Tag Archives: Health

Foam Rolling your ITB won’t fix you…

One current craze in the health and fitness world is the use of a foam roller. Foam rollers are proven to hydrate tissue and improve flexibility without any detriment to power or skill. Most fitness enthusiasts know what a foam roller is and often use it during movement prep and muscle activation exercises. Some know the benefits of using one, however not many know that smashing your lio-tibial band (ITB) until your grimacing is actually a pointless task.


Over the past couple of years, many clients and friends have asked about foam rolling the ITB. My response usually involves asking them what they want to achieve by foam rolling which usually sounds something like “Pete at the office said it will loosen my ITB and stop my knee hurting”. Now, I have no problem with Pete and his suggestion, in fact it’s a great idea to help hydrate your myofascial tissue; but it won’t fix your knee and it won’t ‘loosen’ your ITB. 


In the game of chinese-whispers, foam rolling your ITB is probably the one which has gained most momentum over recent times. A gentle application of slow pressure onto quads, hamstrings and the ITB is recommended prior to and after exercises. For me and my clients, this gentle application is enough – there is no need to buy ‘The Beast’ foam roller (infact anything which claims to ‘deactivate trigger points’ should be questioned) I wouldn’t want to jab that into my quad to be honest. It’s going to be painful! From a sellers perspective, foam rollers are great. Cheap to make and easy to sell; hence the evolution of foam rolling becoming a do or die activity. It’s not long before hardware tools become marketed as ITB fixers!


Lets take three common pathologies that diagnose the ITB as the perpetrator:

Runners knee, ITB friction syndrome and lateral clicking hip syndrome


For these injuries, there’s a common treatment protocol in place from physical therapists – most will prescribe some soft tissue release work through the ITB, some heat and stretches and a little bit of a reduction in activity to allow for recovery. Then we see how we feel in 7-14 days. Most people will then have some great symptomatic relief and will be able to head out for a run again. However it is merely a band-aid solution treating only one part of the chain. The cause of your pain will be either above or below your ITB, lets discuss why:


The ITB is a fascial bridge connecting the hip and the knee, distributing stresses and movements. Establishing the anatomical connections that the ITB has is encouraged to assist in diagnosis, but often overlooked. The ITB is part of the tractus ilius tibias (TIT) which is a fascial band running from the top of the hip, laterally around the knee, and into the plantar fascia of the foot.


Deltoid of Farabeuf

A generic textbook definition of the ITB will describe the proximal attachment to the TFL and it’s distal insertion below the knee into fibula head. A functional description, allowing us to understand movement of the lower limb will mention the deltoid of farabeuf. If we look fascially at the ITB, the structure completely changes. DoF expands the current anatomical definition with more insertions and a greater influence upon gluteal muscles. The DoF suggests superficial fibres of the gluteus maximus and medius attach into the TFL and consequently into the proximal portion of the ITB. Now we can see that the function of the two gluteal muscles have a large influence on our ITB’s position and mechanical stress. This direct effect on ITB function is vital in rehabilitation and conditioning.



Below the ITB

Movement of the foot can affect the insertion of the ITB into the fibular head. Why? Well any movement from the distal end of the fibula creates movement at the proximal head (where the ITB inserts). Plantar and dorsi flexion of the ankle joint creates movement at the distal end of the fibula. Imagine we have limited dorsi flexion of the ankle joint (a very common problem) resulting in the distal head of the fibula ‘stuck’ posteriorly. Up the chain, our proximal distal head is pulled posteriorly placing the ITB in traction. All of our hard work foam rolling the painful ITB is not increasing the range of movement at our ‘stuck’ ankle joint.


Start your assessment and movement patterns above and below the ITB. Analysing your TIT (from your plantar fascia and tracking this up to the iliac crest of the glute medius) is essential. The ITB is only a symptomatic problem in the TIT. Look above and below the ITB, it’s a mechanical transfer device producing symptomatic pain.




“Brain of the upper lower limb”

A quick point to make is the structural difference of the ITB doesn’t make it a black sheep! It’s fascial, collagenous make-up helps position the rest of the quadriceps and hamstrings ensuring muscular balances are maintained. We also have 6 ‘quad’riceps but we’ll discuss that later on.


