Interesting read from you two
Hope you don't start fighting or anything!
Lol, Its not like that. We both have similarly strong views on the importance of good posture/alignment, having good core strength, good movement patterns, good mobiliy, muscle imbalnce etc. We just have a slight different approach in how we would address the issues.
If we look at overpronation in itself, and presume there are no biomechanical flaws higher up causing it, the identified causes (of a flexible overpronation not rigid) are overly loose ligaments (which we cant strengthen or tighten as they are non contractile structures) and overly lengthened muscles (intrinsic foot muscles and tibialis posterior).
The problem with overly lengthened muscles is two-fold. Short term they become less efficient/weak because they are having to work at the end of their range (muscles are most effective/strongest at mid range). Long term the muscles undergo a physiological change which means they become longer making them a bit stronger at end range but losing the ability to stabilise and contract at their inner range (serial sarcomere lengthening/addition - which is scientifically proven). Now this isn't a major problem as it can be reversed by simply by doing two things - placing the muscle in a shortened position for a prolonged period (wearing supportive shoes, laces tied up +/- arch supports) and repeatedly working the lengthened muscle at its inner range (strengthening exercises).
Now unlike the serial sarcomere lengthening findings myofascial release has no established diagnostic tests, meaning that the 'adhesions' don't show up on scans etc. The treatment maybe allows the muscle to work more efficiently but does nothing to address the serial sarcomere increase so the muscle length would never improve and hence neither would the overpronation ?
A small question:
I remember a while ago hearing that the IT band can't be stretched but I know it is often talked about and foam rolling is often recommended for those suffering from IT band syndrome. Could you explain the advised treatment and the physiological problems that occur from ITBS?
It's always confused me that supposedly the band can't be stretched but foam rolling has an affect. Is it more that the rolling has an affect on the surrounding tissue so relieving the pressure of the area?
Yes you're right. There is a lot of debate about whether the ITB can be stretched or not. The first issue for the individual is that it the nerve endings in it only detect stretch when its irritated, so the majority of the time you will not actually feel a stretch in it when you place it under tension. That makes it very difficult for the individual to know when they are 'stretching' it or not.
Personally I advise using the foam roller technique as it is placing direct pressure on it and 'rolling it out' a bit like using a rolling pin on pastry.
The Tensor Fascia Lata is bascically the muscle and the ITB the tendon so my argument would be that either the roll is stretching the ITB and, if not, the stress placed on it will be stretching the TFL anyway. That would mean the whole contractile unit would become lengthened anyway irrespective of whether it was ITB or TFL.
The two main problems that can arise from ITB tightness are :
Trochanteric Bursitis (aka GTPS) - inflammation and swelling of the hip bursa
Iliotibial band friction syndrome - Rubbing/clicking of the band as it passes over the bony prominences of the hip and/or knee.
But ITB tightness often isn't the main cause its mereley a symptom of poor biomechanics, muscle imbalance or poor alignment.
Usually weakness in Glutes (specifically glute medius and glute max), weak Obliques, short hip flexors or overpronation of the foot would lead to either true or "apparent" ITB tightness (you can measure this using Obers test). So those are the structures that would need assessing and whichever was at fault would then decide which exercises you would need to do. I would assess glute med strength with either hip hitch against the wall, inner range clam or inner range side lying abduction hold, glute max with inner range 1 leg bridge or prone hip extension, obliques with side plank holds, hip flexor length with modified thomas test and obers test for itb length. If there were no problems with any of these things or alignment I would then assess the movement patterns.
.....and breathe... sorry for the wall of text
TL;dr
Icecold and myself share the same views on muscle imbalance etc. but different views on how to address them.
The ITB/TFL may or may not be 'stretch-able' but its usually a symptom of other biomechanical issues which are the things that really need addressing.
I'm going to give him the benefit of the doubt and assume that either with that particular guy those treatments were relevant, or that he's providing information for a more general "catch all" treatment plan for elbow pain. I will be paying closer attention in the future though.
