body – Yass For Fitness http://yass4fitness.com Fitness Programs Reviews From a Personal Point of View Wed, 23 Mar 2016 01:53:07 +0000 en-US hourly 1 https://wordpress.org/?v=4.5.1 Spartan Race – Tampa Sprint 2015 http://yass4fitness.com/2015/02/spartan-race-tampa-sprint-2015/ http://yass4fitness.com/2015/02/spartan-race-tampa-sprint-2015/#comments Mon, 23 Feb 2015 19:45:15 +0000 http://yass4fitness.com/?p=174 What better than celebrating Valentine’s Day by running a Spartan Race? Luckily for me, I don’t really celebrate V-Day, but I do love obstacle races, which was a pretty damn good reason to stay away fro all the love posts online.

Left home at 4am to drive up to Tampa, with enough time to get ready for the race, including setting up my GoPro camera. Temperature was around 42º by the time my race was about to start, which is not a big deal, but when you’re about to run and most probably jump in cold water, it becomes one of those “oh crap, this is going to be fun…. not” moments.

IMG_0656

Overall, I thought the race was tougher than my Super race from last year, but I think two main factors that got me to this realization has to do with to very specific issues. The first one, right at the beginning of the race, during the second obstacle, while helping a lady jump over the wooden obstacle, the force she applied in order to reach the top wasn’t downwards but find of forward, literally throwing me to the floor and hitting my knee and wrist against the concrete floor. Although my knee hurt just at that moment, my wrist was the one with more damage, which became worse as I had to keep using my hand throughout the race. The pain became excruciating and there was nothing I could do about it… because I wasn’t going to quit and I wasn’t going to do 30 burpees just to skip each obstacle. The second issue was the amount of stairs we had to climb during 75 to 80 percent of the race. I’ve never in my life climbed so many stairs before in a single day.

I’ll be honest, while I enjoy helping others to overcome obstacles, that initial injury that cost me having to deal with so much pain and ending up not being able to use my hand for a week after the race, taught me that not always I can sacrifice myself for those around me, especially during a race. The worse that can happen during a Spartan race is, that if you can’t complete an obstacle, you’ll have to do 30 burpees, and even then you’re getting something physically positive out of it.

My goal now is to prepare and focus for next year’s Beast race, which most probably will be in Atlanta, and for once I will try to focus on timing other than recording videos with my GoPro. This along with a Tough Mudder race and smaller obstacle races will keep me busy for a while when it comes about outdoors physical activities.

Screen Shot 2015-02-23 at 2.10.15 PMbazu-4674361 bazu-4721420IMG_0709

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How I beat ITBS (ITBFS) http://yass4fitness.com/2014/12/how-i-beat-itbs-itbfs/ http://yass4fitness.com/2014/12/how-i-beat-itbs-itbfs/#respond Sat, 06 Dec 2014 05:42:05 +0000 http://yass4fitness.com/?p=152 What is ITBS or ITBFS? It stands for Iliotibial Band Syndrome or also known as Iliotibial Band Friction Syndrome.

ITBS is an overuse injury of tissues of the outer thigh and knee. The iliotibial band runs along the lateral or outside aspect of the thigh and is an important structure that stabilizes the outside of the knee as it flexes and extends. Inflammation of the IT band can occur as it crosses back and forth across the bony prominence of the femoral epicondyle as the knee flexes and extends causing pain on the outside part of the knee especially during running when the heel strikes the ground.

As I had mentioned before on my ITBFS or ITBS. What is Iliotibial Band Syndrome? I have been suffering from this for a while already. In fact, since my mid 20s I started experiencing pain on my knees, although it wasn’t until my 30s that I found out it was ITBS.

Many online articles have been written about what could be the cause, and different treatments. While in my opinion, the article I make reference too on my other post, has been one of the most complete in my personal opinion, I still didn’t find a way to get rid of my problem. After trying as many methods I could, I ended up giving up and not trying anymore.

My directed my focus towards working my legs from every possible angle, using heavy weights, trying to make them stronger and bigger. I mean, if I couldn’t run anymore, at least I wanted to have bigger lower extremities. What I didn’t know was, that by doing this I was already fighting ITBS and apparently making it go away.

Not until a couple of weeks ago, I decided to run again for warm up before my workout. Usually, with the knee straps I could get to two minutes of running before I started to get knee pain (without the straps it would be less than 2 minutes), but I noticed that somehow I ran 4 minutes and I didn’t feel any discomfort. This was without wearing the knee straps. I was surprised, but I didn’t want to push it and get to the point my knees would hurt. This stayed in my head, wondering what had happened that I didn’t get any pain. A few days after, I decided to try running 6 minutes, if possible, and see what the outcome would be. Once again, I felt no discomfort or pain at all. The excitement started to really wonder how far I could run before I would feel any pain, but my analytical mind kept me from doing something crazy and push my knees too far.

