1
00:00:09,720 --> 00:00:12,440
Hello everybody, and welcome to 
the Doctors of Running podcast 

2
00:00:12,440 --> 00:00:14,960
where we, a group of doctors of 
physical therapy, discuss the 

3
00:00:14,960 --> 00:00:17,160
art and science of running and 
the stuff that we put on our 

4
00:00:17,160 --> 00:00:19,840
feet today. 
At the round table are two 

5
00:00:19,840 --> 00:00:23,280
people, the founder of of 
Doctors Running, Doctor Matthew 

6
00:00:23,280 --> 00:00:25,400
Klein. 
I feel like I'm saying doctor 

7
00:00:25,400 --> 00:00:29,080
about 50 times right now and 
myself, I'm Nathan Brown and I 

8
00:00:29,080 --> 00:00:31,600
will also be here today. 
We get to have another 

9
00:00:31,600 --> 00:00:35,040
conversation about one of the 
more common running related 

10
00:00:35,040 --> 00:00:38,960
injuries and I would say one of 
the more misunderstood running 

11
00:00:38,960 --> 00:00:42,520
related injuries particularly 
and how to manage it and that is

12
00:00:42,800 --> 00:00:45,520
IT band syndrome or iliotibial 
tract syndrome. 

13
00:00:45,720 --> 00:00:49,160
So we are excited to dive into 
the anatomy of this region and 

14
00:00:49,160 --> 00:00:51,760
then some of the ways that 
conservative management is 

15
00:00:51,760 --> 00:00:55,760
considered, factors that can 
actually help, other factors 

16
00:00:55,760 --> 00:00:58,920
that maybe won't be as helpful. 
And a lot of the Gray area 

17
00:00:58,920 --> 00:01:02,000
because there is a lot of Gray 
area with treating this 

18
00:01:02,000 --> 00:01:04,720
condition, particularly with 
prognosis, meaning how long is 

19
00:01:04,720 --> 00:01:07,280
it going to take for me to get 
back to running without any 

20
00:01:07,280 --> 00:01:10,040
pain? 
But before we get into that, 

21
00:01:10,480 --> 00:01:12,360
couple things that we just 
wanted to touch on. 

22
00:01:12,360 --> 00:01:15,800
Matt, you are testing a couple 
of new shoes right now. 

23
00:01:16,280 --> 00:01:18,640
One of them that we're going to 
have you talk about as a trainer

24
00:01:19,160 --> 00:01:21,080
and the other one is more of a 
racing shoe. 

25
00:01:21,080 --> 00:01:22,120
Which one do you want to start 
with? 

26
00:01:22,600 --> 00:01:24,720
Let's start with a trainer. 
So it's always a good place to 

27
00:01:24,720 --> 00:01:27,840
start in general, and it's only 
off topic, but to defend, 

28
00:01:27,840 --> 00:01:30,280
defend, defend you because it's 
so you're like, oh, it feels 

29
00:01:30,280 --> 00:01:33,960
like I'm saying doctor like 1000
times to be fair, and not too 

30
00:01:33,960 --> 00:01:35,600
long ago period. 
There's we're the two of us are 

31
00:01:35,600 --> 00:01:38,160
going to have 4 doctorate 
degrees between us, so. 

32
00:01:38,360 --> 00:01:40,360
It's almost embarrassing. 
Good luck to Nathan, who is. 

33
00:01:41,000 --> 00:01:43,280
Yeah, it's OK. 
I mean, that's what it takes for

34
00:01:43,280 --> 00:01:45,480
us to go and teach an academia 
that was PTS. 

35
00:01:45,800 --> 00:01:47,040
But yeah, it's a different 
story. 

36
00:01:48,000 --> 00:01:49,920
But yeah, I just want to wish 
you good luck with your 

37
00:01:49,920 --> 00:01:51,680
dissertation events. 
Although by the time this comes 

38
00:01:51,680 --> 00:01:52,600
out. 
Right around. 

39
00:01:52,680 --> 00:01:54,080
Right around this time, 
actually. 

40
00:01:54,120 --> 00:01:58,120
Maybe even day of. 
Day of, yeah, so everybody said.

41
00:01:58,320 --> 00:01:59,680
Or the week after, doesn't 
matter. 

42
00:01:59,920 --> 00:02:02,040
They're they're good thoughts, 
although it's a it's a good 

43
00:02:02,040 --> 00:02:04,560
time, the dissertation defense. 
I hope that you have a good one.

44
00:02:04,560 --> 00:02:08,400
I hope that it's it's fruitful 
and it is a a good experience 

45
00:02:08,400 --> 00:02:10,120
for you. 
Something I appreciate about the

46
00:02:10,120 --> 00:02:13,720
program I'm in is that they say 
upfront that they want the 

47
00:02:13,720 --> 00:02:17,000
dissertation to feel like a 
celebration, where it's not so 

48
00:02:17,000 --> 00:02:20,360
much you having to just prove 
your chops and prove your worth.

49
00:02:20,360 --> 00:02:23,680
It's more you've put in a ton of
work, you've done a lot of 

50
00:02:23,680 --> 00:02:25,440
learning, you've done this 
study, you've worked really 

51
00:02:25,440 --> 00:02:27,920
hard. 
Let's show off all the stuff 

52
00:02:27,920 --> 00:02:29,720
that this team of people has 
done. 

53
00:02:29,720 --> 00:02:32,960
So I do appreciate that. 
That's the kind of posturing of 

54
00:02:32,960 --> 00:02:36,800
the program, and I think it 
provides an opportunity, some 

55
00:02:36,800 --> 00:02:40,360
really fruitful discussion 
instead of defensive discussion.

56
00:02:40,360 --> 00:02:42,800
Do you know what I mean? 
That's really nice. 

57
00:02:42,800 --> 00:02:45,920
That's not how mine was. 
Mine was like my advisors were 

58
00:02:45,920 --> 00:02:47,840
like, yeah, we've already ripped
you apart. 

59
00:02:47,840 --> 00:02:48,880
We don't have that many 
questions. 

60
00:02:48,880 --> 00:02:50,840
We're going to bring in some 
other people who don't know bio 

61
00:02:50,840 --> 00:02:53,320
mechanics as well. 
And then I went from being 

62
00:02:53,320 --> 00:02:55,640
defensive to offensive. 
Not like I'm telling an 

63
00:02:55,640 --> 00:02:57,560
appropriate jokes, but I was 
like, oh, so you don't 

64
00:02:57,560 --> 00:02:59,240
understand this. 
Well, let me explain this to 

65
00:02:59,240 --> 00:03:00,040
you. 
And so it was. 

66
00:03:00,040 --> 00:03:03,320
Yeah, it was very still intense.
So I'm very, I've I've always 

67
00:03:03,320 --> 00:03:05,200
been very happy. 
So Nathan's always talked to me 

68
00:03:05,200 --> 00:03:07,320
about this some like a very 
supportive program, which you 

69
00:03:07,320 --> 00:03:10,960
never know what you never know. 
So I'm very, I'm very happy for 

70
00:03:10,960 --> 00:03:13,200
you and the Congrats early. 
Congratulations. 

71
00:03:13,200 --> 00:03:15,080
Hopefully that's not, you know, 
too, too early. 

72
00:03:15,080 --> 00:03:18,840
But yeah, I've, I've, I've been 
super thankful for my committee 

73
00:03:18,840 --> 00:03:20,960
chair and my committee. 
They're just great people. 

74
00:03:20,960 --> 00:03:24,800
And then, as you know, working 
full time job, also getting 

75
00:03:24,800 --> 00:03:27,720
another round of school done, 
like having Gina and Henry and 

76
00:03:27,720 --> 00:03:31,000
Ray, they've just been super 
amazing the whole way and super 

77
00:03:31,000 --> 00:03:34,160
supportive and thankful for 
other families come in and 

78
00:03:34,240 --> 00:03:36,960
helped us out along the way 
because it's, it's quite the 

79
00:03:36,960 --> 00:03:38,480
lift. 
But it's been, it's honestly 

80
00:03:38,480 --> 00:03:41,200
been so fun. 
I know that the whole route of 

81
00:03:41,200 --> 00:03:45,120
dissertation work isn't always 
clean and a joy, but I have, I 

82
00:03:45,120 --> 00:03:47,960
have overall really enjoyed the 
process, learned a ton and 

83
00:03:47,960 --> 00:03:52,120
learned how much I still have to
learn, which is fun. 

84
00:03:52,360 --> 00:03:54,880
And sorry to everybody. 
Like Matt's dissertation came 

85
00:03:54,880 --> 00:03:57,280
out and it was like, Hey, here's
some really cool things we can 

86
00:03:57,280 --> 00:04:00,280
think about the Achilles. 
Sorry, mine has nothing to do 

87
00:04:00,280 --> 00:04:02,400
with running. 
Mine is really looking at 

88
00:04:02,400 --> 00:04:06,040
health, health outcomes in rural
communities in Wisconsin and the

89
00:04:06,040 --> 00:04:07,280
roles of physical therapist 
there. 

90
00:04:07,280 --> 00:04:09,120
So I think it's super 
interesting. 

91
00:04:09,280 --> 00:04:12,480
I don't think people who follow 
Doctors of Running are 

92
00:04:12,480 --> 00:04:16,360
necessarily going to like, can't
wait to read the dissertation, 

93
00:04:16,560 --> 00:04:19,480
so I apologize for that. 
To be fair, I also geek on that 

94
00:04:19,480 --> 00:04:22,680
as someone who's also like in 
the like process of kind of 

95
00:04:22,680 --> 00:04:26,760
getting into a primary carrier 
and, and rural areas here in 

96
00:04:26,760 --> 00:04:28,560
Oregon. 
So I geek out about it, but 

97
00:04:28,880 --> 00:04:31,400
we'll, we'll have some stuff 
waiting and ready to go. 

98
00:04:31,400 --> 00:04:33,480
So don't worry, we'll have 
plenty of other stuff for people

99
00:04:33,480 --> 00:04:34,800
to geek out on. 
Absolutely. 

100
00:04:34,800 --> 00:04:36,720
But sweet. 
All right, let's talk. 

101
00:04:36,720 --> 00:04:38,080
About the cumulus, let's talk 
about. 

102
00:04:38,080 --> 00:04:39,960
The cumulus, I'm going to take 
that off off. 

103
00:04:40,080 --> 00:04:42,640
I got to take that off topic and
wish you good luck. 

104
00:04:43,400 --> 00:04:47,080
So previous stimulus, this is 
the version 27, which blows my 

105
00:04:47,080 --> 00:04:49,160
mind to realize this shoes been 
around for that long. 

106
00:04:49,160 --> 00:04:51,840
It's again one of those I would 
almost call it like a legacy 

107
00:04:51,840 --> 00:04:54,480
shoe where it was around back 
when many of us were younger and

108
00:04:54,480 --> 00:04:56,560
working in running stores and 
it's still around. 

109
00:04:57,040 --> 00:05:00,120
It looks very different than 
what it did for sure, just as 

110
00:05:00,120 --> 00:05:03,320
the Nimbus does, but this is I 
would call this ASIC standard 

111
00:05:03,320 --> 00:05:06,480
daily neutral running shoe, 
although it's not fully neutral,

112
00:05:06,480 --> 00:05:09,920
it's a different story, but it's
a solid shoe. 

113
00:05:09,920 --> 00:05:12,560
It's one of the fewer shoes now,
especially even in the ASICS 

114
00:05:12,560 --> 00:05:15,160
lineup that's under 40mm, 
although running warehouses 

115
00:05:15,160 --> 00:05:17,800
giving some slightly different 
stack height measurements on 

116
00:05:17,800 --> 00:05:19,400
that. 
It's a it's a good standard. 

117
00:05:19,400 --> 00:05:21,840
I'm not going to say borne, but 
just say a good consistent shoe,

118
00:05:21,840 --> 00:05:24,360
like a really great shoe for 
newer runners. 

119
00:05:25,040 --> 00:05:29,560
The foam is slightly softer 
without being mushy and it's 

120
00:05:29,560 --> 00:05:32,160
just got a ton of is there's 
pure gel on the heel flight foam

121
00:05:32,160 --> 00:05:35,200
blast plus, and it's got this 
really interesting outsole where

122
00:05:35,200 --> 00:05:38,640
it's it's like supposed to be an
outsole, but it's kind of not. 

123
00:05:39,080 --> 00:05:42,280
And the last version I hated it.
There was just so much 

124
00:05:42,280 --> 00:05:44,400
aggressive toe spring. 
It felt short. 

125
00:05:44,680 --> 00:05:47,040
I didn't it just wrecked my toes
got wrecked. 

126
00:05:47,040 --> 00:05:49,680
The fit was really, really off. 
So I didn't even I did the best 

127
00:05:49,680 --> 00:05:51,920
I could do to get miles despite 
some blisters and I was like, 

128
00:05:51,920 --> 00:05:55,520
Nah, this even though it's 
supposed to be an upper update. 

129
00:05:55,520 --> 00:05:58,080
They did a lot of changes. 
The toe spring is noticeably 

130
00:05:58,080 --> 00:06:02,000
lower fits much, much better 
because the toe springs lower. 

131
00:06:02,000 --> 00:06:04,160
The four foot is just a teeny 
bit stiffer. 

132
00:06:04,320 --> 00:06:07,400
Side walls feel more prominent. 
Or maybe I just could notice 

133
00:06:07,400 --> 00:06:11,160
some more in the heel. 
But it's really a good, solid, 

134
00:06:11,240 --> 00:06:14,080
consistent shoe. 
Like it's not fancy, it's not a 

135
00:06:14,080 --> 00:06:17,000
super foam, It's not crazy. 
The durability is a little, as 

136
00:06:17,000 --> 00:06:19,000
you can see for those on 
YouTube, you can say I'm already

137
00:06:19,000 --> 00:06:21,320
I'm ripping through this. 
So durability is not hot with 

138
00:06:21,320 --> 00:06:23,000
this. 
And I want to ask Nathan about 

139
00:06:23,000 --> 00:06:24,440
the second this. 
This is not. 

140
00:06:24,440 --> 00:06:26,680
It's like a exposed midsole. 
Slash. 

141
00:06:26,680 --> 00:06:29,720
It's like a rubberized DVA, I'm 
guessing I, I don't know the 

142
00:06:29,720 --> 00:06:33,720
specifics on the material, so if
somebody does let us know, but 

143
00:06:34,560 --> 00:06:38,520
it reminded me back, I don't 
know, four years ago or so when 

144
00:06:38,520 --> 00:06:42,120
the first Carbon X came out, 
they used to rubberize DBA 

145
00:06:42,120 --> 00:06:45,600
outsole and then that was also 
the mock X series until the mock

146
00:06:45,880 --> 00:06:49,720
or sorry not Mac X, the mock 
series until they got to the 

147
00:06:49,720 --> 00:06:52,000
mock 6. 
They added rubber to the 

148
00:06:52,000 --> 00:06:55,240
outsole, which made it one of my
favorite in my favorite mock to 

149
00:06:55,240 --> 00:06:56,720
date. 
They also changed the foam a 

150
00:06:56,720 --> 00:07:01,080
lot. 
But I I appreciate having for a 

151
00:07:01,160 --> 00:07:04,400
workhorse trainer or a daily 
trainer, having rubber on the 

152
00:07:04,400 --> 00:07:06,840
outsole just makes a lot of 
sense to me. 

