How To Reverse Iliotibial Band Pain: Addressing the Trauma Reflex

I've written about Iliotibial Band Syndrome (ITBS) before. In my previous iliotibial band pain post I explain what it is as well as how this condition is yet another example of Sensory Motor Amnesia. Here is an email I just sent to a woman who has my DVDs, has a personal Somatics practice, yet is stumped by her IT band pain: Many people ask me if I have Somatics DVDs for specific body parts that are causing them pain. I tell everyone the same thing - which will be the focus of my upcoming book:

It is never just one muscle causing the pain or problems in your body. It is always a pattern. The brain organizes you as a system in which patterns are primary. Address the dysfunctional muscular pattern and that body part will cease to be painful. In the case of iliotibial band pain, it is the Trauma Reflex.

An habituated Trauma Reflex causes iliotibial band pain.

Pain in your iliotibial band develops because your brain and muscles have habituated to human-body-muscle-diagramthe Trauma Reflex. One side of your leg (the IT band) is working harder than the other side. You may have already seen my iliotibial band release on my YouTube channel. You'll notice that it's a variation of the Side Bend - the most important and powerful movement one can do to regain control and awareness of the waist muscles.

When the waist muscles are tighter on one side than the other, those muscles "hitch" the pelvis up slightly on one side. What happens then? Your brain, the great compensator and integrator of all sensory and motor feedback in your life, teaches your legs to work differently, one side to the other. This happens, in most cases, completely under your conscious awareness.

If you have bilateral IT band pain, you may be stuck in the Startle Reflex (red light reflex). The Startle (red light) Reflex, a full body pattern, causes your knees to bend slightly  which makes it impossible for your pelvis and legs to swing freely.

Look at the full body pattern, learn to reverse that and your iliotibial band pain will go away. Use the mirror: what do you look like side to side? Are you uneven? Do you walk in an uneven gait? Do you put more weight on leg than the other? Consider what you do during the day that may cause that to happen.

Go back to the basic Somatic Exercises on your DVDs and start from the beginning. Look for balance, symmetry, quality of movement, and the ability to move the same on one side of your body and the other. Be mindful of patterns, especially when you get to the Side Bend, Washrag, Steeple Twist and Walking Exercises. Take your time! As you get to the walking exercises you have a great opportunity to even out the pelvis and the movement of the legs. And remember that nothing you do in your practice makes any difference if you don't take that awareness and apply it to the way you move throughout your day - walking, sitting, holding a bag on your shoulder, working out, driving...

This is sensible information that needs repeating again and again and again. This woman is not alone in her frustration. After all, most people are not taught sensible information by our doctors, our physical therapists, our fitness trainers.  We aren't taught that our brains are the source of the problem and that we are the only ones who can re-educate the way our brains and muscles communicate. We are taught to see ourselves as separately moving parts, like a car or bicycle, when in fact we are a beautifully balanced, synergistic process that can only be experience from within.

Once you can walk smoothly and evenly, squat right down through the center (use a mirror!), hitch your hips up side to side smoothly and evenly, you know your iliotibial band pain will be gone for good!

 

How To Know If You're Out Of Balance

Daily stress teaches our muscles to contract in very specific ways. If the stress is on-going or repetitive enough we may even feel as if we're "stuck" in our stress. Over time we may find that we feel out of balance. An imbalance in the center of the body will show up as an uneven gait, twisted pelvis, slumped shoulder on one side, one-side muscle pain or quite commonly, a "hiked" hip. Overly contracted muscles pull us off balance and add excessive stress to our joints. They can contribute to arthritis, joint pain, back, iliotibial band pain, neck, shoulder and hip pain. The key is to learn to ride the waves of stress in our lives - not get stuck in them. One of the biggest benefits of Hanna Somatic Exercises is learning to find neutral in the center of the body and bring the brain back into control of the muscular system. It's one of the most important skills necessary to become stress resilient.

In this video below you'll learn an easy and quick way to determine if you're out of balance. Don't worry! If you are, you can begin to learn how to regain muscular balance and symmetry with Somatic Exercises.

[youtube=http://youtu.be/srE5f0-N5tE]

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Why Is One Leg Shorter Than The Other? The Trauma Reflex!

Here are three frequent questions my clients ask me:

Why do I have one leg shorter than the other?

Why do I have hip pain, knee or foot pain but only on one side?