More recently I ran for 10 minutes and once again, my knees were perfectly ok with it. What is happening?, I thought. I haven’t really don’t any of the suggested therapy (stretching, foam roller, massages) but it seems my ITBS has somehow disappeared? Well, tonight I was committed to try not 15, but 20 minutes of running nonstop, which ended up being 2 miles even, and to my surprise, my kneed were absolutely fine.

I can’t tell you how excited and happy this makes me, knowing there was absolutely no discomfort during the time I was running for such a long time, at least for me. I began to realize, maybe the root of my problem was in fact weak hip abductors and glutes muscles, which I have constantly worked out since I decided to focus on my legs more than I did before. While I had done hip abductor exercises before, when trying different methods to treat the ITBS, it seems it wasn’t long enough to see any results. Now I’m basically doing 4 to 5 sets of 12 reps each using all the weight available on the machine, plus all the squats and other exercises I am doing, has been the solution to rid myself from this extremely frustrating condition.

While many treatments suggest to not stop running during the time ITBS is being treated, I eliminated running completely from my list, and it seems not running at all didn’t make a difference for me to get better. I will keep increasing the time and distance as I have an upcoming Sprint Spartan race. If it ITBS is officially gone completely, I finally see myself registering to run the Beast Spartan race in a near future.

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Week 4 of Shortcut to Shred http://yass4fitness.com/2014/09/week-4-of-shortcut-to-shred/ http://yass4fitness.com/2014/09/week-4-of-shortcut-to-shred/#comments Wed, 24 Sep 2014 04:35:19 +0000 http://yass4fitness.com/?p=143 I apologize for not posting my review and progress during week three. Between work and being busy exploring new events and activities more than I have previously, I barely had any time left to post my review. Instead, here I am, when I have officially completed week 4 of STS. Therefore, what I’m planning to do is an overview of both week 3 and week 4, going over what I consider the most important parts.

During week three my body embraced the strength phase incredibly. During the first three days of the week, the reps goal was to stay between 2 and 5 reps per set, which allowed me to Military Shoulder Press 170 lbs, Squat 270 lbs and Deadlift 315 lbs. All of these I did without feeling out of energy after each set, but on the contrary, I was feeling super pumped to continue to the following set. My Cardio Acceleration sets didn’t affect my performance at all. In my opinion Week 3 was a major success.

Week 4, on the other hand, was kind of a disaster. The reason why is because of the drop on carbohydrates. Going from 1 gram of carbs per body weight pound to 0.5 gram makes a huge difference. The first two days were literally horrible. Deadlifting 275 lb and squatting 180 lbs felt almost impossible to do. My energy levels were super low during the whole day and my workouts weren’t as good as I wish they had been. In many occasions I had to skip the Cardio Acceleration sets because I just didn’t have the energy. By the end of the week my body was already adapting to this lack of carbs, and while I still don’t feel I have the energy I had during Week 3, at least I was able to do better than at the beginning of the week.

I’m positive I have lost certain amount of muscle mass, but for sure I have lost a lot of body fat, as you will see on the pictures below. Tomorrow, is the first day of Week 5, and the macronutrients adjustment wasn’t too big.

This is how my macros look, including how they were during Week 3

Macros Day 0 Week 1 Week 2 Week 3 Week 4
Protein 276 g 273.6 g 272.7 g 269.1 g 268.2 g
Carbs 276 g 182.4 g 181.8 g 89.7 g 89.4 g
Fats 92 g 90.9 g 91.2 g 89.7 g 89.4 g

These are my current results

Stats Day 0 Week 1 Week 2 Week 3 Week 4
Weight 184.2 182.3 181.8 179.4 178.8
Waist 33.50″ 33.00″ 32.75″ 32.37″ 32.00″
Body Fat 12.98 % 12.68 % 12.37 % 11.15 % 11.15 %

The following is a video of me deadlifting the 315 lbs and at the end of this post you can see my progress pictures, showing much better abdominal definition by the end of Week 4.

4 Weeks Progress
4 Weeks Progress
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Week 2 of Shortcut to Shred http://yass4fitness.com/2014/09/week-2-of-shortcut-to-shred/ http://yass4fitness.com/2014/09/week-2-of-shortcut-to-shred/#respond Wed, 10 Sep 2014 17:55:23 +0000 http://yass4fitness.com/?p=123 Here I am, two weeks into the program and about to start my third week of STS (or S2S like some like to call it). So, what has been different about this second week? Not much really, other than reps per set and of course decreasing my carbohydrates. While the first 3 days of training the reps range decreased, allowing me to go heavier on each exercise, during the remaining 3 days of the week the reps increased, which of course, had me using less weight to meet the reps goals. One of my concerns was how my body would react to eating 93.6 g of carbs less a day, but my body reacted nice to it, not making feel with less energy.

