ITB Syndrome 

Iliotibial band syndrome (ITBS) is a common repetitive strain injury of the Iliotibial band.

ITB Syndrome mostly occurs in runners, but can also occur in cyclists, hikers and as a non sporting injury. ITB Syndrome causes pain mainly on the lateral (outside) side of the knee, unlike patellofemoral pain where the pain occurs at the front of the knee.

Although ITB syndrome is very common, ITBS remains neglected by studies and so remains mostly unexplained adding the persistence of many myths.



Heres the Anatomy

The iliotibial band (ITB) is the largest Tendon in the body acting as a longitudinal fibrous reinforcement of the Tensor Fascia Latae muscle and Gluteus Maximus muscle. The action of the ITB and its associated muscles is to extend (take the leg backwards), abduct (take the leg outwards), and laterally (externally) rotate the hip. In addition, the ITB contributes to lateral (outside) knee stabilisation.

Tendons connect our muscles to our bones and each muscle has tendons that attach at each end. Tendons are NOT designed to stretch as they are comprised of highly organised connective tissue and are capable of resisting high tensile forces while transmitting forces from muscle to bone. Tendons are predominately made up of collagen (nearly 85% of the dry weight of tendon) which mechanical and physiological characteristics dictate the qualities of a tendon. Tendons are flexible in terms of being able to bend at joints and act as a damping tissue to absorb shock and limit potential damage to muscle.

Basic Characteristics of a Tendon

  • Tendons attach Muscle to Bone
  • Tendons have one of the highest tensile strengths found among all soft tissues
  • Tendons are made up primarily of collagenous fibres making them remarkably strong
  • Tendons have a very limited bloody supply making them slow to heal

Basically Tendons are tough, they are not designed to stretch or contract. Muscles do the stretching and contracting. It is muscles that become shortened (tight) which can create further forces through a tendon, but tendons do not stretch therefore the joint the tendon acts upon to proximate (pull together) the joint will become restricted or misaligned therefore causing pain.



So how do I relieve the Pain

A couple of the most common methods are Form Rolling or Massaging the ITB.

Now STOP, why do we want to foam roll or massage the ITB?

We cannot increase its blood flow nor can we increase its length, its a tendon not a muscle!

So… if you want to effect the ITB you need to work on the associated muscles which are the Tensor Fascia Latae muscle (TFL) and Gluteus Maximus muscle.


Massage is a great way of releasing tension and will often be more effective than foam rolling because as a patient you can relax and let the therapist do all the work. However, foam rolling is a very good method of loosening muscle tension. Here are a couple of videos showing you how to foam roll the Tensor Fascia Latae muscle and Gluteus Maximus muscle.


TFL Foam rolling;

Glutes Maximus;

Glutes Maximus;


Written by Becky Tyler 26th Feb 2019



Kirkendall, D,T., Garrett W,E., ‘Function and biomechanics of tendons.’ Scand J Med Sci Sports. 1997 Apr;7(2):62-6. Available at; (Accessed: 26 February 2019)

Ingraham, P., “Save Yourself from IT Band Syndrome!” Available at: (Accessed: 26 February 2019)

Newell,L., “A Description of Tendons, Ligaments and Muscles” Available at: (Accessed: 26 February 2019)




Heat or Ice

In most cases; Ice is for injuries, and heat is for muscles tension..


Ice is for injuries — calming down damaged superficial tissues that are inflamed, red, hot and swollen. However the inflammatory process is a healthy, normal, natural process.  Which can be painful response. Therefore studies suggest icing is mostly just a mild, drugless way of dulling the pain of inflammation.

Icing in most studies has been found ineffective in reducing swelling …. but do we need to reduce swelling?

Heat is for muscles, chronic pain, and stress — taking the edge off the pain of whole muscle spasms and trigger points, or conditions that are often dominated by them, like back pain and neck pain, for soothing the nervous system and the mind.


Heres a great short video that might help clear up a few myths




Below are great ways to use Ice and heat.

Ice / Cold

A bag of frozen peas is great apart from they are to cold to put directly onto the skin and therefore you need to wrap them in a tea towel which often masks the cold from getting through.

