Recently, a coach friend of mine for whom I have a lot of respect promoted an article about IT Band syndrome. This is an injury that I know is quite common amongst runners and I am pretty sure I have flirted with it myself in the past. At first I was excited to have another resource in my kit in order to provide quality training to anybody who I teach. However, instead of providing me with useful information I could pass along to clients or friends, this article nearly caused my head to explode with white-hot anger and frustration. The author is highly qualified and has a long list of capital letters behind his name, but he is providing information that is straight up harmful It is articles like this that ensure we remain forever injured and forever mediocre in our athletic pursuits.
First, I want to address what the article does well. Pages 1 & 2 give a great breakdown of the anatomy and function of the IT band. Even the most lay of laymen can understand and learn from these well-written sections. On Page 3 however, the article falls apart and falls apart fast. It is here that the author gives away the fact that they are part of the old wives club by committing an extremely pervasive and detrimental error: “the quadriceps muscles (those in front of the thigh that extend the knee) and the hamstring muscles located in the back of the thigh that flex the knee.”
NO. NO NO NO NO. This is the most common and most damaging misconception of the lower limbs. Everybody from the “bro-fessor” gym rat to the “highly-qualified” medical community seems to believe that the legs are simply a bigger version of your arms. Biceps flex the elbow and triceps extend it, therefore the leg muscles must do the same to the knee, right? NO. Seriously, NO. Why in all of mother natures green goodness would the muscles in the back of a human’s leg be so damn big if its only purpose was to flex the knee? Bringing my heel to my ass does not require all that junk in the trunk. For some reason, nobody seems to understand that the musculature on both sides – front and back – of the legs is active in extending the knee. Sure, the hamstrings and all those other posterior muscles do indeed flex the knee, but they MUST be active in extending the knee as well. You are actually contracting both the quadriceps and the hamstrings when going from the squat position to standing. Relegating the hamstrings and the rest of the backside system to only flexion leads to a long, sad, painful road to mediocrity and misunderstanding. I could turn this article solely into a discussion on the knee, but we’ll save that for a future post. For now, if you don’t believe me, go pick up Mark Rippetoe’s book Starting Strength (Vol. III).
NOTE: I do not know Mr Rippetoe personally nor do I have any stake in his book or other fitness activities. I talk about his book a lot simply because it is the best damn book on strength and musculature that has ever been written.
So yeah, Page 3 of 10 and my head is already about to unscrew from my body because I am so damn angry about the damage this article is doing to us all. Moving on, the author can’t even get the unhelpful RICE adage correct on page 4. We are all familiar with Rest, Ice, Compression, and Elevation approach to injury treatment, but the only really useful part of that is Compression and the author completely leaves it out. WTF. Better yet, he replaces it with pills. RIPE? Well, the author doesn’t bring up Elevation either, so RIP? Exceedingly appropriate since the author seems bound and determined to kill your muscles.
Pain pills are bad. Generally speaking, “anti-inflammatory” sounds like a good thing to most people as inflammation is a result of injury and reducing inflammation should then mean a reduction in injury intensity. I simply don’t get this logic. Inflammation is blood rushing to the site of an injury. Blood flow is critical to recovery. Why on earth would you want to cut down this blood flow? Anti-inflammatories work by constricting blood vessels thereby reducing blood flow thereby reducing inflammation WHICH ALSO reduces the flow of necessary fuel and nutrients to heal and reduces the out flow of waste products from the healing process. That second part doesn’t sound so great to me. Worse yet, pain pills can do some serious damage to other parts of your body, especially your digestive system – a critical piece of the nutrient delivery puzzle. How can you heal when you reduce your ability to take in nutrients AND deliver them to the site that needs them most? I’m wiling to bet this author (and probably you as well, dear reader) has never thought this through. I want to address the rest of the problems inherent to RICE another day, but for now I feel it is my duty as a human being to spread this wisdom as far and as quickly as possible: Pain pills are bad.
On page 5, the author recommends cross training in a sport that doesn’t aggravate an injury as a way to stay active despite IT Band syndrome. This I support. Unfortunately, this advice is tainted by more crap about RICE and by blaming running as an “aggressive activity.” What the hell does “aggressive” mean? I picture a runner with a scowl that is trying to stamp to death a long line of ants really quickly. Running is a great way to maintain muscle and joint health when done correctly…maybe this author had better reevaluate their running form before accusing the sport of a misdemeanor offense.
Next up, the author recommends physical therapy as a way to overcome IT Band syndrome (after plugging pain pills again, of course). Again, on face I agree with this advice. However, if a physical therapist recommends the voodoo that this author advises, such as orthotics, stretches, and phonophoresis and iontophoresis (look these up, they sounds scary as hell) before finally recommending corticosteroid injections, punch that PT in the face and walk out of their office with your middle finger held high. Don’t even get me on surgically sticking an arthroscope into the leg or surgically altering the size of the IT Band. The surgical option in nearly any therapy is not indicative of the wonders of medical science, it is indicative of the laziness in pursuing effective physical therapy. Proper PT requires life style changes and long-term, or better yet permanent, dedication to authentic movement patterns. This is not easy and doesn’t fit with modern instant gratification techniques, but it is the only path that leads to actual improvements in quality of life and health.
How is this clown show not over yet? Next, under the heading “Next Steps” and “Prevention,” the author states an admirable goal: “to return to the level of activity enjoyed prior to the injury.” Again, I would agree if it were not tainted with talk of “footwear options…orthotics…stretching.” More voodoo. I agree that an athlete needs to analyze the root cause of their injury, but slapping one of these modern bandages on the problem will only prevent the system from becoming even weaker and being ever more prone to future injury. Creating this special universe in which we need to exist in order to conduct physical activity is bullshit. Nature gave us what we need, we just need to stop living and exercising in a bubble. My goal is not to return to the level of activity before the injury. My goal is to reach a higher level of quality in activity that will lead to a higher level of health in the athlete’s future.
Everything in this article on IT Band syndrome amounts to what I would consider mainstream “knowledge.” I put knowledge in quotes because it is simply stuff that everybody knows, but it shouldn’t qualify as actual knowledge in the way that we have knowledge on factual information. We learn much of these old wives’ tales and voodoo techniques in grade school and carry them into adulthood. Our modern education system also teaches this same stuff, thereby ensuring the next generation is there to keep the inertia going. To make matters worse, there is a massive fitness industry that “publishes” these “facts” in magazines and the government also advocates this same information. Given this onslaught, it is easy to see how extreme inertia builds up behind these ideas and we somehow all “know” that the knee is a bigger elbow, pills and surgery fix problems, and orthotics and stretching prevent problems.
This was a demonstration of just a little bit of critical thinking against one article. Basically nothing written by this author passes the smell test despite his impressive list of qualifications (MD, FACEP, FAAEM). The whole purpose of movematt is to call out articles like this that actually damage us, but to also provide the tools necessary to think through ALL awful advice. I will keep it coming, but for now, think twice about what you “know” of the function of the knee. Think twice before you pop a pain pill or consider medical options for injuries. Think twice about what a PT recommends to you. And finally, think twice about your post-injury goals.