Iliotibial band syndrome (ITB) is defined as an inflammatory condition of the iliotibial band. The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. This tendon runs down the side of the thigh and connects to the outside edge of the tibia (upper shinbone), below the middle of the knee joint. The iliotibial band provides stability to the knee and hip and prevents dislocation of those joints.

Signs and symptoms Iliotibial Band Syndrome symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground.Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.

Causes
Iliotibial Band Syndrome can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:
Training habits:
Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur.
Inadequate warm-up or cool-down.
Increasing distance too quickly or excessive downhill running .
Abnormalities in leg/feet anatomy:
High or low arches.
Overpronation of the foot.
The force at the knee when the foot strikes.
Uneven leg length.
Bowlegs or tightness about the iliotibial band. Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.
Muscle Imbalance:
Weak hip abductor muscles.

Treatment
Reduce training load and intensity so running remains ‘pain free’. Apply ice to the knee (10mins approx every 2-3 hours). Wrap the ice pack in a damp cloth.
Use non-steroidal anti-inflammatory drugs (eg. Ibuprofen) regularly for 5-7 days. Consult your pharmacist or General Practitioner for the recommended dose.
Take massage therapy to decrease tightness of the iliotibial band. You can also try using a rolling band to self-treat.
Gentle stretching of the iliotibial band approx 3 times daily, holding stretches for 30 seconds.

Prevention
Ensure appropriate footwear. You may require motion control shoes or orthotics to control over pronation. Gait analysis can be used to determine this.
Avoid excessive downhill running or running on cambered surfaces.
If running on a track alternate between running clockwise and anti-clockwise.
On full recovery from iliotibial band syndrome decrease the risk of reoccurrence by the following preventative measures:
Gradually increase training intensity.
Continue iliotibial band stretches regularly.
Ensure footwear remains correct.
Ensure adequate strengthening of the gluteals, quadriceps, hamstrings and calfs within your training program.
Avoid excessive downhill running or running on cambered surfaces.
Ensure adequate rest within your training programme.

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Plantar Fasciitis is a common foot condition that causes heel pain and pain in the sole of the foot. Plantar Fasciitis is inflammation of the Plantar Fascia, a fibrous sheath that runs most of the length of the sole of the foot. It attaches between the heel bone and the bones at the base of the toes, covering the small muscles in the sole of the foot. During walking and running, as you ‘toe-off’, the Plantar Fascia becomes taut and helps the foot act as a lever to push off with force. It is one of the primary stabilising structures of the arch on the inner side of the foot.

Inflammation of the Plantar Fascia usually occurs at the point where it attaches to the heel bone. Plantar Fasciitis is reasonably common in older individuals, where the movement in the joints of the foot has become restricted and strain on the Plantar Fascia is increased. It may also occur in individuals who do a lot of standing, walking or sporting activities, usually as a result of overuse. It tends to be more common in females and in people who are overweight.

Signs and symptoms
Plantar Fasciitis produces foot pain over the inside of the heel and this usually radiates down the inside of the sole of the foot. This foot pain usually occurs with activity and is also typically present in the morning when taking the first steps of the day.

Plantar Fasciitis can be diagnosed by a doctor or physiotherapist, if pain is present on touching the affected area, and/or on stretching the Plantar Fascia (by pulling the toes up). The diagnosis of Plantar Fasciitis can be confirmed on an Ultrasound scan, when the fascia has a thickened appearance. In a small number of cases of heel pain, that fails to respond to normal treatment, it may be necessary to get an x-ray to rule out other conditions such as a bony spur on the heel bone or a fracture of the heel bone

Causes
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage.

Treatments
Physiotherapy is the main treatment for this condition.

Stretching is an important treatment. If the pain is bad in the morning the foot can be stretched up by putting a towel under the forefoot and pulling up with the hands. Standing calf stretches and a night splint to hold the foot up in a partly stretched position can also be useful.

Deep massage along the plantar fascia may be useful and can be done by the sufferer once shown how by a therapist.

Ice can reduce both pain and inflammation, used from 10 to 20 minutes as an ice pack. Use care with ice and ensure your skin is protected. Do not put a freezing pack directly on your skin as this can cause frost-bite like damage.

Taping can be used by a therapist or trainer to attempt to route some of the forces through the sole along a different line.

Advice on activity modification is important as the condition may not completely resolve. Patients may need to consider alternative methods of keeping up their aerobic fitness and strength if weight-bearing activity is too painful.

Shock absorbing heel pads can be useful and should be tried as soon as the condition presents. Silicone gel pads are commonly used and are relatively cheap.

Arch supports may also be useful to restore more normal foot mechanics in cases where this has been disturbed.