153
00:07:06,840 --> 00:07:09,360
And the fact that this is just a
rubberized DVAI think is a 

154
00:07:09,360 --> 00:07:12,520
shortcoming of the shoe. 
I have been able to run a little

155
00:07:12,520 --> 00:07:14,440
bit in that shoe on the 
treadmill. 

156
00:07:14,440 --> 00:07:17,480
I haven't taken outside because 
they're still like snow. 

157
00:07:17,760 --> 00:07:21,560
And if there's ever snow and 
there's no rubber that there's 

158
00:07:21,560 --> 00:07:23,760
no grip at all. 
So it's not worth, it's not even

159
00:07:23,760 --> 00:07:26,560
worth me trying should melt in 
the next couple days because 

160
00:07:26,560 --> 00:07:29,840
it's been like 6 almost 60°. 
It's been amazing. 

161
00:07:30,360 --> 00:07:33,800
And so I think that that's a 
shortcoming of the shoe still is

162
00:07:33,800 --> 00:07:37,640
the decision to have it as a 
kind of rubberized foam of some 

163
00:07:37,640 --> 00:07:40,720
kind or some kind of toughened 
foam on the outside to make the 

164
00:07:40,720 --> 00:07:44,520
outsole because you're just 
missing out on some durability. 

165
00:07:45,320 --> 00:07:49,520
My question for you is if you 
had to choose between that shoe,

166
00:07:49,520 --> 00:07:53,720
the Cumulus and the try NUSA, 
which shoe are you picking? 

167
00:07:53,720 --> 00:07:57,120
Because they're, you know, the 
try new is $135. 

168
00:07:57,120 --> 00:08:01,680
That one's 140. 
And I would say I, I believe 

169
00:08:01,680 --> 00:08:04,720
there's a lot of similarities 
between the two shoes. 

170
00:08:05,240 --> 00:08:08,000
Which one are you picking? 
It will. 

171
00:08:08,200 --> 00:08:11,400
So are we just talking in 
general or we just are we 

172
00:08:11,400 --> 00:08:17,440
talking for a specific purpose? 
That's going to be hard. 

173
00:08:17,640 --> 00:08:20,600
I'm going to have to say, yeah, 
you stumped me. 

174
00:08:20,600 --> 00:08:23,960
You got me really, really good. 
So I've that that is really hard

175
00:08:23,960 --> 00:08:25,680
because I I love lightweight 
trainers. 

176
00:08:25,680 --> 00:08:28,800
So there's a little bit of bias 
toward the Trinusa, but I am 

177
00:08:28,800 --> 00:08:31,440
actually really enjoyed the 
simple ride of this and the fact

178
00:08:31,440 --> 00:08:33,720
that the heel is like really 
nicely stable. 

179
00:08:34,320 --> 00:08:37,400
And they did a really good job 
adding a slightly posterolateral

180
00:08:37,400 --> 00:08:40,520
heel bevel here, which is not 
super common for ASICS or 

181
00:08:40,520 --> 00:08:42,880
anybody. 
So that's been a really nice 

182
00:08:42,880 --> 00:08:44,840
touch and the fact that it's 
really simple. 

183
00:08:47,240 --> 00:08:49,920
I which the durability also 
makes it closer because the 

184
00:08:49,920 --> 00:08:52,640
Chinese has much better outsole 
durability than this. 

185
00:08:52,640 --> 00:08:57,840
But I'm going to have to go with
the Cumulus 27 on this because 

186
00:08:57,840 --> 00:09:00,240
of the verse, the versatility 
into being a little bit more 

187
00:09:00,240 --> 00:09:01,880
cushioned. 
I've done everything in this 

188
00:09:01,880 --> 00:09:03,640
already. 
I've done a workout. 

189
00:09:03,640 --> 00:09:05,000
I just did a longer this 
morning. 

190
00:09:05,000 --> 00:09:06,680
I've done several easy runs in 
this shoe. 

191
00:09:07,800 --> 00:09:10,920
It's not a super fast shoe, but 
it's definitely on the lighter 

192
00:09:10,920 --> 00:09:14,080
end for daily trainers and I've 
done a workout, it's fine. 

193
00:09:14,080 --> 00:09:16,880
It's not the fastest shoe, but 
for kind of where I am at this 

194
00:09:16,880 --> 00:09:19,360
point in my life where I just 
want a like a standard daily 

195
00:09:19,360 --> 00:09:21,800
trainer, a lot of the times I'm 
going to probably pick the 

196
00:09:21,800 --> 00:09:26,280
cumulus and the, the change in 
the forefoot and the the rocker 

197
00:09:26,280 --> 00:09:28,200
profile. 
It really, really made it a lot 

198
00:09:28,200 --> 00:09:29,360
better. 
Just know it's very stiff 

199
00:09:29,360 --> 00:09:31,640
initially. 
So I think it's not running 

200
00:09:31,640 --> 00:09:34,040
nearly as fast right now. 
This. 

201
00:09:34,280 --> 00:09:37,840
If I was in my speedier era, 
then maybe it would be the 

202
00:09:37,840 --> 00:09:41,560
Trinusa, but I think the update 
here is is very, very good, 

203
00:09:41,560 --> 00:09:43,120
although we still got to work on
that durability. 

204
00:09:43,640 --> 00:09:47,800
Yeah, well, that's surprising. 
I'm a I'm a hands down Trinusa 

205
00:09:47,800 --> 00:09:51,600
person because I think a lot of 
what I what you like about the 

206
00:09:51,920 --> 00:09:55,520
cumulus is what I like about the
nuisance, the simplicity of it. 

207
00:09:55,520 --> 00:09:59,560
It's not a fancy foam. 
It's got a mild, mild semi 

208
00:09:59,600 --> 00:10:02,840
rigid, but semi flexible kind of
four foot that has a slight 

209
00:10:02,840 --> 00:10:04,840
rocker. 
The toe springs not too crazy. 

210
00:10:04,960 --> 00:10:06,800
I agree with you. 
They improved the toe spring on 

211
00:10:06,800 --> 00:10:09,160
the 27 as well. 
It's not as noticeable as the 

212
00:10:09,160 --> 00:10:12,960
previous version. 
So because it has rubber and 

213
00:10:12,960 --> 00:10:16,720
because it's $5 cheaper and I 
think the upper is hard to beat 

214
00:10:16,720 --> 00:10:20,280
for the Trinusa I I go that way,
but I also don't need as much 

215
00:10:20,280 --> 00:10:22,840
structure through the heel as 
you do, So I can see why you 

216
00:10:23,040 --> 00:10:24,400
verge that way a little bit. 
Yeah. 

217
00:10:24,520 --> 00:10:26,880
What's the other shoe that? 
Was a tough question, by the 

218
00:10:26,880 --> 00:10:28,400
way. 
That was a really good one, yes.

219
00:10:28,400 --> 00:10:30,840
What's your other shoe that 
you've been testing? 

220
00:10:30,840 --> 00:10:34,440
The racing shoe. 
So it's the Diadora Gar Carbon 

221
00:10:34,440 --> 00:10:38,400
2, which I did not test the 
original 1 Andrea did, but I was

222
00:10:38,400 --> 00:10:41,440
really excited to get this on my
feet and it was it's very 

223
00:10:41,440 --> 00:10:44,160
different. 
It is not kind of in traditional

224
00:10:44,160 --> 00:10:46,360
line with a lot of super shoes, 
although it's got the the 

225
00:10:46,360 --> 00:10:48,680
factors you need. 
It's got the Super foam PX foam,

226
00:10:49,000 --> 00:10:51,640
is that right? 
PX the yeah, PBX foam. 

227
00:10:52,280 --> 00:10:53,640
It's got a carbon plate in 
there. 

228
00:10:53,640 --> 00:10:56,320
It's a little lower drop, so 
it's 5mm drop and then there is 

229
00:10:56,320 --> 00:10:59,560
a full length carbon fiber plate
obviously to to top things off. 

230
00:11:00,760 --> 00:11:03,360
I was very interested in this. 
I never tried it before. 

231
00:11:03,360 --> 00:11:05,800
Some people had said the 
previous version was stable. 

232
00:11:06,600 --> 00:11:10,480
It's not stable really at all. 
I can run decent businesses in 

233
00:11:10,480 --> 00:11:13,080
this just because I'm a lot 
stronger than I used to be, but 

234
00:11:13,080 --> 00:11:16,920
the platform is fairly narrow. 
There's no side walls or 

235
00:11:16,920 --> 00:11:19,680
anything like that, but the 
midsole is fairly soft. 

236
00:11:19,680 --> 00:11:25,240
It feels very similar to like 
almost like the New Balance fuel

237
00:11:25,240 --> 00:11:29,800
cell, the RC Elite 3 or 4. 
It's got that kind of feel. 

238
00:11:29,800 --> 00:11:32,880
It's not as aggressively fast. 
It's still comfortable. 

239
00:11:32,880 --> 00:11:35,400
It could still move it used for 
a lot of workouts, but it feels 

240
00:11:35,400 --> 00:11:37,760
more comfortable, like it would 
work better for some with 

241
00:11:37,760 --> 00:11:40,760
neutral mechanics, especially 
like a recreation runner just 

242
00:11:40,760 --> 00:11:43,880
getting into the stuff who's got
got some cash to burn because 

243
00:11:43,880 --> 00:11:47,880
it's 300 bucks right? 
Which that cost is insane. 

244
00:11:47,880 --> 00:11:51,080
But it's also pretty narrow. 
So not narrow but like snug. 

245
00:11:51,080 --> 00:11:53,680
So people with narrower feet or 
want a narrower platform. 

246
00:11:53,760 --> 00:11:56,480
Not narrow. 
Not narrow on the outsole like 

247
00:11:56,520 --> 00:11:59,440
connection to the ground as much
as you meant narrow upper or. 

248
00:11:59,600 --> 00:12:03,200
Both both actually like the 
actual width of the shoe and the

249
00:12:03,200 --> 00:12:06,960
upper are just a little bit more
narrow which has been fine but 

250
00:12:06,960 --> 00:12:10,400
like for shorter distances, but 
wouldn't be my choice for longer

251
00:12:10,400 --> 00:12:14,160
races where it would probably 
actually do best based on the 

252
00:12:14,160 --> 00:12:16,760
foam responsiveness. 
So it's like it's not in your 

253
00:12:16,760 --> 00:12:21,200
tier one category, it's more of 
like it's the durability is 

254
00:12:21,200 --> 00:12:24,960
actually pretty decent. 
I've got like 40 ish miles on my

255
00:12:24,960 --> 00:12:27,560
pair and I still haven't ripped 
the outsole off completely which

256
00:12:27,560 --> 00:12:29,120
is great. 
Which that's a big deal. 

257
00:12:29,360 --> 00:12:33,120
That's surprising too with how 
the the shorter cut on that 

258
00:12:33,120 --> 00:12:35,440
lateral side. 
Usually that's where you RIP it 

259
00:12:35,440 --> 00:12:37,240
off too. 
Yes, I mean, give me another run

260
00:12:37,240 --> 00:12:41,440
or two, we'll see. 
But yeah, I think it's it's like

261
00:12:41,880 --> 00:12:46,040
a it's like somebody combined 
the Soccone Endorphins speed in 

262
00:12:46,040 --> 00:12:49,320
pro almost where it's like, yes,
this could totally be a great 

263
00:12:49,320 --> 00:12:51,880
speed trainer for people that 
want a really comfortable shoe, 

264
00:12:52,200 --> 00:12:53,680
but it can get aggressive if you
want. 

265
00:12:53,680 --> 00:12:56,400
It's just it's not really in 
either camp. 

266
00:12:56,400 --> 00:12:59,120
It's in this kind of interesting
middle ground for sure. 

267
00:12:59,600 --> 00:13:00,320
Very cool. 
Yeah. 

268
00:13:01,360 --> 00:13:05,280
Also this is. 
I don't know why this popped 

269
00:13:05,280 --> 00:13:07,920
into my head. 
What's your perspective on on 

270
00:13:08,160 --> 00:13:13,040
grape flavored candy or grape 
flavored items in general? 

271
00:13:13,240 --> 00:13:14,960
Can I get to the punchline on 
this really quick? 

272
00:13:15,040 --> 00:13:16,080
Maybe. 
I don't know. 

273
00:13:16,920 --> 00:13:18,560
Yeah. 
Is it a are you a joke? 

274
00:13:18,560 --> 00:13:19,520
No, it's not a joke. 
Or no. 

275
00:13:19,520 --> 00:13:21,520
You know where you're going. 
I know where you're going with 

276
00:13:21,520 --> 00:13:22,000
this. 
OK. 

277
00:13:22,000 --> 00:13:22,880
Yeah, go ahead. 
Yeah. 

278
00:13:23,040 --> 00:13:25,040
So like shout out to Scratch 
Lab. 

279
00:13:25,040 --> 00:13:27,400
They're really kind and they 
send this stuff like to test 

280
00:13:27,400 --> 00:13:28,520
out. 
So they just send us their new 

281
00:13:28,720 --> 00:13:33,640
grape flavored shoes, which I, 
you know, how do I say this? 

282
00:13:34,120 --> 00:13:37,560
I really like to choose and they
are a bit expensive, but I 

283
00:13:37,560 --> 00:13:40,400
really, really, really like 
them, especially from scratch 

284
00:13:40,400 --> 00:13:43,120
labs because they do this a, it 
tastes really good. 

285
00:13:43,120 --> 00:13:44,800
They got the little like 
crystalline thing on the 

286
00:13:44,800 --> 00:13:46,880
outside. 
It's just they melt really 

287
00:13:46,880 --> 00:13:48,480
nicely in your mouth. 
They're always really great. 

288
00:13:49,760 --> 00:13:52,680
But yeah, grape isn't usually 
something I'm going to reach 

289
00:13:52,680 --> 00:13:55,280
for. 
It's not on the top of my list 

290
00:13:55,280 --> 00:13:57,640
of like, ha, these were actually
really good. 

291
00:13:57,720 --> 00:14:00,840
I smiley enjoying them, Yeah. 
For sure enough where it's not 

292
00:14:00,840 --> 00:14:03,520
like what's this Concorde grape 
doing in my stomach and I'm 

293
00:14:03,520 --> 00:14:06,440
trying to run right now. 
Yeah, no, I've taken it as a 

294
00:14:06,800 --> 00:14:10,400
like snack throughout the day. 
I've done an on run and kudos to

295
00:14:10,400 --> 00:14:13,000
scratch and this is like, yeah, 
I know that they like send us 

296
00:14:13,000 --> 00:14:14,080
some stuff and it's really, 
really nice. 

297
00:14:14,080 --> 00:14:17,840
But those choose dissolved so 
nicely on run. 

