that people come in and want to, or they say they have, but I don't know how they came to that conclusion. But arm pain or arm pain with heart attacks is another example that, I mean, it is a very serious condition with having referred pain and whatnot. So it's very distracting to figure out what's wrong because most people might think they have maybe an arm condition or a pec tear. And I've heard of people going to the hospital with gas saying that they think it's a heart attack. But so there's a lot of ways to misdiagnosis for the patients.

And I really think this stresses the importance of going in and getting correctly identified before you go down the wrong path. So back onto this YouTube video and other people have commented as well on these same types of things. They want stretches. They want self-help. They want ways to self-massage. And they want what we call passive therapies. Passive therapies to me are ones that will decrease pain probably very, very quickly. But they don't correct the underlying issue. Ice, heat, massage, foam rolling, stretching, injections. These are all what I would consider passive therapies because they will kill the pain, but they don't correct what is happening.

And in the case of IT band pain, I had a discussion with someone about this actually this morning, was that the IT band, one of the most common things that people try to do in the area is they try to foam roll it. And I don't think that's correct. And the reason is, is on a couple levels. And number one, the IT band is very, very thin. If you see it on ultrasound as, I mean, it's about 2% of the whole page. The whole page or the whole image is taken up by the vastus lateralis, which is the outside quad muscle, which I think actually when people have side of the thigh pain or actual direct pain on the midshaft of the thigh, it's probably more that.

When it's down at the knee, it could possibly be, and majority of the time I see that it is, it's a lateral meniscus tear, which then we have to investigate the popliteal tendon as well. And up higher, a lot of times there's other issues that can be, and we won't even go into that. But the discussion I was having this morning was, I have a video on IT band pain that we talk about tightness there. And this guy commented saying, you know, why is it always have to be tightness? And we elaborated on it and so on. And he's brought to the point that the IT band is a dense structure and it could be this and this and that and so on.

And I agreed with him. And I totally agree that the IT band is a dense structure, just like the plantar fascia in the foot that is not really intended to stretch. Okay, let me say that again. It's not really intended to stretch. So why are we stretching it? If we're foam rolling the area, what are we doing? And the possibility is I believe that we're rolling out trigger points or painful areas, quote unquote, in the vastus lateralis, which is completely fine. But I don't think we should be misleading ourselves saying we're going to stretch this structure that's not intended to be stretched to improve what's going on in our knee or in regards to our pain because it's not.

Now, again, passive therapies or tissue work or massaging there, it really, really does help in regards to a decreasing pain locally and very, very quickly. And I do think there is merit to that, mainly because it's hard to get people to do rehab exercise or to get them to move well if they're in pain. Now, an example of that, if someone comes in with, say, like a knee condition, let's just say patellar tendonitis, and they can't squat. Now, my job is to apply some type of mechanism, passive therapy, active therapy, whatever it is, to get their knee to bend better. And then I have to take them through proper movement patterns and strengthen the areas around it, especially the hip and the torso, which are probably contributing to that condition anyways.

But we have had the situations in the past where people come in and we're like, hey, we're just going to do trunk stuff and hip stuff and all this for this knee because that's what it needs. And they're like, OK, cool. So we do it for about like 10 to 15 minutes, 20 minutes. And at the end, they're like, so are we going to work on my knee today? And I look at him like, we did work on your knee. We worked on the root cause of the knee. What else do you want? And they're like, well, can you just like rub it out a little bit, you know? And sure, that's fine. And so we do it afterwards and you can see the smile on their face and they're like, oh, man, that feels so much better.

I love coming here. I love getting this work done on me. So I guess what I'm bringing up is we do need passive therapies. We do need things that make people mentally feel better. And however you choose to make your brain feel better about rehabbing and strengthening the main reason or normalizing movements. So the main reason why this condition happened in the first place, the IT band issue. Go ahead. I don't have a problem with it. And actually, that is how passive therapies and making people feel better very quickly is how I built my practice. But now, moving on forward, the self-help variety and you'll see these courses that I have on the Performance Place HB site is the main spot where I'm having them.

I'm sure I will transfer them over to the P2 Sports Care one soon. The main purpose of these is to educate and show people how to implement basic rehab or the very fundamental stuff that we typically do with, say, IT band issues. Actually, I take that back. We are not allowed to show exercise directly to one person or corrective exercise because we don't know what they have. But that does not mean that I can't show theory of it. So you'll see that a lot of the comments that I make in there, they're general and I'm very careful with my words just for liability's sake. I don't want you to think that I'm recommending directly to you because I'm not.

I'm just merely showing what we do in the office with these cases that have been confirmed to be having this condition. In this case, IT band pain. So I hope this was helpful to you guys to really elaborate on at least that comment. That is what I that's actually one of the ones that I I scroll through and I see and I I remind myself constantly. This person does just is so irritated that I will not give something that will kill their pain. And I'm sticking to my guns in this stuff. I don't think I should be or anybody should be recommending purely pain management type of approach. I think we need to take our athletes and our patients and you guys to a new level and be able to educate you on how to self-manage your condition in regards to rehab.

