Iliotibial Band (ITB) Syndrome – Is your ITB killing you?

If you’re an active person, and especially if you’re a runner, Iliotibial Band (ITB) Syndrome is one of the most common overuse injuries that can sideline you. Though many people suffer from ITB Syndrome, few understand what it is and how to treat it.

If you’ve ever had ITB Syndrome, then you know how much it can hurt, and how it feels like it’s never going to go away.

It’s one of those pains in your knee or the outside of your leg where you go out for a run or a ride, and have to limp home. Many suffer with this injury for months. It’s like a knife digging into the side of your leg or knee. The ITB is an extension of a short muscle on the side of your hip called the Tensor Fascia Lata (TFL) as well as your gluteus maximus (glute max) muscle, (that’s your behind). The ITB extends from the TFL and glut max down to the outside of your knee.

Symptoms
Pain occurs anywhere along the ITB, usually at the insertion (by the knee) or somewhere in the middle. You’ll have pain running, riding or walking [usually down] stairs, and anytime you try to bend your leg, especially after keeping it straight for a while.

Sometimes, even waking up in the morning will be like an ice-pick in your leg. If you’ve ever had an ITB problem, you probably went through a whole slew of treatments and still had it for 3-6 months; that is very common and no fun.

Causes
ITB Syndrome occurs typically from the following reasons:

Often there is an actual weakness of the TFL or glute max itself. 75% of the ITB is made up of the glute max – the major muscle you use to jump, climb, squat, run, ride your bike, and even just to get out of a chair;
A muscular imbalance between the inside and the outside of the leg;
One or both of those muscles could have fatigued from wearing the wrong type of shoes or orthotics;
An old injury that is still haunting you, but you don’t know it because the pain is gone, but your body has compensated;
An insulin issue from eating too many carbohydrates creating a gait disturbance, or even from a digestive problem, (gut inflammation can inflame the ITB);
Overtraining.

Treatment
Once you notice ITB pain, the best way to get rid of it is to rest immediately. That means fewer miles, or no running at all. While you’re backing off on your mileage, you can cross-train. Swimming, pool running, cycling, and rowing are all fine. If you diagnose an ITB problem early enough treatment can be as simple as rest, massage and stretching.

Medical treatment is cortisone shots and NSAIDs (Non-steroidal anti-inflammatory drugs) for inflammation and if that doesn’t help, then surgery can be recommended to cut and release the band (in severe cases).

Other keys to treating ITB and speeding a healthy return to the track are as follows:

Stop running. It’s simple – if it hurts to run, don’t run.
Increase strength. Simple exercises to strengthen the glutes, quadriceps, hamstrings and core muscles can aid a speedy return to the track.
Massage the injured area. Using a foam roller and/or a tennis ball to work out tightness in my glutes, quadriceps, ITB, hamstrings and hips.
Better quality sleep. Most recovery and healing happens when you’re asleep. Aim for 8 or 9 hours minimum of quality, unbroken sleep.

My training at 36-ish

Goals
Fitter. Faster. Stronger.
Always learning.

Context: 36-year-old. 180cm. Soldier. Student.

My aim is to live as long as possible and as healthy and productive as possible. I’m not a father yet, but I would like to be a parent one day and see those children grow up.

Basically, I want live well and avoid chronic disease (for as long as possible). My grandfather lived to 84 years old, although his last decade was hampered by heart disease, elevated blood pressure, cholesterol, and type 2 diabetes.

So, I plan to use some evolutionary wisdom and apply it to modern society. Simply put, keep my metabolism as healthy as possible (eat whole foods), keep enough muscle mass and remain as mobile (be active) as I can so that I can actually get around and do everything I want to do for as long as possible… and hopefully help a few people out along the way.

Caveat: This is what has worked for me so far…

Food
For those who don’t know me, I have been following Paleo or Primal type nutrition for about six years now. For the most part it’s just eating whole foods as often as possible. I do like my full fat dairy (like cheeses and some yogurt) and they don’t really affect me in a negative way unless I eat them in excess so with a bit of discipline I’m all good.