298
00:14:17,840 --> 00:14:20,840
Like I feel like choose for me 
is like a hit or miss. 

299
00:14:20,840 --> 00:14:24,720
Like, I don't, I'll do that pre 
run, not usually during run, but

300
00:14:24,720 --> 00:14:27,680
it just dissolves very nicely 
and never had an upset stomach. 

301
00:14:27,680 --> 00:14:31,040
And I'm like my stomach's a bit 
of a Prince like Princess like 

302
00:14:31,080 --> 00:14:33,920
and the pee kind of thing. 
So it was that, yeah, I've 

303
00:14:33,920 --> 00:14:35,720
really enjoyed it. 
And the grape is pretty mild. 

304
00:14:35,720 --> 00:14:37,080
It's great. 
Sweet. 

305
00:14:37,960 --> 00:14:40,440
Well, let's get into what we 
really care about talking about 

306
00:14:40,440 --> 00:14:45,320
today, which is IT band 
syndrome, illotibial tract and 

307
00:14:45,680 --> 00:14:47,280
IT band syndrome. 
We're going to get into 

308
00:14:47,280 --> 00:14:51,360
definitions later and causes and
all that kind of stuff, but this

309
00:14:51,360 --> 00:14:53,880
condition is one that affects a 
lot of runners. 

310
00:14:53,880 --> 00:14:57,840
It's usually near the top of 
systematic reviews that look at 

311
00:14:58,080 --> 00:15:01,040
the types of running related 
injuries that runners most 

312
00:15:01,040 --> 00:15:05,040
commonly get. 
About 12 to 16% of runners have 

313
00:15:05,480 --> 00:15:08,600
gotten IT band syndrome at some 
point, or that's the the 

314
00:15:08,600 --> 00:15:10,040
prevalence that happens. 
You've had it. 

315
00:15:10,080 --> 00:15:12,640
I know I've had it. 
It was the thing that was the 

316
00:15:12,640 --> 00:15:15,480
bane of my existence for my 
first marathon when I did 

317
00:15:15,480 --> 00:15:18,840
Chicago back in 2017, I think 
was my first one. 

318
00:15:19,480 --> 00:15:23,640
So it's something that many 
people have dealt with or people

319
00:15:23,640 --> 00:15:27,160
are like, I know it exists, what
the heck can I do to have it not

320
00:15:27,160 --> 00:15:29,520
happen to me? 
But before we get into more 

321
00:15:29,520 --> 00:15:32,400
about the syndrome itself, do 
you want to give us a rundown 

322
00:15:32,400 --> 00:15:35,760
and basic overview of the 
anatomy of the IT band? 

323
00:15:35,800 --> 00:15:38,600
Yeah. 
So the anatomy of this thing, 

324
00:15:38,600 --> 00:15:41,120
and for those who don't know, 
it's kind of ironically, it's 

325
00:15:41,120 --> 00:15:43,880
one of the things that actually 
makes us uniquely human is that 

326
00:15:43,880 --> 00:15:46,800
it's this long band. 
And they kind of argue as to 

327
00:15:46,800 --> 00:15:49,880
what exactly it, whether it's 
fascia, whether it's connective 

328
00:15:49,880 --> 00:15:51,680
tissue, whether it's an extended
tendon. 

329
00:15:51,920 --> 00:15:54,120
You talk to different anatomist,
they're going to argue on the 

330
00:15:54,120 --> 00:15:56,480
stuff, but it's basically this 
tissue that goes from the 

331
00:15:56,480 --> 00:15:59,000
lateral aspect of your hip or 
the outside part of your hip. 

332
00:15:59,000 --> 00:16:03,000
And the two places it originates
from are your ileo, you're not 

333
00:16:03,000 --> 00:16:07,000
your ilio tibial tract, your 
tensor fascial lada, which is a 

334
00:16:07,000 --> 00:16:10,520
small hip flexor hip abductor on
the front of your hip, front 

335
00:16:10,520 --> 00:16:13,720
lateral aspect of your hip, and 
actually your glute Max, that 

336
00:16:13,720 --> 00:16:17,600
big hip muscle in the back. 
But the most external one, those

337
00:16:17,600 --> 00:16:20,040
two muscles come together and 
some of their tendons and some 

338
00:16:20,040 --> 00:16:23,040
of their attachments actually 
come and become the iliotibial 

339
00:16:23,040 --> 00:16:26,480
band that continues down all the
way down the side of your leg 

340
00:16:26,800 --> 00:16:29,280
all the way into this really 
cool area called Giri's 

341
00:16:29,280 --> 00:16:31,600
tubercle, which is on the 
lateral aspect of your knee. 

342
00:16:31,960 --> 00:16:35,320
And the purpose of this thing is
actually to help facilitate 

343
00:16:35,400 --> 00:16:37,560
upright gait. 
And it's one of these things 

344
00:16:37,560 --> 00:16:39,760
that allows us to actually spend
more time up there. 

345
00:16:39,840 --> 00:16:42,160
It's a long thing. 
There's a really long lever arm 

346
00:16:42,360 --> 00:16:45,680
really it does help to some 
degree with some level of knee 

347
00:16:45,680 --> 00:16:48,000
control, a little bit of hip. 
And it's another area that helps

348
00:16:48,000 --> 00:16:51,120
connect the hip and the knee. 
Those areas are very, very 

349
00:16:51,120 --> 00:16:53,280
related. 
Now it's, it's this long 

350
00:16:53,280 --> 00:16:55,520
connective tissue, the IT band 
itself. 

351
00:16:55,520 --> 00:16:57,080
This is really important for 
later. 

352
00:16:57,080 --> 00:17:01,560
That thing does not contract. 
It can get pulled on, but the 

353
00:17:01,560 --> 00:17:03,480
muscles are the things that 
contract. 

354
00:17:03,480 --> 00:17:06,839
So the tenser fascia lotta up 
higher, the glute Max, those 

355
00:17:06,839 --> 00:17:09,160
things contract. 
The iliotibial band does not 

356
00:17:09,160 --> 00:17:11,040
contract. 
And I will tell you, and I'm 

357
00:17:11,040 --> 00:17:12,960
sure Nathan might be able to say
this from being in a cadaver 

358
00:17:12,960 --> 00:17:16,200
lab, if you try to stretch that 
thing, it doesn't really 

359
00:17:16,200 --> 00:17:18,240
stretch. 
It's pretty thick and it's 

360
00:17:18,240 --> 00:17:20,640
pretty stiff. 
It's a wonderful tissue that 

361
00:17:20,640 --> 00:17:23,480
will really pull nicely, create 
some lateral stability on the 

362
00:17:23,480 --> 00:17:26,200
lateral side of the body. 
It does not stretch, however, 

363
00:17:26,400 --> 00:17:29,000
there's some places where it can
commonly get really irritated. 

364
00:17:29,000 --> 00:17:31,400
There are several Bursa that sit
right under it. 

365
00:17:31,400 --> 00:17:34,480
So there's one that sit right 
under it at the at that outside 

366
00:17:34,480 --> 00:17:37,320
part of the hip at what's called
the greater trochanter. 

367
00:17:37,320 --> 00:17:39,160
And there's a like the lateral 
Bursa right there. 

368
00:17:39,360 --> 00:17:42,840
And these are these fluid filled
SAC sacs that help this tissue 

369
00:17:42,840 --> 00:17:44,680
slide over these Bony 
prominences. 

370
00:17:44,840 --> 00:17:48,080
There is also one farther down 
in the lateral knee and these 

371
00:17:48,080 --> 00:17:52,120
are suggested sometimes to 
occasionally be symptom sources 

372
00:17:52,120 --> 00:17:55,920
for iliotibial syndrome and 
other times it might actually be

373
00:17:56,560 --> 00:17:59,800
nerves or the insertion itself. 
So that's the quick overview of 

374
00:17:59,800 --> 00:18:01,400
some of the tissue. 
Anything you would add on that? 

375
00:18:01,720 --> 00:18:04,200
I think the. 
Only thing I'd add is some of 

376
00:18:04,200 --> 00:18:06,160
the diversified attachment at 
the knee. 

377
00:18:06,360 --> 00:18:09,400
So as you said, it goes from the
hip down to the outside of the 

378
00:18:09,400 --> 00:18:12,400
knee and attaches primarily into
Gertie's tubercle, which is part

379
00:18:12,400 --> 00:18:15,120
of the tibia, which is kind of 
your your main shin bone. 

380
00:18:15,120 --> 00:18:17,920
Like if you knock on your shin, 
that's your tibia, it's 

381
00:18:17,920 --> 00:18:20,600
attaching into there. 
But the I team had also kind of 

382
00:18:20,600 --> 00:18:23,160
fans out. 
So part of it will go into your 

383
00:18:23,160 --> 00:18:25,720
kneecap, into your Patella. 
Part of it might go down to the 

384
00:18:25,720 --> 00:18:28,640
fibular head, part is going to 
go into the joint capsule. 

385
00:18:28,880 --> 00:18:32,840
It does fan out and that's why 
sometimes symptom presentations 

386
00:18:32,840 --> 00:18:35,400
can be a little bit varied 
between people depending on 

387
00:18:35,400 --> 00:18:39,360
which area is irritated or where
extra pressure is going. 

388
00:18:39,720 --> 00:18:43,480
The other part of the anatomy 
that I think is interesting and 

389
00:18:43,480 --> 00:18:47,880
contested in some ways is, and 
this kind of brings us into our 

390
00:18:47,880 --> 00:18:51,200
discussion regarding the 
syndrome itself, but is how it 

391
00:18:51,200 --> 00:18:54,120
interacts with your femur, that 
long thigh bone. 

392
00:18:54,280 --> 00:18:58,320
So as it's coming down the 
outside, it crosses over what's 

393
00:18:58,320 --> 00:19:01,920
called the lateral epicondyle, 
which is kind of a Bony 

394
00:19:01,920 --> 00:19:04,080
prominence on the outside of 
your thigh bone. 

395
00:19:05,120 --> 00:19:09,400
And there is some cadaveric 
evidence that the IT band 

396
00:19:09,400 --> 00:19:15,440
actually has solid attachments 
to the lateral epicondyle, which

397
00:19:15,440 --> 00:19:18,880
would mean that the pain that 
can come from it is not from 

398
00:19:18,880 --> 00:19:22,000
friction rubbing over, but due 
to compression over the 

399
00:19:22,000 --> 00:19:26,000
structures underneath it. 
The other side of the coin says 

400
00:19:26,040 --> 00:19:27,840
it doesn't have solid 
attachments there. 

401
00:19:27,840 --> 00:19:31,200
And when you bend and extend 
your knee, the IT band kind of 

402
00:19:31,200 --> 00:19:34,480
flips over and back across this 
external bone. 

403
00:19:34,760 --> 00:19:39,520
And that friction can cause some
of the irritation to the IT band

404
00:19:39,520 --> 00:19:42,320
or the underlying structures. 
So I think that's another 

405
00:19:42,320 --> 00:19:45,120
important part is how it goes 
across the outside of the knee 

406
00:19:45,280 --> 00:19:47,200
and that interaction with the 
femur. 

407
00:19:47,640 --> 00:19:49,040
What you got, Matt and I will 
say. 

408
00:19:49,040 --> 00:19:51,560
That probably whenever I hear 
that so some people might get 

409
00:19:51,560 --> 00:19:53,880
really confused and go, OK, 
well, I guess nothing matters 

410
00:19:53,880 --> 00:19:57,120
then I'm going to disagree with 
that that I think when you hear 

411
00:19:57,120 --> 00:20:00,000
that kind of stuff, both are 
probably true and you have to 

412
00:20:00,000 --> 00:20:03,400
realize this is the variety that
you see with human anatomy that 

413
00:20:03,400 --> 00:20:05,960
sometimes you'll have the 
certain even certain muscles, 

414
00:20:05,960 --> 00:20:08,880
certain things they'll attach 
some odd places sometimes that 

415
00:20:08,880 --> 00:20:12,320
it's not perfect. 
So there are probably different 

416
00:20:12,320 --> 00:20:15,040
and and anatomical variances in 
people and some people might 

417
00:20:15,040 --> 00:20:16,840
get. 
Bit more compressive tension, 

418
00:20:17,160 --> 00:20:20,320
like like twisting friction, 
what have you. 

419
00:20:20,320 --> 00:20:23,240
So no, that's why as we talked 
about this, there's going to be 

420
00:20:23,240 --> 00:20:25,520
some variety of experiences 
there, probably because 

421
00:20:25,520 --> 00:20:27,720
everybody's anatomy is a little 
bit different. 

422
00:20:28,360 --> 00:20:32,480
I would say just to bounce off 
of that as an exemplar of 

423
00:20:32,640 --> 00:20:36,080
anatomical variability, when we 
were doing a cadaveric 

424
00:20:36,080 --> 00:20:39,320
dissection during PT school, we 
were looking at the 

425
00:20:39,680 --> 00:20:42,600
relationship. 
So, well, I'll back up for a 

426
00:20:42,600 --> 00:20:44,480
second. 
Many people have heard of the 

427
00:20:44,480 --> 00:20:49,120
term quote piriformis syndrome 
and part of the theory behind 

428
00:20:49,120 --> 00:20:52,680
piriformis syndrome. 
I'm not putting any sort of 

429
00:20:52,680 --> 00:20:55,200
weight on the words I'm about to
say just for the sake of the 

430
00:20:55,200 --> 00:21:00,480
analogy or the example is that 
the piriformis is very closely 

431
00:21:00,480 --> 00:21:03,520
related to your sciatic nerve. 
They run very close to each 

432
00:21:03,520 --> 00:21:08,640
other and in our cadaver lab, 
some of people's sciatic nerves 

433
00:21:08,640 --> 00:21:12,160
passed underneath the 
piriformis, some of them passed 

434
00:21:12,200 --> 00:21:15,760
over the piriformis, and some of
them went through the 

435
00:21:15,760 --> 00:21:19,240
piriformis. 
We had all three variations in 

436
00:21:19,240 --> 00:21:24,160
our category in our cadaver lab.
So when we talk about variations

437
00:21:24,160 --> 00:21:26,920
at the knee, disagreements 
between different studies that 

438
00:21:26,920 --> 00:21:30,800
look at cadavers for evidence of
the attachments to the IT band, 

439
00:21:31,400 --> 00:21:33,840
it's just true. 
We're all different and we have 

440
00:21:34,040 --> 00:21:36,560
variability. 
I think when it comes to the 

441
00:21:36,880 --> 00:21:39,440
management treatment, 
understanding it doesn't 

442
00:21:39,440 --> 00:21:41,960
necessarily change everything, 
anything too much. 

443
00:21:42,120 --> 00:21:44,760
So don't get too hung up on it. 
But I think it's an important 

444
00:21:44,760 --> 00:21:47,760
thing from conceptualizing 
what's going on because as Matt 

445
00:21:47,760 --> 00:21:50,840
said, this is an extremely thick
tissue. 