Remember, like many other muscles in the body it has a lot more attachments than we give it credit for!



1)   Look above and below the ITB when presenting with pain on the lateral leg

2)   Ensure a good range of dorsi-flexion at the ankle

3)   Poor gluteal function can lead to symptomatic ITB pain.





To Run, or to Lift… Should Endurance Athletes Exploit Strength Training Programmes?

By Josh Betteridge


With marathon season upon us, there is an inevitable increase in pedestrian traffic around us for the next few months. For all of you out there training for an event, aside from putting miles in the tank have you considered what else you can be doing? There is growing evidence suggesting more time spent in the conditioning suite can help prevent injury and to reach your running goals. I had my first run of the year a couple of days ago, running harder than I thought I would and without feeling too sore the following day. Was this a surprise to me? Nope! The training programme I have been following has allowed my body to become a stronger runner without a treadmill in sight. Today we are going to look at how cross-training your physiological systems have a profound effect on your ability to be citius, altius and fortius.


How should I be running?
Every so often, a runner asks whether they should train cross-fit, or implement a hypertrophic training programme, or even attempt to snatch their bodyweight. Before we get carried away with the new ‘lifting’ culture, the most important thing a runner should do is run. The most demanding part of your training should be running with a slight focus on strength training.


During my run I noticed a variety of gait cycles around me, some were likely to be a natural variation without the susceptibility to cause pathological problems and others probably a muscular imbalance creating a diversion of mechanical stress in certain structures.  In 2011, Patrick Makau broke the marathon world record with a time of 2.03:38. A textbook definition of his running style would indicate over-pronation of the foot, limited dorsiflexion of the ankle joint, valgus knee stress and weak gluteal muscles. This is most therapists’ favourite cocktail of pathological movement patterns to correct, using an array of rehabilitation techniques. But why would we bother correcting a world record holder’s running style? Why would we bother correcting anyone’s movement if they are pain-free and hitting their targets? The main point I am getting at here is there will be a huge variety of different running techniques from person to person, textbook definitions of how our body should move are non-applicable! If we are presenting with pain, then yes we need to assess and treat the body to disperse stresses equally. If we suspect loading patterns could be premeditating an injury, again, yes we should assess and treat. If you’re reaching your targets, there is no need to strip down the foundations of movement. If it isn’t broken, don’t fix it.


How does strength training improve my running?
The unfortunate association with strength training asks why we would train anaerobically when we are fully aware the aerobic energy system is utilized when running over a long period of time. Well, lets look at some common goals all runners want to achieve:


1) Increase Speed
Your goal as a runner is to increase the body’s ability to use oxygen efficiently. If we can train our body to use less oxygen at certain speed, the more we’ll have readily available if we want to run harder or for longer. Aagaard and Andersen (2011) concluded there was an enhancement in endurance capacity for short and long distance runners when combining strength and endurance training.  There was a particular increase in endurance performance, maximal muscle strength and muscle morphology. This is one of many studies to suggest a combination of strength and endurance training is beneficial. Taipale et al (2010), also suggested maximal or explosive strength training improves neuromuscular performance and VO2 max when training with endurance. 

It’s imperative to gain a higher percentage of muscle fibre contraction if you wish to increase your running speed. Neuromuscular activation and adaptations will occur in sync with the amount of stress you apply through specific myo-fascial tissue. When we jog, our muscle tissue does not require a large contraction of fibre to produce the movement because it doesn’t take a lot of muscle activation to move the body. The brain understands this and will complete the movement with as little energy expenditure as possible. It can pick and choose what to switch on and off depending on how strong connections are between brain and certain muscles. When we strength train however, we need a larger contraction to move. Our brain realizes it needs a higher proportion of muscle fibres and motor neurons to recruit when squatting, compared to running, to ensure you complete the movement. After consistent strength training, we now have an increased motor unit recruitment and synchronization, as well as increased force development in the muscle tissue. This is due to a simultaneous firing of more motor neurons and more muscle fibres applying an overload principle (Bawa, 2002). Picture a tug of war with only half of the people pulling – if we get the other guys to begin the pull as well, all of a sudden the strength is improved. Transferring this into your running – you’ll have a larger contraction of your muscles from strength training, simple!