I'm told that my pelvis is rotated because I have a weak core. Is that true?

The answer:

Leg length discrepancy, one side hip, knee, and foot pain, sciatica, tilted posture, piriformis syndrome, and a rotated pelvic are all the result of an habituated Trauma Reflex. No, the core is not necessarily "weak." It is likely so strong and tight - within the pattern of the Trauma Reflex - that the center of the body cannot fully relax, rotate and side bend evenly on both sides.

When you respond to any physical trauma, a sudden blow to the body, a slip, fall or crutchesaccident of any kind, the brain instantly, involuntarily, and often violently, contracts the muscles of the waist (the oblique muscles), the trunk rotators (lattisimus dorsii, abdominals, adductors and abductors of the legs) and the muscles that allow the pelvis to swing freely (quadratus lumborum and iliopsoas) in an attempt to avoid injury or to prevent further pain after the accident has occurred. If you've ever prevented what could have been a terrible fall you know the wrenching pain that comes with the sudden twisting movement that helps you regain  your balance.

If the accident is severe or violent - a car accident or a sudden slip on the ice, for example - the brain Trauma reflex - frontteaches these muscles to stay tight and contracted. If you injure yourself on one side of your body and need to protect that injured limb until it is healed (as occurs when using crutches), you can inadvertently learn to walk with a limp once the injury is healed. A one-sided job, like sitting at a computer and using the mouse all day with one hand can create a strong imbalance on one side of the body.

When muscles stay tight the brain loses the ability to fully contract and release the muscle. The ability to fully release the muscle is what gives the muscle power. This state of elevated muscle tonus and tension that won't relax is called Sensory Motor Amnesia. In the case of an habituated Trauma Reflex your brain integrates and organizes this learned and involuntary full-body imbalance into a "neutral" and "balanced" that, as those of you have ever suffered an accident or injury, can sense is out of balance, tilted, rotated and uncomfortable. Not to mention inefficient.

How do you learn to regain symmetry and balance in the center of your body? Muscles that have learned to stay tight and contracted due to stress must learn to relax, release, and move freely again. It's muscle reeducation. Many people can benefit from one-on-one clinical sessions with a qualified Somatic Educator skilled in the methods of Thomas Hanna. However, many people can also easily learn to do this on their own, at home.

The video below can help you learn to lengthen both sides of the waist evenly so you can regain your internal awareness ("somatic" awareness) and proprioception for improved balance and a smoother gait. This easy awareness exercise is best done after you learn to relax and release the waist muscles by doing arch and flatten, the side bend and the washrag.

To learn more Hanna Somatic Exercises and learn to relieve muscle pain and improve mobility, and somatic awareness, you can purchase my Pain-Free series of DVDs. Enjoy the video and enjoy standing tall!

[youtube=http://www.youtube.com/watch?v=mb5Ip0H6jTk&feature=youtu.be]

Why Am I Limping, and Is It Cause For Concern?

Many clients have posture that is "out of balance"; their hips and pelvis are not level, their leg length is uneven, their gait is not smooth. Some clients have said, "Just the other day someone asked me why I was limping, and I never even noticed I limped... all I know is that my back is killing me!" They're not concerned about their limp, because their limp feels "normal." This feeling of "out of balance" feeling "balanced" is an example of Sensory Motor Amnesia, in which the brain literally forgets how to sense, move and control muscles efficiently. We compensate, habituate and adapt to what happens to us in life (accidents/injuries are common) so our muscles no longer move freely the way they once did. When you lose awareness of the way in which you move - something that only you can experience - there is cause for concern.

Most of my clients with back, hip or piriformis pain often accompanied by a limp were treated unsuccessfully by physical therapy, bodywork of all kinds, drugs, and cortisone shots. What was missing in their treatment was the simple understanding of how a limp develops as a compensatory, full body pattern, which muscles are involved in the need to limp, and how to reverse the pattern and move freely again. Back, hip joint, knee pain, sciatica and piriformis syndrome pain are common conditions easily reversed with Hanna Somatics.

Limping means the center of your body is out of balance.

When we walk we are meant to walk with a smooth, even gait. Our pelvis is perfectly designed for upright, bipedal locomotion. The more we allow the pelvis to move as we walk, the more efficient and effortless our movement will be and the less joint stress and pain we will have. Below is a great video of balanced, strong walking and upright posture - a necessity for African women carrying items on their heads.

