ITB and glutes

11 messages
21/05/2012 at 19:19
Hello, I've had itbs for 2 months and gave done the usual rollering and stretching. Was also told I had weak glutes so have been doing clams, squats, lunges etc. But my knee pain has recently got sharper when trying to go for a run and cone on quicker. I think my itb may be doing the work intended for my glutes in the strengthening exercises, thus making the itbs worse. Does this sound plausible? And if so, any ideas for glute strengthening that won't let my itb do any of the work? Cheers.
21/05/2012 at 20:53
Hi DMS

The itb is not a muscle and would not have been doing any work. Its main attachment is the TFL muscle and glute muscles. I am about 5 weeks into a rehab programme and am seeing great improvements. Ran 23 miles yesterday without issue.

Did you have your ITBS seen by a professional who then advised a specific rehab programe of strengthening / stretching. I saw a sports clininc that did gait analysis / assessment and gave me a load of exercises .
21/05/2012 at 21:07
Thanks for the reply. Went to a physio and for gait analysis. Both said weak glutes and gave specific exercises. But when I do the exercises (be they clams, squats or the band you tie round your ankles), I feel it working the side of my leg plenty but not the glutes.

Does that make sense? :/
21/05/2012 at 22:12
Every muscle has an equal and opposite - as Also says the contractile bit of your ITB is your TFL. This will (amongst other things) internally rotate you thigh.

Glut med, not max will externally rotate you thigh - and act as an opposite. It needs to be retrained in a functional, weight bearing fashion. Clams won't cut the mustard as its side lying.

You will need the ability to move better and this is where your mechanics come into it....If you're trying to work your gluts and you can't feel it in your gluts then your not using your gluts because you can't get into the right position to activate (and not strengthen) them. It's not what you're doing, but how your doing it.

I'd get onto the blower to your physio and ask what next, but it sounds as if you need some work to get you moving better.....
21/05/2012 at 22:28
Hi DMS,
It does make sense! Sounds like TFL is doing the work for you and not glutes and you're feeling it in your ITB because of TFL's attachment to it. This is a common issue during ITB rehab.
Try to modify your clam exercise to see if you can feel it in your glutes (in the side of the hip and buttock area). You can do this by extending the hip a bit more or bending/ straightening the knees a little. It's trial and error until you find the right technique. You can also try placing a rolled up towel under your waist or making sure the pelvis stays still as you lift. Tightening your bottom also helps place more emphasis on glutes.
Are you also doing side lying leg lifts and single knee squats?
If you can't find a way to target glutes then I'd ask your Physio to review your exercises with you.
21/05/2012 at 22:42
Only just saw Six Physio's post... I agree that clams may not be that functional as they are side lying but they are a good place to start when trying to improve glutes contraction. I usually use side lying abduction too, as there tends to be more glutes activity than with clams, then progress into weight bearing when strength has improved.
I know people seem to dislike sidelying work but we have a glutes programme from the English Institute of Sport and the whole thing is side lying and really works the glutes.
23/05/2012 at 02:16
Have to agree with six physios thoughts on clams and side lying not being functional for glutes.

There is a big difference between working the glutes and having them work in function. For more info have a look at

http://www.physioblogger.com/2012/05/rehab-for-gluteus-medius/

http://www.mile27.com.au/strengthening-your-gluteus-medius-???-do-exercises-like-the-clam-or-a-side-lying-leg-lift-actually-do-anything/

Side lying exercises may help some people but since they are a long way away from training the muscle to work as it does in function there is limited strength carryover. ( for some that might be enough but for many for it isn't)

Some better strategies here

http://www.physioblogger.com/2012/05/rehab-for-gluteus-medius-my-strategies/

http://www.mile27.com.au/strengthening-your-gluteus-medius/
23/05/2012 at 13:10
Hi DMS,
As you see, physios all do things a little differently!
It all comes down to what works for you really.
You can justify it either way but for you the challenge is to find an exercise that works glutes without increasing your pain, ideally that's a functional exercise in weight bearing but if that's too sore or doesnt target glutes then sidelying exercises are a reasonable option in my opinion. Then you can progress to weight bearing when you fee able. As Six mentions above you may need to see your Physio for some guidance on this.
23/05/2012 at 21:59
DMS, The one thing my PT really drilled into me was to maintain the right form during all the exercises I was given. We went through each one slowly until I was doing the exercise correctly initially, and correctly when I was starting to tire. If in doubt ask for guidance.

I have had ITBS to some extent for years, and this put me off running completely. Why I didn't consult a PT years ago, I do not know!
24/05/2012 at 09:50
Hi DMS, how are the exercises going?

Loads more info on ITBS here;
http://runningphysio.wordpress.com/itb/

And glutes work here;
http://runningphysio.wordpress.com/gluteus-medius-evidence-based-rehab/
27/05/2012 at 22:10

Thanks for all the replies.

 

I tried the glute activation (as per mile27 website) and then went for a run trying to sprint to start with rather than get into the usual jogging pattern and whilst I've only managed 2.5k thusfar, it felt better. Fingers crossed, touch wood etc etc.

 

I certainly think that the initial glute exercises (clam and so on) did more harm than good.


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