I’ve been trying to get about 125-150g of protein per day, with a lot of cooked veggies (for nutrient density) and some healthier fats like avocado and oils such as coconut, macadamia and olive. I must admit, I been fairly liberal with my use of butter and sea salt with my cooking. Not only are they a good source of vitamins and nutrients, but they taste really good.

I would usually split this over two or three meals depending on the day and what was going on during that day or week. The last two or three months I have been fairly low in dietary carbohydrate and have felt pretty good. I do have days where I really lift my carbohydrate intake but they have been fairly random and are usually after some intense training periods where I need a bit of a boost to aid in recovery.

I do a bit of intermittent fasting here and there. I am metabolically flexible, meaning I am well adapted to using fats or ketones as an energy source. Occasionally on a low tempo day, I would dabble in a longer fast of up to 24 hours This wasn’t very regular, maybe once every 6-8 weeks.

These days I don’t count calories or worry too much about when I’m eating or not eating. Basically, I eat when I’m hungry and try to avoid processed foods when practicable.

Most weeks I eat out with friends one night which would usually lead me to the local Vietnamese Pho or Grill’d restaurants.

Supplements
I’ve been supplementing with Nordic Naturals Fish Oil. I think omega-3 supplementation is important for overall health and Nordic Naturals is basically the gold standard of omega-3 supplements.

Magnesium. This is probably one of the most important supplements for me. I generally take it post workout (especially in the warmer months) or in the evenings prior to sleep. Magnesium is vitally important to so many biological functions in the body and these days it’s not that easy to get enough from diet alone. Add in some intense training or workloads, and your requirement increases.

At the moment most of my work days are spent indoors so during the winter months I add 10g L-glutamine daily (in the morning) and about a 10ml of Nordic Naturals Cod Liver Oil every other day. The L-glutamine is got for overall health and recovery while the Cod Liver Oil is a good source of both Vitamins A and D.

Training
There are several coaches that I go to for inspiration when it comes to my program design. They are Dan John, Pavel Tsatsoline and Ross Enimait. When it comes to strength, conditioning, combative and kettlebell training these guys have you covered.

Over the last 12 months or so I have been playing with some basic strength and conditioning programs consisting of mostly compound movements such as deadlifts, squats, rows, bench and overhead presses. Most of the time being spent around the 3-6 repetition range.

Heavy Turkish getups (up to 50kg), kettlebell swings and farmers carries have also featured consistently in my programing.

I had a good three or four month period where I added some decent metabolic conditioning (metcon) circuits a couple of times per week. I felt this was working quite well but I had to really ramp up my caloric intake as the metcon work really depletes the energy levels.

Running. It’s been mostly interval work and 5km racing. The days of running 10km to 21km are behind me. I just found them too taxing on the body as a whole. My preference lately has been to run 200m and 400m intervals and every now and then I just get out and run around for 4km or 6km.

I missed out on the usual Run for the Kids in 2017, but I did compete in the Run Melbourne (26:50 for 5.7km) and Melbourne Marathon (26:03 for 5.7km). This year I have run in the Sole Motive Zoo Run (25:25 for 5km), Run for the Kids (23:20 for 5.2km) and the Mother’s Day Classic (17:41 for 4km).

Right now my training consists of three days of strength and conditioning, two days of running (easy run and some sprint work) and maybe a single boxing workout. Each workout lasts about 30-35 minutes with the exception of the boxing which usually lasts 60 minutes. This gives me a total of about three to four hours of dedicated training per week which allows me to have more free time in my week.

Lifestyle
I’m back in Melbourne. Where I grew up. Around family and friends definitely makes life a little easier. The importance of good social connections is often overlooked when it comes to optimising health and performance.

The last twelve months have been kind of interesting for me. A lot has happened on a personal level. Some good, some not so good, but I believe overall that I have had a net win which is great.

This year will mark 15 years as a soldier. That’s basically a lifetime. Soldiering has taken me to some pretty interesting places around the world and it has given me the opportunity to learn and work alongside some professional people.

I mentioned earlier that I am once again a student. I am finally completing my studies in nutrition which I am excited about. I am doing this via correspondence which will take about two years to complete, then I’ll make a decision on where I go from there.

The big three movements

Deadlifts, overhead presses and farmer’s walks are the most important exercises. Here is why.

