You know the feeling. First thing in the morning, you jump out of bed
ready for a training run. But as soon as your feet hit the floor, pain
radiates along the soles. As you try to walk it off, your IT band makes
your knee lock up. Now every step feels like a battle of wills between
you and your body. Maybe it’s a good day for a swim. 
 


 
If you’re dealing with IT band strain and/or plantar fasciitis, there
is some good news. The two “syndromes” are intricately linked.
Therefore the protocol to prevent and rehab them both is intricately
linked. More on the protocol in a moment. First, let’s get to know
the enemy. (Or you can skip below to see both a stretch and
strengthening protocol.)
 
The IT band and plantar fascia are made of the same substance, fascia.
Every muscle and organ in the body is encased in fascia. It also fills
the space between muscles and skin. In the time before antibiotics,
fascia was the body’s way of containing infection. On a cellular
level, there is very little difference between muscle, bone and fascia.
 
Yet their functions differ greatly. Bones bear weight, and muscles
move bone. Fascia is left to supply tensegrity (tensile integrity) to a
body. Bones define the base of a body’s structure, while fascia
defines the outside parameters.
 
Fascia has intelligence in the sense that fascial cells communicate
directly to other fascial cells. They are governed by the autonomic
(unconscious) nervous system. That is, they do not have to report
their activity to the brain. Our attention is not drawn to the fascial
layer, generally, until there is pain. We can not consciously create
fascia because it does not “build up” in the same way that muscle does. 
It acts more like scar tissue and “lays down” fibers in response to stress.
Therefore it can not be stretched like muscle. It has to be broken down like
scar tissue by applying heat and the pressure of release work.
 
So, if fascia has so much inelegance, how does it become such a
dramatic hindrance? In the case of the IT band, it shares insertion
points with several critical muscles associated with gait. As you
transfer weight over your foot, your glutes, TFL and IT band join
forces to keep your pelvis tracking over your foot. If the pelvis is unstable,
your IT band will respond by overworking. As it lays down
extra fibers, it can pull on the patella, which makes the
patella track out of alignment. So of course you get pain signals.
It’s the body’s way of telling you your medial meniscus and ACL are in danger.
 
Pain in the plantar fascia is the second chapter of the same story.
The major muscles associated with the “toe off” phase of
gait are known as the plantar flexors. They all begin at the
back of the knee and run underneath the heel to insert where the
plantar fascia begins. Thus, if the knee is tracking improperly due to
IT strain, they can cause the foot to contact the floor improperly. In
a balanced body, the plantar flexors are meant to go on stretch at
“heel strike,” then support the arch as we push our weight through,
then contract as we take our toes off the floor. Their action is
exactly mirrored by the action of the plantar fascia. The fascia coils
up at heel strike and becomes a rigid lever at toe off, propelling us
off the ground. Problems arise when the plantar flexor muscles are
locked in a contacted position. They then adhere to the plantar
fascia, locking it in a shortened state. The fascia then loses its
elasticity and cannot drive the foot off the floor.
 
As runners, we do not “heel strike,” but rather land toward the
mid-foot. This prevents the plantar flexors and planter fascia from working
through half their range of motion. In order to avoid pain in this
area, we must spend time either barefoot or in shoes that allow the
heel to truly contact the ground. Otherwise, our feet become
maladaptive, unable to move from a stretched to a contracted state.
(This is not meant to be an argument in support or dispute of any type
of shoe. All it means is that in order to keep our feet pliant and
compliant, we should always ask the foot to adapt to different
surfaces.)
 
All of the above science aside, the main protocol for dealing with
fascial issues is twofold: first, release the fascia, then, strengthen
the muscles that keep all your bones tracking properly. This way the
fascia will get the signal that it can stand down. What follows is
both release work and strengthening/stability exercises.

Release Work:
 1) Start kneeling tall. Tuck a tennis ball in the crook of the knee. (You can either use one ball to work one leg at a time, or two balls to work both legs together.) With hands braced on the floor, lean your weight back on to the balls. This will put pressure on the origins of your gastroc muscle. Slowly work the ball down the center of the leg, to the achilles tendon. Spend some time wherever you have the most sensation.
 *** If you’ve had a history of meniscus tares or damage to any ligaments in the knee, this would be contraindicated. Please see below.

