Your hips and pelvis make up one of the body’s most mobile joints.

With over 30 muscles attaching to the lumbo-pelvic region, big and small, the importance of having a balance between strength and stability is key. Common injuries associated with the lumbo-pelvic hip complex include lower back pain, sacro-iliac joint dysfunction and hamstring, quad and groin strains. However due to the connected chains that the body functions through, injuries that are Commonly overactive presented above and below the hips may also be a result of a dysfunction at muscles in ITB syndrome: the lumbo-hip region. This can include ankle, knee and shoulder pain and/or Tensor Fascia Lata injury. Glute Maximus

Knee injuries are commonly a result of dysfunctions from above or below

A common injury for individuals, recreational and elite athletes is runner’s knee, also known as Iiliotibial Band (ITB) Syndrome. The iliotibial band is a long stretch of connective tissue that attaches at the top of the hip and inserts just below the knee on to the middle of your shin bone (tibia). The ITB is the attachment site for the tensor facia lata (TFL) and gluteus maximus muscles. When this structure becomes tight it can be very painful, often at the side or front of the knee. As the pain presents itself at the knee individuals expect that the knee is the source of the injury. However knee injuries (non-contact) are commonly a result of dysfunctions from above or below as the structures of the knee joint are directed towards stabilisation rather than mobilisation (hips and ankles).

Commonly underactive muscles: Glute Medius

Experiencing ITB syndrome myself it can be a pretty frustrating injury as it feels like it can switch on and off. Sometimes it will completely debilitate your leg and the next minute you are walking around fine. Common aggravations include running and climbing up and down stairs. As this injury can be intermittent it may take a back seat when looking for a treatment plan but it is important to acknowledge the symptoms early so further injury can be prevented.

The iliotibial band is a thick fibrous structure and does not have the same contractile properties as skeletal muscle

SOFT TISSUE TREATMENT The iliotibial band is a thick fibrous structure and does not have the same contractile properties as skeletal muscle. Which brings debate about the best treatment for ITB syndrome. Firstly some believe direct soft tissue treatment to the ITB is the best, this can be rather painful especially when deep/high pressure soft tissue techniques are used. This may involve hands on soft tissue work along the ITB from the attachment at the hip to the insertion at the tibia. On the other hand some would argue that the tightness of the ITB is a result of the overuse of muscles that attach in to the ITB, i.e. TFL and Glute Max. Soft tissue release in these areas are a good way to stretch out the muscles fibres, this involves active stretching of the muscle while under a shortened state as the therapist works proximal to distal along the muscle

belly putting pressure in a downward and upward movement in relation to the muscle fibres. Other soft tissue techniques can be used to target these muscles to aid the release of the ITB also. I find using a mixture of the two treatment options works best as well as working along the lateral edge of the vastus lateralis, and lateral hamstring muscles. It is important to remember that the body is an integrated functional system with subsystems ingrained. Therefore it is important to see the bigger picture when treating and training. It is important to remember that the body is an integrated functional system with subsystems ingrained. Therefore it is important to see the bigger picture when treating and training

SELF-CARE Ultimately it is always down to the individual to manage their own body and treatment. Soft tissue therapy is definitely a worth-while supplement to self myofascial release (foam rolling), stretching and strengthening when experiencing ITB syndrome. I found that foam rolling the quads, hamstrings and lower back help Self-Care Tips release the lumbo-pelvic region (Bigger Picture!). One of my  Self Myofascial Release: loosen favourite self myofascial release techniques is using a hockey tight muscles or lacrosse ball in the glutes. This can be done against a wall  Stretch: tight muscles or sitting on the floor. For this hold the ball on any tender  Strengthen: weak muscles spots and keep rolling through the glutes until you feel some tension has been released. Remember that the glute max. attaches in to the ITB so a tight glute max. can put tension through the ITB. Lastly the gluteus medius is a common underactive muscle in athletes so it is worth strengthening using isolated exercises (this is one of the exceptions where isolation exercises may be more appropriate than functional).

Further Reading: Antonio, S., Wolfgang, G., Robert, H., Fullerton, B., & Carla, S. (2013). The anatomical and functional relation between gluteus maximus and fascia lata. Journal of bodywork and movement therapies, 17(4), 512-517. Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., ... & Benjamin, M. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of anatomy, 208(3), 309-316.