2) I don’t want to get sore
There is a rational fear of strength training for many runners due to the association with muscle soreness and fatigue. Unfortunately, much of the literature surrounding strength training correctly discusses the need for recovery times and the expectation to feel DOMS up to 48 hours post-workout. Remember, we aren’t body builders, we are not expecting you to be slamming weights around and grunting. This stigma also enhances the belief that stretching and a big focus on recovery will boost their running more than strength training. Gee et al’s (2011) study proposed high-intensity strength training increases muscle soreness and decreased strength-based performance 24 hours post-exercise, however it did not reduce performance of aerobic, endurance-based activity. It is key to understand you will feel sore post-strength training, particularly in the early stages as your body adapts. In the long-term however, these adaptations are increasing neural activation and motor recruitment of your myo-fascial system allowing you to produce stronger contraction. Of course we still need to recover with stretching and rest days but they will only take you so far using them as a means of improving running.

Much of the available research is still debating the best type of strength training and when to apply it into our programme. My advice to you out there is to slowly integrate some steady strength training twice a week around your running. The gradual process of combining strength and endurance allows your body to adapt without the concern of injury or negatively affecting your running.


3) I want to prevent injury
Strength training with correct form will ultimately rid you of those niggling injuries and even chronic pain. It is so important to be strong to boost injury prevention (read thetigerbalmwarrior’s blog for more). Our bodies are full of myo-fascial imbalances determining which areas mechanical stress transfer through during movement. We are born with a blue-print of how to move, next time you see a toddler bending down to pick up something, I can guarantee you won’t be able to squat as deep! Over-time our repetitive movements and postures limit our movement ranges – altering our biomechanics. Undesirably, with repetitive running movements where stress is heavily increased, our body struggles to cope with the demand and suddenly that pain we didn’t have has developed into a tendinopathy, bursitis, muscle tear, etc. For those reading who have been clocked up a few mileage in their time will have heard of runners knee, ITBFS, plantar fasciitis, weak gluteals, medial tibial stress syndrome – the list goes on. I digress; the easiest way to eliminate these imbalances is to increase your neuromuscular activation of weak muscles (sound familiar?) to disperse the load equally through the body. How do we increase our neuromuscular and motor unit recruitment of muscle? Strength training. With more muscles recruiting, the stress is more equally distributed, just like our tug of war.

4) I don’t want to get bigger
Once again, the bodybuilding fear factor hit us and we are lead to believe we will gain heaps of muscle mass. Females in particular fear they will end up with big thighs and arms if they conduct a strength programme. This is untrue! Aagaard et al (2011) proved strength training to improve maximal force production without an increase of muscle mass and body weight.  Remember our strength-training programme will be minimalist compared to the endurance training. You will not be demanding a hypertrophic level of adaptation for your muscle. In fact, if we look at the biological processes we appreciate the opposite occurs; we can lose weight. Increased body fat slows down our metabolism due to the hormones produced, whilst more muscle and leaner tissue actually improves it. If you’re a runner who is struggling to shift a few pounds with running, the increase in heart rate with strength training compared to endurance training produces a harder output, thus more energy needed. You will have more fat (non-contractile) used as a fuel source whilst maintaining muscle (contractile) – If you’re lighter, you’re going to be faster!

Understanding our muscles breakdown during exercise and then rebuild post-workout is an important factor. During exercise, our body is working in a catabolic state which is the breakdown of tissue and afterwards an anabolic state which rebuilds our tissues. We don’t particular want muscular hypertrophy as a runner, just an increased neuromuscular adaptation to gain more power from our gait cycle. An increase in muscle mass can be detrimental as we are only fighting gravity and our own body weight when running. When we cross-train endurance and strength, we are contradicting the catabolic and anabolic processes in the body. What this means for the body is we are gaining leaner muscle tissue, converting muscles fibres to type I (more on this shortly) and reducing body fat. Crucially, we are preventing the high anabolic process of muscular hypertrophy. 