2) Start with a tennis ball on the floor. Kneel on the ball, starting below the knee cap, and turning the leg in so the toes point inward. This way you’ll be working your way down the anterior tibialis muscle rather then the bone itself. Listen to your body and put pressure where the body seems to ask for it. End by putting the ball directly at the top of the ankle and sit on your heel. This should release all the muscles that lay on top of the foot.

***An alternate way to release the calf muscles starts sitting on the floor. Stretch the right leg out in front of you. Place the tennis ball under the calf and rest the left leg on top of the right. Roll the ball under the right leg, spending time anywhere there feels a need for it.

Sorry, but now it’s time to roll out the IT band on a roller. It’s not pleasant, but it is necessary. Move the roller north and south along the femur. But also spend time rolling east and west from the front of the thigh to the back. It’s important to get into the fibers that insert near the knee. Your goal is to get your foot to the floor.
 
Strength Work:
Start lying on the floor with your feet on a wall. Your knees should be at a 90 degree angle to the floor and all 10 toes should be facing the ceiling. Let the legs be a fist’s distance apart from each other.
A) Keeping the heels grounded; flex the feet, taking the toes off the wall. Then let the toes slap back on to the wall. The goal is to get all 10 toes moving at the same rate. Repeat 100 times…seriously.
Now keep the toes grounded and lift the heels off the wall. They should lift and lower at the same rate and make true contact with the wall each time. Again, the goal is 100 repetitions.
C) Start with the big toes and heels touching. Make the feet like windshield wipers, sliding the toes away from each other, then back together. Try to keep pressure between all 10 toes and the wall the whole time. Yup, you guessed it…100 times.
D) Lastly, keep the toes together while fanning the heels away from each other. Then drag them back to the starting place. It can be hard to keep the calf on active stretch, making the heels want to come off the wall. Push hard into the heels and count to 100.
 
Now, stand with your back up against a wall. Walk your feet out until you are in a squat position or “wall sit”. Keeping a fist’s distance between the knees, make sure your feet are truly parallel. Feel the feet acting like suction cups, almost holding the floor. Stay for 3 minutes. This is going to work all the muscles that appose the IT band. So if you can hold out for 3 minutes, you won’t have to spend as much time rolling the IT band How’s that for incentive?

After a pause, come back into the wall sit. Pressing the palms into the wall for support, lift the right leg off the floor, bringing the knee toward the chest. The catch is, you can’t shift your hips, spine, or head to the left. All you force has to come from driving the left foot into the ground, and the left femur into wall, as your core holds your spine still on the wall. Repeat to the other side. The first few times, this may seem impossible, but give your body a chance to sort it out.

So, you’re thinking the last thing you need is more on your “to do” list.  Well, here’s some incentive.  Research shows that a muscle can change its resting length with 14-21 days of consistent stretching.  And since a muscle can only contract to half its resting length, stretching should be given serious attention.  More recent research shows that muscles act on a 24 hour cycle.  If you exert a muscle at 6am today, the proteins you need to exert that muscle will show up in the muscle at 6am tomorrow.  Whether you’re exerting it or not!  It’s like a soccer team showing up to a field whether there’s a game scheduled or not.  Reason enough to find a cross training routine which you can do at the same time every day?  Maybe the Yogis are on to something.

Happy Training!

~Joan

Joan Murray is a Pilates Method Alliance Certified teacher. Joan received her Pilates training at the Kane School where she was certified in Touch, Bio-mechanics, and Working With Special Populations.  She currently teaches Pilates at West Side Dance and Physical Therapy.  Her practice includes distance runners, semi-professional tennis players, as well as members of the New York City Ballet and the Metropolitan Opera.  She has helped clients prevent back, hip and knee surgery.  She has also helped clients recover from torn Quadriceps, Meniscus repairs and herniated discs.