For my prenatal clients

In class there is usually at least one woman who points to her lower abdomen and tell me about a pulling sensation. I am never one to diagnose anything, but something called "round ligament pain" is pretty common. These ligaments help support the uterus and they get pulled more and more as the pregnancy continues.

Some things to do:

- Stretch and do prenatal yoga

- Drink lots of water

- Make sure you are getting enough calcium and magnesium in your diet

- Try bringing your knees in my your chest, especially if you feel a sneeze or cough coming on.

- Change positions to prevent the ligaments from contracting. Try alternating to both the right and left sides when sleeping.

- Use a pregnancy pillow while sleeping, placing a pillow between your knees and your ankles to stabilize the pelvis

- Try a pregnancy support belt

- Try acupuncture

The IT Band

Here we are at the controversial IT band. Maybe it is only controversial in my household because my husband isn't convinced that it exists. For some of us, it causes such agony that doubting its existence is ridiculous. Many of us feel it after a big workout or if we run, as we increase mileage. Some of us feel it after a long day or week of simply sitting. The iliotibial band is pretty much what it sounds like: a band that stretches from the iliac crest, meaning hip, to the tibia, meaning lower leg. It is a tendon that runs along the outside of our legs from the TFL down and over the knee.

When people ask me why the IT band needs to be so tight, I sometimes answer, "so your leg bone doesn't pop out the side of your body". In other words, it helps with adduction of the leg, but I like the shock effect of the first answer. When track runners run the track counter-clockwise consistently, it is pretty likely that they are going to suffer from a tighter IT band on their left leg which is their inside leg. This is the leg that they are leaning in towards, the leg that is getting a little more of a challenge when it comes to stabilizing the knee. The IT band tightens so that the knee doesn't collapse. If you look at my previous post on quads and hamstrings, you will see that those muscles do a pretty good job of covering the front, back and inside of the leg. The IT band takes care of the side. The IT band will be even tighter for people with "bow legs" where the knees do not come together when the legs are straight and the feet are together.

So what happens when the IT band is tight? It can pull on the knee, tracking it to the outside of the body. It can pull on the hip, not allowing it to move in its full range of motion. It can simply ache, especially if it "snapping" or "clicking" over a bony part of your theigh called a bursa. The inflammation can cause further discomfort and possibly injury. But for most of us it hinders muscle balance.

Remember in Pilates, we are all about muscles sharing in effort. When the IT band is tight, the inner thigh muscles don't work as efficiently, the gluteus medius also checks out. And you already read about what happens when the gluteus medius doesn't do its job. One of the main culprits of knee clicking is a tight IT band. Sometimes it is a tight Rectus Femoris (quad muscle) but often that is combined with a tight IT band. It pulls on the knee cap so that it moves to the outside of the leg. Sometimes the easiest way to retrack the knee so that it moves effortlessly is to roll out the IT band with a roller and then work on strengthening the VMO, the Vastus Medialis Obliquus. This is at bottom of the inner thigh and is crucial for knee rehabilitation.

So when the knee "clicks" when bending I often check if the quads are tight as well as the IT Band. Here is a youtube video demonstrating how to release your IT band. If you look at the picture above you can see how the VMO can balance any pull on the ligaments around the knee including stabilization of the ACL, one of the four major knee ligaments.