This week marked two main personal records which I have been looking forward to for a while already, one more than the other. Although squats have never been my favorite exercise, I had been stuck on 200 lbs for a while, and I finally was able to squat 230 lbs. My goal wasn’t about reaching that weight but at least getting over the 200 lbs. Now, my main goal was in regards to deadlifts. I have been wanting to reach the 300 lbs, not only I was able to deadlift 305 lbs for one set, but I also was able to do a second set with the same weight, not feeling out of breath, lightheaded or exhausted afterwards, as you can see on the video below.

For now, my nutrition plan virtually looks the same way, so I don’t need to make any big changes.

Macros Day 0 Week 1 Week 2
Protein 276 g 273.6 g 272.7 g
Carbs 276 g 182.4 g 181.8 g
Fats 92 g 90.9 g 91.2 g

Results
This week the weight difference was not as much, but then again, my goal is not weight loss but fat loss.

Stats Day 0 Week 1 Week 2
Weight 184.2 182.3 181.8
Waist 33.50″ 33.00″ 32.75″
Body Fat 12.98 % 12.68 % 12.37 %

Once again, this body fat percentage is very inaccurate, based on the cheap caliper I am using and the fact that I am measuring it myself. This is just for reference purposes.

And here is my photo comparison. Starting next week I will be using only the first set of pictures and the current ones after each week.

Week 2 STS Progress
Shortcut to Shred Progress
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One Week of Shortcut to Shred http://yass4fitness.com/2014/09/one-week-of-shortcut-to-shred/ http://yass4fitness.com/2014/09/one-week-of-shortcut-to-shred/#respond Wed, 03 Sep 2014 16:03:48 +0000 http://yass4fitness.com/?p=106 It has been a week already since I started Shortcut to Shred, and I won’t deny I was a little intimidated by the sudden caloric increase in my diet. This morning, just as I did last Wednesday as soon as I woke up, I took my new set of pictures, got on the scale, measured myself and measured my body fat % using my very cheap caliper.

Before I continue to compare today’s measurements with last week’s, I will talk a little about my experience during this first week when it.

The Workout
For me it was completely new to include any form of cardiovascular exercise in between sets. Since most complains online were in regards to these cardio exercises affecting weight load and causing trouble keeping up with the same weight during the whole set of the same exercise, I came to the conclusion that either these people suffer of lack of conditioning, or my conditioning is way better than theirs. When using the BodySpace app to track my workouts, you have the option to include or exclude these extra sets of exercise. I personally included them, and at no time my weight load was affected during my lifting. Something I’m aware of is, starting today my weight load is supposed to increase each week, so what effect cardio acceleration will have on my workout is still a mystery. The only down side was that I was sweating way too much, and I wouldn’t even consider that a bad thing.

The Nutrition
As I mentioned before, my caloric intake was raised almost 1000 calories based on the amount of macros I had to eat during this first week. From my previous experience, I distributed my macros during the day as it has worked best for me. That made it easier to schedule my meals and not feel like I was force feeding myself, expect for the first and probably second day. Although I didn’t reach the fats target, I was able to be consistent with my protein and carbohydrates.

Based on my new weight and because I’m starting Phase 2, my macros have been adjusted as shown below.

 

Macros Day 1 Day 8
Protein 276 g 273.6 g
Carbs 276 g 182.4 g
Fats 92 g 91.2 g

 

The Results
As you can see below, I was able to lower my waist measurement and even dropped some weight. My goal at this moment is to lower my body fat, and as much as I would like to stay in the weight range of 182-185 lbs, I’m not really worried about losing some weight for now. Based on the pictures, my posing might have been a little different in some cases, and while my back seems to have lost some definition, my abs look like might have gained definition and probably my thighs did as well. For only one week of training, at least there was some significant change overall.

 

Stats Day 1 Day 7
Weight 184.2 182.3
Waist 33.5″ 33.0″
Body Fat 12.98 % 12.68 %

 

 

Week 1 Progress Shortcut to Shred
Week 1 Progress Shortcut to Shred

 

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Day 2 of Shortcut to Shred http://yass4fitness.com/2014/08/day-2-of-shortcut-to-shred/ http://yass4fitness.com/2014/08/day-2-of-shortcut-to-shred/#respond Fri, 29 Aug 2014 03:50:21 +0000 http://yass4fitness.com/?p=98 Hey everyone, today was my second day doing Shortcut to Shred so I decided to go ahead and give you an updated about what I think of the program so far, what my nutrition looks like and show my day 1 pictures.

