19/07/2026
An interesting case study from a runner and mountain bike rider complaining of long standing left sided ITB, lateral quad, peroneals and TFL/glute pain + tightness occurring within 20min of starting every run. He had done several cycles of rehab targeting global hip and strength but with no improvement in pain.
Whilst this patient did have some moderate hip extension and abduction strength deficits, watching him run, ride and move in closed chain showed an interesting pattern of poor ground contact with his toes in stance/toe off (especially the 1st metatarsal) and a propensity to roll through the lateral foot and grip the ground with his toes during single leg movements.
We worked on improving 1st metatarsal ground contact in closed chain, decrease long toe flexor activity alongside improving hip extension strength and power and quickly saw the lateral chain tightness decrease and he was able to return to full activity without pain.
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