July 2nd, 2015

Congratulations to John Verity for taking a senior physiotherapy role at Fiona Stanley Hospital.  We wish him and his family all the best for the future.

Iliotibial Band (ITB) Friction Syndrome – Not just a painful knee ?

April 11th, 2013

Iliotibial Band (ITB) Friction Syndrome – Not just a painful knee ?

With the HBF run for a reason in May and the city to surf in August 2013, one of the most commonly occurring injury we see in the Physiotherapy clinic is Iliotibial Band (ITB) Friction Syndrome (ITBFS).

What is it?

The ITB is the connective tissue band that runs down the lateral side of the thigh and attaches on the lateral surface of the tibial condyle). The ITB originates from the Tensor Fascia Latae (TFL) muscle that originates on the outer third of the antero-lateral iliac crest.

ITBFS is an overuse injury that produces pain on the lateral knee during running and, occasionally, cycling. Pain is generally caused by an unusually tight ITB, the undersurface of which frictions over the lateral femoral condyle. This occurs during knee flexion and extension at approximately 30 degrees knee flexion when running and cycling, when the ITB flicks over the lateral femoral condyle. This process leads to friction, microtrauma, inflammation – and hence pain develops.

What causes it?

The two most common predisposing factors that lead to ITBFS in runners are anterior hip inflexibility and poor rotational control of the lower limb.

First, one of the reasons that this pattern of inflexibility is frequently observed in runners is because of poor lumbar-pelvic position and control while running. This prolonged activity in hip flexion can lead to muscle sarcomere shortening – and hence iliopsoas/TFL muscle tightness develops over time. This increased tension in the TFL that is in turn transferred to the ITB, can cause increased friction and pathology.

This same flexed positioning or lumbar pelvic control (tilt) can also lead to the development of reduced rotational control in the lower limb. This can occur if the TFL muscle becomes overactive in the shortened hip-flexed position described above. The TFL internally rotates the hip and is also a synergistic hip abductor with the Gluteus Medius muscle during stance phase, preventing lateral pelvic tilt. Therefore, if the TFL develops over activity, the Gluteus Medius can potentially become inhibited. This can lead to the lower limb being forced into internal rotation and uncontrolled pronation through the stance phase via the action of the TFL. ITB friction can then increase over the lateral femoral condyle due to this movement.


One strategy essential for preventing this pattern from developing and potentially causing injury is regular hip flexor and quadriceps stretching.

• The muscle groups should be stretched daily and before and after activity to optimally prevent the development of ITB symptoms.

• Self-massage to the outer side of the thigh between the knee and the hip can also assist in reducing tightness in the ITB. Icing the distal ITB is essential after running and cycling for 20 minutes.

• Lower-limb stability, strength and balance exercises are crucial in rectifying ITBFS predisposing factors. Single leg squats and lunges can remarkably improve lower-limb control if performed in front of a mirror with good alignment where the knee flexes over the middle toe. This ensures that the Gluteus Medius activates effectively and that the TFL remains underactive.

Assessing biomechanics

Another strategy used in the prevention and assessment of ITB friction syndrome is to assess the running biomechanics.

At On the Go Physiotherapy, we can assess your running and cycling biomechanics and prescribe various drills and strategies to aim to rectify any biomechanical flaws.

In conclusion, ITBFS is a complex over-use injury that can be easily treated symptomatically but has numerous predisposing factors that, if not addressed, will lead to persistence and/or recurrence of symptoms.

Happy Running

Why do Interval Training.

August 23rd, 2012

My choice of training is Interval cross training

I have noticed that I have a lot of patients who present to On the Go physio, with muscle and joint pain due to doing the same low level prolonged exercise in their training programmes.

They typically do a 40 minute run or 2 hour ride at the same pace, at same frequency over the same distance.

There is growing evidence that the best form of exercise for weight loss, gaining muscle mass and preventing muscle and joint overuse injuries is called interval training.

The University of NSW published a study which suggests that for weight loss 20 minutes, three times a week, of high intensity sprints, alternating with less intense periods was the way to go to improve your fitness and learn body mass.

When we say Interval cross training we mean exercise that is not flat out, its fast movement at about 70-80% (150-170 BPM) of your maximum heart rate for a set period of time. Cross training means that you use alternative forms/types of exercise on different days.

Studies have shown that when you exercise in this manner, you get really high levels of (Stress hormone) catecholamines released and they flood your blood while in circulation . These hormones are shown to break down fat.

The second thing was when you look at steady state aerobic exercise, rarely would you see any change in muscle mass. Interval training adds an extra overload to the muscle only for a period of time. A Study in Journal of Obesity looking at the effect of high intensity intermittent exercise on body composition showed in cycling training muscle mass went up in legs and trunk in legs in only a three month period doing sprint type interval training.

Interval training method also moves away from the trend of having to do long time periods of steady state type of exercise. Using big volumes of training can increase the risk of overuse repetitive micro-trauma. This sustained overload on your muscle and joints increase your risk of developing overuse injuries.

Before you start any exercise programme I would recommend your consult your GP and a biomechanical assessment from you physiotherapist would also be of great benefit.

So if you are starting out on your next exercise programme to get fit for a Iron-man triathlon, Rotto Channel Swim, Adventure race or you are just wanting to improve your health, I would recommended to you, that interval cross training is the way to go. It will get you fitter faster whilst reducing your risk of developing biomechanical overuse injuries


Heydari M et al. The effect of high-level intensity intermittent exercise on body composition of overweight young males. Journal of obesity. Doi:10.1155/202/480467

Quick sprints cut abdominal fat in men-health report-ABC radio National

Sitting down can be a killer.

August 23rd, 2012

Sitting down can be a killer

If you think your job is killing you, you could be right.

A study has found that people who sit down for more than 10 hours a day and don’t exercise have almost doubled the risk of dying sooner than those with active lifestyles.

The researchers say that while exercise does help, it doesn’t totally counteract the damage done by long periods of sitting.

If you’ve spent the week at work sitting at your desk and you’re still lying in bed this morning, this story might motivate you to get up.

Researchers have looked at the lifestyles of more than 260,000 men and women in New South Wales.

Basically those who sat down for more than 10 hours a day had almost double the chance of dying than those who only sat down for four hours a day.

One of the study’s authors is Professor Adrian Bauman, from Sydney University’s School of Public Health.

The highest risk people are people who don’t exercise, don’t do their 30 minutes a day and who are in high sitting lifestyles; they sit a lot at work and at home. That’s the highest risk.

And the best off are the people who meet their exercise recommendations and are low sitters; they don’t sit very much throughout the day, only a few hours a day.

Now you found that people who sit down a lot during the day for work and also in their leisure time, they have almost double the chance of dying earlier than people who are quite active; do you know what these people are dying of?

Another one of the Study’s authors is Professor Emily Banks from the Australian National University.

While exercise may sound like a logical solution to the problem, she says sitting down for long periods can’t be totally reversed by exercising.

A lot of our public health policies say well get out there and get half an hour of exercise a day but they don’t talk about the amount of time that you spend in very inert activities.

So, what we actually found was that not only was this increased risk of death with sitting, it was regardless of how much other physical activity you did in terms of your sort of intensive vigorous activity.

So, I think the message that we saw was that even if you’re getting that half an hour a day, if you’re a couch potato the rest of the time, you’re potentially affecting your health.

A comforting thought for those who’ve just been given a new definition of a dead end job.