Barbells

If you care about being functionally strong then you must be competent at these basic movement patterns:

Picking heavy stuff up off the ground;
Lifting heavy stuff overhead; and
Carrying heavy stuff for time or distance.

If your goal is strength and you’re not doing these, well, the best of luck with that. Yes, deadlifts, overhead presses, and farmer’s walks are really that important. Functionally, picking stuff off the ground, moving it overhead or carrying weight over a given distance are some of the more common real world applications of strength. These movements are practiced almost daily by most people.

Additionally, I would add pull-ups, however the skillset for everybody to pull their own bodyweight over an obstacle is not commonly required these days as it was in previous generations.

Strength standards
Below are some functional strength standards that are highly achievable with some consistent strength training.

Men

Deadlift: 100-150% bodyweight
Single-arm overhead press: 50% bodyweight
Farmer’s carry: 100% bodyweight (total)
Pull-up: minimum 8 repetitions

Women

Deadlift: 100-125% bodyweight
Single-arm overhead press: 33% bodyweight
Farmer’s carry: 66% bodyweight (total)
Pull-up: 3 repetitions

The game changer: loaded carries

Trying to find that right movement that will radically change your body.

Find that missing ingredient to your training programming that will help you build muscle faster, drop fat quicker, along with dominate on any field of play. For most of us it’s as simple as this.

The loaded carry.

Strength coach Dan John states that the loaded carry does more to expand athletic qualities than anything else out there. Because of their versatility, loaded carries can be used by anyone, anywhere. It doesn’t matter if your goal in to get stronger, build muscle, improve overall posture or even lose some body fat.

Loaded carries are very functional. Loaded carries basically work every muscle in the body. Shoulders and upper back, arms, core, and even your legs. By doing them you can improve your strength, stability, and conditioning all at once.

Some variations

Single-handed carries

Waiters walk. The weight is held with a straight arm overhead like a European waiter in a café. This is usually the lightest of the carries and does wonders for shoulders.
Suitcase walk. Grab the weight in one hand like a suitcase and walk. The obliques on the other side of the weight will want to have a discussion with you the next day.
Rack walk. Usually done with kettlebells, hold the ‘bell in the racked position, which is the weight on the chest, like a clean. This is a fairly remedial move but it can teach an athlete about how the abs work.

Two-handed carries

Press walk. This is simply a double waiter’s walk but the weights come alive as you move. Lighter weights are recommended.
Farmers walk. The King of Carries. Go as heavy as you can with ‘bells in both hands, just like in a Strongman competition. This can be done really heavy for short distances or lighter for great distances. My favorite variation is really heavy for great distances.
Double rack walk. Same as above but with two kettlebells. Again, a learning move, but it’s a great way to teach the athlete to breathe under stress.
Cross walk. Waiter’s walk in one hand while doing the farmers walk in the other. It’s a very interesting way to teach the athlete to lock down the midsection during movement.

Sandbags, sleds, packs and vests

Sandbags are a great training tool. Bear hugs and shoulder carries are common variations. Just pick the sandbag up and carry it.
Sleds. Nothing crazy here, just add weight, attach a rope or harness and push, pull, drag, etc.
Packs and vests is just adding weight to a pack or vest and moving. Pretty simple stuff. My preference is to throw on a pack and get outdoors for a hike.

How often
Do some kind of loaded carry three times a week. Farmers walks and sled push / pulls are my personal favorite moves and tend to be some of the best bang-for-the-buck choices.

Final thoughts
I’ve used many of the variations listed above with success. I’ve found that they have contributed to building muscle, improve posture and body composition and have also helped with overall physical conditioning. As a result, loaded carries regularly find their way into my programming.

A month is all it takes. Try it and get back to me. Three times a week for a month. Obviously, your grip will be better. Your legs will be stronger. You’ll discover that the weight room isn’t that tough any more. You’ll look leaner, but be bigger.

A real game changer.

Evolutionary Fitness

Eat fresh wholefoods that we were evolved to eat. Usually three times a day but occasionally skip a meal, let hunger dictate your meals. Workout with short and intense resistance sessions a few times a week. Walk, play and stay active.

– Arthur De Vany, Ph.D.

art-devany-00 — Arthur De Vany, Ph.D. In his 70’s, is 6ft 1in, weighs approx 190lbs and has about 10% body fat.