446
00:21:50,840 --> 00:21:54,440
It is not one that you would be 
able to stretch by any means 

447
00:21:54,440 --> 00:21:56,600
that we have, like you would 
stretch your hamstring or your 

448
00:21:56,600 --> 00:22:00,880
quadriceps muscles or whatever. 
We do not have the tensile 

449
00:22:00,880 --> 00:22:02,840
loading to put through the IT 
band. 

450
00:22:02,840 --> 00:22:06,160
That would actually cause tissue
length changes of the IT band. 

451
00:22:07,040 --> 00:22:09,360
But before we go any further, 
I'm just going to quickly talk 

452
00:22:09,360 --> 00:22:11,520
about what we're zeroing in our 
conversation on. 

453
00:22:12,120 --> 00:22:14,920
When we talk about IT band 
syndrome, we're primarily 

454
00:22:14,920 --> 00:22:17,560
talking about when somebody is 
presenting with pain on the 

455
00:22:17,600 --> 00:22:20,720
outside of their knee so we can 
get pain up in the hip. 

456
00:22:20,800 --> 00:22:23,400
We're going to be focusing our 
conversation down at the knee 

457
00:22:23,800 --> 00:22:26,480
and it usually is sharp in 
nature. 

458
00:22:26,600 --> 00:22:29,840
It usually comes on with a 
predictable amount of stress or 

459
00:22:29,840 --> 00:22:33,040
strain on that tissue. 
So if you notice that every time

460
00:22:33,040 --> 00:22:36,920
when I run, when I get to mile 
2, I start to notice that the 

461
00:22:36,920 --> 00:22:39,320
outside of my knee hurts and 
then it goes from dull to sharp 

462
00:22:39,320 --> 00:22:43,840
sometimes relatively quickly. 
That's what we are referring to.

463
00:22:44,000 --> 00:22:46,600
Is this kind of sharp outside of
the knee pain. 

464
00:22:46,800 --> 00:22:49,600
Sometimes this is also called, 
quote, runner's knee. 

465
00:22:50,360 --> 00:22:53,440
But again, as David and I talked
about a few weeks ago, runner's 

466
00:22:53,440 --> 00:22:56,200
knee is an umbrella term applied
to a lot of different places. 

467
00:22:56,560 --> 00:22:58,320
You're going to say something. 
Yeah, I was. 

468
00:22:58,800 --> 00:23:01,680
Going to say that this is 
usually different than like this

469
00:23:01,680 --> 00:23:03,520
is my argument. 
This is not a tendon that some 

470
00:23:03,520 --> 00:23:05,400
people have. 
It's like so tendons. 

471
00:23:05,400 --> 00:23:07,880
Often times when you have a 
tendinopathy, you'll have this 

472
00:23:07,880 --> 00:23:10,400
thing called a warm up phenomena
where it'll kind of ache as you 

473
00:23:10,400 --> 00:23:13,840
start and then it gets better. 
And then it's obviously it's can

474
00:23:13,840 --> 00:23:17,240
get really bad after you finish 
the IT band stuff from my 

475
00:23:17,240 --> 00:23:20,200
experience has been usually like
it's you start out OK and then 

476
00:23:20,200 --> 00:23:22,440
it gets worse. 
Like it's it transitions to me 

477
00:23:22,440 --> 00:23:24,600
that kind of achy, like you 
said, then it gets worse and 

478
00:23:24,600 --> 00:23:26,880
worse where there are some 
things that in some people can 

479
00:23:26,880 --> 00:23:29,240
actually hold that off and you 
might be able to like, you know,

480
00:23:29,240 --> 00:23:31,560
do a certain thing and then it 
allows you to continue on. 

481
00:23:31,560 --> 00:23:34,880
But generally it's a it gets 
worse as you go on typical kind 

482
00:23:34,880 --> 00:23:37,840
of presentation. 
Not like oh it starts off really

483
00:23:37,840 --> 00:23:39,200
bad and then worms up gets 
better. 

484
00:23:39,720 --> 00:23:42,600
And I think the other difference
with a tendon is elasticity. 

485
00:23:42,600 --> 00:23:45,280
Tendons have a pretty decent 
amount of elastin in them, which

486
00:23:45,280 --> 00:23:47,920
allows them to stretch. 
This thing doesn't doesn't have 

487
00:23:47,920 --> 00:23:50,360
that elasticity. 
There is as we just talked 

488
00:23:50,360 --> 00:23:53,520
about, there's variation 
regarding how much mobility 

489
00:23:53,520 --> 00:23:56,760
someone's IT band may have. 
And again, that's not something 

490
00:23:56,760 --> 00:24:00,640
that we have control over in 
ourselves or in terms of what we

491
00:24:00,640 --> 00:24:02,880
do in rehab. 
It's just kind of a reality for 

492
00:24:02,880 --> 00:24:04,600
you and it may not even be 
testable. 

493
00:24:04,600 --> 00:24:09,000
So again, it's it's we don't we 
don't need to belabor that too 

494
00:24:09,000 --> 00:24:10,560
much, but we're all little bit 
different. 

495
00:24:11,160 --> 00:24:14,080
So let's talk a little bit about
what we know about risk factors 

496
00:24:14,080 --> 00:24:17,160
for this, what types of groups 
of runners, what sort of people,

497
00:24:17,160 --> 00:24:20,040
what sort of things do people do
or partaken that put them at 

498
00:24:20,040 --> 00:24:22,040
risk for developing IT bands and
there is. 

499
00:24:22,040 --> 00:24:24,040
Again, we're going to go say the
same thing you've heard and it's

500
00:24:24,040 --> 00:24:26,120
not to confuse you just to be 
honest with you there is some 

501
00:24:26,120 --> 00:24:28,160
conflicting research on what 
we're about to say. 

502
00:24:28,160 --> 00:24:30,760
So some of the current 
systematic abuse of meta 

503
00:24:30,760 --> 00:24:32,720
analysis that have been out 
there, right that now have been 

504
00:24:32,720 --> 00:24:36,160
like, oh, if you are a female 
runner, that there are certain 

505
00:24:36,160 --> 00:24:39,840
biomechanical risk factors like 
increase peak, peak hip 

506
00:24:39,840 --> 00:24:42,720
adduction, meaning you're your 
femur is coming inwards or your,

507
00:24:42,720 --> 00:24:45,120
your your hip is going this 
direction. 

508
00:24:45,280 --> 00:24:48,280
There's some suggestion that hip
abductor or the muscles on the 

509
00:24:48,280 --> 00:24:52,120
side of your hip, that weakness 
there may predispose you to risk

510
00:24:52,120 --> 00:24:55,200
factors there. 
It's not as clear cut for male 

511
00:24:55,200 --> 00:24:57,840
runners, although there is some 
evidence that there might be 

512
00:24:57,840 --> 00:25:01,240
some similar risk factors there.
But those are also some factors 

513
00:25:01,240 --> 00:25:04,960
that might be things to look at.
Some people suggest that maybe 

514
00:25:04,960 --> 00:25:08,160
if you, if your femur again, 
that long bone that connects to 

515
00:25:08,160 --> 00:25:10,600
your hip, if that rotates 
inwards, you get some internal 

516
00:25:10,600 --> 00:25:13,160
rotation. 
That might be a risk factor 

517
00:25:13,160 --> 00:25:15,040
there. 
And there's also some things on 

518
00:25:15,040 --> 00:25:16,760
the hip. 
But some of the big things I 

519
00:25:16,760 --> 00:25:19,640
look for, even though the 
research is a little conflicting

520
00:25:19,640 --> 00:25:22,480
as going, hey, is there any kind
of motions that might stress it,

521
00:25:22,480 --> 00:25:24,640
right? 
So I'm looking at frontal plane,

522
00:25:24,640 --> 00:25:26,600
like side to side. 
Is there any kind of weird 

523
00:25:26,600 --> 00:25:29,160
motions where people are going 
either a little bit too far in 

524
00:25:29,360 --> 00:25:30,960
or a little bit even too far 
out? 

525
00:25:31,320 --> 00:25:34,040
I'm looking at art, what the 
muscles that attach there. 

526
00:25:34,040 --> 00:25:35,600
Do you have good control of 
that? 

527
00:25:35,600 --> 00:25:39,960
So you have adequate functional 
performance of those the AT band

528
00:25:40,000 --> 00:25:43,040
or not the the tensor, even 
though it's not necessarily 

529
00:25:43,040 --> 00:25:47,040
attached there the glute me the 
glute Max like do you have good 

530
00:25:47,040 --> 00:25:49,440
functional control those or 
those irritated? 

531
00:25:49,720 --> 00:25:52,320
And then finally, I'm also 
looking at hey, rotation. 

532
00:25:52,320 --> 00:25:56,200
Do you have good rotation of the
pelvis of the femur? 

533
00:25:56,440 --> 00:26:00,680
And then I can move from there. 
Usually anything you would add 

534
00:26:00,680 --> 00:26:03,760
to that I think when it. 
Comes down to any injury risk 

535
00:26:04,040 --> 00:26:07,840
there are there's the baseline 
levels of predisposing your body

536
00:26:07,840 --> 00:26:10,960
to any sort of injury. 
So is there increased stress in 

537
00:26:10,960 --> 00:26:13,200
your life, decreased sleep, poor
nutrition? 

538
00:26:13,200 --> 00:26:15,720
And I'm going to harp in that 
every single time we talk about 

539
00:26:15,720 --> 00:26:17,720
injuries because it really 
matters. 

540
00:26:17,960 --> 00:26:21,120
You could have, as I mentioned 
before, you can have the same 

541
00:26:21,120 --> 00:26:24,880
volume of running for 20 years 
and then you have a kid and then

542
00:26:25,160 --> 00:26:27,400
your sleep is less and you do 
the same amount of running and 

543
00:26:27,400 --> 00:26:29,360
you end up getting hurt and 
that's not because you're 

544
00:26:29,360 --> 00:26:31,560
running volume has changed, but 
other factors. 

545
00:26:31,560 --> 00:26:35,280
So holistic picture of are there
changes in my life that could 

546
00:26:35,280 --> 00:26:37,920
predispose you? 
Yes, poor sleep, poor nutrition,

547
00:26:37,920 --> 00:26:40,600
all those kinds of things. 
Then over. 

548
00:26:40,600 --> 00:26:42,360
Over. 
Training things like that, which

549
00:26:42,840 --> 00:26:44,880
probably explains what the 
inconsistency in the research 

550
00:26:44,880 --> 00:26:46,720
going. 
Yeah, this is multifactorial, so

551
00:26:46,840 --> 00:26:47,840
keep going. 
That's where I was. 

552
00:26:47,840 --> 00:26:50,680
Going next was I think the next 
thing that can predispose you to

553
00:26:50,680 --> 00:26:53,880
this is a significant and rapid 
increase in your training, 

554
00:26:53,880 --> 00:26:57,880
whether that's volume or whether
that's duration of running or or

555
00:26:57,920 --> 00:27:00,840
miles or if you're looking at a 
lot of new speed work or running

556
00:27:00,840 --> 00:27:03,040
on hills. 
There's some thought that from 

557
00:27:03,040 --> 00:27:06,000
an environmental factor, if you 
run out in the country on 

558
00:27:06,000 --> 00:27:10,120
cambered roads that have a slope
to them, it can predispose one 

559
00:27:10,120 --> 00:27:13,080
or the other knee, depending on 
who you are to IT. 

560
00:27:13,120 --> 00:27:15,720
Band syndrome on either the one 
that's on the bottom side of the

561
00:27:15,720 --> 00:27:17,760
slope or the one that's on the 
top side of the slope. 

562
00:27:18,360 --> 00:27:22,360
I was going to also bring up 
differences in anatomical shape 

563
00:27:22,360 --> 00:27:25,120
that sometimes follow sex 
differences. 

564
00:27:25,360 --> 00:27:29,920
They found that more often men 
who have IT band syndrome run 

565
00:27:29,920 --> 00:27:34,080
with what's called knee virus, 
meaning that your thigh comes 

566
00:27:34,080 --> 00:27:36,240
down and then your shin starts 
to come in. 

567
00:27:36,240 --> 00:27:37,960
So your knee kind of is knock 
kneed. 

568
00:27:38,240 --> 00:27:42,200
Whereas women who typically have
IT band syndrome have knee 

569
00:27:42,200 --> 00:27:45,440
valgus, which is that hip 
adduction where your thigh is 

570
00:27:45,440 --> 00:27:48,280
coming in and your knees are, 
did I say knock kneed, bow 

571
00:27:48,280 --> 00:27:50,360
legged? 
I meant to say for men, sorry, 

572
00:27:50,600 --> 00:27:53,280
knock kneed for women. 
Apologies on that. 

573
00:27:53,720 --> 00:27:58,200
So I think that's another one of
those differences between people

574
00:27:58,880 --> 00:28:01,960
because what really matters I 
think when it comes to 

575
00:28:01,960 --> 00:28:04,960
understanding why you in 
particular may have IT band 

576
00:28:04,960 --> 00:28:09,200
syndrome is what is the thing 
that's causing more stress to 

577
00:28:09,240 --> 00:28:12,800
the IT band down at the knee 
that you could maybe mitigate or

578
00:28:12,800 --> 00:28:15,400
take care of. 
And they found that you're 

579
00:28:15,520 --> 00:28:19,000
running gait actually plays a 
potentially pretty big role in 

580
00:28:19,000 --> 00:28:20,840
that. 
So more than many other 

581
00:28:20,840 --> 00:28:24,640
conditions, I think gait 
assessment and potentially gait 

582
00:28:24,640 --> 00:28:28,200
retraining, whether temporary or
long term, plays a bigger role 

583
00:28:28,520 --> 00:28:31,280
in this than it does some other 
conditions. 

584
00:28:31,280 --> 00:28:34,280
And this might just be my 
perspective, but I think part of

585
00:28:34,280 --> 00:28:39,920
it is because there isn't a lot 
of other tissues connecting to 

586
00:28:39,920 --> 00:28:42,120
the IT band. 
You can't just like do a tendon 

587
00:28:42,120 --> 00:28:44,760
loading program like you can for
the Achilles. 

588
00:28:44,960 --> 00:28:48,640
You can't just do quad and hip 
strengthening like you can for 

589
00:28:49,000 --> 00:28:50,960
Patel femoral pain. 
And we talked a lot more about 

590
00:28:50,960 --> 00:28:52,360
other things you would do with 
that too. 

591
00:28:52,640 --> 00:28:55,800
So I think looking at mechanics 
and understanding what is 

592
00:28:55,800 --> 00:28:58,680
predisposing you to more stress 
and strain on the IT band. 

593
00:28:58,960 --> 00:29:03,400
So you mentioned a lot of them. 
If you are having increased 

594
00:29:03,960 --> 00:29:07,240
motion of the thigh inward while
you're in that stance phase, 

595
00:29:07,520 --> 00:29:11,000
that is stretching the two 
muscles that Matt said attached 

596
00:29:11,000 --> 00:29:14,240
to the IT band, your TfL and 
your glute Max. 