[youtube=http://www.youtube.com/watch?feature=endscreen&v=cThEt5KmdV4&NR=1]

This kind of natural movement is "the norm" until something occurs to change that.

When we have an accident - a slip on the ice, a fall on our coccyx, or a bone break - the involuntary part of our brain immediately contracts certain muscles of the trunk to protect that area. This is called the Trauma Reflex. We learn to compensate until the injury is healed. The latissimus, obliques, adductors, abductors and abdominal muscles all contract instantly, in a pattern, as we twist and rotate in an attempt to regain our balance or protect our injured limb - as in the photo at right.

This kind of functional problem of one side of the waist and trunk tighter than the other can, over time, create true structural damage, like hip joint pain, labral tears, osteoarthritis, and hip joint impingement.

The Trauma Reflex causes us to limp, putting more weight into one side of the body.

When you get stuck in this particular stress reflex, pain isn't far behind. You begin to walk like a car with one flat tire, galumphing from side to side. The easiest way to reverse a limp is to get the brain back in control of the muscles. Those who have had an accident or injury would be wise to seek the clinical help of a skilled guidance of a Certified Hanna (Clinical) Somatic Educator for a series of clinical sessions in order to restore full muscle function and movement.

Somatic Exercises for limping

For those who own my Pain Relief Through Movement DVD, the following exercises focus on the waist muscles/trunk rotators, and are excellent for helping to restore a free and balanced gait:

  • Side bend - releases and lengthens the waist muscles for equal movement of the pelvis.
  • Washrag - brings in gentle twisting of the pelvis, and shoulders, as the waist lengthens
  • Human X* - the quintessential movement of "crawling," which lengthens both sides of the body
  • Steeple twist* - increases the ability to twist and lengthen the center of the body - back, abdominals, waist
  • Walking exercises, part 1 & 2* - freeing the pelvis and reintegrating a healthy pattern of walking.
  • Hip lift and reach - from my Pain-Free Leg and Hip Joints DVD

* found on the Pain Relief Through Movement DVD

How Somatics Can Help Cyclists Relieve Muscle Pain

Cycling is a versatile activity - one that can be done casually as a form of transportation, a weekend hobby, or one that can be done competitively. Cycling, whether for competition or for pleasure, has the potential for serious injury, sensory motor amnesia and a host of painful muscular conditions. The most frequent problems facing cyclists are accidents, knee problems, iliotibial band pain, low back pain and hamstring strains.

In cycling there is a high risk of trauma.

When you lose your balance on a bike, the consequences can be long-lasting. A bike crash instantly invokes the Trauma Reflex – the somatic reflex of contraction, and retraction of the trunk rotators of your body in response to a sudden loss of balance and the need to avoid further injury. The waist muscles contract unevenly on one side of the body, and the result is a slight twisting and side bending of the torso.  A cyclist who experiences Sensory Motor Amnesia (SMA) in the form of a Trauma Reflex will develop a pelvic imbalance, altered gait (or cadence on the bike), hip joint tightness, uneven weight distribution, and compromised balance.

Cyclists round forward in a hunched posture for long periods of time.

The rounded posture of cyclists is a pattern of muscular habituation that is useful for efficiency, power, and speed. However, this rounded posture of cycling is  a classic Red Light Reflex - the front of the body is contracted, the shoulders are tight and rounded forward and the back is lengthened, yet tight.

There's a "co-contraction" between the front and back of the body - an agreement of sorts - that makes this useful form of Sensory Motor Amnesia great for cycling, but inconvenient and potentially painful for everyday life. The constant co-contraction of the abdominals and lower back can cause chronic lower back pain.

There is limited hip movement in cycling as leg movement comes from the hip joints.

In cycling, the muscles of the quadriceps (thighs) are recruited and developed more than the gluteal muscles. Because of the repetitive and powerful churning of the legs, there is little movement of the hips in cycling. As I wrote in my post on running, limited hip movement contributes to iliotibial band syndrome, back pain, hip joint pain and hamstring strains. SMA can occur in the hamstrings due to habituation; the legs are never fully lengthened, so the hamstrings learn to stay contracted in order to coordinate with the quadriceps. The knees bend, but the leg never fully extends. Both the quadriceps and hamstrings maintain a specific muscle length in order to "get the job done" well.