So the best way we suggest is get a bowl of COLD water with ice, place a flannel or tea towel in the water and completely submerse it. Then rinse it out and place it on the area in question. Leave it on the area for no longer than 5mins.

Heat / Warmth

Taking a warm bath with epson salts is a great way to thoroughly warm the muscles and the epson salts are a great natural muscle relaxer whilst also helping to draw out toxins. Ensure its warm and not scalding hot! Because if you have any inflammation in the muscles the excessive heat can serve to exacerbate it.

Another way is a bowl of HOT water, place a flannel or tea towel in the water and completely submerse it. Then rinse it out and place it on the area in question.

Also Wheat bags and hot water bottles work well on certain areas.

Sports Massage is a form of treatment for those that are suffering from muscular tension, whether that tension, was created through occupational strains, sporting activities or daily stresses, Sports Massage is for everyone.

Sports Massage involves massage and stretching techniques with a focus on increasing circulation, lymphatic drainage, reducing inflammation and aiding the body’s natural healing process.

Although contrary to common misconception, Sports Massage doesn’t have to be painful in order to effective. Quite the opposite Sports Massage shouldn’t be painful. It can however be uncomfortable at times as the area upon which the therapist is working, is usual dysfunctional and therefore tender so any work in the area will be uncomfortable but should be bearable, if not you must speak up and inform you therapist.

Massage is recorded as one of the earliest forms of manual therapy and was used over 3000 years ago in China, today Massage still appears to be one of the most common and effective forms of treatment for muscular tension.

Whilst medication can help relieve pain it doesn’t focus on relieving the cause, so ….. carry on taking paracetamol, ibruphen, co-codamol etc? or help your body inside and out by stopping the medication and book in for a Sports Massage to target the cause.

So what’s the difference between a sports massage therapist, Physio, Osteopath and Chiropractor 

If I have a pound for everyone that has asked me this question. So briefly here it is……

Before going into the differences what you always need to remember is there’s always good and bad practitioners in every field and if you have a bad experience it doesn’t mean that, that profession is bad! It’s about finding a practitioner that you work well with, feel comfortable with and trust. So when ever you’re looking for somewhere always go on recommendations and look at their patient feedback.


So the main difference, of course, is in the Education and the profession’s school of thought.

  • Osteopaths 4yrs Full time or 5yrs Part Time.
  • Chiropractors 4yrs or 5 yrs Full Time
  • Physiotherapy 3yrs Full Time
  • Sports Massage – anything from online courses – 10day intensive courses – 2-3years depending upon the course

Osteopaths believe the “Rule of the artery is supreme” so will look to ensure the body is in the best alignment, working on Joints, Muscles, fascia etc to allow optimal blood / fluid exchange to allow the body to have the best chance to heal. Using soft tissue massage, muscle energy techniques, articulation and Spinal manipulations.
Typical appointment time is 30-45min.

Chiropractic originally came from Osteopathy as there founder of Chiropractic was taught by the founder of Osteopathy. They believe the role of the nerve is supreme. Ensuring optimal nerve supply though alignment of joints will allow the body to have the best chance to heal. Using Spinal Manipulation mainly with small amount of Soft tissue work if required.
Typical appointment time 15-30min.

Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice.
Typical appointment time 30-45min.

All three above have extensive education into a deep understanding of the body as well as disease and dysfunction so medical issues can be investigated and picked up. Don’t get me wrong their not GPs however their education covers signs and symptoms for a lot of medical complaints which allows the practitioner to pick up on potential red flags and send for investigation when needed or to feel confident the patient is ok for the chosen treatment. This is the difference between a therapist treating a patient with shoulder pain as muscular-skeletal dysfunction or picking up on a potential systemic dysfunction such as a Liver, heart, spleen dysfunction etc.

Sports massage therapists vary massively! This is the hardest one.

A level 3 sports massage therapist can gain a qualification via an online academy (not sure I agree with this way) or go on a classroom based course which varies in length, anything from 3days to 1yr.  There are also degrees in Sports therapy which obviously goes into a lot more depth with regards sports injuries I believe. These courses are typically x2-3 years long.



Once qualified in any profession, all therapists / practitioners can attend CPD (continued professional development) courses in different areas such as Acupuncture, cupping, tapping, spinal manipulation, etc
These courses tend to be short courses over 1-4days.