Yesterday morning, after I woke up I did what I always suggest everyone to do before starting a new workout program, and that is to take the “before” pictures. I learned this from P90X and it is totally worth it, because pictured don’t lie, while the scale usually does. I also weighted myself and weighted myself and used a cheap caliper to calculate my body fat. I do want to mention, I use this calculation as a reference, not as an accurate measurement. I am fully aware my body fat is higher than the number I got, but it is a good idea to use the same technique for reference purposes.

My current stats as of yesterday morning.

Weight: 184.2 lbs
Waist: 33.5″
Body Fat: 12.98%
Lean Body: 160.3 lb
Fat: 23.9 lb

The Workout

Day 1
The first workout was Chest and Triceps. While I do feel a little sore today, and during the exercises I left as heavy as I could possible go for, I had to take too many undesired breaks because most of the equipments were in use. One of the reasons why gyms annoy me at times. Other than that, I thought it was a pretty decent workout.

Day 2
Today’s workout was Shoulders and Legs. Now, today was a whole different story. I really felt the intensity today. Although the workout gives you the option to include super sets and an additional cardio exercise in between sets, or to chose from one or the other, I elected for including both. I already can tell tomorrow my calves will be sore. I was exhausted by the end of the workout. Yet, I haven’t experience one of the complains I read online by a few people, which is that due to the cardio in between sets they couldn’t lift as heavy as they usually could. Personally, I was able to lift as heavy as usual without any issue.

Conclusion
I know for many the workout might seem long and tedious, especially if the person doesn’t skip the super sets and cardio. I don’t mind working out for more than one hour. I have done it before and to me is not an issue. While this is completely different from what I have done in the past, if a workout makes me feel I didn’t waste my time at the gym, I am totally up for it, and that has been the case so far. It does take a lot of energy and commitment to do all the exercises suggested, but I find that to be part of the challenge.

Day 1
Day 1
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Team ATRAIN Progress and Review http://yass4fitness.com/2014/08/team-atrain-progress-and-review/ http://yass4fitness.com/2014/08/team-atrain-progress-and-review/#respond Sun, 24 Aug 2014 07:34:45 +0000 http://yass4fitness.com/?p=85 If you haven’t seen or heard of Anthony Perez from TEAM ATRAIN on Instagram, you’re probably haven’t been following the right fitness accounts.This guy is a competitor, a beast, has a killer body and has it all figured out.

After coming from doing different methods to get in shape and up to some level achieving great success, I realized there was one thing I was still unable to achieve, gaining mass without gaining body fat. Last year after I tore my rotator cuff and I had to stay away from the gym for 3 months, which during time, I put on some undesired weight. Emotionally it affected me that I was injured and unable to do any exercises without being in pain. This lead me to not pay much attention to what I was eating (comfort food) and ended with a higher body fat percentage. After I finally recovered to some extend and successfully finishing a Super Spartan Race, I decided to sign up for Anthony’s online coaching. I had been following his account for a while on Instagram and his clients had shown great results. I had nothing to lose but a lot to gain.

The process was pretty simple. We talked about my goals, he provided me with a customized plan to get it done. At the beginning I had some trouble as to how I needed to measure my meals. It wasn’t complicated, but I wasn’t used to his method. It took me a week and I was already familiar with it and didn’t have any issues following his program as instructed.

The plan had been designed to drop body fat and gain muscle mass. Considering I signed up for 12 weeks of training, which I’m aware is a very short time to achieve my personal goals, I didn’t really know what to expect to be honest. Yes, previously I had achieved a lot of 12 weeks, but I had never successfully gained as much muscle as I wish I had. So I followed the plan from beginning to end and soon realized changes were happening and this plan really works.

At one point, due to unknown reasons, I started having major headaches which after and ER visit, several tests and seeing different specialists, no one could figure out what it was and because of it the doctor prohibited me any form of exercises for 3 weeks. Right after I was able to continue the program, kept gain incredibly strength and improving my body in all possible ways. Even exercises I couldn’t do due to some discomfort from my rotator cuff, I am now able to do them with heavy weights.

Based on the picture below, you will see the amazing results I achieved with his plan. With only 2 lbs difference, the changes around my core are mind blowing. My arms are bigger and my back is more defined. I went from 540 lbs on legs press to 700 lbs. Deadlifts from 225 lbs to 285 lbs and soon to hit the 300 lbs. I’m even doing flat bench press with 90 lbs for 13 reps and sometimes even more, with no spotter.