597
00:29:14,440 --> 00:29:18,040
If you internally rotate that 
also puts stretch on your glute 

598
00:29:18,040 --> 00:29:21,480
Max. 
If you are having knee various, 

599
00:29:21,760 --> 00:29:24,960
you are stretching the IT band 
across, not stretching, but 

600
00:29:24,960 --> 00:29:27,800
you're putting tension through 
the IT band at the level of the 

601
00:29:27,800 --> 00:29:32,240
knee if you have hip drop. 
So if your opposite hip is 

602
00:29:32,240 --> 00:29:35,840
dropping down, that's putting 
stretch through the TfL and the 

603
00:29:35,840 --> 00:29:38,360
glute Max. 
Any of those mechanics can 

604
00:29:38,360 --> 00:29:41,240
increase amount of load down at 
the knee and potentially be part

605
00:29:41,240 --> 00:29:43,880
of the reason why you're getting
that increased stress which can 

606
00:29:43,880 --> 00:29:48,000
lead to that pain. 
I think I'm done talking. 

607
00:29:48,440 --> 00:29:53,920
Wait, one more, one or two more.
One of them is crossover as 

608
00:29:53,920 --> 00:29:55,800
well. 
So if you're somebody who has a 

609
00:29:55,840 --> 00:29:59,120
very like weaving gate, very 
narrow foot placement, 

610
00:29:59,360 --> 00:30:02,760
biomechanical studies that are 
looking at correlations between 

611
00:30:02,760 --> 00:30:05,400
people with and without IT band 
syndrome, they usually have a 

612
00:30:05,400 --> 00:30:08,800
more narrow running gate with 
their feet closer together or 

613
00:30:08,800 --> 00:30:11,600
they have that crossover. 
And then the last one that has 

614
00:30:11,600 --> 00:30:14,960
been looked at as well is the 
amount of foot pronation. 

615
00:30:15,000 --> 00:30:19,040
We are very careful on this 
podcast and as doctors running 

616
00:30:19,040 --> 00:30:21,840
to not demonize pronation 
because it's a very good part of

617
00:30:21,840 --> 00:30:23,960
this. 
But there is a kinetic chain 

618
00:30:23,960 --> 00:30:27,480
connection where if you have a 
more pronation of your foot, 

619
00:30:27,480 --> 00:30:30,880
that's going to lead to 
rotation, likely at your hip 

620
00:30:30,880 --> 00:30:34,000
going inwards as well, which we 
had said also can increase 

621
00:30:34,000 --> 00:30:37,320
strain on the IT band. 
So for me, a big thing is 

622
00:30:37,320 --> 00:30:40,240
looking at mechanics. 
What are the mechanics that 

623
00:30:40,240 --> 00:30:42,480
you're presenting with that can 
increase stress or strain on the

624
00:30:42,520 --> 00:30:44,680
IT band? 
And then working on how do we 

625
00:30:44,680 --> 00:30:45,960
fix this? 
And we'll get to that in a 

626
00:30:45,960 --> 00:30:48,040
second too. 
What were you going to say? 

627
00:30:48,560 --> 00:30:50,200
I was going. 
To say that yes, pronation 

628
00:30:50,200 --> 00:30:53,160
certainly plays a factor because
it might kinetic chain wise 

629
00:30:53,160 --> 00:30:55,880
drive some things inwards. 
The same can be said of going 

630
00:30:55,880 --> 00:30:58,280
the opposite way. 
And so if you get driven a 

631
00:30:58,280 --> 00:31:00,320
little bit too far outwards, 
that's going to take these same 

632
00:31:00,320 --> 00:31:02,160
way. 
So I feel like IT band syndrome 

633
00:31:02,160 --> 00:31:03,800
a lot about OK, how are people 
moving? 

634
00:31:03,800 --> 00:31:07,920
Are they going to either extreme
because the body extremes are OK

635
00:31:07,920 --> 00:31:10,520
if your body's accommodated and 
that's just how you're made-up. 

636
00:31:10,720 --> 00:31:13,600
But typically things tend to 
operate a little bit better 

637
00:31:13,600 --> 00:31:16,720
being in a bit more of a middle 
position and middle will vary 

638
00:31:16,720 --> 00:31:19,480
depending on the human being. 
But this is one is like, don't 

639
00:31:19,480 --> 00:31:22,040
go to the extremes. 
You want to have good control in

640
00:31:22,040 --> 00:31:23,240
the middle. 
You want to have adequate 

641
00:31:23,240 --> 00:31:25,400
strength. 
You want to have you, you can 

642
00:31:25,400 --> 00:31:27,600
see, you can see motion. 
You just need to have control 

643
00:31:27,600 --> 00:31:29,960
over those things like, so the 
goal is not to necessarily 

644
00:31:29,960 --> 00:31:32,880
totally stop things, but it's 
going, how do we give you a bit 

645
00:31:32,880 --> 00:31:35,280
more movement control over these
things? 

646
00:31:35,280 --> 00:31:38,480
And maybe they don't happen as 
fast and you'll have got as much

647
00:31:38,760 --> 00:31:42,640
tensile compression or friction 
load that you can't control. 

648
00:31:42,640 --> 00:31:45,880
So it's can you improve the 
quality of the movement? 

649
00:31:45,880 --> 00:31:47,560
And that's why I totally agree 
with you. 

650
00:31:47,560 --> 00:31:49,360
Looking at gait analysis is 
really good to go. 

651
00:31:49,360 --> 00:31:51,240
What's the quality of this 
movement? 

652
00:31:51,240 --> 00:31:53,720
Not quite just quantity, but 
quality wise, what's it look 

653
00:31:53,720 --> 00:31:56,200
like right? 
I think something that's also 

654
00:31:56,200 --> 00:32:00,160
tricky with this one is a little
bit of a paradox because a lot 

655
00:32:00,160 --> 00:32:03,800
of times the answer to a lot of 
things is we'll do some 

656
00:32:03,800 --> 00:32:06,680
strengthening and get stronger 
and strengthen the muscles that 

657
00:32:06,680 --> 00:32:10,120
help control this motion. 
The muscles that help control 

658
00:32:10,120 --> 00:32:13,040
the motion are also the ones 
that put tension through the IT 

659
00:32:13,120 --> 00:32:16,600
band for namely your glute Max. 
And so if you're training your 

660
00:32:16,600 --> 00:32:19,080
glute Max for Max strength, 
every time you can track your 

661
00:32:19,080 --> 00:32:22,560
glute Max, you're also putting a
pole through the IT band, which 

662
00:32:22,560 --> 00:32:24,880
could lead to compression at the
outside of the knee. 

663
00:32:25,280 --> 00:32:28,440
And so there is this weird 
balance of figuring out what 

664
00:32:28,440 --> 00:32:32,200
type of strength training is 
important and is it truly Max 

665
00:32:32,200 --> 00:32:34,120
strengthening or is it something
different? 

666
00:32:34,120 --> 00:32:37,120
So what's your perspective on 
how strengthening and IT band 

667
00:32:37,120 --> 00:32:39,360
syndrome come together? 
Yeah, the. 

668
00:32:39,360 --> 00:32:41,720
First piece of this is, and I 
don't know if we've talked about

669
00:32:41,720 --> 00:32:43,640
this before, but like tissue 
healing timeline. 

670
00:32:43,640 --> 00:32:46,480
So like if you just injured this
thing, doing a ton of 

671
00:32:46,480 --> 00:32:49,280
strengthening may not be the 
best option in that early phase 

672
00:32:49,280 --> 00:32:51,680
of healing because the tissues 
not ready to get loading. 

673
00:32:51,680 --> 00:32:55,200
If things are still irritated a 
little inflamed and there's this

674
00:32:55,200 --> 00:32:57,160
conflict and like is 
inflammation good or not, we're 

675
00:32:57,160 --> 00:32:59,080
not going to go there. 
But when things are really 

676
00:32:59,080 --> 00:33:01,920
acutely irritated, doing a ton 
of strength or right then isn't 

677
00:33:01,920 --> 00:33:03,840
the best thing. 
Like your goal at that point is 

678
00:33:04,080 --> 00:33:06,760
let's calm this down, Let's get 
some movement in there if 

679
00:33:06,760 --> 00:33:10,000
running, if you can run, great. 
If not, it might be best to let 

680
00:33:10,000 --> 00:33:13,200
this calm down. 
That early phase is not when 

681
00:33:13,200 --> 00:33:15,680
loading is really is at least 
not heavy. 

682
00:33:15,680 --> 00:33:18,480
Strength training may be the 
most appropriate thing, but as 

683
00:33:18,880 --> 00:33:22,680
things calm down, then yes, 
strengthening may be part of 

684
00:33:22,680 --> 00:33:24,600
what you need. 
But it really depends on what 

685
00:33:24,600 --> 00:33:26,920
type of, and I'm going to move 
away from strengthening to say, 

686
00:33:27,120 --> 00:33:28,640
what kind of loading do you 
need? 

687
00:33:28,640 --> 00:33:31,480
Is this an endurance problem? 
Is it a strength problem? 

688
00:33:31,480 --> 00:33:34,760
Is it a power problem? 
And when your symptoms show up, 

689
00:33:34,880 --> 00:33:37,480
we'll kind of guide you from a 
rehab perspective of what you 

690
00:33:37,480 --> 00:33:38,520
need. 
Like if you're someone who's 

691
00:33:38,520 --> 00:33:41,640
like, yeah, I'm totally fine for
like 8 to 10 miles. 

692
00:33:41,640 --> 00:33:44,560
And all of a sudden at that 
point, that's when I started to 

693
00:33:44,560 --> 00:33:47,600
feel that that assuming some 
testing might be more of an 

694
00:33:47,600 --> 00:33:49,680
endurance problem if you're 
someone who goes, yeah, I get 

695
00:33:49,680 --> 00:33:52,520
this more when I'm like either 
on hills or I'm like having to 

696
00:33:52,520 --> 00:33:55,160
produce more force. 
That might be something that 

697
00:33:55,160 --> 00:33:57,160
might guide your PT or whoever. 
Just go. 

698
00:33:57,160 --> 00:33:58,160
You know what? 
Maybe we need to look at 

699
00:33:58,160 --> 00:34:01,160
strength. 
So make sure that you pay 

700
00:34:01,160 --> 00:34:04,040
attention to your symptoms and 
go, OK, let me make sure I match

701
00:34:04,040 --> 00:34:06,160
this. 
But some level of muscle 

702
00:34:06,160 --> 00:34:08,440
performance is probably going to
be helpful. 

703
00:34:08,440 --> 00:34:12,360
But what type is really, really 
key to think about? 

704
00:34:12,360 --> 00:34:16,400
And then also when making sure 
that is it is the environment of

705
00:34:16,400 --> 00:34:19,760
the IT band ready to be loaded 
is really key because a lot of 

706
00:34:19,760 --> 00:34:21,120
people would jump right into 
strength stuff. 

707
00:34:21,120 --> 00:34:22,960
And it's like, oh, it's making 
it worse. 

708
00:34:22,960 --> 00:34:25,040
Like, yeah, because it's not 
ready to get loaded yet. 

709
00:34:25,080 --> 00:34:28,000
You have to wait and let things 
have the tissue be ready for 

710
00:34:28,000 --> 00:34:30,920
that, right? 
And what I think is really 

711
00:34:31,560 --> 00:34:34,159
there, there's, there's a lot of
complexity here, but I think 

712
00:34:34,159 --> 00:34:38,719
what is really interesting is 
that loading of any tissue is 

713
00:34:38,719 --> 00:34:40,800
good. 
We're not necessarily talking 

714
00:34:40,800 --> 00:34:42,960
about can I run through IT band 
syndrome right now. 

715
00:34:42,960 --> 00:34:49,040
But usually for any sort of soft
tissue thing, complete rest is 

716
00:34:49,040 --> 00:34:53,199
not the answer. 
Complete rest leads to poor 

717
00:34:53,639 --> 00:34:56,639
healing over time because if it 
doesn't get a stimulus, it's not

718
00:34:56,639 --> 00:34:58,880
going to respond to the stimulus
in a way that makes it more 

719
00:34:58,880 --> 00:35:02,120
robust for that movement. 
So in general, some sort of 

720
00:35:02,120 --> 00:35:05,160
loading is good, which is why 
although strengthening may put 

721
00:35:05,160 --> 00:35:07,320
more tension through it, maybe 
that's the amount of tension you

722
00:35:07,320 --> 00:35:09,920
need to help healing it. 
Finding that balance is tricky. 

723
00:35:10,440 --> 00:35:13,560
I think the other thing that I 
think about when I'm working 

724
00:35:13,560 --> 00:35:15,640
with people with IT, band 
syndrome, got a couple of men 

725
00:35:15,640 --> 00:35:19,640
are running clinic right now 
actually is not let's get you as

726
00:35:19,640 --> 00:35:24,120
strong as possible. 
It's let's learn how to use the 

727
00:35:24,120 --> 00:35:27,000
strength you have or get the 
strength necessary to change 

728
00:35:27,000 --> 00:35:29,840
your movement. 
Matt and I met at a course with 

729
00:35:29,840 --> 00:35:32,840
Doctor Chris Powers and I 
remember him saying several 

730
00:35:32,840 --> 00:35:36,160
times that weakness doesn't 
cause pain. 

731
00:35:36,880 --> 00:35:41,080
It's movements that happened due
to weakness can put increased 

732
00:35:41,080 --> 00:35:43,400
stress or strain on a tissue 
that can cause pain. 

733
00:35:43,800 --> 00:35:46,000
So does the person have a 
weakness? 

734
00:35:46,080 --> 00:35:48,120
Yes. 
Does that result in the movement

735
00:35:48,120 --> 00:35:50,320
impairment that would be 
associated with that weakness? 

736
00:35:50,600 --> 00:35:53,160
Maybe or maybe not. 
If yes, then yes, you got to 

737
00:35:53,160 --> 00:35:55,400
strengthen so that you can 
change the way you move 

738
00:35:55,400 --> 00:35:58,640
potentially or no, they have 
full strength. 

739
00:35:58,640 --> 00:36:00,720
They are, they're weak, but 
they're moving just fine. 

740
00:36:00,960 --> 00:36:03,240
Then your exercises are going to
be targeted towards 

741
00:36:03,280 --> 00:36:07,880
neuromuscular retraining, 
learning how to walk, do stairs 

742
00:36:08,120 --> 00:36:12,000
or run in ways that decrease the
amount of stress or strain on 

743
00:36:12,000 --> 00:36:14,640
the IT band. 
And so to say kind of two 

744
00:36:14,640 --> 00:36:16,760
things. 
It's you might not do heavy 

745
00:36:16,760 --> 00:36:18,680
strengthening, but you probably 
should do some sort of 

746
00:36:18,680 --> 00:36:21,920
neuromuscular control depending 
on what your movements are. 

747
00:36:21,920 --> 00:36:23,240
Again, you need to have them 
assessed. 