Prevention
Inadequate footwear is often implicated in Plantar Fasciitis. Shoes should provide adequate support for the foot. Unsuitable footwear can increase strain of the Plantar Fascia and lead to the development of inflammation.

Insoles that support the arch on the inner side of the foot can be helpful for limiting excessive pronation and relieving stress on the Plantar Fascia and Achilles tendon.

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The Achilles tendon, named after the seemingly indestructible mythological Greek warrior, is the largest and strongest tendon in the human body. Your Achilles tendon is the large band of tissues connecting the muscles in the back of your calf to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump, or push up on your toes.

Achilles tendonitis is present when your Achilles tendon becomes inflamed or irritated.Often, Achilles tendonitis results from sports that place a lot of stress on your calf muscles and Achilles tendon. Achilles tendonitis also is often associated with a sudden increase in the intensity or frequency of exercise, hence why so many endurance based athletes suffer from the condition.When treated promptly, Achilles tendonitis is often short-lived. Left untreated, Achilles tendonitis could cause persistent pain or potentially cause your tendon to tear through lack of treatment and rehab exercises. If so, you may need surgery to correct the damage. Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendonitis.

Signs and symptoms
The signs and symptoms of Achilles tendonitis often develop gradually. They include:

 - Dull ache or pain when pushing off your foot during walking or when rising on your toes

 - Tenderness over your Achilles tendon

 - Stiffness that lessens as your tendon warms up

 - Mild swelling or a “bump” on your tendon

 - A crackling or creaking sound when you touch or move your Achilles tendon

You may notice that the affected tendon is sore when you get up in the morning or after you’ve rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you’ve ruptured the tendon completely, you won’t be able to rise on your toes on the injured leg. You may feel as if you’ve been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.

Causes
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. A sudden increase in a repetitive activity that involves the Achilles tendon can be to blame. A number of other factors can cause Achilles tendonitis, including:

Improper conditioning
Achilles tendonitis is most common among athletes whose bodies aren’t properly conditioned for their sport or activity. Inadequate flexibility and strength of the calf muscles can contribute to overload of the tendon. Frequent stops and starts during the activity, as well as activities that require repeated jumping can also increase your risk of Achilles tendonitis.

Too much, too soon
Achilles tendonitis resulting from overuse can occur when you begin a new exercise regimen. If you’re just beginning a new exercise program, be sure to stretch after exercising, and start slowly, increasing your activity over time. Don’t push yourself too quickly. Excessive hill running can also contribute to Achilles tendonitis.

Flattened arch
Flattening of the arch of your foot (excessive pronation) can place you at increased risk of developing Achilles tendonitis. This is because of the extra stress placed on you Achilles tendon when walking. If you have excessive pronation, be sure to wear shoes with appropriate support to avoid further aggravating your Achilles tendon.

Trauma or infection
In some cases, inflammation of the Achilles tendon is due to trauma or infection near the tendon.

Complications
Achilles tendonitis can progress to a degenerative condition called Achilles tendinosis, in which the tendon begins to lose its organized structure, making the tendon weaker and more fibrous. Continued stress to your Achilles tendon could cause it to tear (rupture), which may require surgery to correct the damage.

Treatments
If you’ve tried self-care measures, such as rest, ice and over-the-counter pain relievers, and they aren’t working for you, your doctor may suggest other Achilles tendonitis treatments:

Orthotic devices
A temporary foot insert (orthotic device) that elevates your heel within your shoe may relieve strain on the stretched tendon. Your doctor also might prescribe special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night that will keep the Achilles tendon stretched while you sleep.

Boot and crutches
In severe cases, your doctor may suggest a walking boot or have you use crutches to enable the tendon to heal.

Surgery
Nonsurgical treatments, including physical therapy and perhaps a change in your exercise program, should allow the tendon to heal and repair itself over a period of weeks. If these treatments aren’t effective, surgery to remove the inflamed tissue from around the tendon may be necessary; however, this is usually a last resort.
If left untreated and if the tendon continues to sustain small tears through exercise and repeated movement, the tendon can rupture under excessive stress.

Sports Massage/Physiotherapy
A sports therapist or physiotherapist will aid you to a quicker recovery be performing massage techniques and/or ultrasound on the injured Achilles tendon in order to break up scar tissue, promote healing, and increase blood flow to the injured area. Whenever I have an injury and feel rest and stretching isn’t working I always pay a visit to my local physiotherapist. The recovery rate using a private sports physiotherapist is much quicker than going through a doctor. You may have to pay for the treatment yourself if you wish to get back to full fitness as quickly as possible, however in my opinion the benefits of such services outweigh the costs.