The biggest surprise for me was when comparing this two sets of pictures from when I first started and the present, and realizing I wasn’t as in shape as I thought it was.  In my opinion the changes were drastic and I am beyond pleased with them. This has been a unique experience, a transforming one. Learned how to approach fitness from a angle, and for the first time I was able to not focus on body weight, but instead on losing body fat while gaining muscle mass.

Conclusion? I do recommend to reach out to Anthony if you really don’t want to waste your time figuring things out and instead just get help from someone who won’t will provide you with what you need to succeed.

Progress Using ATrain Plan

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Calculating Calories and Macronutrients http://yass4fitness.com/2014/08/calculating-calories-and-macronutrients/ http://yass4fitness.com/2014/08/calculating-calories-and-macronutrients/#respond Fri, 22 Aug 2014 19:27:32 +0000 http://yass4fitness.com/?p=81 Calories (noun) – Tiny creatures that live in your closet and sew your clothes a little bit tighter every night.

 

Calories and Macros
There are probably more articles about calories and macronutrients than there are about any other trending topic online. I am sure the amount of information can be overwhelming and at times confusing, especially when most articles seem to contradict each other and everyone claim to be right while the rest are wrong. Because of that, those of us trying to understand the impact and importance calories and macronutrients have on our fitness goals, it only adds to frustration and mistakes that lead us to failed attempts to achieve our goals.

Because I understand the frustration, I want to share with all of you small article, which in my opinion describes very precisely what calories and macronutrients are, and how to properly calculate them.

The article was written by Emma Leigh and posted on BodyBuilding.com and it can be found in the following link.

http://forum.bodybuilding.com/showthread.php?t=156380183

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What’s Next? Jim Stoppani’s Six-Week Shortcut To Shred http://yass4fitness.com/2014/08/whats-next-jim-stoppanis-six-week-shortcut-to-shred/ http://yass4fitness.com/2014/08/whats-next-jim-stoppanis-six-week-shortcut-to-shred/#comments Wed, 20 Aug 2014 17:09:03 +0000 http://yass4fitness.com/?p=63
The name Jim Stoppani creates controversy in the BodyBuilding.com forums like no other. For some, the guy who hides behind a Ph.D. degree and knows nothing about fitness and nutrition, who only cares about selling his supplement brand. For others, he is a fitness expert who provides useful and scientific articles and workout routines that has help people change their lives. With such mixed opinions, then why Six-Week Shortcut to Shred?

From my personal point of view, any form of exercise will have an effect on the body, especially when combined with proper nutrition. While not every program will be ideal for every person, depending on the that person’s goals, exercising, for the most part will benefit your body and health. So after reading in the BodyBuilding forums a great debate whether this is a good program or a scam, I decided to give it a try myself and record my progress from beginning to end.

As unfortunately as it is, I really haven’t seen many, if any full review by people who has tried this program. Part of the negative comments towards this program in the forum points out people quit before finishing the program. It sounds very familiar to me, thinking how many negative comments are towards P90X and how many people have given up up half way through it.

For that reason, and because I do like both, challenging my body and challenging those who would bash fitness programs without even trying them, I will start it next Wednesday August, 27th. From that moment on, I will post weekly reviews of my progress and experience using this program, hoping by the end of week 6, to either prove this program does work or it doesn’t.

The one element that will be different when I do this plan is, I will NOT use any of the supplements suggested by Jim on his plan. The only supplements I will be using are the pre-workout ones I always use. Other than that, I will base my macros strictly on food intake, and maybe if needed a protein shake.

I will post a link to a MyFitnessPal account I will open specifically to track the macro nutrients for those of you who are interested in seeing what I will be eating on a daily basis.

Link:
Jim Stoppani’s Six-Week Shortcut To Shred

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ITBFS or ITBS. What is Iliotibial Band Syndrome? http://yass4fitness.com/2014/08/itbfs-or-itbs-what-it-is/ http://yass4fitness.com/2014/08/itbfs-or-itbs-what-it-is/#comments Tue, 19 Aug 2014 17:38:21 +0000 http://yass4fitness.com/?p=53 As I mentioned before, I suffer from Chronic ITBS or iliotibial band syndrome. This condition is very common among runners and cyclists. I had no idea what it was until I started researching what could cause pain on the external side of the knee when running.  Although there are many articles online about possible solutions for this condition, I believe this article from the National Center for Biotechnology Information has been the most complete of all the ones I’ve read.

So for those who are not familiar with ITBS or if you suffer from it and want to read more about it, here is the article.