The danger is you could get a L3 Sport Massage therapist that has just qualified after a 3week course attend a spinal manipulation course and therefore appear to be doing the same as an Osteopath or Chiropractor.
Yes they are working on the painful area with similar or even the same methods but it’s the knowledge, education and experience that sets them apart.

If you see a sports massage therapist as a GP. Osteopaths, Chiropractors and Physiotherapists would be the specialists.

Techniques are just techniques, Knowledge is Power 

I hope this sheds some light on the difference.
I write this as a final Year Osteopathic student (Yr5) a qualified Sports Massage Therapist and a Sport Massage academy Owner. I have some great friends who are amazing chiropractors and physiotherapists and love working with them whenever I get chance.

Remember the saying “Horses for Courses” a good practitioner will always refer a patient on if they feel they cannot help!
Like GPs and consultants, therapists will have their own areas of expertise.


Written by; Becky Tyler 22.1.19

Sports massage was created to help athletes prepare physically for optimal performance, pre & post event and ultimately be in the best possible shape for training and competition, keeping injuries at bay.
However, contrary to its name “Sports Massage” is not just for Sports people and is enjoyed and utilised by many. Sports Massage breaks down restrictions in the bodies muscles, increases range of movement helping us feel more mobile.

What is it you do when your shoulders hurt? You rub them, the body knowns what it needs unconsciously we just need to listen to it.

Pain is a warning sign, don’t ignore it, it could cost you more in the long run.

Tennis elbow is a common injury that causes pain around the outside of the elbow and is clinically known as lateral epicondylitis.

As the name suggests this injury is commonly caused through playing racket sports such as Tennis, however this injury can also be caused through several other sports and repetitive daily activities.

Lateral Epicondylitis occurs from repetitive strenuous overuse of the extensor muscles and tendons of the posterior forearm, causing inflammation of the common extensor tendon that join the extensor forearm muscles onto the outside of the elbow (lateral epicondyle).

Ultimately the forearm muscles and tendons become damaged from overuse (repeating the same motions again and again). As the body becomes unable to repair the damage, as the rate of damage supersedes the rate of healing, therefore resulting in failed healing leading to pain and tenderness on the outside of the elbow.


Your elbow joint is made up of three bones: The Humerus (your upper arm bone) and the Ulna & Radius (the two bones in your forearm). The bony bumps at the sides of your elbow (bottom of the humerus) are called epicondyles. The bony bump on the lateral side (outside) of the elbow is called the lateral epicondyle.

The common extensor tendon that originates from the lateral epicondyle of the elbow is directly involved. The extensor carpi radialis brevis and longus, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris come together to form the common extensor tendon. The extensor carpi radialis brevis is almost always the primary muscle involved.

Recent studies show that Lateral Epicondylitis is often due to damage of the extensor carpi radialis brevis  (ECRB) muscle which helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to failed healing causing inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.



The symptoms of Lateral Epicondylitis often develop gradually and in most cases, the pain begins mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

You may notice pain:
– When lifting or bending your arm
– When gripping small objects
– When turning a door handle or opening a jar
– Find it difficult to fully extend your arm.


Heres some useful sites and PDFs for further information on Lateral Epicondylitis, ‘Tennis Elbow’

Oxford Shoulder and Elbow Clinic




Regularly using a Foam Roller and/or Massage Balls offers many of the same benefits as a sports massage, including reducing inflammation and joint stress, improving circulation and flexibility and therefore helping to ease aches and pains caused from tight muscles.

Regularly foam rolling pre and post workout will mean you will help prepare your muscles for the workout ahead and also help with post muscle recovery reducing the effect of DOMS (Delayed Onset Muscle Soreness).

Foam rolling will not replace the benefits of a sports massage, as a sports massage therapist will be able to target the areas of tightness more precisely and in areas foam rollers and massage balls may struggle to reach but couple them together by using your foam roller between your sports massage appointments will help prolong the effects of the sports massage and help space out your appointments.

Here is a list of benefits form rolling offers;

 Prevents Injury & Helps You Recover Fast

 Breaks Up Scar Tissue

 Improves Mobility And Flexibility

 Removes Lactic Acid To Aid Recovery

Saves You Money

However be aware there are still cons to using a foam roller.