748
00:36:23,720 --> 00:36:28,760
And then the second thing is to 
always be doing something 

749
00:36:28,880 --> 00:36:31,000
complete. 
Rest is probably not your answer

750
00:36:31,000 --> 00:36:33,440
for long. 
If it's a day or two, sure, but 

751
00:36:33,440 --> 00:36:35,680
you probably should have some 
sort of loading going through 

752
00:36:35,680 --> 00:36:39,720
this that you don't run into a 
long chronic situation where 

753
00:36:39,720 --> 00:36:42,240
you're having worsening 
condition of the IT band. 

754
00:36:43,640 --> 00:36:46,560
So the next thing I want to 
actually talk about is probably 

755
00:36:46,560 --> 00:36:51,200
what people most commonly hear 
and do, and it's OK, You've got 

756
00:36:51,200 --> 00:36:53,720
pain on the outside of your 
knee, you better foam roll and 

757
00:36:53,720 --> 00:36:55,480
you better ice and you better 
rest. 

758
00:36:56,360 --> 00:37:01,600
What's your perspective on soft 
tissue massage of any kind to 

759
00:37:01,640 --> 00:37:07,400
the IT band or in management of 
IT band syndrome and icing and 

760
00:37:07,800 --> 00:37:11,640
rest and things like that? 
So I'll be very honest that we 

761
00:37:11,640 --> 00:37:14,240
when you try to foam or or do 
any kind of soft tissue 

762
00:37:14,240 --> 00:37:16,400
mobilization of the IT band, 
you're not going to change the 

763
00:37:16,400 --> 00:37:19,400
tissue, you're not breaking up 
adhesions, you're not. 

764
00:37:19,400 --> 00:37:22,120
We this has been, there's lots 
of data suggest that that is not

765
00:37:22,120 --> 00:37:24,000
what's happening. 
Does it make some people feel 

766
00:37:24,000 --> 00:37:24,800
better? 
Yeah. 

767
00:37:24,800 --> 00:37:27,320
Do we understand totally why 
there's some suspicion that 

768
00:37:27,320 --> 00:37:30,040
you're stimulating some of the 
what's called cutaneous 

769
00:37:30,040 --> 00:37:32,480
receptors and mechanic 
receptors, IE the nerves, 

770
00:37:32,560 --> 00:37:35,800
nerves, specific nerves that are
responsive for like pressure 

771
00:37:35,800 --> 00:37:38,120
into the skin. 
Maybe you're stimulating those 

772
00:37:38,120 --> 00:37:41,600
and that might for in some 
population provides some relief.

773
00:37:42,240 --> 00:37:46,000
I would be more likely to go if 
you are someone that responds 

774
00:37:46,000 --> 00:37:48,800
well to soft tissue stuff. 
I'd honestly do it on the 

775
00:37:48,800 --> 00:37:51,400
tissues that actually changed, 
which is the muscles up higher. 

776
00:37:51,400 --> 00:37:56,120
So glute Max tensor fatulata. 
I am much less likely to suggest

777
00:37:56,120 --> 00:37:59,480
doing that over the IT band 
because that's just tissue. 

778
00:37:59,480 --> 00:38:02,440
Like if if you're going to be 
doing soft tissue mobilization, 

779
00:38:02,440 --> 00:38:06,560
the mechanisms by which that is 
supposed to do something is not 

780
00:38:06,560 --> 00:38:08,520
really going to affect this 
tissue very well. 

781
00:38:08,520 --> 00:38:10,840
And we know that it's not 
breaking up adhesions or doing 

782
00:38:10,840 --> 00:38:13,760
any of those things. 
Does it provide some potentially

783
00:38:13,760 --> 00:38:16,200
pain relief because you're 
actually stimulating your brain 

784
00:38:16,200 --> 00:38:17,840
and some of your peripheral 
nervous systems? 

785
00:38:17,920 --> 00:38:19,680
Yeah, that's a real thing, 
right? 

786
00:38:20,560 --> 00:38:23,080
I was telling Nathan we were at 
combined sections meeting and I 

787
00:38:23,080 --> 00:38:26,240
went to a guy whose name is 
Adrian Lau, who's like one of 

788
00:38:26,240 --> 00:38:28,800
the, the really good like pain 
and chronic pain researchers. 

789
00:38:28,800 --> 00:38:31,480
And it's ironic because I'm 
teaching modalities right now. 

790
00:38:31,480 --> 00:38:34,120
So I'm teaching massage, ice and
stuff like that as someone who's

791
00:38:34,120 --> 00:38:35,560
like very. 
Yeah. 

792
00:38:35,800 --> 00:38:36,840
Oh, that's right. 
We both teach this. 

793
00:38:36,840 --> 00:38:40,720
So it's like we're in a 
situation where like modalities 

794
00:38:40,720 --> 00:38:43,080
by themselves, there's never 
something that should be used 

795
00:38:43,080 --> 00:38:44,320
like it should be in 
conjunction. 

796
00:38:44,320 --> 00:38:46,240
And then a lot of the evidence 
is not very good. 

797
00:38:46,600 --> 00:38:48,680
But then, you know, hearing him 
say, you know what, you can't 

798
00:38:48,680 --> 00:38:51,360
ignore this stuff because pain 
is not just in your brain. 

799
00:38:51,360 --> 00:38:53,520
There's, there's multiple 
components that go into this. 

800
00:38:53,520 --> 00:38:56,480
So I would say if you are going 
to foam roll or do soft tissue 

801
00:38:56,480 --> 00:38:59,760
stuff, I would do it proximately
on the muscles that influence 

802
00:38:59,760 --> 00:39:01,000
this. 
I think that's going to be more 

803
00:39:01,000 --> 00:39:05,280
effective from a icing thing. 
There's also some good evidence 

804
00:39:05,280 --> 00:39:08,040
that icing actually really 
effects your nervous system and 

805
00:39:08,040 --> 00:39:11,600
some people may do super well 
with that, but it's honestly 

806
00:39:11,600 --> 00:39:13,960
going to be something that 
there's a very small window of 

807
00:39:13,960 --> 00:39:16,080
time where that might be 
effective and it's usually very 

808
00:39:16,080 --> 00:39:19,160
early on. 
Later, what's probably going to 

809
00:39:19,160 --> 00:39:21,960
be like if you just injured it, 
if you respond really well to 

810
00:39:21,960 --> 00:39:25,320
ice, awesome, go to town. 
If you don't, you hate it, don't

811
00:39:25,320 --> 00:39:27,680
do it right. 
If you respond really well to 

812
00:39:27,680 --> 00:39:30,800
soft tissue massage or foam 
rolling, I would suggest doing 

813
00:39:30,800 --> 00:39:33,520
it up like proximately closer in
the hip where those muscles are.

814
00:39:33,960 --> 00:39:36,160
If you don't, great. 
But and that's going to work 

815
00:39:36,160 --> 00:39:38,320
well earlier on and maybe 
reducing some tension. 

816
00:39:38,320 --> 00:39:41,400
But some point you got to get as
quickly as you can to the 

817
00:39:41,400 --> 00:39:43,280
appropriate loading or the 
appropriate movement. 

818
00:39:43,560 --> 00:39:49,040
So in small dosages with active 
motion, fine, great. 

819
00:39:49,080 --> 00:39:52,040
I'm not going to say no, but 
long term, that's not going to 

820
00:39:52,040 --> 00:39:52,960
fix this. 
Yeah. 

821
00:39:53,880 --> 00:39:57,640
I think that where people fall 
short, and this includes myself 

822
00:39:57,720 --> 00:40:01,480
and tons of good friends. 
So this is not a an indictment 

823
00:40:01,480 --> 00:40:04,240
on, on people without myself 
being involved, you know. 

824
00:40:05,720 --> 00:40:08,160
Foam rolling shouldn't be your 
mainstage treatment. 

825
00:40:08,240 --> 00:40:11,120
It can be part of it as you 
said, for pain management and 

826
00:40:11,120 --> 00:40:14,520
management of some of the other 
soft tissues that may be have it

827
00:40:14,520 --> 00:40:17,520
holding tension, which can again
increase the amount of tension 

828
00:40:17,520 --> 00:40:20,440
on the IT band, which can 
increase the the compression on 

829
00:40:20,440 --> 00:40:22,240
that area. 
Yeah, great. 

830
00:40:22,240 --> 00:40:24,720
Let's relieve some of that cause
some short term changes in 

831
00:40:24,720 --> 00:40:26,240
symptoms. 
There's nothing wrong with that,

832
00:40:26,240 --> 00:40:29,200
but it can't be your mainstage 
treatment to actually solve the 

833
00:40:29,200 --> 00:40:32,320
problem. 
The other thing we didn't talk 

834
00:40:32,320 --> 00:40:35,160
about anatomically is that 
because it's this band and it 

835
00:40:35,160 --> 00:40:38,600
kind of has this spanning 
nature, it does also have 

836
00:40:38,600 --> 00:40:41,520
relationships with one of your 
quad muscles, the vastus 

837
00:40:41,520 --> 00:40:44,960
lateralus, as well as with your 
one of your hamstring muscles, 

838
00:40:44,960 --> 00:40:49,520
the biceps femoris. 
And so doing soft tissue work to

839
00:40:49,520 --> 00:40:54,360
those areas as well is also 
something that wouldn't be a bad

840
00:40:54,360 --> 00:40:56,760
idea. 
Instead of going directly over 

841
00:40:56,760 --> 00:40:59,960
the IT band, work on the things 
that can actually change. 

842
00:41:01,120 --> 00:41:03,400
So I would recommend those two 
things as well. 

843
00:41:03,400 --> 00:41:04,760
What were you going to say? 
I was going. 

844
00:41:04,760 --> 00:41:07,440
To say from a differential 
diagnosis thing, because I've 

845
00:41:07,440 --> 00:41:10,360
seen this actually several 
times, Speaking of things that 

846
00:41:10,360 --> 00:41:12,240
are around that, there's 
something called your lateral 

847
00:41:12,240 --> 00:41:15,880
femoral cutaneous nerve that 
travels all along the outside of

848
00:41:15,880 --> 00:41:18,160
your hip and nerves like three 
things. 

849
00:41:18,160 --> 00:41:20,400
They like blood space and 
movement. 

850
00:41:20,720 --> 00:41:24,040
And sometimes when you really 
compress those things with like 

851
00:41:24,280 --> 00:41:27,520
like a foam roller, if it's 
louder for more cutaneous nerve 

852
00:41:27,520 --> 00:41:30,520
syndrome, that often doesn't 
respond really well. 

853
00:41:30,520 --> 00:41:32,840
And it's kind of one of the 
reasons, not that I'm saying 

854
00:41:32,840 --> 00:41:36,120
it's all that, but in that area,
I kind of leave that. 

855
00:41:36,120 --> 00:41:39,040
Like I don't tend to push that 
area too much, like Nathan said,

856
00:41:39,040 --> 00:41:41,680
rather actually work on the soft
tissue structures in the area. 

857
00:41:41,920 --> 00:41:44,280
And it's not to scare you if you
respond really well from going 

858
00:41:44,280 --> 00:41:46,720
to that area and it helps 
modulate your symptoms. 

859
00:41:46,720 --> 00:41:48,240
Awesome. 
Just please do something active,

860
00:41:48,240 --> 00:41:50,880
not just passive. 
But yeah, I would say stick to 

861
00:41:50,880 --> 00:41:55,040
doing soft tissue techniques to 
the muscles and not to like 

862
00:41:55,080 --> 00:41:57,960
tissues like this just for like 
efficiency. 

863
00:41:57,960 --> 00:42:00,560
Like if if you're going to do 
this, that's where you're going 

864
00:42:00,560 --> 00:42:02,560
to have probably a larger 
impact. 

865
00:42:03,040 --> 00:42:05,960
And it's it's a really, it's a 
really, it's a solid management 

866
00:42:05,960 --> 00:42:07,880
technique either using a 
formula. 

867
00:42:07,880 --> 00:42:10,480
The common thing like this will 
happen to Regina all the time. 

868
00:42:10,480 --> 00:42:13,880
So like my wife, who's a pro 
runner will be out in a run and 

869
00:42:13,880 --> 00:42:16,760
then like during the warm up, 
like after 2 miles, she's like, 

870
00:42:16,760 --> 00:42:19,000
Oh yeah, by the way, this hurts.
I'm like, I know what, this is 

871
00:42:20,040 --> 00:42:21,920
awkward if you ever see us on 
the road. 

872
00:42:21,920 --> 00:42:24,480
And I've got like caress my 
wife's hip and I've got my thumb

873
00:42:24,480 --> 00:42:27,320
jammed into the front of her 
like a front outside of her hip.

874
00:42:27,320 --> 00:42:30,360
That's I'm just like digging 
into her tensor fascia and 

875
00:42:30,360 --> 00:42:32,320
trying to change the tone. 
And then I was like, usually 

876
00:42:32,320 --> 00:42:35,600
takes one time, a little bit of 
hip muscle isometric stuff and 

877
00:42:35,600 --> 00:42:36,880
she's fine. 
And go like, yeah, you're not 

878
00:42:36,880 --> 00:42:37,960
doing your hip exercise. 
It's cool. 

879
00:42:37,960 --> 00:42:40,840
So do that when you get home, 
right, But that can be that can 

880
00:42:40,840 --> 00:42:42,240
change tone. 
It's really great. 

881
00:42:42,240 --> 00:42:46,720
It can, you know, doing like a, 
a like ATFL stretch sometimes 

882
00:42:46,720 --> 00:42:49,520
can or can reduce tone. 
It can be helpful for people to 

883
00:42:49,520 --> 00:42:52,440
keep running. 
But all these things this is 

884
00:42:52,440 --> 00:42:53,640
should not be your main 
treatment. 

885
00:42:53,680 --> 00:42:57,000
They are going to be Nathan. 
What's the term I'm looking for?

886
00:42:57,080 --> 00:43:02,000
They are short term symptom mod 
modification, but not symptom 

887
00:43:02,000 --> 00:43:03,880
elimination or problem 
elimination. 

888
00:43:04,920 --> 00:43:08,080
So there's a couple more topics 
that I think we should cover. 

889
00:43:08,160 --> 00:43:10,320
I can hit one of them relatively
briefly. 

890
00:43:10,880 --> 00:43:12,440
It's how long is this going to 
take? 

891
00:43:12,440 --> 00:43:14,680
If I have IT band syndrome, how 
long is this going to take? 

892
00:43:15,240 --> 00:43:18,360
Unfortunately, the answer is it 
is extremely varied depending on

893
00:43:18,360 --> 00:43:20,920
the level of irritability and 
the potential causes. 

894
00:43:21,040 --> 00:43:23,120
Some people are going to get IT 
band syndrome, they're going to 

895
00:43:23,120 --> 00:43:25,960
catch it early, they're going to
do a couple quick modifications 

896
00:43:25,960 --> 00:43:29,080
to their training and it could 
be gone in two to four weeks. 

897
00:43:29,400 --> 00:43:32,320
Unfortunately for some folks, 
whether it's because, oh, 

898
00:43:32,320 --> 00:43:34,520
they're in the middle of a 
marathon training block and 

899
00:43:34,520 --> 00:43:37,240
they're just going to push 
through it no matter what, I'm 

900
00:43:37,240 --> 00:43:40,400
pointing to myself, they're 
going to have this linger the 

901
00:43:40,400 --> 00:43:43,720
entire rest of that training 
cycle, maybe 10 weeks, and then 

902
00:43:43,720 --> 00:43:45,560
it's going to like bug them 
afterward. 