Abstract

Published articles on iliotibial band friction syndrome have been reviewed. These articles cover the epidemiology, etiology, anatomy, pathology, prevention, and treatment of the condition. This article describes (1) the various etiological models that have been proposed to explain iliotibial band friction syndrome; (2) some of the imaging methods, research studies, and clinical experiences that support or call into question these various models; (3) commonly proposed treatment methods for iliotibial band friction syndrome; and (4) the rationale behind these methods and the clinical outcome studies that support their efficacy.

Keywords: Iliotibial band, Knee pain, Running injuries, Iliotibial band friction syndrome

What is iliotibial band friction syndrome?

Iliotibial band friction syndrome (ITBFS) involves pain in the region of the lateral femoral condyle or slightly inferior to it, that occurs after repetitive motion of the knee, typically in a runner, cyclist, or other athlete.

Most typically a diagnosis is made based on the case history and physical examination, though in some cases MRI’s might be indicated to rule out another disorder in the region.

An important finding on physical examination is local tenderness of the lateral knee inferior to the epicondyle and superior to the joint line. The Ober test for distensibility of the iliotibial band is also frequently a measurement of interest.

What is the prevalence of ITBFS?

It is generally accepted that ITBFS is the most common running injury of the lateral knee, with an incidence between 1.6 and 12%. [15]. Linenger states that ITBFS comprises 22% of lower extremity injuries [6].

ITBFS is also commonly diagnosed in cyclists, reported as comprising 15% of all overuse injuries of the knee region [7].

Devan and others found iliotibial band friction syndrome to be the most common overuse injury of the lower extremity in a group of female college athletes who played soccer, basketball, or field hockey [8]. Rumball et al. also noted the common occurrence of ITBFS among competitive rowers [9].

What is the pathology of the condition?

When the concept of iliotibial band friction syndrome was first developed, the presumed model was that during activities involving repetitive knee flexion (such as running), the iliotibial band repetitively shifted forward and backward over the lateral femoral condyle, causing friction and thus inflammation of the ITB.

However, this view has been called into question in several ways.

Fairclough and others reason that the ITB is not a distinct anatomical structure but merely a thickened zone within the lateral fascia, which moreover is firmly connected to the linea aspera by an intermuscular septum [10]. Based on these anatomical considerations, they believe that anterior–posterior glide of the ITB is impossible, and a friction syndrome cannot truly exist in the region. Instead, they propose that an illusion of anterior–posterior movement of the ITB results from repetitive cycles of tightening; with each cycle of tightening the lateral fascia exerts a repetitive compression effect on connective tissues lying deep to the ITB.

The study of Hariri and others also calls into question whether inflammation of the ITB is actually involved in ITBFS [11]. In their case series, the symptoms of ITBFS were alleviated by surgical excision of what they described as a bursa in the sub-ITB space. Costa and colleagues also reported on a case in which a large cyst, arising from the joint capsule, was discovered in a 28-year old runner with lateral knee pain [12]. Nemeth and Sanders may have been describing the same tissue in their anatomical review [13], but they referred to it as a lateral extension of the knee synovial capsule.

On the other hand, Isusi and others did not identify a bursa in the area, but did report MRI findings of signal changes from the soft tissues immediately below the ITB, and osseous edema and subchondral osseous erosion of the lateral condyle, without evidence of inflammation or thickening of the band itself [14]. Further supporting this view is the study of Muhle and others [15], whose MRI studies of both cadavers and ITBFS patients showed poorly defined signal intensity abnormalities in a compartment-like space bounded laterally by the ITB, but did not identify a bursa, cyst, or lateral recess in this area, or pathological changes in the band itself. Nemeth and Sanders reported similar findings [13].

It may be that different subtypes of iliotibial band friction syndrome exist, one that involves irritation of a cyst, bursa, or lateral synovial recess, and a second type arising from compression by the iliotibial band of the connective tissues that underlie the portion of the band between the lateral epicondyle and the knee joint line. There is less evidence that a pathological change takes place in the iliotibial band itself. Whether actual anterior–posterior friction-producing motion of the ITB takes place or not is also controversial.

What are the biomechanical factors that contribute?

Weak hip abductors?

It would be logical to correlate the presence of weak hip abductors with iliotibial band friction syndrome, since weak abductors might lead to increased hip adduction during the stance phase of gait with a consequent increase strain of the iliotibial band and a greater tendency for it to compress the tissues underneath.

MacMahon and colleagues, Noehren et al., and Fredericson et al. all reported that ITBFS sufferers had abductor weakness or increased hip adduction during the stance phase of gait, a finding which could be interpreted as being due to abductor weakness [4, 16, 17].