Prevention
While it may not be possible to prevent Achilles tendonitis, you can take measures to reduce your risk:
Increase your activity level gradually. If you’re just beginning training, don’t feel like you have to be Ironman-ready in record time. Starting slowly will help you determine your limits and follow a sensible training program.

Take it easy.
If you can, avoid other activities away from your multi-sport training that place excessive stress on your tendons, especially for prolonged periods. If you can’t avoid this, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.

Choose your shoes carefully
The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes.

Stretch daily
Take the time to stretch your calf muscles and Achilles tendon in the morning very gently and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendonitis. Use steady exercise as warmups prior to your main training session.

Strengthen your calf muscles
Performing exercises such as toe raises, especially with a slow return to the ground after each toe raise, trains the muscle-tendon unit to withstand more loading force.
Cross-train. Alternate impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Finally, if you are unsure of the extent of you injury, don’t hesitate to visit the doctor or a sports physiotherapist. With the limited time us muli-sport athletes have, you wouldn’t want to be out of action any longer than necessary would you!

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During a 10k road race earlier in the year I stumbled over what was maybe half an inch of paving stone and fell to the ground holding my ankle. For me this is quite a regular occurrence. Often when I’m competing or training, and not necessarily on uneven ground, I quite regularly experience the feeling of the ankle joint wishing to ‘give way’. In the past I have ignored the issue to a certain degree, rested for a short while and then returned to training a couple of weeks later. Following the last sprain in April I received a more intense range of therapy from my local physio involving friction massage and ultrasound, and also performed additional rehab strengthening exercise using a wobble board as well as other stability aids. So far so good, as the extra rehab seems to have done the job.

The information below will hopefully provide you with more of an understanding into the common ankle sprain and hopefully get you back to full fitness a little quicker than normal.

An ankle sprain is a common injury and usually results when the ankle is twisted, or turned in (inverted). The term sprain signifies injury to the soft tissues, usually the ligaments, of the ankle. Ankle sprains can range from mild, to moderate, and severe. Type 1 ankle sprain is a mild sprain. It occurs when the ligaments have been stretched or torn minimally. Type II ankle sprain is a moderate level of sprain. It occurs when some of the fibers of the ligaments are torn completely. Type III ankle sprain is the most severe ankle sprain. It occurs when the entire ligament is torn and there is great instability of the ankle joint.

What part of the ankle is involved?

Ligaments are tough bands of tissue that help connect bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. They are the ‘anterior talofibular ligament’ (ATFL), the ‘calcaneofibular ligament’ (CFL), and the ‘posterior talofibular ligamen’t (PTFL). The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side.

Why do I have this problem?

A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain.
The lateral ligaments are by far the most commonly injured ligaments in a typical inversion injury of the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of the foot angles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn.

A severe form of ankle sprain, called an ankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called a high ankle sprain because it involves the ligaments above the ankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting the tibia and fibula bones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain.

What does an ankle sprain feel like?

Initially the ankle is swollen, painful, and may turn bruised. The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain.

People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is called ankle instability. Athletes who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesn’t go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily.

People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint.

What can be done for the problem?

Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability.
Ankle Sprain

The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the word RICE. These stand for rest, ice, compression, and elevation.

Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle.
Ice: Applying ice can help ease pain and may reduce swelling.
Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap.
Elevation: Supporting your ankle above the level of your heart helps control swelling.

Your doctor may also prescribe medications. Mild pain relievers help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain. These medications include common over-the-counter drugs such as ibuprofen.
As treatment progresses, it is helpful to gradually begin putting weight through the joint.
Healing of the ligaments usually takes about six weeks, but swelling may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength.

Ankle Instability.

If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain.

Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation called position sense. For example, nerve sensors in your arm and hand give you the ability to touch your nose when your eyes are closed. The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint.

Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called the peroneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability.

What will it take to make my ankle healthy again?

If you don’t need surgery you still may need to follow a program of rehabilitation and exercise. Doctors recommend that their patients work with a physical therapist for two to four weeks. Your therapist can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle.

Swelling and pain are treated with ice and electrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward the knee with your leg kept in an elevated position. This helps get the swelling moving out of the ankle and back into circulation. Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg.

An effective treatment for ankle sprains is disc training, which uses a circular platform with a small sphere under it. Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense (mentioned earlier).

When you get full ankle movement, your ankle isn’t swelling, and your strength is improving, you’ll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport.

The physical therapist’s goal is to help you keep your pain under control, improve range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program. 

Don’t just think rest itself will repair any ankle ligament injury. It is very important to seek medical advice from a physio or sports therapist as soon as possible, in order to make the quickest possible recovery and prevent any further occurances.

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