My name is Tamar Brand Perez. I'm a physical therapist. I teach in the Joint Program for Physical Therapy at San Francisco State University and University of California, San Francisco, and as well as at Stanford University. My focus of teaching is biomechanics, kinesiology, and orthopedics. In IT band syndrome, one of the concerns is weakness in the gluteus muscles, and the hip joint has movement in basically just about every direction. And we do have muscles that control the movement in all directions. We need to make sure that we are training those muscles to control the movement in all the different directions. So I'm going to demonstrate some variations of strengthening for the gluteus muscles. And so we're going to start with a clamshell. So bringing the top leg into abduction and external rotation. Another variation in this position will be the top leg going into flexion and internal rotation. And then extension, abduction, external rotation. So working on that top leg, so the right leg muscles mainly. And then another variation will be creating arches with the top leg from the front to the back, including some rotation of the whole lower extremity, again, kind of to get all the fibers of those glute muscles. Shifting to a hands and knees position. In this position, you can do like the typical kind of fire hydrant exercise. So that's kind of for the side fibers primarily. And then you can also add a more complex motion where the leg crosses over the opposite leg and then extends and straightens together with a little bit of rotation as well. So internal rotation in the bent position, external rotation with the extended position. Again, addressing different parts of the gluteus muscles. Another variation of strengthening the gluteus medius is kind of carrying the weight of the body in a plank position. So it can be kind of just holding that position, adding more kind of stability to that. You can ask the patient to work into retraction at the upper extremity and that the level of tension there can be kind of addressed to the level of the patient. Go ahead and come down. As the patient progresses, we shift to weight-bearing type exercises. So the first one is a sumo squat. Toes pointing out with a TheraBand to increase the resistance. And the patient goes into a squat and back down. In this position, it's really important that the center of the patella points to the second toe to protect the patellofemoral joint. And the next exercise is starting from kind of feet hip-width apart. Again, with that TheraBand in a squat position, the patient takes three steps to the side. Maintaining that good form all the time with the center of the patella over the second toe and then jumping at the end. And the landing from the jump is a really important place to focus on that kind of position of the lower extremity and preventing that dynamic valgus as this is happening. And then steps to the opposite side. And again, a jump. And the next exercise will be standing on one leg. And in that position, going into abduction. And also extension with external rotation. So toes pointing out as the movement backwards is happening. So sort of a diagonal-type movement. And here, actually, a lot of the work is happening on the stance limb. The gluteus muscles that are on the stance limb are doing a lot of the work in addition to also the opposite side doing the open-chain kind of workout. And then go ahead and take the band off. And as we increase the level of the exercise for a patient that has really good control and good balance, you can do something like a single-leg RDL. So arms up and above your head. Straight arms up above your head. And then lean forward as you lift your leg backwards. So all the way down. And then come back up. So arms stay all the way up and go back again. And then you can repeat that as many times as appropriate. And then the last one, which is an example of a really advanced exercise, will be the star. So go ahead in that side plank on your hand. And lift the arm up, lift the leg up. And that will be kind of activating pretty much the whole body.

3rd Edition, CASE 28

3rd Edition

Knee

gluteus muscles

IT band syndrome

exercise rehabilitation

muscle strength

joint alignment