1. The foam roller won’t be able to feed back and tell you what the tissue feels like, people think pain is good. But pain is also the bodies way of telling you there’s something wrong.

2. Your foam rolling tight muscles to loosen them off only the question is why are they tight? Imagine a tent pole with guide-ropes keeping it straight. A couple become tight pulling the pole towards them putting the opposite ones on stretch. Now they all feel tight, so do they all want loosening off?

3. IT-Band to foam roll or not to foam roll. It’s very easy to foam roll everything that feels tight but having the understanding and knowledge to know why your foam rolling a particular area and what your trying to achieve and lack of knowledge and understanding can lead to using a foam roller incorrectly and ultimately put yourself at risk.

Ask your therapist for further information and advise of what and how to foam roll correctly and safely.

Hope this helps ?

Rotator Cuff ….. what is the rotator cuff?

The rotator cuff is made up of 4 muscles which live (attach) onto the scapular (shoulder blade) and they assist other muscles of the shoulder in abduction and rotation movements.

So why do does it seem to be some common? 
Well unfortunately it’s because it’s very easy to damage one of these muscles due to repetitive activities and poor posture.
And if you’re one of the lucky ones to have had a rotator cuff injury you’ll agree with me on how painful and restricting it can be.

So how can you stop this from happening in sports such as Archery ?

POSTURE! – listen to your mother! If she was anything like mine “Pull your shoulders back” she used to say. The best thing is, I now tell her the same thing ?
One of the main Rotator cuff muscles that can become damaged and injured is the Supraspinatus. When we have poor posture our shoulders become rounded and this poor muscle becomes squished between our A/C joint and the Humerus (upper arm) every time we lift our arm. Now can you count how many times you lift your arm in Archery? Now image repetitive friction on tissue ? …… ouch! ?

How can you stop this?

Train your whole body, Archery is strenuous but it’s also very repetitive in the same motion. By doing a full body workout you will not only increase your overall strength and core stability which could result in the ability to shoot an increased poundage, but it will also balance your body and thus limiting injuries.
(Seek a fitness instructor for advise if unsure, as training incorrectly can cause further problems)

Seek a therapist, whether the therapist be an Osteopath, Sports Massage therapist, Physiotherapist or Chiropractic they will all catch things before they develop but they will also iron out any muscular strains and torsion patterns in the body, keeping you in the best shape for you and your activity. Helping you be the best you can be.

You don’t think twice about taking your car for a service, or replacing worn out tires or brakes. Our bodies are the same and pain is a warning ⚠️on the dashboard something isn’t right!

We as a nation will spend money on cars, phones, eating out, clothes, sporting equipment etc. Yet when was the last time you spent money on the one thing you rely on everyday? Your body!!

Instant debilitating back pain

If you’ve ever experienced instant debilitating back pain where the lower back essentially Locks up, you’ll know how painful it can be and how scary it can be if you don’t know how or why it’s happened.

Whilst there are many reasons for your back to “lock up” it’s essentially a protective function where the surrounding back muscles go into spasm and contract to protect the area. This spasm although protective causes pain and very limited movement.

When the body goes into lock down, the best thing to do at the beginning is try and get into a comfortable position so your not tensing up further and take medication such as ibruphen. You can also try ice in terms of a cold flannel as actual ice could cause you to tense further and heat could further inflame the area if there’s inflammation. When the initial spasm eases slightly and you can get your breath back, GENTLE movement is good. The body likes movement and it will help to encourage the area to relax and heal.

After a couple of days seek treatment, as your therapist will be able to examine and assess why it happen and help you fully recover and reduce the risk of it happening again.

If you experience any of the following symptoms you MUST go straight to A&E

* Neurological symptoms in both legs. Weakness, tingling, Pins and needles or numbness in both legs.

* Altered sensation in the “saddle region,” or saddle anesthesia. The saddle region is the area of the body that would be in contact with a saddle when sitting on a horse. This region includes the groin, the buttocks and genitals, and the upper inner thighs. Such as numbness, tingling, and/or weakness.

* Bladder or bowel incontinence. Such as poor urinary stream, an altered or lack of sensation while urinating, urinary retention, loss of rectal control, and/or the need to strain in order to urinate.