903
00:43:45,800 --> 00:43:50,200
For me, it was for several 
months after my marathon still, 

904
00:43:50,200 --> 00:43:53,160
I was dealing with this and it 
required modification to my 

905
00:43:53,160 --> 00:43:54,560
training during that entire 
thing. 

906
00:43:54,560 --> 00:43:58,960
So it can be anywhere from very 
short to quite a long recovery, 

907
00:43:58,960 --> 00:44:02,840
even up to a year for folks that
I've worked with, unfortunately 

908
00:44:02,840 --> 00:44:05,080
can stick around. 
So then I think the next 

909
00:44:05,080 --> 00:44:10,840
question is what sort of 
recommendations do you have for 

910
00:44:10,840 --> 00:44:15,040
how much pain is acceptable? 
Is pain acceptable at all? 

911
00:44:15,480 --> 00:44:19,000
Should I run it all that's a? 
Very good question And the 

912
00:44:19,000 --> 00:44:21,640
reason that this might be even 
the most important part of what 

913
00:44:21,640 --> 00:44:23,920
we talked about today is that 
like this really plays into like

914
00:44:23,920 --> 00:44:27,360
concerns and we get this as 
runners going like wait, like is

915
00:44:27,360 --> 00:44:28,880
any pain OK? 
Can I deal with this? 

916
00:44:29,120 --> 00:44:31,120
The answer is some symptoms are 
OK. 

917
00:44:31,280 --> 00:44:34,080
Like it's OK like like Nathan 
mentioned, it's OK to keep 

918
00:44:34,080 --> 00:44:38,560
moving if your symptoms have a 
manageable level of 

919
00:44:38,560 --> 00:44:40,360
irritability. 
And when I say irritability mean

920
00:44:40,960 --> 00:44:43,960
how quickly, how intense do 
those symptoms get and how 

921
00:44:43,960 --> 00:44:47,480
quickly do they get there? 
So if you're a someone who's, 

922
00:44:47,480 --> 00:44:49,880
and I'm going to use the pain 
scale, which is not perfect, but

923
00:44:49,880 --> 00:44:53,240
it's kind of what we have. 
If you're as an example, you're 

924
00:44:53,240 --> 00:44:56,520
going and running and your 
symptoms are like an 8-9, like 

925
00:44:56,520 --> 00:44:59,320
10 out of 10 and you cannot 
modulate them at all. 

926
00:44:59,720 --> 00:45:03,000
That's not a good reason to be 
running like that is too high. 

927
00:45:03,040 --> 00:45:04,800
That is going to really change 
your mechanics. 

928
00:45:04,800 --> 00:45:06,440
That's going to really alter how
you're moving. 

929
00:45:06,680 --> 00:45:08,480
And that might honestly put 
stress elsewhere. 

930
00:45:08,800 --> 00:45:12,120
If it's like a 2 or a three out 
of 10 and it's manageable and 

931
00:45:12,120 --> 00:45:16,080
you're OK and it doesn't get 
that much worse, that's probably

932
00:45:16,080 --> 00:45:17,520
fine. 
You still need to pay attention 

933
00:45:17,520 --> 00:45:19,280
to this and you still have some 
work to do. 

934
00:45:19,480 --> 00:45:23,000
But again, it's going to depend 
on what's tolerable for you and 

935
00:45:23,000 --> 00:45:25,320
what can handle and then what 
it, how it progresses. 

936
00:45:25,320 --> 00:45:29,040
If it suddenly jumps up and it 
won't go down, that's you're 

937
00:45:29,040 --> 00:45:30,440
probably pushing more than you 
should. 

938
00:45:30,440 --> 00:45:33,280
If it's staying level and it's 
that low level manageable, 

939
00:45:33,280 --> 00:45:35,760
you're like, I know it's there. 
I know this is, it's, it's not 

940
00:45:35,760 --> 00:45:37,760
threatening, it's staying 
consistent. 

941
00:45:38,080 --> 00:45:40,520
Then that might suggest you 
might be able to get away with 

942
00:45:40,520 --> 00:45:41,600
this. 
This is very different than 

943
00:45:41,600 --> 00:45:43,760
something I always think about 
when we talk about like, Oh, 

944
00:45:43,760 --> 00:45:46,760
it's OK to stay like loading. 
If it's just that, you know, 

945
00:45:46,760 --> 00:45:48,600
it's not a bone stress injury, 
right? 

946
00:45:48,600 --> 00:45:49,800
It's not like bone stress 
injury. 

947
00:45:49,880 --> 00:45:51,760
You have pain. 
That's that has to be zero. 

948
00:45:51,800 --> 00:45:55,120
That is the the rule with that. 
It's not that you can move 

949
00:45:55,120 --> 00:45:57,240
through this. 
Some symptoms will linger. 

950
00:45:57,400 --> 00:46:00,080
There's a lot of the issues in 
this area too that can actually 

951
00:46:00,080 --> 00:46:03,120
potentially be pain generators 
and there's even someones away 

952
00:46:03,120 --> 00:46:06,920
from that area that might like 
fear or fatigue or other like 

953
00:46:07,080 --> 00:46:09,360
preconceived notions or how 
you're viewing your body or 

954
00:46:09,360 --> 00:46:11,200
stress level can also generate 
symptoms. 

955
00:46:11,200 --> 00:46:14,400
Like I I love, I have a love 
hate relationship with my IT 

956
00:46:14,400 --> 00:46:16,520
band because I know how to 
manage it pretty well. 

957
00:46:16,520 --> 00:46:18,880
Like I'll feel and go. 
I just need to be for me, it's 

958
00:46:18,880 --> 00:46:21,120
like I know I need to be doing 
my hip strengthening stuff and 

959
00:46:21,120 --> 00:46:23,440
I'm like, I've been slacking. 
I deserve this. 

960
00:46:23,440 --> 00:46:25,720
Or I had a sudden jump and 
training and I, I can, I can 

961
00:46:25,720 --> 00:46:28,680
manage it pretty well. 
And then like it'll be fine. 

962
00:46:28,680 --> 00:46:30,600
And I'll just be sitting there 
and be stressed out and I'll 

963
00:46:30,600 --> 00:46:31,760
feel it. 
Come on. 

964
00:46:31,760 --> 00:46:34,040
I'm not running. 
I'm literally sitting down and 

965
00:46:34,040 --> 00:46:37,160
I'm like, what the heck is? 
I'm like, yeah, that's just, 

966
00:46:37,200 --> 00:46:41,760
I've had this enough that when I
start freaking out that I will 

967
00:46:41,760 --> 00:46:44,640
get some like psychosomatic 
symptoms in that area. 

968
00:46:44,640 --> 00:46:47,360
So that is a real thing. 
That's my spot. 

969
00:46:47,480 --> 00:46:51,280
So it's like I've had a lot of 
Achilles stuff, but IT band is 

970
00:46:51,280 --> 00:46:53,400
the my go to if something's 
going to happen. 

971
00:46:53,400 --> 00:46:56,240
It's like that's what flares up 
and it's happened enough that I 

972
00:46:56,240 --> 00:46:59,240
probably have a couple neurons 
in my brain that when they get 

973
00:46:59,240 --> 00:47:02,080
stimulant I get symptoms even if
I'm not loading the tissue. 

974
00:47:04,720 --> 00:47:06,160
No, I think that's great. 
I am. 

975
00:47:06,280 --> 00:47:08,760
I am not a physical therapist 
that tells people to stop 

976
00:47:08,760 --> 00:47:13,400
running very often. 
I think that continual load is 

977
00:47:13,400 --> 00:47:18,120
necessary for proper adaptations
to tissues save bone stress 

978
00:47:18,120 --> 00:47:20,280
injuries. 
That's that's definitely an 

979
00:47:20,280 --> 00:47:22,360
exception to the rule. 
So I agree with you that some 

980
00:47:22,360 --> 00:47:25,240
level of symptoms is fine. 
I think though there is a 

981
00:47:25,240 --> 00:47:29,160
threshold that it's like maybe a
break from running of some 

982
00:47:29,160 --> 00:47:32,120
extent, which you could change 
depending on how severe is 

983
00:47:32,120 --> 00:47:34,200
necessitated. 
I think that if you are somebody

984
00:47:34,200 --> 00:47:39,400
who is walking and having more 
than minimal pain, it's probably

985
00:47:39,400 --> 00:47:42,080
the irritability is high enough 
that it's worth taking some time

986
00:47:42,080 --> 00:47:44,560
off to allow it to heal faster 
than it would if you just kept 

987
00:47:44,560 --> 00:47:46,320
putting that increased strain 
through it. 

988
00:47:47,200 --> 00:47:49,680
I think another good sign is if 
you're having a lot of issues 

989
00:47:49,680 --> 00:47:52,600
with stairs, if you can't handle
stairs and you can't handle 

990
00:47:52,600 --> 00:47:54,560
walking, you probably aren't 
ready for running. 

991
00:47:55,200 --> 00:47:59,120
And when I say handle them 
again, I mean minimal pain, 1-2 

992
00:47:59,240 --> 00:48:00,920
out of 10. 
And so you should be able to do 

993
00:48:00,920 --> 00:48:04,200
like 30 minutes of walking and 
then you should be ready to to 

994
00:48:04,200 --> 00:48:06,800
go on a run and try that out. 
And then I'm with you on like 

995
00:48:06,800 --> 00:48:11,200
the pain scale kind of shadowing
the pain monitoring model for 

996
00:48:11,200 --> 00:48:13,400
Achilles. 
Anywhere from zero to 3 is going

997
00:48:13,400 --> 00:48:15,840
to be very much in the safe zone
dull. 

998
00:48:16,200 --> 00:48:19,240
And then, you know, four to five
is still going to be acceptable.

999
00:48:19,320 --> 00:48:22,120
It's giving it a stimulus that 
it should adapt to. 

1000
00:48:22,640 --> 00:48:26,440
But I think if you don't like 
the numbers, I like to say if it

1001
00:48:26,440 --> 00:48:29,080
goes from this dull pain to 
anything that you could 

1002
00:48:29,080 --> 00:48:32,720
determine is sharp, that's 
beyond the threshold, that's 

1003
00:48:32,720 --> 00:48:34,960
beneficial for the IT band at 
that time. 

1004
00:48:35,360 --> 00:48:39,120
And then any sort of soreness 
that you had should resolve by 

1005
00:48:39,120 --> 00:48:41,080
the next day. 
You should wake up the next day 

1006
00:48:41,080 --> 00:48:43,680
and not be wondering, oh, is 
that still there? 

1007
00:48:43,840 --> 00:48:47,360
Oh, that feels worse or that 
feels like it hasn't calmed back

1008
00:48:47,360 --> 00:48:49,320
down. 
That's you're trying to like 

1009
00:48:49,480 --> 00:48:52,400
play this line where you're 
letting the symptoms decrease 

1010
00:48:52,480 --> 00:48:54,960
sequentially over time. 
And if you're just doing the 

1011
00:48:54,960 --> 00:48:57,720
thing to bump it up a little bit
more each time, you're just 

1012
00:48:57,720 --> 00:48:59,640
setting yourself on a long 
recovery path. 

1013
00:48:59,880 --> 00:49:04,240
So there is is not a perfect 
course, not a perfect amount of 

1014
00:49:04,240 --> 00:49:06,880
running. 
It's you figuring out what does 

1015
00:49:06,880 --> 00:49:10,680
it feel like when I go on a 30 
minute easy run, does that 

1016
00:49:10,680 --> 00:49:13,120
increase my symptoms above 
something like a three-year into

1017
00:49:13,120 --> 00:49:15,120
that sharp zone? 
No great. 

1018
00:49:15,120 --> 00:49:16,520
Does it calm down by the next 
day? 

1019
00:49:16,520 --> 00:49:18,360
Yes. 
OK, this seems like an 

1020
00:49:18,360 --> 00:49:21,400
acceptable amount of discomfort 
that I, I'm going to keep moving

1021
00:49:21,400 --> 00:49:24,800
forward because that stimulus 
that causes discomfort is also 

1022
00:49:24,800 --> 00:49:28,160
going to promote hopefully 
positive healing in the tissue 

1023
00:49:28,360 --> 00:49:31,200
itself. 
So the last question that we 

1024
00:49:31,200 --> 00:49:34,160
want to talk about is this 
question of shoes. 

1025
00:49:34,160 --> 00:49:36,160
Because we're on the doctor's 
running podcast, we have to talk

1026
00:49:36,160 --> 00:49:38,400
about shoes. 
Do you think that there are any 

1027
00:49:38,400 --> 00:49:42,040
shoes that are ideal for people 
with IT Band syndrome? 

1028
00:49:42,320 --> 00:49:43,440
That's a. 
Great question. 

1029
00:49:43,440 --> 00:49:46,960
So I was talking to Nathan about
this beforehand. 

1030
00:49:46,960 --> 00:49:48,560
I'm like, they're going to hate 
us for this. 

1031
00:49:48,560 --> 00:49:50,480
I'm going to try not to give 
this like, oh, whatever works 

1032
00:49:50,480 --> 00:49:54,680
for you, I think you need to 
address if there's any risk 

1033
00:49:54,680 --> 00:49:57,280
factors than a shoe can 
modulate, then that's what you 

1034
00:49:57,280 --> 00:49:58,720
think about. 
And I'm going to use myself as a

1035
00:49:58,720 --> 00:50:00,960
case study and we're going to 
expand on that and say how other

1036
00:50:00,960 --> 00:50:02,000
people might be a little 
different. 

1037
00:50:02,000 --> 00:50:05,960
So I am someone that needs at 
least a mild level of guidance 

1038
00:50:05,960 --> 00:50:08,320
that might be from a stable 
neutral shoe that might be from 

1039
00:50:08,320 --> 00:50:12,080
some medial support. 
I just need a little bit there. 

1040
00:50:12,360 --> 00:50:15,480
If I go too far, that actually 
will take me the opposite 

1041
00:50:15,480 --> 00:50:17,520
direction. 
So every time and thank you 

1042
00:50:17,520 --> 00:50:20,000
Brooks, for sending this shoe 
every time they send us the 

1043
00:50:20,000 --> 00:50:23,280
Brooks Beast, which is the like 
one of the few true motion 

1044
00:50:23,280 --> 00:50:24,920
control shoes left on the 
market. 

1045
00:50:25,280 --> 00:50:28,320
I know that to get miles on this
shoe, I'm going to piss my T 

1046
00:50:28,320 --> 00:50:31,160
band off. 
It is just too stiff for me. 

1047
00:50:31,240 --> 00:50:33,720
There's too many stability 
features and it's going to drive

1048
00:50:33,720 --> 00:50:35,400
me in a way that's going to 
bother me. 