Arthur De Vany believes that we have virtually the same genetic makeup as our Paleolithic ancestors who lived 40,000 years ago. The problem, he and many others believe, is that our environment has changed dramatically.

De Vany contends that we would be healthier, fitter, and live longer if we adopted a modern version of the Paleolithic lifestyle. Having spent more than 30 years studying and practicing how to do that, he is regarded by many as the “grandfather” of the Paleo movement.

In this post I am going to sum up some of his basic principles and show you how to get started working out and eating how we evolved to for optimal health.

Nutritional Philosophy

To call a [low-carb] diet on which humans lived for millennia a fad is just ignorant. In fact, it is the modern fad of eating a high carb, high grain, high sugar diet that is harmful.

Arthur De Vany, Ph.D.

Cook by colour and texture so that meals look beautiful. If busy, skip meals with little worry. You don’t have to have three square meals a day. Snack on nuts or celery. Drink plenty of water. Also drink tea, coffee and a little wine.

Basically, eat animal proteins, vegetables, fruits, nuts and seeds. Full fat diary is fine if tolerated.

Carbohydrates

Avoid bread, muffins, bagels, pasta, white potatoes, cereals, vegetable oils, beans or anything in a package.

These foods are empty, high-calorie foods that are not only detrimental to your health, but are of no dietary requirement to the body.

Fats, Herbs and Spices for Flavour

Spice up your food with fresh ingredients such as basil, cayenne, garlic, parsley, rosemary, spring onions or tumeric.

Avocados, nuts and seeds, and use oils, such as coconut, macadamia and olive oil, for flavor.

Celery adds texture (and is good for testosterone too).

Fruits

Fresh fruits and berries of all sorts are good; They are good source of vitamins, minerals, fiber and antioxidants. De Vany focuses on melon and red grapes. Fruit juice is out.

I personally have one or two pieces of fruit most days. Mostly bananas or apples, as they’re readily available to me. I do rotate as different fruits and berries come in and out of season.

Fruits are one of the best ways for quick fresh energy.

Vegetables

Eat lots of fresh raw, steamed, sauteed or grilled vegetables. Try not to use frozen, canned or packaged vegetables, although they are generally better than no vegetables.

Protein

Eat plenty of meat, such as ribs, steak, bacon, pork loin, turkey and chicken, but trim excess fat from the edges. Fish, seafood and eggs are also excellent choices. Don’t forget your organ meats, liver is one of the most nutrient dense foods available.

Try to have protein with most meals as it will improve satiety and keep you feeling fuller longer.

Intermittent Fasting

Our ancestors lived with feast and famine. Research indicates that chronic or intermittent fasting improves health. I do it the easy way. Never chronically; your mind and body will not accept it. And you will lose vital lean body mass; muscle and organ mass. Easy intermittent fasting is skipping meals randomly and eating to fill later.

Don’t be afraid to skip a meal and prolong your overnight fasts, I often workout first thing in the morning totally fasted (maybe a cup of coffee and some BCAA’s) and do not eat for up to an hour afterwards.

This is great for Growth Hormone release and will boost lean muscle growth and accelerate fat loss.

Training Philosophy

An introduction into kettlebell training

What is a kettlebell?

It’s a cannonball with a handle. It’s an extreme handheld gym. It’s a great strength and conditioning tool.

The kettlebell can deliver high level all-around fitness. Functional strength. Staying power. Flexibility and mobility. Fat loss without the dishonor of an aerobics class. Kettlebells can be used virtually anywhere.

Kettlebells are traditionally measured in poods. An old Russian unit of measure, a single pood weighs 16 kilograms (kg).

The general rule of thumb is that men should start with a 16 kg kettlebell. An experienced athlete can start with a 24 kg kettlebell.

For women, it is suggested that they start with an 8 kg kettlebell and 12 kg if they’re an experienced athlete.

Kettlebell safety 101
Below is a short list of rules on how to use a kettlebell safely as stated in the book Enter the Kettlebell written by kettlebell master trainer Pavel Tsatsouline.

