Iliotibial Band Syndrome (ITBS)

The iliotibial band is a thick layer of tissue along the outer part of the leg that runs from the hip to the knee. Irritation can occur either in the hip or knee.

Symptoms
Pain at the outside part of the knee that is worse when bending the knee. Also may present as pain on the outside part of the hip over the greater trochanter.

Causes
Tightness in the iliotibial band is a common cause. Other causes include weakness in the muscles around the hip and buttocks (gluteus muscles), running on a sloped surface such as the beach or road or excessive pronation or rolling in of the foot.

Prevention & Treatment
Ice massage to the painful area for 10 to 15 minutes after workouts can decrease the pain. Stretching of the iliotibial band is an important component if the tendon is tight.

One stretch is to stand and cross your injured leg behind your uninjured leg and bend over to touch your toes.
A second stretch is to sit or lay on the floor with the legs out straight. Bending at the hip and knee, take the injured leg and cross it over the uninjured leg. Slowly extend at the knee to increase the stretch.

Strengthening the gluteus muscles is also important. Step lunges and leg squats can help increase gluteal muscle strength.

Exercising while sick

With the cold and flu season upon us, a common question we hear from athletes is recommendations for exercising when ill. There is some misinformation out there that suggests trying to “sweat out” a cold or flu. However, that exercise could be doing more harm than good when you’re sick.

While regular and moderate exercise such as light jogging has been shown to boost immune system function, more vigorous exercise such as a hard tempo run, intervals or racing temporarily suppresses the immune system up to 24 hours after exercise.

Immune system suppression may lead to a worsening infection such as pneumonia or bronchitis, or even an infection of the heart muscle (myocardium) called myocarditis that can be life threatening or fatal.

One easy piece of advice is to remember the “neck check” in determining whether to exercise during an illness or not. If your symptoms are mild and isolated to the neck and above, such as a runny nose or sore throat, then you’re probably ok for light to moderate workouts. If the symptoms are below the neck- fever, muscle aches and pains, productive cough, or diarrhea, then consider holding off and rescheduling your workouts.

How fast can you return to a full workout schedule? Start back at about fifty percent of your normal exercise distance or time at a reduced intensity. Also allow extra recovery time between workouts. A proper amount of rest is important to a quicker recovery. Listen to your body and if you’re finding that you fatigue quickly, continue to limit your exercise time, duration and intensity.

Plantar Fasciitis

Are you waking up in the morning dreading those first few steps because of the pain it causes in your feet? Do you avoid going barefoot on the beach because of the pain that develops in the arch of your foot?? There’s a good chance you make be suffering from plantar fasciitis.

Symptoms
Pain in the arch or the heel of the foot, usually worse with the first few steps in the morning or after sitting for a long period of time. The pain usually improves after a few minutes of walking or stretching. Some people complain of pain that develops after standing for a long period of time.

Causes
The plantar fascia is a thick band-like structure that originates from the heel bone (calcaneus) and attaches to the metatarsals. Plantar fasciitis is the result of inflammation and tightness of the fascia of the bottom of the foot.

Prevention & Treatment
Basic treatments include stretching, massage and ice. Other tips include filling a plastic soda bottle with cold water and rolling the injured, bare foot over the side of the bottle for 3 to 5 minutes at a time several times a day. Massaging the area with either a golf or tennis ball or cross-friction massage may help break up scar tissue.

Stretching exercises for plantar fascia focus on stretching the Achilles and calf muscles. Other exercises include trying to pick up a towel or small objects with the toes, which increases flexibility of the plantar fascia.

Hyponatremia in Endurance Sports

What is hyponatremia?
Hyponatremia, or low blood sodium, is a growing concern among medical staff at endurance events such as marathons and long-distance triathlons. While most cases of hyponatremia are mild and may have no symptoms at all, more serious cases can lead to significant medical problems such as seizures, swelling or the brain or even death.
A study done at the 2002 Boston Marathon found that about 13% of athletes participating in the study had mild hyponatremia after the race based on analysis of a blood sample taken at the finish line. Most of these runners had no symptoms but there was one runner died from hyponatremia.

Who is at risk?
Hyponatremia typically occurs in runners and triathletes that drink too much fluid before and during the race. It usually occurs in slower participants because they are able to drink more fluid than they lose in sweat and urine. Several cases have made national headlines including a woman the the 2002 Boston Marathon and more recently, a young mother participating in a radio contest that involved drinking large amounts of water in a short period of time.
Drinking too much water or sports drinks can dilute the level of sodium in the blood. In most cases, the kidneys handle the excess fluid intake by producing more urine. However, in athletes that develop hyponatremia, the kidneys are not able to process the extra fluid.

Hyponatremia Risk Factors
Female runners
Slower runners (> 4 hours for marathon)
Lower body-mass or weight
Drinking more than 3 liters during race
Drinking at every aid station
From Christopher SD, et al “Hyponatremia among Marathon Runners in the Boston Marathon” , NEJM

Avoiding Hyponatremia
Hyponatremia can be prevented by avoiding excessive fluid intake during the race. The goal is to try to match your fluid loss through sweating. Trying to take in fluids that have a higher sodium content may help prevent hyponatremia, although we have seen some cases of hyponatremia in triathletes that only drank sports drinks, and not water, during the race.

Achilles Tendinosis

Symptoms
Pain or swelling in the back of the calf, usually 2 to 3 inches above the back of the running shoe. The pain is typically worse when the heel strikes the ground or when pushing off from the ground on your toes.

A rupture of the Achilles can occur during a forceful push-off. Typically there is a “pop” or ripping sensation in the back of the calf, followed by pain and decreased movement of the ankle.

A suspected Achilles rupture requires evaluation by a sports medicine physician and may require surgery or prolonged immobilization in a cast or walking boot.

Causes
Common causes of Achilles tendinitis include: tight calf muscles, recent increase in running mileage or running up hills. Over-pronation (rolling in of the foot) as well as high foot arches (pes cavus) and flat feet (pes planus) can also cause Achilles tendinitis.

Prevention
Prevention includes proper stretching, slowly increasing your mileage and proper running shoe selection.

Treatment
Ice decreases inflammation, pain, and swelling. Apply ice for 10 to 15 minutes three to four times a day. Anti-inflammatory pain medications such as ibuprofen (Motrin or Advil) or naprosyn (Aleve or Naproxen) as directed by your physician.
Gentle range of motion and calf stretches can be helpful. Eccentric calf exercises can be helpful in recurrent cases.

These exercises are done by standing on a step or stairs with the toes on the step and the heels hanging off the step. Slowly lower your heel so that it drops below the step. You should feel a slight stretch in the calf. This movement is the eccentric or lengthening movement. Slowly return to the starting position. Repeat 10 to 15 times twice a day.