On the other hand, Grau et al., using a dynamometer that was mechanically stabilized instead of hand-held, did not find hip abductor weakness in their study of 10 runners with ITBFS as compared to healthy matched controls [18].

Thus, we may have more to learn about the relationship of iliotibial band friction syndrome to hip abductor weakness or to the related issues of the timing and magnitude of hip abductor activation during the gait cycle and the amount of hip adduction that occurs during the stance phase of gait.

Tight iliotibial band?

It is also logical to link tightness of the ITB with iliotibial band friction syndrome, since presumably a tighter band would lead to greater compression of the underlying tissues with each gait cycle.

The Ober test is most commonly used to assess tightness of the iliotibial band. As described by Gajdoski et al. [19], the Ober test is performed with the examiner standing behind the side-lying patient. The examiner stabilizes the pelvis with one hand, flexes the uppermost thigh, and then moves it into maximal abduction. He or she then maintains the abduction while moving the thigh into extension. The examiner then lowers the limb into adduction until it stops, or until the pelvis starts to tilt. The angle of hip joint adduction (or abduction, if the thigh cannot adduct even to neutral) is considered to be a measurement of ITB length or distensibility. Gajdoski’s article also describes variations of the Ober test that call for the knee of the side being tested to be either flexed or extended.

However, no study to date has actually correlated the findings of the Ober test (or any other test for ITB distensibility) with iliotibial band friction syndrome. Moreover, Devan and others did not find a correlation between a positive Ober test and the occurrence of ITBFS in female college athletes [8].

On the other hand, Fredericson [20] believes that most athletes with ITBFS exhibit a tight iliotibial band, though the Ober test and other clinical examination methods, as they are used in common clinical practice, may not be sensitive enough to detect it.

In 2007, Hamill, Miller, Noehren, and David published findings that showed that runners with ITBFS had a “looser” iliotibial band, exhibiting increased strain (it elongated more when subject to an external load) and, to a statistically significant degree, an increased strain rate (it elongated more rapidly) during running [21].

These findings seem to contradict the commonly asserted link between a tight iliotibial band and ITBFS. Furthermore, they would imply that stretching the ITB—insofar as the purpose of stretching would be to increase the distensibility of the band—could accentuate the symptoms of ITBFS.

Angle of knee flexion during stance phase?

The portion of the knee range of motion at which the ITB is most likely to rub against or compress the underlying structures is with the knee flexed about 20°–30°. Perhaps differences in the degree of knee flexion between individual runners play a role in the onset of ITBFS. The commonly held association of ITBFS with running downhill [22, 23] may be due to the fact that downhill running results in a higher degree of knee flexion at heel strike, thus increasing the friction of the ITB with the lateral epicondyle or the pressure the ITB places on the underlying soft-tissues.

However, Orchard et al. found no difference in the angle of knee flexion between runners with or without ITBFS when running on a treadmill [22]. This finding was echoed by Noehren et al. [17].

An additional subtlety was studied by Miller and others in 2006 [24]. Hypothesizing that a runner’s biomechanics might deteriorate adversely with fatigue, they tested runners’ biomechanics at the end of an exhaustive run. Indeed, runners with a history of ITBFS exhibited an increased angle of flexion of the knee at heel strike.

Rearfoot eversion?

Busseuil et al. found a higher incidence of ITBFS and other lower extremity injuries in athletes who over-pronated [25].

However, Messier et al. and Noehren’s group reached the opposite conclusion, that runners with ITBFS had reduced rearfoot pronation as compared to controls [3, 17].

Other biomechanical factors

Other biomechanical factors that have been linked with iliotibial band friction syndrome include: increased landing forces, increased knee internal rotation, low hamstring strength as compared to the quadriceps strength on the same side, and genu recurvatum [3, 8, 17, 25].

What other injuries and conditions are related to ITBFS?

Tightness of the ITB may play a role in patellofemoral syndrome [2628].

Vasilevska’s group studied patients with osteoarthritis of the medial compartment of the knee and found a high incidence of iliotibial band friction syndrome. Their model was that reduced medial joint space created a varus knee deformation, thus putting extra tension into the iliotibial band [29].

Greater trochanteric pain syndrome (previously known as trochanteric bursitis) may also reflect altered biomechanics of the ITB.

Pelfert and others have reported the occurrence of ITBFS subsequent to repair of the anterior cruciate ligament [30].

Costa and others reported having removed a synovial cyst from the lateral knee of a runner diagnosed with iliotibial band friction syndrome [12].

Hammer reports the common occurrence of various hip and knee problems in those with iliotibial band friction syndrome, though the individual manifestations vary so that no consistent associations can be made between ITBFS and any other specific syndrome [31].