Check with you doctor before you start training;
Always be aware of your surroundings;
Wear flat shoes;
Never, never contest for space with a kettlebell;
Practice all safety measures at all times;
Keep moving once your heart rate is high;
Build up your training load gradually using common sense, and always listen to your body;
Instruction can not cover all contingencies, and there is no substitute for good judgement.

The kettlebell sumo deadlift
The first movement to master is the kettlebell sumo deadlift. This movement requires the athlete to safely pick up the kettlebell from the floor.

Taking a comfortable stance, with feet slightly turned out. Sit back as you would in a high chair, and pick up the kettlebell with both hands by extending your hips and knees.

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The checklist:

Your arms are straight; the legs are doing all the lifting.
Your knees are pointing in the same direction as your slightly turned-out feet.
Your heels are planted. You are sitting back, rather than dipping down or bending forward.
Your back stays straight throughout. Don’t confuse “straight” with “vertical”! “Straight” in this context means “not rounded.”
You are looking straight ahead, not up or down, at all times.

Once you have mastered this simple and functional movement you will be ready to progress on to more advance kettlebell movements such as:

The kettlebell swing;
The kettlebell get-up;
The kettlebell snatch.

I have personally used kettlebells with great success over the years and can attribute a large part of my own physical conditioning to the kettlebell.

The Burpee: the ultimate conditioning tool

The burpee is a staple in many conditioning routines, and for good reason. This simple exercise can be done almost anywhere, by almost anyone.

To perform a Burpee:

Begin in a squat position with hands on the floor in front of you.
Kick your feet back, while simultaneously lowering yourself into the bottom portion of a pushup. Your arms will not be extended.
Immediately return your feet to the squat position, while simultaneously pushing “up” with your arms. You will perform a pushup as you return your feet to the squat position.
Leap up as high as possible from the squat position. Repeat, moving as fast as possible.

Burpee benefits
Some of the benefits of adding burpees to your workout routine:

Strength;
Total body conditioning;
Improved anaerobic capacity;
Improved body composition; and
Weight loss.

It’s not a Squat Thrust
At first glance, you may associate the burpee with a traditional squat thrust. Squat Thrusts are typically performed without the vertical jump. With a squat thrust, you simply “stand up” before returning to the squat position. Squat thrusts are much easier than explosive burpees.

Variations
There are many variations to performing burpees. Some will lower the intensity, while others will increase it. They include:

Burpees without a push-up;
Dumbell Burpees;
Weighted Vest Burpees; and
Medicine Ball Burpees.

With or without weighted resistance (dumbbells, vests, medicine balls, etc.), a regular dose of burpee conditioning will provide immediate, and drastic improvements in your physical fitness.

Burpee Intervals
Burpee Intervals are one of the best conditioning drills. Here is one of my favorite Burpee conditioning workouts from Infinite Intensity by Ross Enamait.

Begin with 30 seconds of Burpees, and immediately follow with 30 seconds of shadow boxing. Continue this pattern for a full 2 or 3-minute round.

The Round

30 sec x Burpees;
30 sec x shadow boxing.

Beginners

4 x 2-minute rounds with 1 minute of rest between rounds.

Intermediate

6 x 2-minute rounds with 1 minute of rest between rounds; or
4 x 3-minute rounds with 1 minute of rest between rounds.

Advanced

6 x 3-minute rounds with 1 minute of rest between rounds.

Master

6 x 3-minute rounds with 30 seconds of rest between rounds.

Energy systems of the body (simplified)

ATP broken down

The first thing to remember is that ANY muscle contraction or physical effort is due to a molecule called adenosine triphosphate (ATP). When an ATP molecule is combined with water the last of three phosphate groups splits apart and produces energy. This breakdown of ATP for muscle contraction results in adenosine diphosphate (ADP). The limited stores of ATP must be replenished for the physical effort to continue; so chemical reactions take place to add a phosphate group back to ADP to make ATP.

How ATP is produced
Take three different activities and put them on a continuum. On one end would be a quick, explosive burst such as throwing a punch. On the other end would be an extended, lower-level event such as walking five miles. Between the two could be anything. An intense twenty-second activity, one minute of constant force exertion, or a five-minute event with varied intensities of effort.