And nothing to put down physical therapists at all. But I know people that come into my office, one of the most probably one of the most common things. Why? I mean, they're obviously coming in because I haven't had results elsewhere, but they they commonly the feedback they give me about what they've done. Because I ask them what they what are they tried? And they're like, well, I tried a chiropractor. I tried to rest it. I tried physical therapy. And a lot of times what people tell me about physical therapy is they say that they got frustrated because they could do it at home. And I do believe they can do it at home.

But also, too, on the clinical side, I realized that people do things incorrectly and also they realistically don't do them. And I'm sure physical therapists and physios can can resonate. This is that people get busy with their lives and they don't properly do the exercises. They put the other parts of their life first. And it's our responsibility to get them to do stuff the X amount of days, X amount of time for X amount of months to give them the best possible chance at recovering from this condition. So it's our responsibility to keep them doing that. Yet I know the patients a lot of times what they say is that they're like, it was easy.

I could do it at home. I don't know why I was going. And and I can see there's a lack of communication there and just the lack of understanding of knowing why these exercises or rehab exercises were were put in place. And I did have a call actually from a lady the other day who was talking about her knee and she she resonated the same thing. And I told her here's the she actually got my cell phone number, which I don't know how she got it. But oh, no, I know how she got it. A patient had another patient and given it to her. But so I was talking on the road and, you know, I had nothing else to do.

I was driving like 20 minutes. So I just I was just prying a little bit. I'm like, well, what are they doing? They're like, oh, they're doing stretches and so on. And I'm like, well, you know, increasing range of motion is important. So you should be doing that. And she's like, well, I know, but I don't feel any better. And I'm like, I know. But these are the things we have to go through. I'm like, if you come and see me, we're going to do the same thing. Partly, you know, I might do things a little bit differently because everyone has a different way to skin the cat. But but for the most part, I mean, it sounds like they were doing exactly what they should be.

And the problem is, and I told this directly, is the problem is that you are not understanding why and possibly for that reason, not implementing what they're asking. And if you come in, we're probably going to do the same thing and we might do it a little bit differently. But I will force you into doing this for X amount of time, because if you're coming here, you're not you're paying a bit of money and I want you to get the most out of it. And I didn't want her to be misled, thinking I was going to do a quick fix on her or anything, because it sounded like she had a knee thing, plus a back thing, plus a hip thing.

And she's like, oh, my posture is not great and all this. So she was kind of already saying all the stuff which made me feel she was understanding that they were all partially connected. So I will stop right there. And again, I want to make sure everyone realizes that I'm not I'm not bashing any physical therapists because we we in my profession also have the same thing. I have people come in and saying they didn't like X, Y and Z about other places. And there's there's good and bad of every profession. The great ones, I think, that work in sports rehab. It's we kind of all do the same thing. You know, it's we all follow what the most current research is.

We really try to empower the patient. We do corrective exercise and all that kind of stuff. So there's lots of ways that we can help out patients. And I just want to make sure that you guys know that if you don't like what you're doing at rehab or don't see the point in it, just ask them. And they should. Our responsibility as health care providers is to implement and educate these types of treatment plans with you and let you understand. So I would say, first off, if you're if your doctor or therapist is not paying attention to you, then maybe you want to find a new one, because this lack of communication or lack of understanding is going to be probably one of the reasons why you're not going to get better or you're not going to decrease your pain.

If you understand it, you should be able to implement it because it should become important. On the next grounds, if you understand it and you're not doing it, you have to look deep inside and figure out why you're not doing it. Perhaps you figure out why or why this injury is still around and why you're holding on to it, because I have actually met people that they I consider one is one is my grandma. Actually, she she I remember we're at a family party and she's like, oh, you know, my back really hurts. So I, you know, like it hurts all the time. I'm like, well, you know, grandma, you can come in and I'll I'll look at it and I'll I'll help you out and so on.

And and she's like, oh, no, no, no, no. Like, you can't help me. I have arthritis. And I thought that was the most debilitating thing she can possibly tell herself. You can't help me. I have this. So I think at some point it becomes people's identity to have something or they almost like the attention of the condition and like talking about it. And I'm not saying my grandma was like this. It's a possibility. But I have met quite a few people that they are not listening to reason and they just want to talk about the condition. And in that case, you might want to find a sports psychologist to talk to them about it, because there's a deep underlying condition of why or deep underlying reason why you still have not implemented a strategy to get rid of it or committed to a treatment plan.

If you want to get rid of it, I believe you can unless there's certain extreme circumstances, which I have seen as well. And in those cases, those would be the exotics, the exotic cases, as we call them. They're very, very hard. They're the ones we'd publish articles on to educate the other people in our profession about. But standard run-of-the-mill IT band cases, there's no reason you should have this for years and years and years or even months at a time. There's ways to correct it. So, if you want to submit your question, go ahead and go to p2sportscare.com and there should be that speak pipe button right there.

Also, if you want to check out the courses, some of these self-education courses I have, currently they're on performanceplacehb.com. Just check under courses and they should all be there, but not all of them are working yet. I'm still developing some of them as we speak. So, I'll talk to you guys soon and see you later. Thank you.