How is iliotibial band friction syndrome treated?

As described by Fredericson and others, the accepted treatment of iliotibial band friction syndrome follows the outline common to the treatment for many connective tissue injuries, beginning with treatment of the acute inflammatory response and progressing through a corrective treatment phase and ultimately to a return to regular activity [32].

Acute phase treatment to limit the inflammatory response

Care in the acute phase focuses on activity limitation or modification, and measures to relieve pain and inflammation, such as ice, oral NSAID’s, or corticosteroids delivered via phonophoresis or injection.

There is a limited body of research establishing the effectiveness of any of these measures in ITBFS. Ellis et al., in a review of published trials of therapy for ITBFS, found only one prior study of adequate quality that tested the use of NSAIDs, and two other studies that focused on the use of corticosteroids, in one case applied via phonophoresis and in the other via injection. In all three studies, improvement was demonstrated in both the control group and the treatment group, but the groups receiving anti-inflammatory agents showed significant improvement compared to those that did not [33].

On the other hand, other research, not specific to ITBFS, points to the risks of these anti-inflammatory measures when treating connective tissue injuries, and raises the possibility that the pharmaceutical limitation of the inflammatory stage in connective tissue injury actually leads to a delay in healing or to poorer healing [34, 35].

Stretching of the iliotibial band and related structures

Stretching of the iliotibial band, lateral fascia, gluteus medius, and other muscles is frequently recommended as part of the treatment plan for ITBFS.

A variety of stretching protocols have been suggested. Fredericson measured the change in length of the iliotibial band while athletes performed variations of ITB stretches, and found that a particular stretch—with the athlete standing, placing the affected foot adducted and behind the other, and laterally flexing away from the affected side with the arms stretched overhead—created the greatest lengthening of the band [36].

On the other hand, Falvey et al. found that the optimal stretch varied considerably from individual to individual [37].

Neither study documents a link between short term distension of the iliotibial band, such as during a stretching routine, and longer-term changes in the tissue’s mechanical response, in improved running mechanics, or in relief of ITBFS. In addition, in light of the discussion above on the questionable role of iliotibial band tightness on the etiology of the disease, there may be reason to question the rationale for attempting to stretch the ITB.

Connective tissue manipulation

Manual therapy techniques to release myofascial restrictions in the iliotibial band and related structures are also frequently recommended.

Pedowitz reported on a single case that he treated effectively with strain–counterstrain technique [38]. Hammer emphasizes the use of connective tissue treatment methods to release restrictions not only in the ITB but in the gluteal muscles and any other areas found to be restricted in the hip area, thigh, or lower extremity [31]. Fredericson agrees that treatment of trigger points in the band can help significantly [20].

On the other hand, of the scarce published data that has tested the efficacy of these measures, Ellis et al. found a single trial of deep transverse friction massage used in the treatment of ITBFS. It was not found to confer any added benefit [33].

Strengthening of the hip abductors

Though no trials have been published on the efficacy of strengthening exercises in the treatment of ITBFS, strengthening of hip abductors is often recommended [32].

Improved neuromuscular coordination

Improving neuromuscular control of gait is also frequently mentioned as a useful approach in the treatment of ITBFS. Fredericson et al. depicted a number of exercises to train complex multidimensional movement patterns involving weight shift and other aspects of hip abductor function [32]. Pettit and Dolski also described the successful application of a multi-dimensional corrective therapeutic exercise program combined with stretching, massage, soft tissue mobilization, shoe modification, and electrical stimulation [39].

Surgical excision of a cyst, bursa, or lateral synovial recess

Practitioners utilizing conservative means report a satisfactorily high rate of positive response, so that few patients should require surgical intervention [2, 4042]. Yet a number of case series reporting resolution of ITBFS from the surgical excision of a bursa, cyst, or portion of a lateral synovial recess have been published [1113, 43].

Summary

Iliotibial band friction syndrome is a common occurrence among physically active individuals, causing pain in the lateral knee.

There is much to be learned about the etiology, pathology, and optimal treatment of the condition. Many published studies seem to approach the problem from differing and hard-to-reconcile viewpoints.

Despite these limitations, and despite the fact that few outcome studies have been done to establish a consensus clinical approach, most practitioners are confident in their ability to diagnose ITBFS based on the case history and physical examination, and most are satisfied with the treatment results they get with conservative measures that include methods to control the inflammatory reaction, strengthening, stretching, modification of neuromuscular control of gait, and connective tissue therapy. Corticosteroids and NSAID’s have documented benefits in the short term.

In those few cases that do not respond to a conservative regimen, surgical excision of tissues deep to the band also has an established track record of effectiveness.

 

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