5) What type of strength training do I do?
The type of strength training will assist the converting of slow twitch muscle fibres (Type I) to fast twitch muscles fibres (Type IIa/IIb). Type II fibres produce speed and power, whereas type I are for endurance based activities. Increasing the proportion of type II allows you to sustain power and speed for a longer duration during exercise. The only way to convert these fibres is by training them in their adaptation zone, which is strength. There is plenty of research needed on fibre type, a recent course I attended suggested there are between five and seven variations of muscle fibre with varying roles. Unfortunately there are differing thoughts on how many of our fibres we can actually convert and the length of time it takes for this to happen. However, if you have rarely trained for strength consistently, you will find an immediate change in your power output as pretty much all of the research out there suggests! The adaptation process allows the fast-fatiguing, powerful type II fibres to become more fatigue-resistant and increase in concentration allowing you to rely on IIa and IIb opposed to purely the slow-twitch type I.


So, the type of strength training does not matter initially in my eyes – all have been proven to increase the proportion of faster-twitch fibres, increase neuromuscular hypertrophy and create a leaner body composition.


6) Can I get it wrong?
Using basic strength training principles it is simple to prevent yourself from getting it wrong. However there are common mistakes we make leading to pain or preventing us from improving our running. It’s essential to make sure we don’t over-train certain muscle groups. For example, most runners will have dominance through the quads and lower back where there will be a strong neuromuscular connection, plenty of sporadic collagen synthesis and plenty of fascial connections (refer to the last blog!). Because of this, the predictability of developing weak gluteal muscles, hamstrings and lower abdominals are quite likely.


Strength training should be varied! All exercise should be varied in fact (I’m sure cross-fitters have got something to say here). What’s important is to create activation of these weak areas – your glutes have probably never really functioned efficiently when running, your elongated hamstrings aren’t supporting mechanical stress and your achilles aren’t producing as much kinetic energy as they could be. We need to create a base-level of neuromuscular activation utilizing all three fibre types, producing a balanced muscular system to become energy efficient and a hell of a better runner! Once we have a base-level of strength, lets start chucking in some multi-planer, multi-dimensional power lifting exercises into the equation and you’ll soon find the myo-fascial connections between your toes all the way up to your spine will be a well-oiled machine.


Start off slow and integrate a few basic strength exercises into your programme, I have purposefully not included specific exercises – that’s a blog for another occasion. Pretty much all of the research available concludes any form of strength training will assist your running programme as long as there is a minimalist approach and correct movement patterns for your body are addressed!


A) Slowly integrate
B) You can only strength train so much before your running is compromise.
C) Build up towards multi-planer, varied, whole-body movement patterns.
D) Neuromuscular and motor unit recruitment is essential to address myo-fascial imbalances
E) You will not get bigger!!!
F) Utilizing three types of muscle fibre is better than one type.
G) Keep your energy systems guessing – variance is what keeps you strong!

(George Ashwell performing a KB clean, pout and jerk)

1) Aagaard, P. Andersen, JL. (2010) Effects of Strength Training on Endurance Capacity in Top-Level Endurance Athletes. Scandinavian Journal of Medicine & Science in Sports 2, 39-47.

2) Bawa, P.  (2002)  Neural control of motor output: Can training change it?  Exercise and Sport Science Reviews 2, 59-63.

3) Okada, T. Huxel, KC. Nesser, TW. (2011) Relationship Between Core Stability, Functional Movement and Performance. Journal of Strength and Conditioning Research 1, 252-61

4) Sato, K. Mokha, M (2009) Does Core Strength Training Influence Running Kinetics, Lower-Extremity Stability and 5000-M Performance in Runners? Journal of Strength and Conditioning Research 1, 133-40

5) Taipale, RS. Mikkola, J. Nummela, A. Vesterinen, V. Capostagno, B. Walker, S. Gitonga, D. Kraemer, WJ. Hakkinen, K.  (2010) Strength training in endurance runners.  International Journal of Sports Medicine 7, 468-76

6) Yamamoto, LM. Lopez, RM. Klau, JF. Casa, DJ. Kraemer, WJ. Maresh, CM. (2008) The Effects of Resistance Training on Endurance Distance Running Performance Among Highly Trained Runners: a systematic review. Journal of Strength and Conditiioning Research 6, 2036-44