The three energy systems
Conventionally, there are three energy systems that produce ATP:

ATP-PC;
Glycolytic or lactic acid;
Aerobic or oxidative.

All systems are available and “turn on” at the onset of any activity. What dictates which one (or two) is relied upon the most is the effort required.

ATP-PC system – maximum power / short duration
ATP and phosphocreatine (PC) compose the ATP-PC system, also sometimes called the Phosphogen system. It is immediate and functions without oxygen. It allows for up to approximately 12 seconds (+ or -) of maximum effort. During the first few seconds of any activity, stored ATP supplies the energy. For a few more seconds beyond that, PC cushions the decline of ATP until there is a shift to another energy system.

Examples:

100m sprint;
Discus throw;
Weight lifting.

Lactic acid system – moderate power / moderate duration
Now it becomes more complicated as the energy demands shift to this system. The glycolytic or lactic acid system is the “next in line” tool after the ATP-PC system runs its course. Dietary carbohydrates supply glucose that circulates in the blood or is stored as glycogen in the muscles and the liver. Blood glucose and/or stored glycogen is broken down to create ATP through the process of glycolysis. Like the ATP-PC system, oxygen is not required for the actual process of glycolysis (but it does play a role with the by-product of glycolysis: pyruvic acid).

Here is where it gets interesting. After maximum power declines around 12 seconds, further intense activity up to approximately 30 seconds results in lactic acid accumulation, a decrease in power, and consequent muscle fatigue. This high, extended effort is labeled “fast” glycolysis. Exerting further effort up to approximately 60 seconds results in another drop in power due to the shift in dependence on the oxidative system.

Enter “slow” glycolysis into the discussion. Remember that the by-product of glycolysis is pyruvic acid. In fast glycolysis, more power can be generated, but pyruvic acid is converted to lactic acid and fatigue ensues quickly. Slow glycolysis is different. Relatively less power is generated, but pyruvic acid is converted to acetyl coenzyme A (acA), fed through the oxidative Krebs cycle, more ATP is produced, and fatigue is delayed.

Examples:

400m sprint;
800m sprint.

Aerobic system – low power / long duration
Your maximal effort was fueled initially by the ATP-PC, but your performance declines. Continued effort results in further decline, either via fast glycolysis (quick decline) or slow glycolysis (slower decline). You’re now entering the complex world of the low power but longer duration aerobic or oxidative system.

Examples:

5km run;
long distance running or walking.

The effort demand is low, but ATP in this system can be produced three ways:

Krebs cycle;
Electron transport chain;
Beta oxidation..

First, the science. The Krebs cycle is a sequence of chemical reactions that continues to oxidize the glucose that was initiated during glycolysis. Remember the acA? It enters the Krebs cycle, is broken down in to carbon dioxide and hydrogen, and “bang” two more ATP molecules are formed.

The problem is, the hydrogen produced in the Krebs’s cycle and during glycolysis causes the muscle to become too acidic if not tended to. To alleviate this, hydrogen combines with several enzymes and is sent to the electron transport chain. Through more chemical reactions in the electron transport chain, hydrogen combines with oxygen, water is produced, and acidity is prevented. Notice this takes time due to the need of oxygen, which is why the oxidative energy takes a while and intensity of effort declines (i.e., max effort sprints become a slow jog/walk).

The Krebs cycle and the electron transport chain metabolize triglycerides (stored fat) and carbohydrates to produce ATP. The breakdown of triglycerides is called lipolysis. The byproducts of lipolysis are glycerol and free fatty acids. However, before free fatty acids can enter the Krebs cycle they must enter the process of beta oxidation, where a series of chemical reactions downgrades them to acA and hydrogen. The acA now enters the Krebs cycle and fat is metabolized just like carbohydrates.

Simply put…
Due to the time-line, the aerobic system provides energy much more slowly than the other two systems, but has an almost unlimited supply (in your adipose tissue – yeah, that fatty stuff you can pinch). The aerobic system by itself is used primarily during complete rest and low-intensity activity. It can produce ATP through either fats (fatty acids) or carbohydrates (glucose).

Hopefully that was simple enough to understand. It is important to have a basic understanding of these energy systems when developing a training program for everybody ranging from the weekend warrior to the elite level athlete.

In a Nutshell