1049
00:50:35,400 --> 00:50:37,320
And for some people, that's 
actually going to be their 

1050
00:50:37,320 --> 00:50:39,760
Goldilocks shoe. 
So you need to make sure you you

1051
00:50:39,760 --> 00:50:43,320
have adequate support or 
stability for you. 

1052
00:50:43,360 --> 00:50:46,640
And that might be in a new pure 
neutral shoe because some people

1053
00:50:47,040 --> 00:50:49,480
you put them in a stability shoe
and it starts driving them One 

1054
00:50:49,480 --> 00:50:51,280
Direction. 
That knee might go with them and

1055
00:50:51,280 --> 00:50:54,000
they're not going to like that. 
So for me, I find that that 

1056
00:50:54,000 --> 00:50:55,800
perfect level keeps me in the 
middle. 

1057
00:50:55,800 --> 00:50:59,000
So that's actually something 
ironically with the Gar Carbon 

1058
00:50:59,000 --> 00:51:01,640
too, that we've been talking 
about because the platform's too

1059
00:51:01,640 --> 00:51:03,680
narrow. 
I know as I take this up to 

1060
00:51:03,680 --> 00:51:07,400
higher mileage, I start to feel 
my IT band a little bit because 

1061
00:51:07,400 --> 00:51:09,560
the platform's narrow. 
There's not really any stability

1062
00:51:09,560 --> 00:51:10,960
mechanisms that I typically 
need. 

1063
00:51:11,000 --> 00:51:14,840
If I keep shorter, I'm fine. 
But narrow platform, no, no 

1064
00:51:14,840 --> 00:51:16,880
structure. 
Like there is some stiffness, 

1065
00:51:16,880 --> 00:51:20,080
but you know, it's still, you 
know, mostly in one plate, the 

1066
00:51:20,080 --> 00:51:22,360
front to back. 
I know it's going to get 

1067
00:51:22,360 --> 00:51:25,400
irritated. 
So too unstable, not going to 

1068
00:51:25,400 --> 00:51:28,360
work really, really well, too 
stiff and stable. 

1069
00:51:28,360 --> 00:51:30,280
It's also going to be too much 
for me. 

1070
00:51:30,360 --> 00:51:32,680
So that's where for me 
personally, shoes like stable 

1071
00:51:32,680 --> 00:51:36,240
neutral shoes are great. 
That's why I think I'm working 

1072
00:51:36,240 --> 00:51:39,840
so well with the Cumulus as it's
got not the narrowest midfoot. 

1073
00:51:39,840 --> 00:51:42,560
There's some other features that
make it stable, but here's some 

1074
00:51:42,560 --> 00:51:44,960
things you need to think about. 
You need it to be stable enough.

1075
00:51:44,960 --> 00:51:47,920
So if you have some stability 
needs, you might need that. 

1076
00:51:48,080 --> 00:51:49,800
OK. 
If you don't, you should be 

1077
00:51:49,800 --> 00:51:52,640
avoiding anything that's stable 
because that's that's going to 

1078
00:51:52,640 --> 00:51:54,920
irritate that that structure 
might bother you more. 

1079
00:51:55,320 --> 00:51:57,960
The other thing that might be 
irritable is I have found that 

1080
00:51:57,960 --> 00:52:00,640
super soft shoes typically don't
do well. 

1081
00:52:00,640 --> 00:52:05,000
So like moderate, like slightly 
firm or like fairly in the 

1082
00:52:05,000 --> 00:52:07,880
middle with that tend to do very
well because I get good 

1083
00:52:07,880 --> 00:52:11,040
proprioceptive impact feedback 
and I don't feel like I'm like 

1084
00:52:11,040 --> 00:52:13,760
collapsing one way. 
This is why I like not to put 

1085
00:52:13,760 --> 00:52:16,680
poo on this shoe, the Neo Zen 
and I did not get along. 

1086
00:52:16,720 --> 00:52:19,800
It was just too soft. 
I felt like I was going all over

1087
00:52:19,800 --> 00:52:22,080
the place and as I went up to 
higher mileage, I'm like, Yep, I

1088
00:52:22,080 --> 00:52:25,680
can feel my IT bands start to 
tighten up a little bit just and

1089
00:52:25,760 --> 00:52:27,200
then I'm. 
Enjoying it right now, I knew 

1090
00:52:27,200 --> 00:52:28,560
Nathan. 
'S loving it right. 

1091
00:52:28,760 --> 00:52:30,520
So this shoe is just too soft 
for me. 

1092
00:52:30,520 --> 00:52:34,040
So when I for me personally, 
when I land on this, I get too 

1093
00:52:34,160 --> 00:52:37,240
too wobbly and then I can feel 
my mechanics kind of like I'm 

1094
00:52:37,240 --> 00:52:40,200
either stiffening up too much to
holding too much tension or 

1095
00:52:40,200 --> 00:52:43,520
moving too much. 
So typically really soft shoes 

1096
00:52:43,800 --> 00:52:48,120
may not be the best option. 
So, but firmer also might be a 

1097
00:52:48,120 --> 00:52:51,360
little a little bit too much. 
So I have found for me 

1098
00:52:51,360 --> 00:52:55,400
personally, stable neutral shoes
are that nice middle ground, not

1099
00:52:55,400 --> 00:52:58,080
having too much sole flare 
because I've also found that the

1100
00:52:58,080 --> 00:53:01,360
sole extends too far out and I 
hit it and it drives me in words

1101
00:53:01,360 --> 00:53:04,360
that could be irritable. 
So just finally that Goldilocks 

1102
00:53:04,360 --> 00:53:07,280
fit of like and maybe a little 
bit more rocker so it moves you 

1103
00:53:07,280 --> 00:53:09,040
forward rather than side to side
could be helpful. 

1104
00:53:09,040 --> 00:53:11,920
But it is a this is going to be 
unique to you. 

1105
00:53:12,000 --> 00:53:15,720
And that whole run cat thing is 
like really important. 

1106
00:53:15,720 --> 00:53:19,320
Finding what works for you, 
what's stable enough, what is 

1107
00:53:19,320 --> 00:53:22,080
just feels right under foot. 
Great. 

1108
00:53:22,600 --> 00:53:25,280
Yeah, I have had experiences 
with this too. 

1109
00:53:25,280 --> 00:53:29,120
And actually I'm blanking on the
name of the shoe. 

1110
00:53:29,120 --> 00:53:33,680
It probably would have been in 
2019 and it was from 361. 

1111
00:53:33,920 --> 00:53:36,600
It was one of it was their mild 
stability shoe at the time. 

1112
00:53:36,600 --> 00:53:38,560
They they don't make this model 
anymore. 

1113
00:53:40,160 --> 00:53:42,000
I tried to Google it. 
I'm going to go I'm. 

1114
00:53:42,120 --> 00:53:45,040
Going to go look this up. 
I know what you're talking 

1115
00:53:45,040 --> 00:53:48,640
about, but I. 
I'm a person where my running 

1116
00:53:48,640 --> 00:53:52,800
gate is kind of straight line 
from my hip down to my ankle or 

1117
00:53:52,800 --> 00:53:55,200
I have a slightly bow legged 
position. 

1118
00:53:55,280 --> 00:54:00,200
And so if I'm in a shoe that has
a medial post, I kind of bend 

1119
00:54:00,200 --> 00:54:02,600
outwards a little bit which 
increases stress on the outside 

1120
00:54:02,600 --> 00:54:03,560
of my knee. 
What's it called? 

1121
00:54:03,560 --> 00:54:04,840
Did you find it? 
Is it the? 

1122
00:54:04,840 --> 00:54:08,720
Sensation, yes. 
Yes, so I got the sensation. 

1123
00:54:08,880 --> 00:54:11,360
I remember the run, It was a 
five mile run that I go through 

1124
00:54:11,360 --> 00:54:14,160
Schmeekly Reserve in town. 2 1/2
miles. 

1125
00:54:14,160 --> 00:54:16,920
In I was like crap, so I had to 
like walk and I because I was 

1126
00:54:16,920 --> 00:54:18,040
like, I'm not going to push 
this. 

1127
00:54:18,840 --> 00:54:22,560
So for me, it's that those 
posted shoes that keep me a 

1128
00:54:22,560 --> 00:54:26,320
little bit out up the chain for 
me does something enough to 

1129
00:54:26,320 --> 00:54:29,080
change it. 
So I think there is that 

1130
00:54:29,080 --> 00:54:31,640
Goldilocks phenomena with 
finding a shoe. 

1131
00:54:31,640 --> 00:54:37,520
If you're a person that's having
kind of that hip adduction 

1132
00:54:37,640 --> 00:54:40,600
positioning, you probably want 
something that would facilitate 

1133
00:54:40,600 --> 00:54:43,280
in theory. 
I'm very hesitant to like 

1134
00:54:43,280 --> 00:54:47,080
connect knee mechanics to foot 
to shoe mechanics because. 

1135
00:54:47,080 --> 00:54:50,600
They don't know that. 
We're saying this loosely, but 

1136
00:54:51,040 --> 00:54:53,520
if you are one of those people, 
you'd probably want something 

1137
00:54:53,520 --> 00:54:55,200
with a little bit more 
structural as Matt is saying, 

1138
00:54:55,200 --> 00:54:57,560
like a stable neutral thing. 
Whereas if you're someone like 

1139
00:54:57,560 --> 00:55:01,000
me where you're a little bit 
more knee various, you probably 

1140
00:55:01,000 --> 00:55:04,480
want something much more neutral
that's going to allow you to 

1141
00:55:04,560 --> 00:55:07,920
versus even stable neutral, less
soul flaring as you were saying.

1142
00:55:07,920 --> 00:55:11,400
Except my soul flaring issue is 
when it's on the inside and then

1143
00:55:11,400 --> 00:55:15,160
it like keeps me out. 
So I think that that's that 

1144
00:55:15,160 --> 00:55:17,160
Goldilocks phenomena. 
It depends on what your 

1145
00:55:17,160 --> 00:55:20,160
mechanics are are going to 
dictate what shoe might be a 

1146
00:55:20,160 --> 00:55:23,120
good option for you. 
Whether or not it's worth buying

1147
00:55:23,120 --> 00:55:24,840
a new shoe because of IT. 
Band syndrome. 

1148
00:55:24,840 --> 00:55:27,160
I'm not ready to go there. 
But if you have multiple shoes 

1149
00:55:27,160 --> 00:55:29,800
to choose from, that's how I 
would and conceive it. 

1150
00:55:29,960 --> 00:55:30,880
Yeah, yeah. 
That's. 

1151
00:55:30,880 --> 00:55:33,760
Actually, what I would say is if
you have this, if you have a 

1152
00:55:33,760 --> 00:55:36,800
rotation of shoes, this does not
necessitate buying a new shoe, 

1153
00:55:36,920 --> 00:55:38,920
right? 
Because this that by like, it's 

1154
00:55:38,920 --> 00:55:41,080
kind of like foam rolling, like 
going through the that's not 

1155
00:55:41,080 --> 00:55:43,760
what's going to fix this. 
It's making sure that you figure

1156
00:55:43,760 --> 00:55:46,840
out like, are you overtraining, 
you know, do is there some kind 

1157
00:55:46,840 --> 00:55:49,360
of movement or muscle weakness 
thing that you got to deal with?

1158
00:55:49,600 --> 00:55:53,120
Like that's the real answer. 
But if you have a variety of 

1159
00:55:53,120 --> 00:55:57,400
shoes, MOOC, staying away from 
extremes is probably going to be

1160
00:55:57,400 --> 00:55:59,800
better or knowing what you 
typically they tend to work 

1161
00:55:59,800 --> 00:56:02,360
better in is going to go that 
direction. 

1162
00:56:02,360 --> 00:56:05,800
Like for example, I think super 
shoes are typically not a great 

1163
00:56:05,800 --> 00:56:09,000
option for this because they 
tend to be really stiff, but 

1164
00:56:09,000 --> 00:56:12,800
also super soft and unstable. 
That is a group I would probably

1165
00:56:12,800 --> 00:56:16,400
stay away from versus like your 
your trainer that you know works

1166
00:56:16,400 --> 00:56:19,440
for you, that gives you either 
the guidance you need or it 

1167
00:56:19,440 --> 00:56:22,280
doesn't overcorrect you. 
That's the shoe you probably 

1168
00:56:22,280 --> 00:56:25,480
want to spend more time in as 
this as this gets better and 

1169
00:56:25,480 --> 00:56:29,160
then slowly ease your way into 
shoes that maybe are like a team

1170
00:56:29,320 --> 00:56:30,680
bit outside of that comfort 
zone. 

1171
00:56:30,680 --> 00:56:33,040
Great. 
Well, thank you everyone for 

1172
00:56:33,040 --> 00:56:35,360
joining us on this journey where
we talked about IT band 

1173
00:56:35,360 --> 00:56:37,280
syndrome. 
If you have other questions 

1174
00:56:37,280 --> 00:56:41,640
about IT Band syndrome or things
that you found that you have 

1175
00:56:41,640 --> 00:56:43,600
worked well or things you've 
learned from your physical 

1176
00:56:43,600 --> 00:56:46,120
therapist, you can drop those in
a comment. 

1177
00:56:46,360 --> 00:56:48,840
And we're excited to continue 
this conversation and other 

1178
00:56:48,840 --> 00:56:50,400
ones. 
If there are other conditions 

1179
00:56:50,400 --> 00:56:53,480
you'd like us to cover, we have 
a number of these types of 

1180
00:56:53,480 --> 00:56:56,960
episodes that we've done over 
the years, but they can always 

1181
00:56:56,960 --> 00:56:59,760
do a refresh and kind of revisit
with new things that have come 

1182
00:56:59,760 --> 00:57:02,400
out in the literature. 
So if there are specific topics 

1183
00:57:02,400 --> 00:57:05,040
you would like us to talk about,
you can either e-mail us at 

1184
00:57:05,240 --> 00:57:08,520
doctorsofrunning@gmail.com or 
you can comment below. 

1185
00:57:08,520 --> 00:57:10,560
If you're watching on YouTube, 
Matt, what you got? 

1186
00:57:10,600 --> 00:57:13,000
And yes, we've. 
Seen the 1000 emails about 

1187
00:57:13,000 --> 00:57:14,360
plantar fasciitis? 
We will. 

1188
00:57:14,400 --> 00:57:16,040
We will get to that one. 
Yes, we will. 

1189
00:57:16,320 --> 00:57:19,080
I know. 
We've heard it before the 40,000

1190
00:57:19,080 --> 00:57:21,720
comment planet. 
We know we're working on it, 

1191
00:57:21,800 --> 00:57:24,120
Yes, and that was the hardest 
one of all these to do. 

1192
00:57:24,120 --> 00:57:25,720
Do you think it depends on this 
one? 

1193
00:57:25,720 --> 00:57:28,120
Wait till we get there, yes? 
It's tricky. 

1194
00:57:28,120 --> 00:57:30,120
There's just so much going on, 
but that's not what this is 

1195
00:57:30,120 --> 00:57:31,680
about. 
Thank you everybody. 

1196
00:57:31,720 --> 00:57:32,600
We'll talk to you next time.