Shoulder hunching can become a habit if you're not careful.

Cyclists using bikes with upright handlebars are in a less stressful position because of the placement of the handlebars. Though they don't hunch over as much as using a standard road bike, there is still a tendency to hunch the shoulders slightly when reaching for the handlebars.
Lengthening the spine to keep the back muscles long as you hinge at the hips to sit up will ease back pain. Here is a good demonstration that illustrates how to elongate your spine as you ride on a bike with upright handlebars.

Try these Somatic Exercises as a warm-up before you ride:

Try these Somatic Exercises to cool down afterward:

Contact Martha to find out how Hanna Somatics can complement and strengthen your current athletic training program.

How Somatics Can Help Runners

Running is one of the most convenient activities available for those who want to move vigorously.  University of Utah biologist David Carrier hypothesized that our ability to run long distances evolved in humans for the simple reason that the ability to pursue predators for long distances (endurance hunting) meant a steady food supply. We were born to run, but for some people, running is a painful and laborious activity.

As with any sport – and especially one that can be taken to an extreme – runners suffer from injuries and Sensory Motor Amnesia (SMA). The most frequent running injuries are knee pain, iliotibial band syndrome,  plantar fasciitis and hip pain.

Running when injured creates more injury.

Many runners will often continue to run, even when they are nursing an old injury. Some of the runners I've worked with say that they figured they could just "run it out" thereby fixing the problem. Unfortunately this causes more harm than good. Here's why:

  • When you're injured, your muscles reflexively adapt and learn to move differently. This is called compensation.
  • Long-term compensation develops into Sensory Motor Amnesia (SMA).
  • Running while compensating for an injury doesn't doesn't change what your muscles are doing; it only creates more compensation.
  • You must first eliminate the compensatory pattern (the SMA) before you can regain your original running form.

Runners often run on uneven, paved roads.

A majority of runners in cities and suburbs run on uneven asphalt roads. The road is slightly graded to allow for water runoff, so rather than using the legs and hips equally, they run with a slight tilt in the hips, with  more weight on one leg than the other. This causes the waist muscles on the higher side of the graded road to contract tighter than the other side. It's slight, but when this kind of sensory motor amnesia develops it alters the gait and contributes to iliotibial band pain and knee pain. The angle of the road also put the foot an an awkward angle to the ankle.

Runners often have limited hip movement.

When hip and pelvis movement is limited, you will be more likely to have iliotibial band syndrome, back pain, hip joint pain, and hamstring strains. A pelvis that doesn't rotate gently doesn't allow the body to move gracefully and efficiently. If the body is stiff and the hips and pelvis are rigid, the swinging action of the legs while running (or walking) will come solely from the hip joint - what I like to call "running with your legs instead of your whole body." This can create overuse injuries of the hips and hamstrings. Here's a ChiRunning article that goes more into depth about pelvic rotation.

Orthotics and "supportive" running shoes reduces the foot's ability to move.

The feet are one of the most important sensory organs of the body. When we encase our feet in  shoes we risk losing sensory awareness and motor control of the muscles of the foot and lower leg that help us stabilize ourselves for upright movement. There is more of a tendency to "heel strike" when wearing thicker running shoes. This is both jarring for the spine and inefficient for forward motion.

Orthotics, thought to fix foot problems, interfere in the ability of the feet to absorb impact properly and adjust to changes in terrain (as in trail running). Thankfully there's a trend toward more minimalistic and "barefoot" running shoes, which allows both the foot and lower leg muscles to move naturally.

Here are 5 somatic exercises for an easy "warm up" before running:

  1. Back lift - for control of the back muscles
  2. Cross lateral arch and curl - for control of the abdominal muscles
  3. Side bend - to equalize waist muscle function
  4. Steeple twist - for gentle twisting of the shoulders, spine and hips
  5. Walking exercises - for proper mechanics of walking and pelvis rotation

After your run, try these:

  1. Reach to the Top Shelf - for full body lengthening
  2. Hamstring pandiculations - if you need it (from Pain-Free Athletes)
  3. Standing calf release - if you need it (from Pain-Free Athletes)

Visit the Essential Somatics® store to purchase the Pain-Free Athletes DVD and more!

Many thanks to Jim Hansen, a runner and Somatics enthusiast whose shared running experience helped me write this post. Check out his blog, Recover Your Stride.